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Asthma capital: Springfield said to have highest rates of asthma in the U.S., says national research group

  • Roberta Bennett and her 11 year-old daughter, Aiyanna Rodriguez, who has asthma, have learned to make adjustments that improve the air quality in their apartment. Staff Photo/Andy Castillo

  • Roberta Bennett and her 11- year-old daughter, Aiyanna Rodriguez, who has asthma, have learned to make adjustments that improve the air quality in their apartment. Staff Photo/Andy Castillo

  • An air conditioner in Aiyanna Rodriguez’s bedroom helps her breathe better during hot, humid spells. Staff Photo/Andy Castillo

  • Aiyanna Rodriguez uses a rescue inhaler to keep her asthma under control. Staff Photo/Andy Castillo

  • Aiyanna Rodriguez demonstrates how to use a nebulizer, (also shown top left,) which delivers medication in the form of a mist to help her breathe during an asthma attack. Aiyanna uses a rescue inhaler to keep her asthma under control (top right.) Staff Photo/Andy Castillo

  • A nebulizer delivers medication in the form of a mist inhaled into the lungs. Staff Photo/Andy Castillo



@AndyCCastillo
Tuesday, September 04, 2018

She used to dance, but can’t anymore now that her asthma has flared up.

“It takes a really big toll,” said Roberta Bennett of Springfield of the illness her daughter Aiyanna Rodriguez, 11, is learning to cope with.

Managing asthmatic symptoms is an all-day affair, starting with morning medication. But mother and daughter go for evening walks and bike rides together when the day’s heat has passed. Humidity makes Aiyanna’s asthma worse.

Bennett attributes at least part of the blame for her daughter's condition to New England’s volatile climate — above 90 degrees at times in the summer and dipping below zero in the winter.

But the explanation is more complicated than that, health professionals say. Multiple factors are to blame for a condition that doctors say is hard to explain.

And on top of that, Bennett and Aiyanna are living in a city and an area that’s been designated the asthma the capitol of the United States by the Asthma and Allergy Foundation of America in its 2018 annual report.

That distinction is based on a variety of factors including high numbers of asthma cases and emergency room visits due to asthma emergencies and air quality.

About 8 percent of the U.S. population has asthma, a lung disease that inflames and constricts airways and can cause wheezing, shortness of breath, and coughing, according to 2015 data from the national Centers for Disease Control and Prevention in Atlanta. Springfield's rate is more than double the national average, and in Holyoke, there are three times more people with asthma than the national average.

In the Asthma and Allergy Foundation’s report, the regions of Richmond, Virginia; Dayton, Ohio; Philadelphia, Pennsylvania; and Louisville, Kentucky, were ranked second through fifth respectively. In Massachusetts, Worcester ranked 12th, and Boston ranked 11th.

A mysterious illness

Drastic weather swings coupled with variables such as traffic conditions and lower socioeconomics that can account for unhealthy living conditions and inadequate health care, may explain why the Springfield area has higher than average asthma rates, said Dr. Nico Vehse, chief of pediatric pulmonary at Baystate Medical Center in Springfield. The city’s income level is comparatively low; in 2016, Springfield’s median household income was $35,742, according to data from the United States Census Bureau. Statewide, the median income for that same year was $70,954.

In general, how someone develops asthma “is a mystery,” Vehse said, which makes Springfield’s statistics hard to explain. “Your entire immune system is involved. It’s a complex system to understand,” he said.

Rates of asthma among school-aged children in Hampshire and Franklin counties, also are above the national average but aren’t as concerning, says Dr. Estevan Garcia, chief medical officer at Cooley Dickinson Hospital in Northampton.

“The burden of asthma that we see here is not what we see in Springfield,” he said.

One reason for that, he speculates, might be a strong primary health care network in the Northampton area. Controlling asthma through long-term medications, and having regular checkups, is a good way to prevent emergency room visits, he says.

Resources to help

In light of the asthma foundation’s report, the Massachusetts’ Health Policy Commission recently awarded the Baystate Health Care Alliance and BeHealthy Partnership ACO, a partnership of various local healthcare organizations, a $750,000 grant to expand a pilot program currently underway. That program, Springfield Healthy Homes Asthma Program pilot, tackles the problem by removing asthma triggers from homes and providing instruction on how to better manage symptoms. It has been funded by small grants, according to Sarita Hudson, director of programs and development at the Public Health Institute of Western Massachusetts. Supporters of the pilot program include the Green & Healthy Homes Initiative, the Social Innovation Fund, and Baystate Health, Hudson said.

Bennett and Aiyanna are among those who have been receiving assistance, which has included tips for house-cleaning improvements

The additional grant money, Vehse said, will be used to do more extensive work on houses where people with asthma live in to eliminate aggravating factors.

“If there’s a leaking roof, and there’s mold in the house, fixing the roof (might) eliminate the mold. Dust mites are very common triggers. If there’s carpeting, the carpeting can be removed and hardwood flooring can be installed,” he said.

Families are chosen based on their income status — most are MassHealth recipients — and how seriously health has been affected.

“It’s for people who have been either hospitalized, in-patient, or had two or more emergency department visits in the last year,” Hudson said.

Besides triggers like carpeting in old houses, Emily Bender, spokeswoman for the United States Environmental Protection Agency, noted there are many factors that can make asthma more prevalent among a city’s population — outdoor pollution from smoke, pollen, exhaust, and road dust. Bender says that, overall, air quality in the Valley meets all quality standards, and that it’s unlikely that outdoor air pollution is contributing to asthma prevalence.”

But, Hudson said, localized circumstances can affect air quality and how it affects people with asthma.

“Certainly, air quality in this region has improved when it comes to particle pollution,” she said, but added an individual may live in a particularly congested area of the city or near a factory or other facility that emits pollution.

Vehse notes that periods of high humidity, smoking, and lower socioeconomic status could make individuals more susceptible. Even belonging to a certain ethnic group can put a person at higher risk, due to genetics.

“Asthma is more prevalent in low social-economic areas, and the ethnic mix we have in Springfield might be part of it, too,” he said. “Definitely, Hispanic populations have a higher risk of asthma.”

An attack leads to help

Having an asthma attack can be terrifying, Aiyanna Rodriguez said one recent day, standing at the dining room table of her Springfield apartment. An air conditioner whirred in a kitchen window.

She showed how she uses a nebulizer, a delivery device used to administer medication in the form of a mist inhaled into the lungs. which she uses during particularly bad asthma attacks.

“It feels like you’re out of breath, and you’re breathing super, super hard,” she said.

Last year, she had a particularly bad attack while in school at St. Thomas the Apostle School in West Springfield, her mother says,

“It was toward the end of the year,” Bennett recalled. “There’s was no AC.”

The weather was hot and humid, and, suddenly, Aiyanna could hardly breathe.

She was taken to the hospital where she stayed for over a week. “Her lungs were tight, she was wheezing very heavily,” said Bennett, “It was scary.”

Following that ordeal, Bennett and Aiyanna were connected with the asthma pilot program through which they received new bed sheets, informational books and cleaning supplies, including a vacuum to help control dust, which makes Aiyanna’s asthma worse. Professional inspectors looked through their home, alerted Bennett to areas susceptible to mold, and explained what causes mold and how to prevent it.

These days, partly because of the Springfield Healthy Homes Asthma Program pilot, Bennett says Aiyanna’s asthma has become more manageable.

“This program is one-of-a-kind. It’s very helpful, and very educational.”

Andy Castillo can be reached at acastillo@gazettenet.com.

How to connect

For more information on the Springfield Healthy Homes Asthma Program, visit springfieldhealthyhomes.org, or call 413- 794-2807. For more on the Public Health Institute of Western Massachusetts’ asthma coalition visit www.pvasthmacoalition.org