Low Income, High Asthma, Poor Health

Exercise induced asthma in kids is twice as likely among those living in neighborhoods with less income

/ Author:  / Reviewed by: Chris Galloway, M.D.

(RxWiki News) It takes a lot out of kids who run and play. They can be even more breathless if they live and exercise in an asthma hotspot, typically located in lower-income neighborhoods. Do you live in a 'hotspot'?

Asthmatic children who live in areas where breathing is a problem are twice as likely to have exercise-induced wheezing and seek medical attention, according to a recently published study.

The results showed that parents and doctors together need to be more aware in order to prevent kids from having asthma attacks and making unwarranted trips to the hospital.

"Use your inhaler as prescribed."

The study, led by Timothy Mainardi, MD, MA, past fellow at Columbia University Medical Center and currently in practice at Hudson Allergy, looked at 195 children with asthma who come from middle class families in neighborhoods across New York City over the course of a year.

The children were 7- and 8-years-old and were recruited through the Health Insurance Plan of New York that looks primarily at the middle class population. Neighborhoods in the Bronx, Brooklyn, Queens and Manhattan were considered the asthma hotspots and had more asthmatic kids.

Children were asthmatic if they wheezed, were awakened by cough at night, used medication for asthma or wheezed with exercise.

After the children had a physical examination and completed a survey on how much they wheezed during exercise, researchers compared kids' asthma rates to those who come from low-income, high-asthma neighborhoods selected through the United Hospital Fund's asthma level database.

They found that 43 percent of the kids had wheezed because of exercise at some point. Among them, a third had not used an inhaler before exercising.

About 27 percent of the asthmatic episodes ended up as urgent medical visits. Children living in places that are hotspots for asthma were twice as likely to wheeze and have trouble breathing after exercising.

They are also more likely to visit the ER or doctor's office because of these symptoms, even after looking at factors like the children's families' income, neighborhood and other factors.

"Exercise-induced wheeze is very uncomfortable for children," Dr. Mainardi said in a press release.

"It can present rapidly after beginning any strenuous activity and lead quickly to respiratory symptoms, so it is not surprising that it is a factor in ER visits."

Researchers still are not sure why asthma hotspots cause more symptoms. Air pollution and allergens were eliminated as possible causes.

Differences in children's weight, level of physical activity and neighborhood conditions also didn't affect results.

"The good news is that these symptoms are preventable," Dr. Mainardi said. "Parents should talk with their doctor so they can be ready with a plan, including the use of appropriate medication such as a bronchodilator inhaler prior to exercise."

No matter where the children lived, their lung function, allergy to common triggers and occurrence of symptoms were all the same, according to co-author Matthew Perzanowski, PhD, associate professor of environmental health sciences at Columbia's Mailman School of Public Health.

"Exercise-induced symptoms may identify a distinct population of asthmatics with causes for their exacerbations yet to be determined," he said. "The important lesson is that with greater awareness and treatment, we can hope to prevent those unscheduled visits to the doctor and trips to the ER."

The authors note that the children included in the study do not fully represent all the children in their neighborhoods. They also did not look at other breathing problems such as bronchoconstriction, nor how well various treatment methods worked in helping children's asthma symptoms.

The National Institute of Environmental Health Sciences, Housing and Urban Development Healthy Homes and Lead Technical Study and the National Institutes of Health funded the study. The authors do not declare any conflicts of interest. The study was published online December 17 in the journal Pediatrics by the American Academy of Pediatrics.

Reviewed by: 
Review Date: 
December 19, 2012
Last Updated:
December 27, 2012