Childhood Asthma in Riverside County, 2009
Asthma affects Riverside County children of all backgrounds, but particularly those living in relative poverty. In order to gauge the severity of childhood asthma and its impact on health care utilization across the county, hospital emergency department (ED) data was reviewed over a three year time period. It should be noted that many areas of high need are not urban centers where the highest childhood asthma rates are usually expected. Because this data is taken from ED visits it is not an indicator of asthma prevalence, rather an indicator of where childhood asthma is uncontrolled. The reasons for lack of control may vary from zip code to zip code. The lack of primary care providers (PCPs) may explain why uncontrolled asthma is resulting in ED usage. Families need to be able to access the PCP, afford medications, understand and comply with prescriptions and identify and avoid triggers. Hospitalization of a child for asthma is categorized as a preventable hospitalization by national and state agencies. According to a recent study by the Centers for Disease Control and Prevention, the cost of treating asthma in the hospital is almost 40 times greater than an outpatient visit. Improving asthma symptoms and helping families gain control is the primary goal of the Riverside County Department of Public Health’s Asthma Program. The free services include asthma education, allergen-proof mattress and pillowcase covers, medication delivery devices and an environmental assessment. Click here to read the entire brief.
Secondhand Smoke in Multi-Unit Housing: Special Hazard for those with Asthma
For the over 40% of Californians who live in dwellings that are attached to others, secondhand smoke can be not only a nuisance that leads to confrontations with neighbors, but also a serious health hazard. The populations most at-risk include those with asthma and other respiratory diseases, children, and the elderly. Their most common complaint is that neighbors allow their tobacco smoke to drift from their housing units, balconies and other outdoor areas into the homes of other residents. Smokers tend to deny the damage that their smoking does, despite the proclamation of the US Surgeon General that, “There is no risk-free level of exposure to secondhand smoke.”
Recent research has shown that secondhand smoke from a neighbor’s home can reach startling high levels. Dr. Neil Klepeis, a researcher from Stanford University, recently studied the level of contaminants in a condominium in San Jose and confirmed this. At a press conference hosted by Breathe California of the Bay Area, Dr. Klepeis revealed that the level of hazardous tobacco chemicals in the nonsmoking victim’s home was as high as one would find in a gambling casino.
The declaration of the California Air Resources Board that secondhand smoke is a Toxic Air Contaminant that “may contribute to an increase in deaths or serious illnesses” needs to be taken seriously; multi-unit housing managers and owners need to be educated and encouraged to adopt smoke-free policies. They need to be informed that such smoke-free policies would be popular since 84% of Californians do NOT smoke, and that they can lead to fewer fires, reduced insurance, and reduced maintenance. Moreover, clear policies will reduce the time spent arbitrating tenants’ arguments, since polls show 40%-50% of owners/managers have had to deal with complaints about secondhand smoke. In Santa Clara County, 96% of apartment residents expressed that smokers should not be able to smoke where they want, and 84% would support a no-smoking policy for their complex (Santa Clara Public Health Dept. survey, 2009).
Unfortunately, in this economy building owners/managers are especially reluctant to make changes, even ones that might prove popular. Therefore, the best route to protection is getting laws passed. In January, the Santa Clara County Board of Supervisors passed an ordinance that bans all smoking in multi-unit residences including apartments, condominiums, and senior citizen residences. The ordinance, one of the strongest in the US, applies to all unincorporated areas in the County. Approximately twenty-five communities in California, and many more in the US, have adopted smoke-free housing laws of varying types. Others like San Jose have adopted resolutions that encourage builders/owners to go smoke-free.
Until such laws are commonplace, those who have asthma need to take steps to protect themselves:
- Check out listings of smoke-free housing such as www.smokefreeapartments.com or call your local apartment association for information.
- Read rental or home owners' association documents thoroughly before signing them. Determine the exact smoking policies and enforcement methods and confirm with the agent.
- Do not accept anecdotal information that the agent may provide; stick to what is written on the agreement.
- If your options are limited, by factors such as location or cost considerations, try to get an apartment or condominium next to nonsmokers and get the owner to create smoke-free future spaces by only renting/selling to nonsmokers adjacent to your unit (in writing).
- Take a physical tour of the exact unit, not a model, and look for proximity to others’ balconies and patios. Also check any intake air vents and their position relative to areas where there might be smoke. Absent wind, smoke tends to go up, so avoid living above smokers as much as next door.
- Report violations of any policies immediately and continuously.
- Get to know your neighbors. A request not to let smoke drift from someone you know and like is harder to ignore than an a request form an unknown neighbor.
- Best of all, form a group of tenants who want smoke-free housing and advocate to the owner/manager regularly.
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U.S. Asthma Rates Continue to Rise
In May, the Centers for Disease Control and Prevention(CDC) released a report in their “Vital Signs” publication about the continued rise in asthma rates throughout the nation. It reminds us that here in California and throughout the country, more needs to be done to address this growing public health problem. The following article by CDC highlights some of the findings and links to the full report.
People diagnosed with asthma in the United States grew by 4.3 million between 2001 and 2009, according to a new Vital Signs report released today by the Centers for Disease Control and Prevention. In 2009, nearly 1 in 12 Americans were diagnosed with asthma. In addition to increased diagnoses, asthma costs grew from about $53 billion in 2002 to about $56 billion in 2007, about a 6 percent increase. The explanation for the growth in asthma rates is unknown.
Asthma is a lifelong disease that causes wheezing, breathlessness, chest tightness, and coughing, though people with asthma can control symptoms and prevent asthma attacks by avoiding things that can set off an asthma attacks, and correctly using prescribed medicine, like inhaled corticosteroids. The report highlights the benefits of essential asthma education and services that reduce the impact of these triggers, but most often these benefits are not covered by health insurers.
"Despite the fact that outdoor air quality has improved, we've reduced two common asthma triggers—secondhand smoke and smoking in general—asthma is increasing," said Paul Garbe, D.V.M., M.P.H, chief of CDC's Air Pollution and Respiratory Health Branch. "While we don't know the cause of the increase, our top priority is getting people to manage their symptoms better."
Asthma triggers are usually environmental and can be found at school, work, home, outdoors, and elsewhere and can include tobacco smoke, mold, outdoor air pollution, and infections linked to influenza, cold-like symptoms, and other viruses.
Asthma diagnoses increased among all demographic groups between 2001 and 2009, though a higher percentage of children reported having asthma than adults (9.6 percent compared to 7.7 percent in 2009), Diagnoses were especially high among boys (11.3 percent). The greatest rise in asthma rates was among black children (almost a 50 percent increase) from 2001 through 2009. Seventeen percent of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.
Annual asthma costs in the United States were $3,300 per person with asthma from 2002 to 2007 in medical expenses. About 2 in 5 uninsured and 1 in 9 insured people with asthma could not afford their prescription medication.
"Asthma is a serious, lifelong disease that unfortunately kills thousands of people each year and adds billions to our nation's health care costs," said CDC Director Thomas R. Frieden, M.D., M.P.H. "We have to do a better job educating people about managing their symptoms and how to correctly use medicines to control asthma so they can live longer more productive lives while saving health care costs."
This report coincides with World Asthma Day, an annual event sponsored by the Global Initiative for Asthma. This year's theme is "You Can Control Your Asthma." Reducing asthma attacks and the human and economic costs of asthma are key priorities for the U.S. Department of Health and Human Services and the focus of a collaborative effort involving many parts of HHS. In support of this effort CDC recommends:
- Improving indoor air quality for people with asthma through measures such as smoke-free air laws and policies, healthy schools and workplaces
- Teach patients how to avoid asthma triggers such as tobacco smoke, mold, pet dander, and outdoor air pollution
- Encouraging clinicians to prescribe inhaled corticosteroids for all patients with persistent asthma and to use a written asthma action plan to teach patients how manage their symptoms.
- Promoting measures that prevent asthma attacks such as increasing access to corticosteroids and other prescribed medicines.
- Encourage home environmental assessments and educational sessions conducted by clinicians, health educators, and other health professionals both within and outside of the clinical setting.
Read the full report
About Vital Signs
CDC Vital Signs is a report that appears on the first Tuesday of the month as part of the CDC journal Morbidity and Mortality Weekly Report (MMWR). Vital Signs is designed to provide the latest data and information on key health indicators – cancer prevention, obesity, tobacco use, alcohol use, access to health care, HIV/AIDS, motor vehicle passenger safety, health care-associated infections, cardiovascular health, teen pregnancy, asthma, and food safety.
Upcoming CAP Webinar:The Role of Bronchial Thermoplasty in the Treatment of Severe Asthma
As part of our webinar series, our next webinar will focus on Goal 3: Health Care of the Strategic Plan. Register here. Topic: Bronchial Thermoplasty Title: The Role of Bronchial Thermoplasty in the Treatment of Severe Asthma Presenter: Andrew Greenberg, MD, PhD Date: May 18, 2011 For many patients with severe persistent asthma, the primary therapy includes inhaled corticosteroid at higher doses plus a long-acting inhaled beta 2-agonist. However, Bronchial Thermoplasty is a fairly new Food and Drug Administration (FDA) approved, non-drug surgical procedure used to alleviate severe persistent asthma for patients 18 years or older whose asthma is not well controlled with inhaled corticosteroids and long acting beta agonists. Bronchial Thermoplasty is a bronchoscopic procedure that involves delivering energy (heat) at several locations in the major airways in order to reduce the mass of smooth airway muscle and decrease bronchial constriction in severe asthmatics.
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