Addressing Phila. asthma crisis

For nearly two decades, Tyra Bryant-Stephens has worked to lessen the asthma crisis among children in Philadelphia neighborhoods where rates of the potentially deadly condition far outstrip the national average.

In 1997, the physician at Children's Hospital of Philadelphia founded the Community Asthma Prevention Program, which she has led ever since. The staff of 12 includes nurses, educators, and lay home visitors. Bryant-Stephens also is active with the American Lung Association.

This month, as part of National Public Health Week, Bryant-Stephens joined a roundtable in Washington with President Obama, Surgeon General Vivek H. Murthy, Environmental Protection Agency Administrator Gina McCarthy, and others to discuss the need to address climate change to protect public health.

"My particular concern is asthma - the environmental consequences of climate change and how that affects asthma," she said in an interview later about how a global issue is showing up in the lungs of her young patients.

Question: What are the major effects of climate change that could affect those with asthma?

Answer: Increased heat will lead to high ozone days, and higher ozone means poor air quality. Also, there will be an increase in airborne allergens, and more days with high pollen counts, because of a longer growing season. Wildfires, potentially caused by the effects of climate change, could blow smoke and particulates long distances. There are some far-reaching effects that we can't really predict right now, but it certainly is worrisome.

Q: Are your patients already experiencing the effects of climate change? If not, do you expect to see effects in the short term?

A: More days with higher pollen counts will lead to more asthma attacks. In general, when there is more heat, it leads to more ground-level ozone, and that results in asthma symptoms.

Q: What specifically happens to an asthma patient?

A: Asthma is a chronic inflammatory problem. So the airways are inflamed already. We use medication and therapy to control that. But people with asthma react to triggers. High pollen counts are a trigger that causes more inflammation, and more squeezing of the airways, and more mucous production. It's the same with poor air quality, especially for children affected by heat and high humidity. Heat alone can be a trigger for some children with asthma. It is individual.

Q: What are the childhood asthma rates nationwide, and how does that compare to the rates in Philadelphia?

A: Right now, about 9 percent of children nationwide have asthma. In Philadelphia in 2008, we did a study looking at the poorest neighborhoods in West and North Philadelphia. We found that one out of four children have been diagnosed with asthma, a rate of 25 percent.

Q: Why the difference?

A: We know that children who are poor and who are minority - blacks and Hispanics - have a higher prevalence of asthma. As for why that is the case, there is no simple answer. One, there is probably a genetic component. Two, these children live in the poorest of environments. We know that poor people live in inadequate housing in under-resourced neighborhoods. That means more exposure to asthma triggers and pollutants in general.

Q: Will climate change affect the rates of asthma, exacerbate things for patients who already have asthma, or both?

A: We don't know that climate change causes asthma itself. We just know it causes asthma attacks.

Q: People often think of climate change as being related to the outdoors. Are indoor effects also expected?

A: A recently released national climate assessment looking at human health found there could be impacts to indoor air. One thing is easily understandable: Extreme weather with heavy rainfalls and flooding can lead to mold growth, and mold is another trigger for asthma attacks. This could particularly affect low-income children in inadequate housing, where structural defects could allow rainwater to leak through. So they are even more vulnerable to the effects of flooding and heavy rains.

Q: President Obama has launched a broad climate change and health initiative. What has impressed you?

A: Recently, 30 deans of medical and nursing schools traveled to Washington to commit to including environmental health in their curricula. That's something we probably should have done a while ago. We see the need for it more and more every day.

Q: What would you like to see happen now?

A: What I would love to see happen is that we get the message out to the public that climate change and its environmental consequences are a public health problem. We work a lot with community groups and parents and caregivers, and we're used to teaching about asthma. One of the things that's hard for us all to grasp is that we really can't control the outdoor pollutants on an individual level. Reduction of carbon emissions through cleaning up power plants is one way to start. Sometimes, it's hard to understand all the science behind climate change. I think we have to focus on the health consequences, saying, "This is what it does to children with asthma."