AHN physicians announce results of study on Asthma in Pittsburgh-area kids

A local study examining asthma prevalence, severity and risk factors among Pittsburgh-area schoolchildren has found that more than 40 percent of participating fifth-grade students already have or are at risk for developing asthma. Deborah Gentile, MD, Director of Allergy and Asthma Clinical Research in the Division of Pulmonary, Allergy and Critical Care Medicine at Allegheny Health Network (AHN), presented her findings today at “The Air We Breathe: A Regional Summit on Asthma in Our Community” at the Pittsburgh Marriott City Center.

Dr. Gentile was the lead investigator and author of the study, which was funded by a grant from The Heinz Endowments’ Breathe Project. The study enrolled a total of 267 students from 10 elementary schools in four western Pennsylvania school districts, including Northgate, Allegheny Valley, Gateway and Woodland Hills, as well as two independent schools, Environmental Charter School and Waldorf Elementary.

Among the study participants, the prevalence of physician-diagnosed asthma was 28.7 percent with an additional 11.7 percent of students found to be at risk of developing the disease. Furthermore, 45.4 percent of the study participants diagnosed with asthma were found to have uncontrolled asthma, and poor air quality was associated with a five times higher rate of uncontrolled asthma.

Dr. Gentile said it is important to note that the study population was not randomly selected and that participation among eligible fifth graders was approximately 50%. The schools as well as the students self-selected to participate on a volunteer basis, so it is possible that students without any signs or symptoms of asthma chose not to participate and the overall prevalence could be inflated.

“However, if you adjust the rate assuming that the 50 percent who did not participate in the study did not have asthma, the prevalence would be approximately 20 percent, which is still much higher than the rates reported at the county, state and national levels,” said Dr. Gentile. “These results show a connection between increased asthma prevalence in children and exposure to higher levels of outdoor air, suggesting that poor air quality is at least partially responsible for the high incidence of childhood asthma in the Pittsburgh region.

“Our findings are significant because they show that, despite the availability of local primary care providers, asthma specialists, and excellent controller medications, asthma is underdiagnosed and undertreated in many local children,” added Dr. Gentile. “They also suggest that poor regional air quality contributes to the local incidence and severity of asthmatic disease.”

Bolstered by the results of the study, district-wide screening for asthma already is underway this year at the Woodland Hills, Clairton and Northgate school districts, and Dr. Gentile next hopes to develop a regional and possibly even statewide screening program for asthma among schoolchildren. Future studies will focus on identifying triggers of asthma as well as treatment and possible prevention of asthma among schoolchildren.

According to the recently released American Lung Association annual “State of the Air” report, the Pittsburgh metro area ranked as the 14th-most polluted area in the country for daily fine particle emissions and the eighth worst for annual particle pollution. Particulate matter pollution is tied to multiple illnesses, including asthma.

The Allergy and Asthma Foundation ranks Pittsburgh as the 27th-most challenging U.S. city in which to live with asthma, based on factors such as high level of exposure to known asthma triggers such as poor outdoor air quality, indoor allergen exposure, tobacco smoke exposure and high poverty rates. Some Pittsburgh-area school districts report asthma rates that rank among the state’s highest.

“Prior to this study, there was a lack of objective regional asthma surveillance data on area schoolchildren,” said Philip Johnson, MPH, PhD, Program Director for Science and Environment and Director of The Breathe Project at The Heinz Endowments. “As part of The Breathe Project – one of the most important environmental health initiatives ever undertaken by The Heinz Endowments – we awarded the grant to AGH to study this so that it would be possible to begin pinpointing the triggers of childhood asthma and build a base to formulate the best methods to fight this dangerous disease.”

Nearly 25 million Americans, and more than 9 percent of children, suffer from asthma. It accounts for 25 percent of all emergency room visits, and 3,300 deaths yearly, many of which could be avoided with proper treatment and care. African-Americans are three times more likely to be hospitalized for, or die from, asthma. Nationally, asthma is the number one chronic cause of school absenteeism, with more than 13 million total missed school days per year.

Joining Dr. Gentile in the study were David Skoner, MD, Director of the Division of Allergy, Asthma and Immunology at AHN, as well as Jennifer Elliott, PharmD, from Duquesne University’s Mylan School of Pharmacy; Albert Presto, PhD, from Carnegie Mellon University and representatives from the American Lung Association.

“The importance of a study like this cannot be overstated, and we hope that these findings will lead to new measures to help improve the health of our children,” said Susan Manzi, MD, MPH, Chair of the Department of Medicine at AHN.

In addition to the asthma in schools study, The Heinz Endowments’ Breathe Project has partnered with AGH since 2012 on the annual “The Air We Breathe: A Regional Summit on Asthma and Other Health Impacts of Air Pollution” event. The Summit attracts internationally leading experts on the health impacts of air pollution to speak to local health professionals and government officials and raise further awareness about this public health issue.

The keynote speaker at this year’s Summit is Michael Brauer, ScD, a professor of medicine at The University of British Columbia who sits on the Scientific Advisory Panel of the Climate and Clean Air Coalition (CCAC), part of the United Nations Environment Program (UNEP). Dr. Brauer specializes in the assessment of exposure and health impacts of air pollution, particularly transportation-related and biomass air pollution. His keynote address will focus on the health aspects of urban living.

Allegheny Health Network, part of Highmark Health, is an integrated healthcare delivery system serving the Western Pennsylvania region. The Network is comprised of eight hospitals, including its flagship academic medical center Allegheny General Hospital, Allegheny Valley Hospital, Canonsburg Hospital, Forbes Hospital, Jefferson Hospital, Saint Vincent Hospital, Westfield Memorial Hospital and West Penn Hospital;  a research institute; Health + Wellness Pavilions; an employed physician organization, home and community based health services and a group purchasing organization. The Network employs approximately 17,500 people and has more than 2,800 physicians on its medical staff. The Network also serves as a clinical campus for Drexel University College of Medicine, Temple University School of Medicine and the Lake Erie College of Osteopathic Medicine.