Atlanta's Ranking Falls with a Breath of Fresh Air

GFP Note: Atlanta's ranking dropped from number 4 in 2008 to number 9 in 2009 as America's most challenging place to live with asthma.

St. Louis Named Top Asthma Capital

/PRNewswire/ -- St. Louis, MO, is ranked as the No.1 Asthma Capital – the most challenging place to live with asthma in the U.S.(1,a,1) – according to the Asthma and Allergy Foundation of America (AAFA), which conducted the study. This ranking was determined based on an analysis and scoring of 12 factors in the 100 largest U.S. metro areas.(1,b,5) St. Louis was ranked No.1 this year in part due to worse than average scores in crude death rate due to asthma (2.2%), higher than average pollen counts over the previous year and the lack of “100-percent" public smoke-free laws, which many other large cities are enacting.(1,a,1)

St. Louis topped the study after being ninth last year (2,a,1) due to a variety of factors, including poor air quality and a rise in the percentage of uninsured residents (2,a,1). It is interesting to note, however, that the prevalence of asthma, both estimated and self-reported in this city decreased slightly over the last year.(1,a,1; 2,a,1)

In 2008, Knoxville, TN, ranked No.1 (2,b,1) but moved to the number seven spot in 2009 (1,b,1) because both the estimated and self-reported prevalence of asthma decreased, and reported pollen levels were lower than the national average, among other factors. (1,b,1) Of note, all of the top 10 Capitals scored “below average” with regard to whether these cities embraced “100-percent” public smoke-free laws.(1,d,1) The complete rankings with detailed data for each city can be found at www.asthmacapitals.com.

For six years, AAFA has scientifically researched and evaluated conditions in the largest metropolitan areas in America and ranked them based on quality of life for people with asthma in each city. The Foundation reviews 12 factors: Crude death rate (CDR-recorded metro area deaths from asthma) for asthma; the estimated prevalence of adult and pediatric asthma; risk factors, such as air pollution, pollen counts and public smoking bans; and medical factors, such as the number of asthma medications used per patient and the number of asthma specialists in the area.(1,e,5)

“For the last several years, I have seen an increase in the severity of asthma in our patients and how their life is affected by it,” (1,a,1;2,a,1) said Mario Castro, MD, MPH, Professor of Medicine and Pediatrics, Washington University in St. Louis. “The lack of a smoke-free public environment for our patients with respiratory problems, especially asthma, (1,a,1) in St. Louis is appalling. Our return to the No. 1 Asthma Capital ranking is very concerning news for St. Louis asthma patients and physicians.”(1,a,1) Asthma, if left uncontrolled, can result in serious consequences.(3,a,1) In fact, sudden asthma episodes account for an estimated 1.8 million emergency room visits (3,b,4) and nearly 500,000 hospital admissions (3,c,4) each year in the United States.

AstraZeneca sponsored this research to better understand the environmental factors and health policies that impact people with asthma, specifically around asthma control. For the last 20 years, AstraZeneca has helped millions of people manage their respiratory conditions through discovery and development of asthma medications.

“Although St. Louis was found to be a particularly difficult place for people with asthma to live, asthma triggers are present in every American city,” says Mike Tringale, AAFA's Director of External Affairs. “There is no way for asthma patients to escape their disease,(4,a,1) but no matter where they live, patients can work with their physicians to find ways to effectively control their symptoms.” (5,a,1)

“We hope this survey ranking encourages asthma patients everywhere to talk to their doctors about how to avoid asthma triggers and about effective asthma control,” said Dr. Castro. “While asthma may not be curable, (4,a,1) it can be kept under control by following an asthma action plan that may in some cases include a controller treatment, as prescribed by a physician.” (6, a, 1;6,b,1)

Top 2009 Asthma Capitals

The top 10 Asthma Capitals for 2009, considered to be the most challenging places to live with asthma, are:
1.St. Louis, MO
2.Milwaukee, WI
3.Birmingham, AL
4.Chattanooga, TN
5.Charlotte, NC
6.Memphis, TN
7.Knoxville, TN
8.McAllen, TX
9.Atlanta, GA
10.Little Rock, AR(1,d,1)

References:
1.2009 Allergy Foundation of America Asthma Capitals study results. Available at www.asthmacapitals.com. Accessed on 1/22/09.
2.2008 Allergy Foundation of America Asthma Capitals study results. Available at www.asthmacapitals.com. Accessed on 1/22/09.
3.Centers for Disease Control. “Asthma Prevalence, Health Care Use and Mortality, 2003-2005” Available at http://www.cdc.gov/nchs/products/pubs/pubd/hestats/ashtma03-05/asthma03-05.htm. Accessed 1/22/09.
4.Asthma and Allergy Foundation of America. “Asthma Facts and Figures.” http://www.aafa.org/display.cfm?id=8&sub=42. Accessed 1/22/09.
5.Asthma and Allergy Foundation of America. “Asthma Overview Prevention.” http://www.aafa.org/display.cfm?id=8&cont=9. Accessed 1/22/09.
6.National Heart, Lung and Blood Institute. “How Is Asthma Treated and Controlled?” http://www.nhlbi.nih.gov/health/dci/Diseases/Asthma/Asthma_Treatments.html. Accessed 1.22.09.

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CDC Study Finds 3 Million U.S. Children have Food or Digestive Allergies

The number of young people who had a food or digestive allergy increased 18 percent between 1997 and 2007, according to a new report by the Centers for Disease Control and Prevention. In 2007, approximately 3 million U.S. children and teenagers under age 18 – or nearly 4 percent of that age group – were reported to have a food or digestive allergy in the previous 12 months, compared to just over 2.3 million (3.3 percent) in 1997.

The findings are published in a new data brief, “Food Allergy Among U.S. Children: Trends in Prevalence and Hospitalizations.” The data are from the National Health Interview Survey and the National Hospital Discharge Survey, both conducted by CDC′s National Center for Health Statistics.

The report found that eight types of food account for 90 percent of all food allergies: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Reactions to these foods by an allergic person can range from a tingling sensation around the mouth and lips, to hives and even death, depending on the severity of the reaction.

Children with food allergy are two to four times more likely to have other related conditions such as asthma and other allergies, compared to children without food allergies, the report said.
Other highlights:

* Boys and girls had similar rates of food allergy – 3.8 percent for boys and 4.1 percent for girls.
* Approximately 4.7 percent of children younger than 5 years had a reported food allergy compared to 3.7 percent of children and teens aged 5 to 17 years.
* Hispanic children had lower rates of reported food allergy (3.1 percent) than non-Hispanic white (4.1 percent) or non-Hispanic black children (4 percent.)
* In 2007, 29 percent of children with food allergy also had reported asthma compared to 12 percent of children without food allergy.
* Approximately 27 percent of children with food allergy had reported eczema or skin allergy, compared to 8 percent of children without food allergy.
* Over 30 percent of children with food allergy also had reported respiratory allergy, compared with 9 percent of children with no food allergy.
* From 2004 to 2006, there were approximately 9,537 hospital discharges per year with a diagnosis related to food allergy among children from birth to 17 years. Hospital discharges with a diagnosis related to food allergy increased significantly over time between 1998-2000 through 2004-2006.

The mechanisms by which a person develops an allergy to specific foods are largely unknown. Food allergy is more prevalent in children than adults. Most affected children will outgrow food allergies, although food allergy can be a lifelong concern.

The full report is available at www.cdc.gov/nchs.

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News to Use in Fayetteville, Atlanta, Augusta, Peachtree City and all of Georgia

Program Targets School Bus Fumes

When the bell rings signaling the end of the school day, students race to the buses waiting to take them home. Some of those buses sit with their engines running, churning up dangerous diesel exhaust particles.

Inhaling diesel exhaust can worsen or cause asthma, the most common childhood chronic lung disorder, according to the Centers for Disease Control and Prevention. Medical College of Georgia researchers aim to reduce that risk in Richmond County through Clean My R.I.D.E. - A Coalition to Reduce Inhalation of Diesel Exhaust.

"We'll assess the particulate exposure at schools, educate parents, teachers and bus drivers about the associated dangers and current idling policies and ultimately help develop a plan to decrease exposure to diesel exhaust," says Kitty Hernlen, assistant professor in the School of Allied Health Sciences Department of Respiratory Therapy and principal investigator of the $6,400 East Central Health District grant funding the program.

Bus and carpool practices will be monitored in five Richmond County schools: A. Brian Merry Elementary, Willis Foreman Elementary and Meadowbrook Elementary Schools, SpiritCreek Middle School and Butler High School. The research team will spend three days at each school to observe bus configurations, count idling vehicles and count airborne particles in the transportation pick-up areas 30 minutes before and after the dismissal bell rings.

"Every day, kids are walking through a diesel cloud to buses that are filling with diesel fumes and particulates," says Dr. Randy Baker, co-principal investigator and chair of the respiratory therapy department. "Buses at some schools will be in a straight line and others in a bus farm, where buses wait side by side. We want to determine if the bus configuration makes a difference in the concentration of particles and how long the particles hang around after the buses leave."

Diesel exhaust contains carbon particles and more than 40 hazardous air pollutants. Researchers will use a portable airborne particle counter to measure those that reach the lungs. Approximately 94 percent of particulate matter emitted through diesel exhaust is small enough to penetrate a child's narrow airways, which can inflame lungs and trigger asthma.

Pediatric deaths due to asthma are rare, but the Central Savannah River Area has seen a dramatic increase in asthma deaths in recent years – from three deaths between 1999-2004 to four deaths in a three-month period in 2006, says Ms. Hernlen.

"That cluster of deaths prompted the CDC to investigate the Augusta area," she says. "They didn't find one specific cause, but a whole list of things, and recommended asthma education for the entire community."

Ms. Hernlen is counting on the school community to do its part.

"We want to educate the schools through the parent-teacher associations, show them our findings and see if they can help change the idling policy. It's ultimately up to the school board whether they want to pursue a no-idling policy," she says.

The Richmond County Board of Education is already taking steps to eliminate unnecessary idling with a new directive to conserve fuel and lessen accumulation of fumes in and around the buses, says spokesperson Louis Svehla.

A no-idling policy would reduce diesel exhaust and save gas and money, says Dr. Baker. Other steps are more costly, such as buying new buses or retrofitting the old fleet with a particle scrubber, which can cost up to $10,000 per bus.

"We're trying to give parents some knowledge they may not have had about their children's safety and how it can be addressed now," says Dr. Baker. "Parents may think about fights on the bus, but not necessarily what their child is breathing at the bus stop."

By Paula Hinely

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Link Shown Between Thunderstorms and Asthma Attacks in Metro Atlanta Area by Team of Researchers from University of Georgia and Emory University

In the first in-depth study of its kind ever done in the Southeastern United States, researchers at the University of Georgia and Emory University have discovered a link between thunderstorms and asthma attacks in the metro Atlanta area that could have a “significant public health impact.”

While a relationship between thunderstorms and increased hospital visits for asthma attacks has been known and studied worldwide for years, this is the first time a team of climatologists and epidemiologists has ever conducted a detailed study of the phenomenon in the American South.

The team, studying a database consisting of more than 10 million emergency room visits in some 41 hospitals in a 20-county area in and around Atlanta for the period between 1993 and 2004, found a three percent higher incidence of visits for asthma attacks on days following thunderstorms.

“While a three percent increase in risk may seem modest, asthma is quite prevalent in Atlanta, and a modest relative increase could have a significant public health impact for a region with more than five million people,” said Andrew Grundstein, a climatologist in the department of geography at UGA and lead author on the research. Grundstein went on to say that “three percent is likely conservative because of limitations in this study.”

The next step for the UGA and Emory team will be, for the first time, to apply Doppler radar, modeling and observational data to the “thunderstorm asthma” problem based on what Grundstein calls an intriguing initial finding. He points out that “radar data coupled with the metro Atlanta database will allow us to correlate thunderstorm-asthma interactions that we are probably missing today.”

Paige Tolbert, professor and chair of the department of environmental and occupational health in the Rollins School of Public Health at Emory and a co-author of the just-published study, said the expertise of the two universities came together strongly in studying the problem.

“The Emory team has experience with a comprehensive emergency department database, and the UGA team can provide a much more refined characterization of thunderstorms than was performed in the previous studies of this question,” she said. “The study will thus provide new insight into the mechanisms under the phenomenon of thunderstorm-induced asthma.”

The research was published in the online edition of the medical journal Thorax. Other authors of the paper include: Marshall Shepherd and Thomas Mote from the UGA department of geography; Luke Naeher from the UGA department of environmental health science; and Stefanie Ebelt Sarnat and Mitchell Klein, who along with Tolbert are from the department of environmental and occupational health in the Rollins School of Public Health at Emory.

About 20 million Americans have asthma, according to the American Academy of Allergy, Asthma and Immunology. There also has been a dramatic increase in reported cases of the disease, with its prevalence increasing 75 percent between 1980 and 1994. Some 5,000 Americans die annually from asthma attacks.

Approximately 210,000 Georgia children under the age of 17 have asthma, according to the Division of Public Health of the Georgia Department of Human Resources. Some 65 percent of that number had an attack within the last year.

While associations between thunderstorm activity and asthma deaths and emergency room visits have been reported around the world, virtually no studies have been done in the American South, where hundreds of thousands suffer from asthma and thunderstorms are prevalent.

Some people may find it odd that thunderstorms, which supposedly “clear the air” of pollen and pollutants, are implicated in asthma attacks. The most prominent hypothesis as to why it happens, the authors of the paper say, is that “pollen grains may rupture upon contact with rainwater, releasing respirable allergens, and that gusty winds from thunderstorm downdrafts spread particles . . . which may ultimately increase the risk of asthma attacks.”

The team used thunderstorm occurrences from meteorological data gathered at Atlanta’s Hartsfield-Jackson International Airport and compared that information with the vast database of emergency room visits to arrive at the figure of a three percent increase in asthma-related emergency room visits following thunderstorms for the study period.

In all, during the 11-year period, there were 564 thunderstorm days, and in order to better understand the physical mechanisms that relate thunderstorms and asthma, the team also mined the information on total daily rainfall and maximum five-second wind gusts, which they used as “a surrogate for thunderstorm downdrafts and to indicate the maximum wind speed of the storm.”

In all, there were 215,832 asthma emergency room visits during the period and 28,350 of these occurred on days following thunderstorms. While the new study is the first of its kind in the South and does clearly indicate a relationship between thunderstorms and asthma in the metro Atlanta area, much more work remains, Grundstein said.

“Obtaining a better understanding of the mechanistic basis of the phenomenon of thunderstorm-induced asthma will allow for better intervention strategies and improved emergencies services planning,” said Stefanie Ebelt Sarnat of Emory. “This will be particularly important in the era of climate change.”

Grundstein added that in the Atlanta area conditions favorable for an estimated doubling of severe thunderstorms are expected within this century.

By Philip Lee Williams
University of Georgia