Asthma rate and costs from traffic-related air pollution are much higher than once believed
A research team led by University of Massachusetts Amherst resource economist Sylvia Brandt, with colleagues in California and Switzerland, have revised the cost burden sharply upward for childhood asthma and for the first time include the number of cases attributable to air pollution, in a study released this week in the early online version of the European Respiratory Journal.
The total cost of asthma due to pollution is much higher than past traditional risk assessments have indicated and there is growing evidence that exposure to traffic-related air pollution is a cause of asthma and a trigger for attacks, so it should be included, say the authors. They conducted the study in Long Beach and Riverside, Calif., communities with high regional air pollution levels and large roads near residential neighborhoods.
Total additional asthma-specific costs there due to traffic-related pollution is about $18 million per year, almost half of which is due to new asthma cases caused by pollution, they report. Brandt worked with researchers at the University of Basel, Switzerland, Sonoma Technology, Inc. and the University of Southern California.
Using updated techniques that count asthma cases attributable to air pollution for the first time and including a broader range of health care costs such as parents’ missed work days, extra doctor visits and travel time along with prescriptions, the researchers found that a single episode of bronchitic symptoms cost an average $972 in Riverside and $915 in Long Beach. Bronchitic symptoms (daily cough, congestion or phlegm, or bronchitis for three months in a row) are a critical outcome for children with asthma.
Further, people who live in cities with high traffic-related air pollution bear a higher burden of these costs than those in less polluted areas, they say.
Not all children have the same asthma symptoms, and these symptoms can vary from episode to episode in the same child. Possible signs and symptoms of asthma in children include:
Frequent coughing spells, which may occur during play, at night, or while laughing or crying
A chronic cough (which may be the only symptom)
Less energy during play
Rapid breathing (intermittently)
Complaint of chest tightness or chest “hurting”
Whistling sound when breathing in or out - called wheezing.
See-saw motions in the chest from labored breathing. These motions are called retractions.
Shortness of breath, loss of breath
Tightened neck and chest muscles
Feelings of weakness or tiredness
While these are some symptoms of asthma in children, your child’s doctor should evaluate any illness that complicates your child’s breathing. About half of infants and toddlers with repeated episodes of wheezing with shortness of breath or cough (even though these illnesses usually respond to asthma medications) will not have asthma by the age of 6. Because of this, many pediatricians use terms like “reactive airways disease” or bronchiolitis when describing such children (instead of labeling them as asthmatic).
Brandt and colleagues say the total annual cost for a typical asthma case was $3,819 in Long Beach and $4,063 in Riverside, and “the largest share of the cost of an asthma case was the indirect cost of asthma-related school absences.” School absences are an important economic consequence, they add, because “they often lead to parents or caregivers missing work.”
Overall, Brandt points out that the results are relevant and applicable to many settings and “families with children who have asthma are bearing a high cost. The total annual estimate between $3,800 and $4,000 represents 7 percent of median household income in our study in these two communities. This is troublesome because that is higher than the 5 percent considered to be a bearable or sustainable level of health care costs for a family.”
Answers to Commonly Asked Questions
Will my child outgrow his/her asthma?
Many babies who wheeze with viral respiratory illnesses will stop wheezing as they grow older. If your child has atopic dermatitis (eczema), allergies or if there is smoking in the home or a strong family history of allergies or asthma, there is a greater chance that asthma symptoms will persist.
Can asthma be cured?
Not yet. However, for most children and adults, asthma can be controlled throughout life with appropriate diagnosis, education and treatment.
Should my child exercise?
Once a child’s asthma is controlled, (usually with the help of proper medications) exercise should become part of his or her daily activities. Children with asthma certainly can and do excel in athletics. Many Olympic athletes have asthma.
How can symptoms be controlled at school?
You, your family, physician and school personnel can work together to prevent and/or control asthma. Share your child’s asthma management plan with the school nurse and any coaches who oversee your child. With the approval of physicians and parents, school-age children with asthma should be allowed to carry metered-dose inhalers with them and use them as appropriate.
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American Academy of Allergy, Asthma & Immunology
Riverside and Long Beach account for about 7 percent of the total population of California, the authors say, which suggests that state-wide costs of asthma related to air pollution are “truly substantial.”
For this work, Brandt and colleagues analyzed several surveys on health care visits by children with asthma and their previous estimates of the number of asthma cases attributable to pollution to estimate the annual costs of childhood asthma. They also estimated the cost of asthma exacerbation due to regional air pollutants. They feel the new method does a better job of accounting for the full impact of traffic-related pollution and will be widely applicable in urban areas.
She points out, “Traditional risk assessment methods for air pollution have underestimated both the overall burden of asthma and the cost of the disease associated with air pollution. Our findings suggest the cost has been substantially underestimated and steps must be taken to reduce the burden of traffic-related pollution.”
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This work was supported by California’s South Coast Air Quality Management District and its settlement funds from BP, as well as by the U.S. National Institute for Environmental Health Sciences, the U.S. Environmental Protection Agency and the Hastings Foundation.
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Janet Lathrop
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413-545-0444
University of Massachusetts at Amherst