Across the nation’s capital, more than 16,000 children suffer from asthma, and the condition is far more common in communities east of the river—a disparity that primarily stems from environmental factors, including triggers inside homes and air pollution indoors and outdoors.
Research from Children’s National Hospital’s asthma clinic, IMPACT DC, has tracked the connection between housing issues and asthma incidents to create an interactive Healthy Housing Map. The tool identifies multi-family buildings in the District that have both high rates of kids’ asthma-related emergency room visits and unhealthy housing conditions connected to asthma severity. Those conditions include pest issues, dust and mold.
In an interview with The Washington Informer, IMPACT DC’s Dr. Candice Dawes discussed how environmental factors affect childhood asthma in the District and what families can do to help keep asthmatic kids healthy.
This interview has been edited for length and clarity.
WI: What are some of the early signs that parents should be aware of when identifying asthma in children?
CD: For some people it may [present] a little bit different. [However], some of the common symptoms that we usually see is a chronic cough, or maybe some shortness of breath. The children may [express] that they feel like they can’t sort of keep up with their peers when they do activities, whether in sports or [in] P.E. or recess. One of the other things that we commonly see is when a child or an adolescent has a cold, they have a cough that lingers longer than the time period we would expect.
WI: We know that environmental factors play a huge role in triggering asthma episodes and increasing the severity of attacks. Can you share some of the most prevalent environmental factors that trigger asthma attacks for children when it comes to housing and community design?
CD: There are lots of things that sort of predispose a child to asthma. There could be genetic factors. Prematurity can do that. But some of the things that we commonly see that are specific to D.C. are housing issues. We see that quite often. We see houses that aren’t up to code and so they may have mold, mildew, pest issues that exacerbate a child’s asthma.
Poor ventilation is a big one that actually makes children’s asthma worse. We see houses that either don’t have good ventilation or either the family or the landlord can’t keep up with changing the filters. Other things in a home may be gas or kitchen appliances, which can exacerbate the symptoms. In addition, pollen in D.C. We do have really high pollen counts, especially this time of year. So, March, April and May tend to be times where asthma in D.C. is particularly worse.
Depending on the neighborhood that you live in and the proximity that you are to highways, some of that pollution from cars, trucks, etc. can also exacerbate the symptoms, especially for children who live in southeast D.C. who are sort of close to 295. Some of that air pollution can actually be an allergen for them.
Even though a lot of the buildings have codes about smoke and how close you can be in a proximity to smoking near a building, a lot of people don’t uphold those regulations, so smoke can be a big factor too, to exacerbate asthma symptoms for juveniles and children.
WI: Are there any particular wards or communities with more prevalent cases of asthma in children?
CD: You definitely have disparities throughout the city in terms of asthma, and it’s particularly in Wards 5, 7 and 8. If you look at some of the spatial maps of the District and you look at where the population of most of the children in the District live, you will see that the majority of children in the District actually live in Wards 7 and 8.
If you superimpose over that and see where are the cases of severe or moderate persistent asthma (the more severe on the spectrum of asthma), if you look at where those children live, you will see that they also live in Wards 5, 7 and 8. If you also superimpose on emergency department visits, you will see that the majority of those emergency room visits to Children’s National, both the main campus and the campus over in southeast, that most of those children are from wards 5, 7 and 8.
WI: Can you tell me a little about the educational tools and guidelines that you share with families to help moderate their children’s vulnerability to asthma?
CD: So, there are several things that we aim to do. IMPACT DC, which stands for Improving Pediatric Asthma Care in the District of Columbia, is our premier asthma program in the city. We have several arms of things that we try to do: Clinical care, Education, Research, and Advocacy. Through that clinical care arm, we try to see the majority of the children who are seen at any emergency room or hospitalized for asthma, regardless of whether or not you see us for primary care, we will see all of those children who have had a hospitalization or an emergency visit for asthma.
In addition, we take referrals from school nurses, we take referrals from primary care doctors and the community and we take referrals from insurance companies. Through part of that visit, what we try to do is make sure that you manage well on your current regimen of medication, but two, a big part of those visits is education. Education about the triggers, about the medications, and education about the housing and school environments that may be making the child’s asthma worse or contributing to the child’s asthma.
One of the things that we always make sure of is that a child has an Albuterol inhaler, which is their rescue if they are having symptoms, and has an asthma action plan, which is essentially a plan that tells anyone who was involved in that child’s care how to manage their asthma. Meaning when their asthma is great, this is what they take, which may be no medications, and when their asthma is starting to flare, what do they take, and then when they are having an asthma attack, what do they take?
We do virtual home visits where we go into the home of some of those kids who have pretty uncontrolled or not well-controlled asthma and really identify triggers that are in the home that we can help the family to work on remediating. Whether that’s the family doing something or they’re on their own, or we were giving them sort of supplies to help or either helping them to get through to the landlord to to actually help them.
WI: What can parents do to combat or reduce the severity of their children’s asthma to prevent emergency assistance in most cases?
CD: That is ideally what we try to avoid, is having asthma have any sort of impact on their life. And so yes, knowing the triggers, and either avoiding or limiting triggers is a big key. If your trigger is dust, make sure the home is dust free. So, we advocate for homes without carpet, because what does carpet do? It harbors dust. If heat is a trigger, on those days we say watch the heat advisories on those days where we have a code red or one of the higher codes that is not so safe. If a cold is a trigger, there’s no way we can really avoid a cold, but making sure we have good hand washing and good hand hygiene at the first sign of a cold. Or if it’s smoke, we ask those family members who care for you, to smoke around you.
A second big key is medication management. Knowing what medications you are on and being compliant with the medications is a big key, and that’s where that asthma action plan comes in. It tells you what your medications are and when you need medications.
And then just making sure that you see your pediatrician or primary care doctor if your child has asthma every three to six months, so that these things can be reevaluated and the education can be given again, so that we don’t have a space where either you’re out of medications or you don’t know what the triggers are so you constantly end up in the emergency room or in the hospital for something that we could possibly avoid.
