Various conditions in Washington already make breathing difficult for many, but in a city that is disproportionately affected by asthma, with rates higher than national averages, those factors become even more hazardous. Luckily, medical institutions and researchers in the nation’s capital are working diligently to advance sustainable, multifaceted asthma care.
According to the Centers for Disease Control and Prevention (CDC), approximately 8% of adults and 7% of children in the United States have asthma. Per the D.C. Asthma Coalition’s website, adult asthma rates range from 11.6% to 18.1%, and children’s rates range from 8.1% to 9.7%. D.C. Health Matters reports that Black children in the area make up 32.1% of pediatric cases, as compared to their white counterparts who make up 20.5% of cases.
“We all have to work together to make the environment safe for young children,” Janet Phoenix, an assistant research professor at George Washington University (GWU) and chair for the D.C. Asthma Coalition, told The Informer. “Some of that means working on policies… [and] some of it is trying to make sure there are resources available for families who are trying to address asthma triggers in their home environments.”
Celebrating its 25th anniversary in the fall, IMPACT D.C. Asthma Clinic has been one of the city’s beacons in pediatric asthma response. Described as the heart of Children’s National Hospital’s treatment for the chronic lung disease, IMPACT D.C. focuses on clinical and educational intervention for children who frequently visit the emergency department (ED).
The clinic’s professionals’ dedication to ensuring the city’s children live long, healthy lives has resulted in a 50% decline in ED visits for its patients in the six months following their initial visit.
“[IMPACT D.C.] is an intervention; it’s not like a clinic where we see patients over and over,” Dr. Shilpa Patel, IMPACT D.C.’s Medical Director, told The Informer. “They come in when they have poor control, and we send them back to… whoever’s managing their asthma, and [we’re] there to empower families and patients so they have all the information they need so they can better take care of their asthma.”
When Outdoor Air Pollution Follows You Home
Many outdoor factors exacerbate symptoms. For example, Washington’s position as a low-lying delta city, significant precipitation, and the air masses it receives from the Gulf of Mexico and the Atlantic Ocean contribute to high humidity, which can cause excess pollen in the air during early winter and through the spring, worsening allergies and breathing conditions. High concentrations of ozone pollution can cause throat irritation, and inhaling this pollutant can constrict airway smooth muscle, leading to wheezing and shortness of breath.
The air quality outside can directly affect the air indoors through infiltration and natural ventilation. Infiltration occurs when outdoor air flows inside buildings through cracks and openings in floors, ceilings, walls, and around windows and doors. Natural ventilation is when open windows and doors bring air inside from the outdoors. High humidity flowing indoors can lead to contaminants like pests, dust mites, mold and bacteria, which can worsen respiratory conditions.
“We have a lot of families who are living in housing that’s older, and low-income rental housing in particular that may have hazards that are aggravating the asthma,” Phoenix told The Informer. “If you have a stock of housing that’s poorly maintained, then you’re going to have more children living in that housing who experience respiratory symptoms.”
Throughout her research and work on lead exposure and pediatric respiratory health, Phoenix has pushed for a prioritization of home visits, deeming them necessary, especially for children who have been recently hospitalized or who frequent EDs. Through these home visits, vulnerable residents are one step closer to necessary resources like pest control services.
Phoenix has worked with committees in Washington to help improve programs that address housing issues like the Healthy Housing Program, which offers home inspections and environmental assessments for families with asthmatic children. If the family is renting, the program’s first responders help provide landlords with information about any existing housing code violations. The program also informs the Department of Buildings about these households and tries to develop solutions for the families and their residences.
IMPACT D.C. also prioritizes the improvement of home environments for the sake of families with respiratory issues.
“If you are genetically at risk, meaning you have a family history of asthma, and then you’re born into a home that has certain allergens [like] dust mites or cockroaches, then you’re more prone to getting asthma later in life,” Patel told The Informer, “so it’s kind of this vicious cycle.”
One of the many ways the intervention program supports its patients is by helping ensure housing codes are enforced across the city, accomplished by giving families a letter to send to their landlords outlining any violations.
IMPACT D.C. also developed the Healthy Housing Map in 2022 in collaboration with the Child Health Advocacy Institute, Children’s Law Center and Yachad, a local home remediation program. The map identifies multi-family buildings in the city that have high rates of pediatric asthma-related ED visits and unhealthy indoor conditions.
“I think that’s a great policy solution from a larger solution to say, ‘Let’s look at those buildings,’” Patel told The Informer. “Data can be very powerful in terms of telling a story and fixing a problem at a [population] health level.”
Switching from Gas to Electric Could Save You
While poor indoor air quality can be detrimental to children’s respiratory health, it can also be dangerous for adults, even if they are active and relatively healthy. Ward 1 resident Katherine Leiden became aware of this in her own home.
Leiden, 37, moved to Washington almost 15 years ago and lives in an English basement apartment in a row home. She is a fitness instructor, often does cardio and prides herself on being very in tune with her body. When Leiden moved into her apartment, it had a gas range stove and oven and a gas fireplace that lacked a protective glass barrier.
“After living here for a couple of years, I felt like my breathing was really impacted [and] I was having trouble breathing,” Leiden told The Informer. “Then I started to get nosebleeds– the inside of my nose was raw– and they wouldn’t go away. That’s never happened to me in my entire life.”
A 2022 article published in the International Journal of Environmental Research and Public Health attributed 12.7% of childhood asthma cases in the U.S. can be attributed to gas stoves. These appliances are fueled by natural gas that is primarily composed of methane and propane, and when combusted, they generate pollutants such as nitrogen dioxide that are harmful to respiratory systems.
Anytime Leiden would use her stove, oven or fireplace, waves of noxious gas would infiltrate her home and invade her senses. One day, a representative from the Sierra Club visited her home and tested her appliances’ nitrogen dioxide ranges. According to the Environmental Protection Agency (EPA), the maximum level for this pollutant indoors is 100 parts per billion (ppb). Her oven and stove measured at 250 ppb, and while at standstill, her fireplace measured at the 100 ppb threshold.
“I completely closed the valve and switched the fireplace off, and it was after I did that that I noticed my breathing improved and the nosebleeds stopped,” the Ward 1 resident told The Informer. “Eventually, I did get the oven replaced… [to] an electric one, and I have no further issues.”
Before she switched to electric appliances, which took two years after the initial testing to convince her landlords to help her do so, Leiden primarily relied on cooking with her microwave and a crockpot. She limited her stove use to approximately once every two months and only used her oven twice in those two years.
Leiden hopes that city officials or utility companies can start persuading landlords to make those changes in their properties because a tenant’s health should be non-negotiable.
“If that prioritization were high enough, it might encourage cities to… figure out how to logically redistribute money in a way that you could prioritize issues like greener housing [and] switching to renewable sources,” she told The Informer.
With the work IMPACT D.C. and research from experts like Phoenix are doing to help at-risk families improve the air quality inside their homes, cities like Washington move closer to a surefire way that guarantees its residents can easily breathe indoors.
“When we’re thinking about asthma and the disparities and inequities that we see in asthma nationally and in Washington, D.C., I think we can be a model for the nation,” Patel told The Informer. “I think we can kind of take what we’ve done, continue to broaden and expand… care locally… and take it to other cities in the country and learn from them to improve us, and also share our story with them.”
