Why are kids in asthma hotspots in NYC more likely to visit the ER? Exercise may be a factor

December 17, 2012

Asthmatic children in New York City neighborhoods with high rates of asthma make many more visits to the emergency room (ER) than those who live in other parts of the city. While socioeconomic factors such as lack of adequate preventive care are part of the equation (high-asthma neighborhoods tend to be lower income), new research points to a possible biological basis for the disparity. Asthmatic children living in asthma hotspots were twice as likely to experience a common symptom known as exercise-induced wheeze than were those in neighborhoods with lower asthma rates.

Results by researchers at Columbia University Medical Center and Dartmouth-Hitchcock Medical Center appear online in Pediatrics, the journal of the American Academy of Pediatrics.

The study enrolled 195 middle-income children with asthma, ages 7 and 8, living throughout New York City—in areas with varying . The children were given a , and their caregivers completed a that included whether they had experienced exercise-induced wheeze one or more times in the past year.

Overall, 43% of the children had experienced exercise-induced wheeze. Those living in asthma hotspots were twice as likely to have experienced symptoms after exercise and more likely to have visited their doctor in a hurry or an ER because of , even after adjusting for neighborhood, income, and other factors.

"Exercise-induced wheeze is very uncomfortable for children. It can present rapidly after beginning any strenuous activity and lead quickly to , so it is not surprising that it is a factor in ER visits," said lead author Timothy Mainardi, MD, past fellow at Columbia University Medical Center and currently in practice at Hudson Allergy.

Dr. Mainardi and his colleagues found that one-third of the children experiencing exercise-induced wheeze had not used an prior to exercising. "The good news," he said, "is that these symptoms are preventable. 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."

Addressing neighborhood disparities in asthma-related ER visits has been a public health priority for many years. A 2002 report by the New York City Department of Health and Mental Hygiene found that ER visits for asthma were up to 20 times more common in low-income neighborhoods than elsewhere. Since then, asthma-related ER visits have declined, although a gap between higher and lower income neighborhoods remains.

To help explain these differences, the Columbia researchers first looked to see if asthma was more severe in low-income, high-asthma neighborhoods. It was not. "Lung function, airway inflammation, allergy to common asthma triggers, and symptom frequency were similar no matter where the child lived," said senior author Matthew Perzanowski, PhD, associate professor of environmental health sciences at Columbia's Mailman School of Public Health. By process of elimination, the researchers focused on one particular manifestation of the disease: rapid airway constriction brought on by exercise.

Exactly why asthma hotspots have higher rates of this symptom remains a mystery. While inadequate use of a bronchodilator inhaler prior to exercise was part of the story, it didn't fully explain the findings. Allergens and air pollution related to fossil fuel burning were not found to be factors. Neither were differences in physical activity, obesity, or neighborhood conditions such as the number of parks.

"Exercise-induced symptoms," said Dr. Perzanowski, "may identify a distinct population of asthmatics with causes for their exacerbations yet to be determined. 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."

Explore further: Cockroach allergens in homes associated with prevalence of childhood asthma in some neighborhoods

Related Stories

Cockroach allergens in homes associated with prevalence of childhood asthma in some neighborhoods

May 17, 2011
In New York City, the prevalence of asthma among children entering school varies by neighborhood anywhere from 3% to 19%, and children growing up within walking distance of each other can have 2-3 fold differences in risk ...

Air pollution from trucks and low-quality heating oil may explain childhood asthma hot spots

March 27, 2012
Where a child lives can greatly affect his or her risk for asthma. According to a new study by scientists at Columbia University, neighborhood differences in rates of childhood asthma may be explained by varying levels of ...

London smog may be tough on Olympians

July 26, 2012
(HealthDay) -- Air pollution may aggravate breathing problems among athletes with asthma or a related condition known as exercise-induced bronchoconstriction at the 2012 Summer Olympics in London, an allergists' group warns.

Childhood asthma linked to depression during pregnancy

July 6, 2011
Anxiety, stress and depression during pregnancy may lead to a greater risk of asthma for your child, according to researchers at Columbia University's Mailman School of Public Health. Study results are published in the July ...

Recommended for you

Small drop in measles vaccinations would have outsized effect, study estimates

July 24, 2017
Small reductions in childhood measles vaccinations in the United States would produce disproportionately large increases in the number of measles cases and in related public health costs, according to a new study by researchers ...

At the cellular level, a child's loss of a father is associated with increased stress

July 18, 2017
The absence of a father—due to incarceration, death, separation or divorce—has adverse physical and behavioral consequences for a growing child. But little is known about the biological processes that underlie this link ...

New comparison chart sheds light on babies' tears

July 10, 2017
A chart that enables parents and clinicians to calculate if a baby is crying more than it should in the first three months of its life has been created by a Kingston University London researcher, following a study of colic ...

Blood of SIDS infants contains high levels of serotonin

July 3, 2017
Blood samples from infants who died of Sudden Infant Death Syndrome (SIDS) had high levels of serotonin, a chemical that carries signals along and between nerves, according to a study funded in part by the National Institutes ...

Is your child's 'penicillin allergy' real?

July 3, 2017
(HealthDay)—Many children suspected of being allergic to the inexpensive, first-line antibiotic penicillin actually aren't, new research indicates.

Probiotic supplements failed to prevent babies' infections

July 3, 2017
(HealthDay)—Probiotic supplements may not protect babies from catching colds or stomach bugs in day care, a new clinical trial suggests.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.