Reducing the Rising Rates of Asthma

  • Date: Jan 01 2000
  • Policy Number: 200012

Key Words: CDC Centers For Disease Control And Prevention, Asthma, Environmental Health, Childrens Health

The American Public Health Association,

Observing that, according to the U.S. Centers for Disease Control and Prevention, asthma prevalence and mortality have been steadily rising in the US over the last 15 years in children and young adults under the age of 35;1 and

Noting that, while the cause of the rising asthma rates is unknown, there are a number of environmental factors known to exacerbate asthma; such factors include ambient air pollution, occupational allergens, environmental tobacco smoke, and indoor environmental factors such as pesticides, dust mite, cockroach, mold and pet allergens,2-7 as well as socioeconomic status, economic development, and urbanization;1-3,6-8 and

Noting that at present there is very little surveillance for asthma prevalence at either a state, national, or international level, leaving state and local health departments, as well as national agencies, uncertain about the prevalence rates in the areas they serve; there is little surveillance for asthma incidence, nationally or internationally;9 and 

Recognizing that numerous studies have documented that asthma disproportionately impacts low income and minorities in terms of emergency room visits and hospitalizations, such communities are more likely to have higher air pollution levels, are likely to live in homes with higher allergen loads, and have less control over their home environments; to compound this they often have less access to medical management to control asthma attacks and are more likely to utilize emergency rooms and other acute care services for routine medical care;6,7,10-12 and

Noting that rates of asthma are highest in children aged 6-16, that asthma in childhood is an important predictor of asthma over a lifetime, that asthma rates are rising most steeply in children, and that children are known to be more exposed and susceptible to a number of environmental factors known to be associated with asthma;1,5,13 and

Noting the continued high incidence of acute respiratory infections in children in developing countries, and that the significance of asthma as a comorbid factor is not appreciated; and

Noting that infants breathe more air per kilo of body weight per day than adults and their immune systems and lungs are in sensitive stages of development;14 and

Noting that it passed a resolution in 1995 entitled “Children’s Environmental Health,” in which it recognized the unique environmental health concerns affecting children including asthma; and

Recognizing that whereas primary and secondary prevention strategies have not been clearly identified or evaluated for asthma, there is a set of evidence-based treatment guidelines that have been developed by the National Heart, Lung and Blood Institute and its expert committees to guide medical and environmental intervention for people who have asthma;15 and

Noting the importance of a strong evidentiary basis for public health practice as well as assessment of costs and effectiveness for public health strategies and the lack of such data for many asthma interventions; and

Observing that we are in the midst of an epidemic of asthma1 and noting that broad-based public health strategies are necessary to better understand, reduce and prevent the disease; therefore, encourages and supports:

  1. The federal coordination effort and calls for a long range and more comprehensive plan of action on asthma involving all of the agencies of the Public Health Service, but most notably the Centers for Disease Control and Prevention (CDC), National Institutes of Health (NIH), Agency for Toxic Substances and Disease Registry (ATSDR), Health Resources and Services Administration (HRSA), Occupational Safety and Health Administration (OSHA),and Food and Drug Administration (FDA); the Health Care Financing Administration (HCFA), and the Environmental Protection Agency (EPA) and voluntary organizations;
  2. Federal and private research efforts directed at identifying the cause or causes of the rising rates of asthma;
  3. Federal, state, and local efforts to develop nationwide surveillance of asthma cases and environmental factors that may possibly be involved with asthma causation and/or exacerbation;
  4. Global efforts to strengthen surveillance and to better understand the global pattern of asthma and the cause for such distribution;
  5. Inclusion of asthma in federal, state, and local initiatives on reducing health disparities;
  6. Public health and other interventions at all levels of government and by nongovernmental organizations to reduce the severity of asthma in the U.S. and help people with asthma lead healthy, active lives, including reduction of indoor and outdoor air pollutants. This includes provision of insurance coverage and/or reimbursement for programmatic approaches to prevention of acute episodes of asthma requiring emergency treatment;
  7. Appropriations to public health agencies at the federal, state, and local level for asthma surveillance, education and public health intervention and prevention efforts by health departments and related agencies;
  8. Provision by health care systems and school health personnel, including school nurses and physical education teachers, of adequate diagnosis, treatment, family or caregiver, and patient education, equipment, and case management systems, including implementation of the National Heart Lung and Blood Institute asthma treatment guidelines;
  9. Intervention trials designed to help to identify causal factors for the increased rate of asthma and establish cost-effective measures to relieve the burden of asthma on the population;
  10. Collaborative efforts among housing, transportation planners, land use planners, education, environmental, public health, labor and employer representatives and health care professionals to combat the rising rates of asthma;
  11. Effective education and training of public health and health care professionals and the public about the prevention and treatment of asthma, including attention to the environmental and occupational triggers associated with asthma;
  12. Rigorous evaluation of existing intervention strategies and programs, including those of the U.S. Department of Education and the U.S. Department of Housing and Urban Development, and wide dissemination of results; and
  13. Effective evaluation of existing prevention and intervention strategies to determine the most effective population-based approaches.

References

  1. Mannino DM, Homa DM, Pertowski CA, et al. Surveillance for asthma—United States, 1960-1995. Morb Mortal Wkly Rep CDC Surveill Summ. 1998;47(1):1-27.
  2. Samet JM. Asthma and the environment: Do environmental factors affect the incidence and prognosis of asthma? Toxicol Lett. 1995;82-83:33-38.
  3. Institute of Medicine. Clearing the Air: Asthma and Indoor Air Exposures. Washington, DC: National Academies Press, 1999.
  4. Holgate ST, Samet JM, Koren HS, Maynard RL. Air Pollution and Health. San Diego, CA: Academic Press; 1999.
  5. Gern JE, Lemanske RF, Jr., Busse WW. Early life origins of asthma. J Clin Invest. 1999;104(7):837-843.
  6. Eggleston PA, Buckley TJ, Breysse PN, Wills-Karp M, Kleeberger SR, Jaakkola JJ. The environment and asthma in U.S. inner cities. Environ Health Perspect. 1999;107 suppl 3:439-450.
  7. Claudio L, Tulton L, Doucette J, Landrigan PJ. Socioeconomic factors and asthma hospitalization rates in New York City. J Asthma. 1999;36(4):343-50.
  8. Stolberg S. Poor people are fighting baffling surge in asthma. New York Times. 1999.
  9. Healthy People 2010, conference edition. Washington, DC: US Department of Health and Human Services, 2000.
  10. Sarpong SB, Hamilton RG, Eggleston PA, Adkinson NF, Jr. Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol. 1996;97(6):1393-1401.
  11. Coultas DB, Gong H, Jr., Grad R, et al. Respiratory diseases in minorities of the United States [published erratum appears in Am J Respir Crit Care Med. July 1994;150(1):290]. Am J Respir Crit Care Med. 1994;149(3 pt 2):S93-131.
  12. Gergen PJ, Mortimer KM, Eggleston PA, et al. Results of the National Cooperative Inner-City Asthma Study (NCICAS) environmental intervention to reduce cockroach allergen exposure in inner-city homes. J Allergy Clin Immunol. 1999;103(3 pt 1):501-506.
  13. Weiss ST. The origins of childhood asthma. Monaldi Arch Chest Dis. 1994;49(2):154-158.
  14. Weiss ST. Environmental risk factors in childhood asthma. Clin Exp Allergy. 1998;28 suppl 5:29-34, 50-51.
  15. Action Against Asthma, Washington, DC: US Department of Health and Human Services 2000.

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