Chances are you have asthma or know of someone who does. Almost seven million—or roughly nine percent—of children in the United States are currently afflicted by asthma, and that rate continues to rise each year. Climate change is expected to make it worse.


The NIH reports that changing air quality and increased levels of atmospheric carbon dioxide can lead plants to produce more pollen of higher allergenicity for longer periods of time. Allergens such as pollen do not only trigger asthma episodes, but can also sensitize infants to asthma.

New Haven is no safe haven. In fact, according to a 2015 report by the Asthma and Allergy Foundation of America, New Haven is the 12th most challenging city in the United States in which to live with asthma. The consequences of this issue are evident in a study published by the state DPH: “from 2000 to 2009, the rates of hospitalization with a primary diagnosis of asthma increased 29.2%.” It is difficult to fully comprehend why rates of asthma are especially high in New Haven and in other urban areas of Connecticut—but it is a question that a broad range of individuals and organizations, from doctors to parents to the city health department, are working hard to answer.

A chronic inflammatory disease of the airways, asthma has many recurring symptoms and defining characteristics, including wheezing, airflow obstruction and shortness of breath. When an asthmatic is exposed to a trigger, the airway becomes more swollen and muscles tighten, making it difficult to move air in and out of the lungs.

Yet, identifying and isolating the triggers that cause asthma attacks is much more complex and far less understood than the mechanisms of the disease, making it challenging to explain the distinctive trends of asthma rates in a small city the size of New Haven. Factors ranging from genetic predisposition to various environmental factors are suspect. “I believe Long Island Sound, humidity, things such as ozone and air quality that relate to being close to major highways, as well as socioeconomic factors are all contributors,” said Geoffrey Chupp, professor at Yale School of Medicine and director of the Yale Center for Asthma and Airways Disease (YCAAD). Avenues of research focused on identifying communities most at risk of asthma may be mediated by modeling the impact of climate change on air quality and allergen distribution in certain geographic regions.

 

For local residents like Julie Frischstein, asthma has been a way of life since an exceedingly young age. Julie’s diagnosis prevented her—at two years old—from experiencing the carefree childhood most people take for granted. “As a kid growing up on steroids, you can’t exercise or partake in a lot of activities because it’ll alter your breathing. I’m doing a lot of things for the first time in my life that I should have done in high school,” Julie said. “I’m 50 years old and hiking for the first time in my life.”

However, with bronchial thermoplasty—a treatment that prevents asthma attacks by reducing airway smooth muscle and thus constriction—her long battle against asthma is ending in a victory. The treatment is still in its developing stages, but it is already making a noticeable difference in the lives of asthma patients who no longer respond to medication. Julie credits Chupp for changing her life: “He’s an amazing doctor that goes above and beyond for all of his patients,” she says. “You feel more than a professional relationship with him.”   

Dr. Geoffrey Chupp, director of the Yale Center for Asthma and Airway Diseases (YCAAD), is a leader in asthma research and treatment. Dr. Chupp discovered a method of characterizing asthma severity by a molecular basis. Courtesy of YCAAD.

Chupp’s battle against asthma is fought outside the doors of the YCAAD clinical center as well. His research focuses on understanding the mechanisms underlying the development of asthma and ultimately advancing treatments for asthma. Recently, Chupp and his team of researchers identified a method to categorize patients into three clusters—near fatal, severe, and milder asthma—by analyzing gene expression for transcriptomic endotypes of asthma (TEA) from patient blood samples. “We decided to cast away our usual definitions of asthma severity as clinicians,” Chupp said. While before, clinicians could only categorize a patient’s asthma along a continuum of mild to severe by examining outward symptoms, there is a biological basis to this new approach.

Tackling the increasing rates of asthma is not only critical for improving the quality of life of Connecticut residents, but also for lowering the amount that the state spends on avoidable causes of hospitalization—in 2009, an amount totalling a whopping $112 million for acute care cases cited asthma as a primary diagnosis. Chupp hopes to expand his study and personalize asthma treatment so that patients receive the care they need before they end up in the hospital. “That’s really the ultimate goal—to reduce severity of disease, decrease healthcare cost and increase the quality of life for these people,” Chupp said.

Meanwhile, there are other avenues of generating change that may alleviate the detrimental effects of asthma in New Haven. Many of these include increasing disease awareness and education. Low-income residents are less likely to visit clinics, may not know how to take their medication correctly and often, do not know how to look for the signs and symptoms of asthma in their children. This lack in understanding may in part contribute to the disparity in hospitalization rates among socioeconomic classes in New Haven, as asthma disproportionately affects Hispanic and non-Hispanic black children.

“The tools are out there, but parents just need to be able to know how to access them,” Julie said. One of these many resources, the Asthma Program, is sponsored by Connecticut’s Department of Public Health (DPH). The program has compiled a list of free educational materials and local healthcare resources. For residents seeking more personal assistance, the Putting on AIRS Asthma Education Program provides services in several Connecticut cities. The program assigns patients an asthma educator who reviews asthma plans and medications and an environmental specialist who identifies potential asthma triggers around the home.   

Particulate matter scale diagram. Courtesy of U.S. EPA

Yet, while many of these organizations are making great strides in tackling asthma, there is a surprising lack of educational support groups in the state. Those with childhood asthma often struggle with the social and emotional impacts of the disease. In many of these cases, an understanding community of fellow asthmatics and health care providers can make just as great a difference in a child’s life as medical treatment.

Meanwhile, other organizations examine the underlying roots of asthma. Connecticut Fund for the Environment’s (CFE) Environmental Justice and Save the Sound programs are committed to protecting the air and water quality of the state and Long Island Sound. One of their main goals is to shut down Bridgeport Harbor Station, the last operating coal plant in Connecticut, which has been releasing air pollutants they believe strongly contribute to the area’s relatively high asthma mortality rate. Similarly, the EPA, the state DPH, and Environment and Human Health, Inc. (EHHI) have been monitoring and raising awareness about high motor vehicle pollutant concentration near schools, which places children at risk for developing asthma.

Improving air quality is essential to reduce asthma in urban environments. Almost every other state other than Connecticut in the New England region received an “A” for “SmokeFree Air” on the State of Tobacco Control Report conducted by the American Lung Association. This is problematic for the health of asthmatics living in New Haven, as secondhand smoke has been shown to trigger asthma attacks. “We are working to improve the general air quality in Connecticut. We want to make sure we close loopholes from secondhand smoking exposure and from vehicle emissions,” said Ruth Canovi, Public Policy Manager for the American Lung Association in Connecticut.

It is evident that all aspects of progress—whether through a medical, scientific, public health or environmental direction—will be necessary to combat the complexity of asthma in New Haven.  


Learn more from the American Lung Association:

Ozone pollution

Particle pollution