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Gasping for air: Asthma in inner city youth

Asthma is one of the most common diseases among inner city children. In Philadelphia alone, approximately 22 percent have been diagnosed with the respiratory…

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Delysha Jordan, a mother of four, discovered something wasn't right when her 9 and 13-year-old woke up in the middle of the night gasping for air. "I could tell it was hard for them to breathe by looking at their chest and seeing how much work it took them to take their next breath," she said.  All of her children, ages ranging from 2 to 13 years old,  have been diagnosed with asthma. "Sometimes its a struggle," she said. "It's a struggle because I have to go to work and sometimes the asthma symptoms will appear and then I have to take my children to the doctor."

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Jordan's youngest, a 2-year-old toddler, was diagnosed with chronic asthma, a more aggressive version of the lung disease. "My youngest kept getting sick, over and over again," she said. "The doctor said the sickness was due to breathing problems." Jordan and her children visit the Health Connections Center in South Philadelphia for check-ups and asthma management. She explains the disease limits her children's physical activity but is grateful for her kids to have access to medication, which can reduce asthma symptoms on the spot. "The pump is better than the machine, helps make things a little easier."

Asthma is one of the most common diseases among inner city children. In Philadelphia alone, approximately 22 percent have been diagnosed with the respiratory disease, nearly double the national rate.  Asthma is a chronic lung disease that inflames and narrows the airways, which carries air in and out of your lungs.  As a result, people can suffer from asthma attacks. During an attack, muscles around your airways tighten, causing less air to flow into your lungs. Symptoms include recurring periods of wheezing, chest tightness, shortness of breath and coughing.  As someone who experienced asthma attacks more than once, it can sometimes feel like a set of bricks sitting on your chest, weighing heavily, making each effort to breath extremely difficult and exhausting. The attacks can be mild or severe.  Mild asthma attacks are easily treated with medication such as Albuterol, an aerosol inhalant that immediately relaxes the muscles surrounding the airways. However, severe attacks may need more medical attention and can be fatal if not treated. 

Racial disparities of asthma among Latino and African American youth 

According to a report by the Environmental Defense Fund, Latinos are three times more likely to die from asthma than any other racial groups. Latino children are 40 percent more likely to die from the respiratory illness than non-Latino white children and nearly 1 in 10 adolescents under the age 18 are affected. 

In another report by the Office of Minority Health, Puerto Ricans have twice the asthma rate in comparison to the overall Latino population.  African Americans, are 20 percent more likely to develop asthma than non-latino whites and about 10 percent of African American children have the disease in comparison to 8 percent of white children. 

Dr. Tyra Bryant-Stephens, director of Community Asthma and Prevention Program at the Children's Hospital of Philadelphia explains why so many inner children have Asthma. 

"There are several factors. Children who are poor, live in houses that are falling apart. Those children tend to have more symptoms," Bryant-Stephens said. "We know when you look at poverty, African Americans and Latinos make up a higher percentage of that population. Also, we know that asthma is an interaction between genes and environment, so if you're predisposed to asthma and you live in an environment that promotes asthma symptoms, you are more likely to have the disease."

"Physicians are also better at diagnosing asthma," she added. 

One of the most common factors that triggers asthma are cockroaches. According to the Asthma and Allergy Foundation of America, 78 to 98 percent of homes in metropolitan areas and inner cities have cockroaches. Roaches spread their waste as they travel and the inhaled debris from the insects can trigger an allergic reaction in the bronchial tubes. Other asthma triggers include mice, dust mites, mold, animal dander (hair, flakes of skin and dried saliva from animals), tobacco smoke, and outdoor pollution.  

"The common triggers we see in housing are cockroaches, dust, mold, tobacco smoke and pets. All of these are multiplied in homes that are not well maintained." Bryant-Stephens said. "Home maintenance is expensive, families that are challenged with meeting their monthly bills don't have money left over to take care of the house."

Mice may be the number one reason for asthma in inner city adolescents, according to a study by the journal of Allergy and Clinical Immunology.  

Researchers analyzed 144 children aged 5 to 17 years old with asthma. Each chid underwent a prick test, which is an allergy testing method that involves placing a small amount of suspected allergen underneath the skin to provoke a reaction. Researchers also collected dust samples from the homes where the participants lived. The results showed 41 percent were exposed to mice and an additional 40 percent were exposed to cockroaches based on bedroom floor samples collected. Both mice and cockroach exposure were generally related to the children having worse asthma but according to the findings, mouse allergen appeared to be more strongly associated with poor asthma than cockroaches. 

Outdoor air pollution

Philadelphia is one of the most air-polluted places in the country, according to the American Lung Association. The report gave Philadelphia an F grade on ozone, D in 24-hour particle pollution (which counts daily spikes of polluted particles in the air) and F in annual particle pollution. Exposure to high amount of air pollution daily can increase risk for asthma, damage the lungs, and can lead to premature death. 

The Latino community in particular, suffers disproportionately from the health impacts of poor air quality. To address this issue, Al Dia News Media on Thursday, June 5, will be hosting a roundtable discussion about the efforts to improve air quality and reduce health disparities among Latino communities. Speakers include representatives from Congreso de Latinos Unidos, Clean Air Council of Philadelphia, and the American Lung Association. 

Resources to help families deal with childhood asthma 

The Children's Hospital of Philadelphia (CHOP) has implemented a Community Asthma Prevention program, (CAPP) for more than 10 years. "We teach our families to avoid the triggers of asthma and use our community health workers to provide this education," Bryant-Stephens said. CAPP offers Philadelphia communities free asthma education, home visits, and emergency training to school staff, faculty members, parents and primary care givers. "What I saw is that even though doctors are giving the right treatment, our children still ended up in the emergency room, so my concern was the gap between what we knew worked and whats going on in the home."

There is no "fool-proof" way to prevent asthma, but you can manage the disease so it won't hinder everyday life and physical activities. For example, having an "asthma action plan" can help manage the disease more effectively and keep emergency room visits at bay. The plan, is a written list of steps to follow and routinely check on a daily basis and is meant to be filled out with your doctor. Medications that treat asthma include inhaled corticosteroids such as (Advair, Flovent Diskus, and Pulmicort). Long term use of inhaled corticosteroids may slightly delay growth in children but regular use of these treatments help prevent asthma attacks and are vital in controlling symptoms.  

"Asthma, no matter how severe it is, can be controlled. The way to control it is with optimal medical management and environmental conditions." Bryant-Stephens said. "If we can give them the right medication and reduce exposure to triggers of asthma in places where they sleep, learn and pray, then we know we can reduce the effects of asthma on children." 

 

 

 

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