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The number of children with asthma in the United States is rising. Unlike some childhood diseases, like polio, that have faded into the past because of vaccines, there is no vaccine for asthma — and the situation is getting worse. According to the Centers for Disease Control, in 1980, 3.6 percent of American children had asthma. By 2005, that total had more than doubled to 8.9 percent. Although there is no definitive cause, there is mounting evidence that a child's environment, both inside and outside the home, plays a part in the frequency of asthmatic attacks. Mold is one of these environmental triggers, and in post-Katrina New Orleans, that's something we have aplenty. How much mold and other airborne allergens are affecting asthmatic children is the subject of a new study, Head-off Environmental Asthma in Louisiana (HEAL), a collaborative research project conducted by Tulane University's Health Sciences Center and the New Orleans Department of Health. Dr. Maureen Lichtveld, the study's principal investigator and department chair for Environmental Health Sciences at Tulane University's School of Public Health and Tropical Medicine, discusses the project's goals and methods for reducing the severity of asthma.


Q: What is asthma?

A: Asthma is when your breathing airways become narrowed down, either because you are allergic to something such as allergens in the air like dust mites or pollen, or if you have a hereditary predisposition. Sometimes those two things work together. You have difficulty breathing, and that's why you hear people wheezing when they have asthma attacks.

Q: The number of reported asthma cases has increased, especially for minorities and inner-city children. How much worse is it?

A: It's quite clear that childhood asthma is on the rise in the United States ... especially among minority and inner-city children. Up to 24 percent of minority children living in cities like New Orleans may have asthma, and that concerns us.

Q: Why minorities and inner-city children?

A: There have been many multi-city studies looking at the inner-city environment. There is a relationship between exposures to asthma triggers such as dust mites and the worsening of the asthma. We would want to particularly know what is in the home environment that someone with asthma might be exposed to that triggers the asthma. Many studies have shown that in inner cities there are more asthma triggers present, either in the home environment or in the immediate outdoors. These triggers can include dust mites, cockroach feces and dust. We will examine in our study factors that have been found in other studies as to why there is an increase of asthma in minority children. These factors include socio-economics, access to health care and genetic susceptibilities at play — does asthma run in the family? Asthma can also be influenced by stress.

Q: What is the purpose of the HEAL project?

A: The purpose of the project is to learn about the effects of mold and other allergens on children with asthma in the New Orleans area after Hurricane Katrina. Is there a special connection between the impact of Hurricane Katrina on the environment and the number of children with asthma? We know that mold and other allergens are triggers — that's established. We also know that many homes were flooded, and we know that many families are still engaged in renovating, gutting or remediating their homes. In some cases, people are living in trailers next to their home and remediating as they go along. We want to know what that exposure will do to children with asthma.

Q: How damaging is the post-Katrina environment to asthmatic children?

A: That's exactly what we're going to find out. We're going to focus on about 450 school-age children with asthma. What's the exposure to mold in this unique situation post-Katrina doing to children who already have asthma? We're going to look at what the relationship is between those unprecedented levels of mold indoors and other indoor allergens on children who already have moderate-to-severe asthma.

Q: The full name of the study is Head-off Environmental Asthma in Louisiana (HEAL). What are some of the preventative measures you'll be using in the study?

A: Integral to the study is the role of an asthma counselor. An asthma counselor typically works with families to reduce the asthma symptoms by understanding not only what the clinical evaluation tells us, but also understanding the risks in the home environment and providing ways to intervene. This is an intervention study. One of the ways that we will intervene is to provide not only counseling and advice, but also making sure that the child is connected to a health-care provider, making sure that there are ways to reduce the asthma triggers in the home setting, whether it is providing a HIPA filter or making sure the bedding is covered. We're going to put into place intervention strategies that will reduce the triggers that could put the extra burden on the child's asthma.

Q: Don't most children grow out of asthma?

A: It's an easy question, but with a difficult answer. Sometimes people will say they grow out of it, and a lot of it has to do with the maturity of the child. But also maturation of the child's immune system is a big factor. As a child grows up, the immune system matures and they're better able to deal with infections. There are children that, between the ages of 4 and 18, will move, so their home environment will change. There are a number of factors like this that may lead to a lessening of the disease as an entity or a decrease in the number of attacks. One important issue is adherence to medication. It's absolutley critical. If there's limited adherence or times when medication is not taken, then you have a limited opportunity to control it. Q: By modifying an asthmatic child's environment, will you be able decrease the number of asthma attacks they have? A: We have seen that effectively dealing with the environmental factors actually decreases the number of symptom days in asthmatic children. We've seen this in many cities, and we're hoping to replicate that in New Orleans by using the same model of the asthma counselor.

PAULA BURCH, TULANE UNIVERSITY
  • Paula Burch, Tulane University

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