Disparities in CT asthma are driven by race, money and environment

Maria Cotto of East Hartford says hello to Brigadier Wendy Gabriel as she walks her grandson, Percy Diaz, 7, to school. Cotto, who suffers from asthma, does it every morning.

Robert Carmon shows off his basketball skills on the Glade Street court near his West Haven home. His asthma has improved since he was diagnosed as an infant.

Kamyle Dunn used to sleep with her hand on her mother’s chest so she could feel it expand and contract and know that her mother hadn’t stopped breathing during the night.

Dunn’s mother, Maria Cotto, has long suffered from severe asthma. Dunn inherited the disease although she mostly grew out of it as an adult. Today, Dunn’s 12-year-old son also suffers from severe asthma.

“People are kind of ignoring it’s not that bad,” said Dunn, who lives with his family in East Harford. “But I see what it did to my mother, and I see what it did to my son, and what it did to me.”

In Connecticut, 10.6% of children and 10.5% of adults have asthma, according to state data from 2019. According to DataHaven’s 2021 Community Wellness Survey, 12% of adults suffer from asthma.

Asthma does not affect everyone in the same way.

“In the state of Connecticut, as in other states across the country, this condition disproportionately affects minority populations, including African Americans and Hispanics,” said Dr. Mario Perez, assistant professor of medicine at UConn Health which studies asthma disparities and who Cotto sees for his asthma.

DataHaven’s survey found that 11% of whites, 13% of blacks, and 21% of Latino adults have asthma.

The economy also seems to play a role. Only 6% of adults in affluent cities have asthma, while 16% of adults in cities like New Haven, Waterbury, Hartford and Bridgeport have it. Additionally, 19% of adults earning less than $30,000 a year have asthma, compared to only 9% of those earning $100,000 a year.

“Inner city residents are generally three to four times more likely to visit the emergency room with an asthma diagnosis than residents of outer suburbs,” said Mark Abraham, executive director of DataHaven.

Connecticut has long been known as the “nation’s exhaust pipe” due to pollution from other states. The American Lung Association’s 2022 State of the Air Report gave every Connecticut county a low score for ozone levels. Fairfield, Middlesex, New Haven and New London all received an F grade, while Tolland and Windham counties received a D grade, and Hartford and Litchfield each received a C grade.

“We know that environmental factors, especially factors such as air pollution, can be associated with and contribute to disease and its flare,” Perez said.

A 2009 study of New Haven County children recruited at the Yale Asthma Care Center found an increased risk of symptoms and inhaler use in asthmatic children exposed to traffic-related fine particles.

Additionally, some research has suggested a link between crime and asthma rates, highlighting the need for healthier communities overall. “Feeling your neighborhood is safer actually decreases the rate of asthma and asthma exacerbations,” Perez says.

Robert Carmon, 11, who recently moved from New Haven to West Haven, developed asthma as a baby and was rushed to hospital by his parents almost every week for the first few years of his life. Robert has improved since C-HIT first reported him in 2018, but the condition is still impacting his life. He would like to play on the school basketball team, but he can’t because he’s worried his asthma will get worse. “I can play pickup games as long as I don’t play too hard,” he said.

The frequency of his ER visits has decreased, but he still visits the hospital about once a month or so, Robert’s father, Chaz Carmon, said.

Stories like Robert’s are common in Connecticut towns. For the past few years, they’ve ranked highly in the Asthma and Allergy Foundation of America’s annual Asthma Capitals report, but this year has seen a marked improvement. Hartford fell from 17th worst to 69th on the list, Bridgeport fell to 85th from 29th in 2021, while New Haven fell from 5th to 90th.

“New Haven had the biggest positive jump in the rankings of the 100 metropolitan statistical areas we analyze,” said Hannah Jaffee, research analyst at the Asthma and Allergy Foundation.

However, people shouldn’t read too much into the improved rankings, as this year’s list was created based on different data sources than in previous years. For example, insurance claims were reviewed instead of the self-reported surveys used previously. Also, more localized data was used rather than the county-level data used for previous years’ report.

Even still, Jaffee said, the three most populous counties saw some improvement.

“When we look at county-level data on which we previously used asthma prevalence rates for Fairfield, Hartford, and New Haven counties, they have all declined over the past five years,” he said. she stated. The death rate has also generally declined in those three counties over the past 20 years, Jaffee added.

Strategies proven to reduce the incidence and severity of asthma include ensuring all residents have access to culturally appropriate health care and improving indoor and outdoor air quality for city dwellers.

“Asthma triggers can be lessened through improvements in housing quality, such as better air conditioning filters and educating families about what the triggers might be,” Abraham said.

“If you use a gas stove for cooking and you don’t have good ventilation, it produces a lot of indoor air pollution.”

The Connecticut Asthma Program is a state-run initiative that attempts to reduce asthma disparities through partnerships with health care providers while providing education about the disease and expanding program access of home visits for asthma in Connecticut. The state has also promoted the Centers for Disease Control and Prevention (CDC) EXHALE framework for asthma management.

Maria Cotto of East Hartford says hello to Brigadier Wendy Gabriel as she walks her grandson, Percy Diaz, 7, to school.  Cotto, who suffers from asthma, does it every morning.

Perez says the most effective interventions will take place before a patient comes before him. “I think we as a society need to tackle everything from the environmental and climate pollution we create as humans to improving education and access to healthcare. of health, but also to the improvement of the socio-economic status of the population in general.”

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In the meantime, some say more can be done individually to help asthmatics. For example, while Robert’s current school allows him to keep his asthma pump handy, he was not allowed to do so in the past. “They always said you had to keep your bag in your locker,” he said. This could cause uncontrollable asthma attacks before he can reach his pump.

Her father adds that every school should have a nebulizer in the nurse’s office with staff trained to administer asthma medication. That way, a student “can be on the nebulizer at least until the parents arrive,” Carmon says, and if the nebulizer helps enough, the student may be able to return to class.

Cotto says it’s important for medical staff to remember that every patient is different. Cotto learned this horribly when she was given epinephrine during an emergency asthma attack. Although the drug may be helpful to some patients, it almost killed her.

“I’m allergic to it. When they gave it to me, my heart stopped,” she said. When this happened in 2013, she ended up in a coma for 22 days.

After Cotto’s coma, her asthma worsened and she could not leave the house without oxygen for many years. In 2014, she started seeing Perez, who took the time to understand her specific triggers and a treatment plan that worked for her. Although she struggles at times, her asthma is better controlled than it has been in years.

“He tried a whole bunch of different drugs and finally found the one that worked for me,” Cotto says. “I’m actually able to leave the house without oxygen.” It’s something she hasn’t done in almost a decade.

This story was reported in partnership with the Connecticut Health I-Team (c-hit.org), a nonprofit news organization dedicated to health reporting.

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