The danger inside

For kids with asthma, the air they breathe at home can be worse than the pollution and pollen outdoors

March 02, 2009|By Stephanie Desmon | Stephanie Desmon,

Parents have long known that the polluted, pollinated air outdoors can bring on asthma attacks in their children. Now it turns out that many asthmatic inner-city kids are under assault inside their homes - where cigarette smoke, dust mites, mold and even cooking smells can make them sicker than car exhaust or ragweed.

Researchers are finding a direct link between the air children breathe at home and the asthma attacks that are the source of hundreds of thousands of emergency room visits in the U.S. every year. The latest study, published last month by Johns Hopkins researchers, quantified the increase in asthma symptoms for every increase in air pollution particles inside Baltimore homes.

Such findings have begun a movement of health professionals who are going door to door to educate families about the potential dangers of indoor air and helping them clean up their homes. Their goal is to reduce childhood asthma by 50 percent by 2012.

"We tend to think of outside as being the polluted place and indoors being the sanctuary," said Dr. Gregory B. Diette, a director of the Johns Hopkins Center for Childhood Asthma in the Urban Environment. In many of the Baltimore homes he surveyed, Diette found that inside air is a problem.

As many as one in five Baltimore children are believed to suffer from asthma, the most common chronic childhood disease but one that disproportionately affects inner-city African-American children. Scientists don't yet know exactly what causes asthma, a lung condition that temporarily narrows the airways and causes wheezing, coughing and difficulty breathing. The number of children with asthma has risen significantly over the past two decades.

"What is then responsible for this dramatic increase in asthma over the past 20 years? That's the million-dollar question," said Dr. Elizabeth Matsui, a pediatric allergist at the Johns Hopkins Children's Center and, along with Diette, an author of the study.

Matsui said allergists have known for years that the home - where children spend most of their time - holds hidden dangers for those with asthma. But only recently, she said, have pollution scientists started to research the relationship between indoor air and asthma.

Syeadda Spears says she tried to do all she could to protect her children, two of whom suffer from asthma. She kept her sons inside their Northeast Baltimore home. She was constantly sweeping the floors. She even bought plug-in air fresheners to make everything smell nice.

Then she got a visit from Hopkins researchers doing another study - and learned she was doing a lot of things wrong. She was kicking up dust that made her sons wheeze every time she swept. The air fresheners were triggering symptoms in 9-year-old Da'Shawn. She even made him sick when she tried to bake a treat of snickerdoodles because of her kitchen's poor ventilation. The indoor air, Spears was learning, could be worse than the pollution and pollen outdoors.

"I thought, 'The house is clean. You've got wood floors. It smells fresh.' But no," she said.

Not every parent listens. Last spring, outreach workers from the Coalition to End Childhood Lead Poisoning began visiting the homes of 250 Baltimore children as part of a program aimed at keeping asthma in check. Kevin Gummer and Gia Wilkerson come armed with special particle-removing vacuums and pest management advice and new windows - whatever a home needs. The idea is that a $100 HEPA vacuum might save $1,500 in doctor or emergency room visits avoided.

The workers say that showing a family how they can make changes is far more effective than just handing out pamphlets about how to make a home healthier.

"We'll go in and ask people, 'Do you smoke?' and they say, 'No,' " Wilkerson said. "But the child sleeps in the same bedroom as they do and the ashtray is right there."

Sometimes, families trying to make things better only make them worse. For example, in trying to get rid of mice and cockroaches - which, among other ills, can trigger asthma attacks - families often use foggers or other chemical sprays. Gummer says those don't solve the problem, and they can aggravate asthma symptoms.

The childhood lead coalition moved into the realm of asthma as a complement to its successful efforts to reduce lead paint in city homes. "When we were leaving homes in the late '90s, cleaning up the lead, our guys were replacing windows ... [but] the kids were still getting sick - not necessarily from lead but asthma and injuries," said Executive Director Ruth Ann Norton. "In those families, about 50 percent of their kids had asthma."

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