Asthma

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The number of people in the United States with asthma roughly doubled from 1980 to 1995 and continues to rise.[1] Between 2001 and 2009, asthma prevalence increased 12.3% from 20.3 million to 24.6 million Americans. By 2009, nearly 1 in 12 people suffered from the disease.[2]

Asthma is one of the most common childhood chronic diseases, and a higher percentage of children than adults have asthma. Nearly one in ten (9.6%, or about seven million) children in the U.S. have asthma. Diagnoses are especially high among boys. The greatest rise in asthma rates from 2001 to 2009 was among black children, with a nearly 50% increase in prevalence. Seventeen percent of non-Hispanic black children had asthma in 2009, the highest rate among racial/ethnic groups.[3]

The annual costs associated with asthma grew from about $53 billion in 2002 to about $56 billion in 2007, an increase of 5.7%. These costs include medical expenses ($50.1 billion per year), loss of productivity resulting from missed school or work days ($3.8 billion per year), and premature death ($2.1 billion per year).[4]

The link to chemical exposure

AsthmaThe doubling of asthma rates over the last two decades has prompted researchers to examine the role that various environmental factors may play in this trend. Genetics alone cannot explain such dramatic increases in prevalence over such a short time.

Asthma is highly likely to result from the interaction of a complex mixture of underlying risk factors. Maternal nutrition, exposures to environmental contaminants, and stress can alter fetal lung and immune system development, not only prenatally but also after birth during infancy and childhood. Post-natal exposures to allergens and indoor and outdoor air pollution also can increase asthma risk.[5][6] One theory holds that altered bacterial composition in the intestine and living in environments that are “too clean” can increase risk as well.

But whatever the explanations of this troubling trend, extensive evidence from occupational and general population epidemiological studies and medical case reports documents that hundreds of chemicals can cause asthma in individuals previously free of the disease or can put asthma patients at greater risk for subsequent attacks.[7][8]

A 2007 literature review found 21 studies linking indoor residential chemical emissions with respiratory health or allergy problems in infants or children.[9] The study identified formaldehyde (in particleboard), phthalates (in plastic materials), and recent interior painting as the most frequent risk factors. Elevated risks also were reported for renovation, cleaning activities, new furniture, carpets, and textile wallpaper. Table 3 provides an overview of the indoor sources identified in this study.

A 2004 Swedish study compared 198 young children with asthma and allergies to 202 healthy control subjects. The home environment of every child was examined, with air and dust samples taken in the room where the child slept. The children whose bedrooms contained higher levels of the phthalate DEHP were more likely to have been diagnosed with asthma by a physician.[10] Current studies are reexamining the possible association between phthalates and asthma with more rigorous prospective study designs.

How chemical policy reform can help

Consumers, retailers, and other downstream users of chemicals—including manufacturers and distributors of toys and other products—have a problem in common: they cannot gain access to basic information about the chemicals used to make their products. Because federal law does not ensure the right to know what we are exposed to, we don’t have the information we need to identify all the sources of indoor air pollution that may be causing asthma or triggering symptoms.

How can an expectant mother determine if there is formaldehyde in the particleboard used to make cribs and other nursery furnishings? How does a new father decide which baby shampoo may contain phthalates? Why should new parents have to worry about whether potentially dangerous chemicals are in the products they choose for their newborn children?

To be effective, TSCA reform should include a requirement that chemical manufacturers publicly disclose information on the uses of and health hazards associated with their chemicals, and the ways that people could be exposed in their homes, schools, or places of work.

Table 3: Examples of Chemical Pollutants from Indoor Sources Implicated in Asthma or Its Symptoms[11]
Compounds Example Sources
Aldehydes
Formaldehyde Composite wood and other products with ureaformaldehyde resin, some architectural finishes, tobacco smoke, and other combustion processes
Aromatics
Benzene, toluene, xylenes, styrene, ethylbenzene, ethyltoluenes, and naphthalene Motor vehicle exhaust, gasoline/fuel, tobacco smoke, solvent-based paints, floor adhesives, PVC flooring, carpeting, printed material, solvent-based consumer products
Dichlorobenzene Moth balls, bathroom deodorizers
Chlorobenzene Possibly solvent-based paints
Aliphatic hydrocarbons
Hexane, nonane, decane, undecane, and dodecane Some architectural finishes, floor adhesives, PVC flooring, waxes, aerosol air fresheners
Aliphatics (general) Carpet padding, adhesives, caulks, paint
Volatile organic compounds (VOCs), other
Methylcyclopentane Motor vehicle exhaust and evaporative emissions
Butanol Some architectural finishes
Limonene Cleaning products, air fresheners, many consumer products
Tetrachloroethylene Dry-cleaning solvent and dry-cleaned clothing
Trichloroethylene Aerosol paints, adhesives, lubricating oils, paint removers
Phthalate esters
BBZP Vinyl flooring, carpet tile, adhesives
DEHP Vinyl flooring, PVC plastics

Citations:

  1. Woodruff T, et al. Trends in environmentally related childhood illnesses, Pediatrics 2004;113(4):1133-1140.
  2. Vital Signs: Asthma prevalence, disease characteristics and self-management education – United States, 2001-2009. [Internet] Atlanta: U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 2011 60(17):547-552; [2011 May 6]. Available from: www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm.
  3. U.S. Asthma Rates Continue to Rise, Press Release [Internet]. Atlanta: U.S. Centers for Disease Control and Prevention; [2011 May 3]. Available from: http://www.cdc.gov/media/releases/2011/p0503_vitalsigns.html.
  4. Vital Signs: Asthma prevalence, disease characteristics and self-management education – United States, 2001-2009. [Internet] Atlanta: U.S. Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report 2011 60(17):547-552; [2011 May 6]. Available from: www.cdc.gov/mmwr/preview/mmwrhtml/mm6017a4.htm.
  5. Duijts L. Fetal and infant origins of asthma. European Journal of Epidemiology 2012; 27(1):5-14.
  6. Sly P. The early origins of asthma: who is really at risk? Current Opinion in Allergy and Clinical Immunology 2011;11(1):24-28.
  7. Bernstein D, et al. Asthma in the Workplace, Third Edition. New York: Taylor & Francis; 2006.
  8. Association of Occupational and Exposure Clinics Exposure Codes [Internet]. Washington, DC: Association of Occupational and Environmental Clinics; Available from: www.aoec.org/aoeccode.htm.
  9. Mendell M, et al. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: A review. Indoor Air 2007;17(4):259-277.
  10. Bornehag CG, et al. The association between asthma and allergic symptoms in children and phthalates in house dust: A nested case–control study. Environmental Health Perspectives 2004;112(14):1393-1397.
  11. Mendell M, et al. Indoor residential chemical emissions as risk factors for respiratory and allergic effects in children: A review. Indoor Air 2007;17(4):259-277.

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