# data[].attributes.body
- BfT Project Director
- BfT Project Coordinator
- 10 Peer Educators
- 3 Doctors
- 4 Nurses

# data[].attributes.body
Breathing for Tomorrow

# data[].attributes.body
The program’s participants are parents and children in Bayview-Hunters Point. Since children are the most susceptible to asthma, parents are encouraged to bring their children (ages 11-13).

# data[].attributes.headline
Program Activities Phase 1: Program Development (mos. 1-3)

# data[].attributes.subject
Program Activities Phase 1: Program Development (mos. 1-3)

# data[].attributes.body
outreach to the community for 10 asthma peer leaders to educate.

hire 3 doctors and 4 nurses to perform check-ups

find central space to hold this program in high community gathering spaces

develop curriculum to train peer leaders on what is asthma/how it affects individuals/managing asthma

create curriculum to train peer leaders and health professionals on how to run workshops and what to teach

Assess the community in terms of what their needs are in order to pinpoint what should be taught/given (pre-program assessment)

buy materials needed

# data[].attributes.headline
Program Activities Phase 2: Program Implementation (mos. 4 - 21)

# data[].attributes.subject
Program Activities Phase 2: Program Implementation (mos. 4 - 21)

# data[].attributes.body
Train Community Peer Leaders

Peer leaders will attend a training 2 days a week for 4 hours for four weeks that targets how to manage asthma (breathing exercises) and asthma triggers

Training on how to host workshops

Train Health Professionals

review pre-health assessment to understand what the participants need

asthma-related training

Community Peer Leaders Conduct Asthma-Management Workshop

Community peer leaders pass out flyers door-to-door in low-income public housing units to tenants to promote asthma-management workshop and pop-up clinic

Promote to parents and encourage to bring child or children

Create monthly flyers about the pop up clinics and services provided to update the community

Create a mass text message

Attend community events to do outreach

Conduct a workshop monthly that targets one specific topic about asthma (three-hour asthma management workshops with different cohorts of 20 people [10 parents and 10 children] with a free-check-up that follows the workshop)

Understand what asthma is

Asthma triggers

Prevention/Coping

Strategies

Environmental impacts

Breathing exercises

Create Asthma Take-Home Kits

Consist of preventive care information, suggestions/referrals of other clinics and affordable care for asthma, peak flow meter, spacer, pamphlet that teaches individuals how to use it

One kit will be distributed every house, for a total of 160-200 kits for this program.

Follow Up Check ups

trained health professionals conduct follow-up check-ups for program participants after workshop

Low-income families who are diagnosed with asthma are eligible for check-ups. These check-ups will last an hour each. The check-ups will be hosted in the pop-up clinics that will happen at the end of each month. Throughout the 16-month period, there will be a total of 16 pop-up clinics. We won't be able to estimate the overall number of participants until the end of the 16-month period since the pop-up clinic is available to the public.

# data[].attributes.headline
Phase 3: Program ClosingHow will your program end?

# data[].attributes.subject
Phase 3: Program ClosingHow will your program end?

# data[].attributes.body
Conduct survey evaluation to see whether the program was helpful.

Data report for a comparison of emergency visits in the beginning of the program compared at the end

Community block party at our last pop-up clinic where we provide extra supplies and last check-ups for community members

# data[].attributes.body
2 curriculums to train peer leaders and health professionals

10 peer leaders

6 health professionals

16 pop-clinics

16 health workshops

Each house will receive one asthma kit, for a total of 160-200 kits throughout the program.

320 participants (160 adults and 160 children) will learn how to manage their asthma

# data[].attributes.body
1. Decrease in the number of children (11-13 years old) of all races living in Bayview-Hunters Point public housing who visit the emergency room due to uncontrolled asthma. (Behavior)

# data[].attributes.body
1. When there is a decrease in the # of parents in Bayview-Hunters point who engage in smoking (Behavior)

2. Increase in the # of children in Bayview-Hunters Point who take their asthma medication such as oral corticosteroids, inhalers, spacers, allergy medications, and Albuterol (Behavior)

3. Increase in the # of children in Bayview-Hunters Point who go to check-ups regularly in order to get preventive and maintenance care. (Behavior)

# data[].attributes.body
You have done a great job addressing alot of my comments on your draft. I have made some new comments about ways you can continue to improve your problem description. It is important that you add some pieces of information. You need to give the reader a sense of the population on which you are focused. Are you focused on kids in Bayview? Just kids who live in public housing in Bayview? It is not clear to me. You need some demographics -- age, ethnicity/race, size of the population. Also, you present a lot of important causes and you need to make sure they are all shown to be of important to the population on which you are focused. Finally, if you are going to do a program about uncontrolled asthma you need to present more data about it -- you are mostly telling the reader about things that exacerbate or cause asthma -- which is really important. And you need to give us the emergency room visit info, the info about why is asthma not well controlled for the population on which you are focused. For the impact of the problem -- can you provide more information about how having uncontrolled asthma effects the population. For instance -- do they miss alot of school? You are doing great work and I am looking forward to seeing your outcomes!

# data[].attributes.body
Asthma is a respiratory condition that causes swelling and mucus buildup in your airways. Symptoms include, but are not limited to coughing, wheezing, and tightness of the chest.

Mayo Foundation for Medical Education and Research. (2022, March 5). Asthma. Mayo Clinic. Retrieved September 30, 2022, from https://www.mayoclinic.org/diseases-conditions/asthma/symptoms-causes/syc-20369653

# data[].attributes.attachment_link.readable_text
Overview

Asthma is a condition in which your airways narrow and swell and may produce extra mucus. This can make breathing difficult and trigger coughing, a whistling sound (wheezing) when you breathe out and shortness of breath.

For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack.

Asthma can't be cured, but its symptoms can be controlled. Because asthma often changes over time, it's important that you work with your doctor to track your signs and symptoms and adjust your treatment as needed.

Symptoms

Asthma symptoms vary from person to person. You may have infrequent asthma attacks, have symptoms only at certain times - such as when exercising - or have symptoms all the time.

Asthma signs and symptoms include:

Shortness of breath

Chest tightness or pain

Wheezing when exhaling, which is a common sign of asthma in children

Trouble sleeping caused by shortness of breath, coughing or wheezing

Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold or the flu

Signs that your asthma is probably worsening include:

Asthma signs and symptoms that are more frequent and bothersome

Increasing difficulty breathing, as measured with a device used to check how well your lungs are working (peak flow meter)

The need to use a quick-relief inhaler more often

For some people, asthma signs and symptoms flare up in certain situations:

Exercise-induced asthma, which may be worse when the air is cold and dry

Occupational asthma, triggered by workplace irritants such as chemical fumes, gases or dust

Allergy-induced asthma, triggered by airborne substances, such as pollen, mold spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet dander)

When to see a doctor

Seek emergency treatment

Severe asthma attacks can be life-threatening. Work with your doctor to determine what to do when your signs and symptoms worsen - and when you need emergency treatment. Signs of an asthma emergency include:

Rapid worsening of shortness of breath or wheezing

No improvement even after using a quick-relief inhaler

Shortness of breath when you are doing minimal physical activity

Contact your doctor

See your doctor:

If you think you have asthma. If you have frequent coughing or wheezing that lasts more than a few days or any other signs or symptoms of asthma, see your doctor. Treating asthma early may prevent long-term lung damage and help keep the condition from getting worse over time.

To monitor your asthma after diagnosis. If you know you have asthma, work with your doctor to keep it under control. Good long-term control helps you feel better from day to day and can prevent a life-threatening asthma attack.

If your asthma symptoms get worse. Contact your doctor right away if your medication doesn't seem to ease your symptoms or if you need to use your quick-relief inhaler more often.

Don't take more medication than prescribed without consulting your doctor first. Overusing asthma medication can cause side effects and may make your asthma worse.

To review your treatment. Asthma often changes over time. Meet with your doctor regularly to discuss your symptoms and make any needed treatment adjustments.

From Mayo Clinic to your inbox

Sign up for free and stay up to date on research advancements, health tips, current health topics, and expertise on managing health. Click here for an email preview.

Email field is required

Include a valid email address

Learn more about Mayo Clinic's use of data.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Thank you for subscribing!

You'll soon start receiving the latest Mayo Clinic health information you requested in your inbox.

Sorry something went wrong with your subscription

Please, try again in a couple of minutes

Causes

It isn't clear why some people get asthma and others don't, but it's probably due to a combination of environmental and inherited (genetic) factors.

Asthma triggers

Exposure to various irritants and substances that trigger allergies (allergens) can trigger signs and symptoms of asthma. Asthma triggers are different from person to person and can include:

Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste

Respiratory infections, such as the common cold

Physical activity

Cold air

Air pollutants and irritants, such as smoke

Certain medications, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)

Strong emotions and stress

Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine

Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

Risk factors

A number of factors are thought to increase your chances of developing asthma. They include:

Having a blood relative with asthma, such as a parent or sibling

Having another allergic condition, such as atopic dermatitis - which causes red, itchy skin - or hay fever - which causes a runny nose, congestion and itchy eyes

Being overweight

Being a smoker

Exposure to secondhand smoke

Exposure to exhaust fumes or other types of pollution

Exposure to occupational triggers, such as chemicals used in farming, hairdressing and manufacturing

Complications

Asthma complications include:

Signs and symptoms that interfere with sleep, work and other activities

Sick days from work or school during asthma flare-ups

A permanent narrowing of the tubes that carry air to and from your lungs (bronchial tubes), which affects how well you can breathe

Emergency room visits and hospitalizations for severe asthma attacks

Side effects from long-term use of some medications used to stabilize severe asthma

Proper treatment makes a big difference in preventing both short-term and long-term complications caused by asthma.

Prevention

While there's no way to prevent asthma, you and your doctor can design a step-by-step plan for living with your condition and preventing asthma attacks.

Follow your asthma action plan. With your doctor and health care team, write a detailed plan for taking medications and managing an asthma attack. Then be sure to follow your plan.

Asthma is an ongoing condition that needs regular monitoring and treatment. Taking control of your treatment can make you feel more in control of your life.

Get vaccinated for influenza and pneumonia. Staying current with vaccinations can prevent flu and pneumonia from triggering asthma flare-ups.

Identify and avoid asthma triggers. A number of outdoor allergens and irritants - ranging from pollen and mold to cold air and air pollution - can trigger asthma attacks. Find out what causes or worsens your asthma, and take steps to avoid those triggers.

Monitor your breathing. You may learn to recognize warning signs of an impending attack, such as slight coughing, wheezing or shortness of breath.

But because your lung function may decrease before you notice any signs or symptoms, regularly measure and record your peak airflow with a home peak flow meter. A peak flow meter measures how hard you can breathe out. Your doctor can show you how to monitor your peak flow at home.

Identify and treat attacks early. If you act quickly, you're less likely to have a severe attack. You also won't need as much medication to control your symptoms.

When your peak flow measurements decrease and alert you to an oncoming attack, take your medication as instructed. Also, immediately stop any activity that may have triggered the attack. If your symptoms don't improve, get medical help as directed in your action plan.

Take your medication as prescribed. Don't change your medications without first talking to your doctor, even if your asthma seems to be improving. It's a good idea to bring your medications with you to each doctor visit. Your doctor can make sure you're using your medications correctly and taking the right dose.

Pay attention to increasing quick-relief inhaler use. If you find yourself relying on your quick-relief inhaler, such as albuterol, your asthma isn't under control. See your doctor about adjusting your treatment.

# data[].attributes.attachment_link.description
Find out what can trigger asthma and how to relieve your symptoms and breathe easier.

# data[].attributes.body
Residents living in Bayview-Hunters Point have always been prone to severe asthma as shown in a survey dating back to 2006 showing that before entering kindergarten, 86% of the children living in Bayview developed asthma.

Weisbrod, K. (2021, November 29). In San Francisco's Bayview-Hunters Point neighborhood, advocates have taken air monitoring into their own hands. Inside Climate News. Retrieved October 11, 2022, from https://insideclimatenews.org/news/27112021/air-pollution-bayview-hunters-point-san-francisco/

# data[].attributes.headline
Asthma Conditions in Children Living in the Bayview-Hunters Point

# data[].attributes.subject
Asthma Conditions in Children Living in the Bayview-Hunters Point

# data[].attributes.body
Asthma is a big issue in the Bayview-Hunters point public housing and many residents are not educated on triggers like environment or living conditions and the effects it can have on asthma many families with children don't take it seriously until their child's airways are closed or inflamed which is an issue because hospital visit to the ER is high in the Bayview area. Several studies have shown that air pollution has a major impact on asthmatic patients.

Rigby, Theo. “Struggling for Breath / Asthma Hits Children Hard in Bayview-Hunters Point Area of S.F.” SFGATE, San Francisco Chronicle, 27 Jan. 2012, https://www.sfgate.com/health/article/Struggling-for-breath-Asthma-hits-children-hard-2746153.php.

# data[].attributes.attachment_link.title
Struggling for breath / Asthma hits children hard in Bayview-Hunters Point area of S.F.

# data[].attributes.attachment_link.description
In addition to poverty and violent crime -- the Bayview-Hunters Point neighborhood has...

# data[].attributes.body
During the years of 2006-2010, data has shown that 44.5% of children in California who are already diagnosed with asthma have uncontrolled asthma.

Uncontrolled asthma is characterized as having frequent symptoms that interfere with everyday life despite taking medicine on a regular basis. Shortness of breath is one of the symptoms, as well as tightness in the chest, wheezing,  coughing, and night waking due to asthma.

Uncontrolled asthma with frequent and severe periods of symptoms can be costly to families since it increases the likelihood of job and school absenteeism, emergency room visit, and hospitalization.

Centers for Disease Control and Prevention. (2014, September 15). AsthmaStats - uncontrolled asthma among persons with current asthma. Centers for Disease Control and Prevention. Retrieved October 11, 2022, from https://www.cdc.gov/asthma/asthma_stats/uncontrolled_asthma.htm

“AsthmaStats: Uncontrolled Asthma among Children, 2012–2014.” Centers for Disease Control and Prevention, Centers for Disease Control and Prevention, 3 July 2019, https://www.cdc.gov/asthma/asthma_stats/uncontrolled-asthma-children.htm.

Thomas C. Corbridge, MD. “Addressing Uncontrolled Asthma: Understanding the Right Treatments for the Right Patients.” AJMC, AJMC, 30 June 2021, https://www.ajmc.com/view/contributor-to-address-uncontrolled-asthma-understand-the-right-treatments-for-the-right-patients.

# data[].attributes.body
San Francisco housing has changed over the course of years to provide adequate protection from external forces, but even with all of the renovations, some houses are left to crumble. Some of the public housing in SF that children live in were used during World War II.

Old housing has caused about 39% of children to visit hospital emergency rooms compared to children that live in renovated or newer housing

People living in public housing have a higher risk of asthma there are many factors that could contribute to asthma such as environment Residents in the Bayview Hunters Point public housing have been living near a PG&E power plant that was active for years polluting the air these residents were breathing but also polluting the water that surrounded this area. They also lived in poor Units that were built decades ago. These units were infested with mold and other things that can trigger asthma. These residents also suffer other health disparities such as lack of access to primary health care due to health insurance which also explains the high percentage for ER visits in this area.

Staff, E. (2014, December 8). Children in dilapidated public housing in SF visit er more often, study shows. San Francisco Examiner. Retrieved September 30, 2022, from https://www.sfexaminer.com/news/children-in-dilapidated-public-housing-in-sf-visit-er-more-often-study-shows/article_2b274ee5-2104-5736-875c-d608da5f0e93.html

Lungsrus.org, https://lungsrus.org/san-francisco-county-summary/.

# data[].attributes.attachment_link.readable_text
It's well known that living in public housing in San Francisco can be dangerous, but now a new report suggests The City's outdated public housing is also hazardous to children's health. Children living in the San Francisco Housing Authority's dilapidated stock - some of which was built for temporary usage as far back as World War II - are 39 percent more likely to repeatedly visit hospital emergency rooms than children living in renovated public housing or private homes, according to a study published Monday in the December issue of Health Affairs. "It's a fairly large number," said Dr. Nancy Adler, a professor of psychiatry and pediatrics at UC San Francisco and one of the study's five authors. And since emergency room visits are between two and five times more costly than a visit to a physician during office hours, the frequent trips are "also a lot of unnecessary expense." Researchers looked at data from four years of emergency room visits, January 2007 through December 2011, by 5,711 children with public insurance. Children from all of The City's public housing were studied, including residents of dilapidated buildings like those in the Potrero Hill and Sunnydale projects and recently renovated units at Valencia Gardens and North Beach Place. The latter were part of a federal program called HOPE VI that rehabilitated the nation's worst public housing projects. Those children who lived in places like Valencia Gardens visited emergency rooms at roughly the same rate as children living in private housing, the study found. "We were surprised at how well these [public housing] kids did," Adler said. Meanwhile, the poor health and repeat hospital visits could keep these children stuck in the cycle of poverty for their entire lives. "If you're sicker, if you have uncontrolled asthma, you're more likely to miss school," Adler said. "This is why investments in early childhood are so important." Researchers have not determined how many of the emergency room visits were due to "legitimate" medical emergencies or conditions that could have been dealt with by regular physician visits. However, the fact that children living in poorly maintained public housing have more frequent, unrelated emergency room visits could represent higher levels of underlying stress and mental anxiety, Adler said. The study did not examine the impact of traumatic, violent events to which some public housing residents are subjected, such as the brazen murder in June of a reformed gang member in front of as many as 60 kids at Herz Playground near Sunnydale. The findings also corroborate anecdotal and limited data suggesting that mold and lead in crumbling public housing contribute to childhood asthma and lead poisoning. Residents in public housing have for years complained of vermin, mold and lead hazards in their units. In a five-year span, nine units at Sunnydale were inspected for lead contamination by the San Francisco Department of Public Health. Lead violations were found at three of them, according to records, including one with an infant who had elevated levels of lead in her blood. There were 758 units not inspected. Much of The City's 6,000 units of public housing are scheduled to be demolished and rebuilt into mixed-income communities using a combination of public and private money in a program called HOPE SF. Rebuilds are already underway at Hunters View in Hunters Point. Other public housing like Sunnydale still has no funding or timetable for a rebuild. The San Francisco Housing Authority was not available Friday to comment on the study.

# data[].attributes.attachment_link.title
Children in dilapidated public housing in SF visit ER more often, study shows

# data[].attributes.attachment_link.description
It's well known that living in public housing in San Francisco can be dangerous, but now a new report suggests The City's outdated public housing is also hazardous to children's health.

# data[].attributes.body
Bayview hunters point has both high prevalence of asthma relative to the country and relatively higher hospitalization rates for asthma relative to other neighborhoods in san francisco

Data found that 10% of the total population suffered from asthma 15.5% were children and youth

Data shows the link between gas stoves and asthma triggers. Individuals do not consider the items in their houses that are necessary for daily living, not realizing that they might also be hazardous to their health.

Health Programs in Bayview Hunter’s Point and Recommendations ... - SFDPH. https://www.sfdph.org/dph/files/reports/StudiesData/HlthProgsBVHPyRecommends07052006B.pdf.
http://www.asthmahandbook.org.au/clinical-issues/triggers/avoidable-triggers

# data[].attributes.body
over 4 million children living in decaying housing which is home to harmful bacteria, chemicals, and living creatures

Housing that is susceptible to decay, mold, and harmful biological substances can contribute to asthma and asthma-inducing causes

Bashir, S. A. (2002, May). Home is where the harm is: Inadequate housing as a public health crisis. American journal of public health. Retrieved October 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3222229/

# data[].attributes.attachment_link.readable_text
Abstract

Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature.

You have to call it an epidemic because it is increasing, and it is becoming not only more common, but more serious.
Megan Sandel, MD Department of Pediatrics, Boston University School of Medicine, on the link between inadequate housing and childhood asthma 1

FOR MANY BREADWINNERS of low-income families, going home at the end of a long workday can be a challenge, but it is a challenge they look forward to from the moment they arrive at work. The battle might begin with stepping off site into a city block filled with diesel exhaust. Perhaps a hard worker straps into a car for a fight with congested traffic on the long commute home, constantly alert to each potential danger the modern roadways present.

Or maybe this breadwinner walks through the exhaust to a bus or subway platform littered with garbage, stepping over a foul-smelling river of leakage and spills that play host to germcarrying insects and vermin. There may be a tense wait for the push onto overcrowded public transportation, then a bumpy ride back to dark and dirty streets whose dimly lit corners conceal hidden threats and whose sidewalks are paved with broken glass and discarded, jagged-edged junk. Finally she'll arrive at the comfort of home-a welcoming community, a loving family, and rooms and doors that close against the dangers of the outside world.

Home is where we want to feel safe. Access to a safe and comfortable "home," as necessary shelter, a source of identification, and a place to rest and relax, is both a psychological and a physical necessity. 2 Today's culture of fear and isolation have driven many families, particularly those living in crowded, urban environments, to seek safety and security behind the tightly closed doors of home.

DANGEROUS COMFORT

The physical and social makeup of the urban environment encourages this isolation. Corner markets make inexpensive junk food, liquor, soda, and cigarettes available close to home and at all hours. The amount of television being watched by each member of a family continues to increase, and what's more, individuals are sitting alone and sedentary, watching separate programs in separate rooms, eating from individual supersized bags of chips. Interaction, even among close-knit families, is discouraged.

The unfortunate reality is that home often harbors dangers of its own, and the tendency to isolate indoors is shown to have ill effects on family health. The connection between inadequate housing and poor health is increasingly well documented. 3 Substandard and deteriorating housing contributes to a variety of ailments, from respiratory disease and neurological disorders to psychological and behavioral dysfunction. These often life-threatening ailments disproportionately affect children of color and children from low-income families. 2

Significant research demonstrates the harmful association of asthma, neurological damage, malnutrition, stunted growth, accidents, and injury with household triggers like poor insulation, combustion appliances, cockroach and rodent infestation, dust mites, hyper- and hypothermia, unaffordable rent, and dangerous levels of lead in soil and household paint. 4 Furthermore, the culture of isolation ensures that the persons who are most vulnerable to these diseases- infants, children, the elderly, the chronically ill, and the immunocompromised-are also those who spend the most time indoors and alone.

The temptations of "virtual living" can be too strong to resist. Use of personal computers, surfing the Web, Internet shopping, televiewing, telecommuting, telecommunicating, and teleliving are fast becoming the norm for those in the middle classes. Many see no reason to leave home. There is little, in an affluent urban environment, that can't be "ordered in"-from food to services to entertainment.

Those who can't afford these luxuries find virtual living through television (and the bombardment of advertisements that encourage sedentary consumerism). These, together with rising levels of malnutrition, contribute to a national epidemic of obesity, and the variety of chronic illnesses to which it contributes, exacerbating the crises of public health and housing (J. Harkness, unpublished data, 2001).

HOME SICK

The prevalence of childhood asthma is increasing at an alarming rate. Between 1982 and 1994, the number of children afflicted with this chronic respiratory disease increased 70%. Worse still, the number of asthma-related deaths among children increased 50%. 5 Although environmental pollution, such as hazardous and toxic emissions and overall poor air quality, contributes greatly to this increase, the role that a harmful home environment plays in negative health outcomes is being taken more seriously.

In the case of asthma, environmental conservatives are quick to point to indoor triggers as being solely responsible for the marked increase in prevalence rates. Health advocates, both on a professional and a grassroots level, assert that both indoor and outdoor triggers are the culprits. Both triggers disproportionately affect poor children, children of color, and children living in inner-city environments.

Across the country, more than 5 million families-over 4 million children-are living in substandard housing that, despite its wretched state, they can barely afford. 4 Inside many of these deteriorating houses and apartments are hosts of harmful biological and chemical contaminants that contribute to the growing asthma epidemic. Asthma triggers like mold, cockroaches and cockroach dust, mice and rats and their droppings, dust mites, carbon monoxide, and environmental tobacco smoke are all more prevalent in low-income and inner-city homes. Once again, the most vulnerable find themselves at greatest risk of harm.

In addition to home-based environmental hazard-related instances of childhood asthma and skin ailments such as eczema and alveolitis, lead poisoning continues to strike specific pockets of children at an alarming rate. Nationally, there has been a 77% decline in the prevalence of childhood lead poisoning over the past 15 years. This drop was predominantly due to the legislated termination of the use of leaded gasoline. Still, poor children and children of color, particularly those living in dilapidated, inner-city housing, continue to show dangerously high blood lead levels.

The lead found in dust, household paint, and the bare soil common in crawl spaces and tracked in from yards and poorly maintained parks contributes to the continuing crisis of childhood lead poisoning among the poor. Children in poor and inner-city communities and between the ages of 18 and 36 months are at greatest risk of lead poisoning. In fact, children from low-income families are 5 times more likely to have elevated blood lead levels. 6 Lead poisoning can result in neurological damage, reduced IQ, hyperactivity, increased aggression, learning disabilities, and behavioral problems. 6

It is no mere coincidence that the problems identifiably associated with childhood lead poisoning are also the problems associated with the education and safety of children and young people in inner-city communities. Lead poisoning doesn't come with the benefit of observable symptoms. Without proper screening, it can go undetected for the duration of an affected person's life. Unfortunately, the children and communities hardest hit by childhood lead poisoning are also those with limited access to health care. 7

PRIMARY PREVENTION

Research also indicates that the type of housing in which low-income families reside adversely affects their health outcomes. 8 Whether a family lives in owner-occupied housing, privately rented housing, or public housing has a significant relationship to their health. Not only are health outcomes affected in terms of childhood asthma and lead poisoning, but studies have shown that overcrowding in childhood homes can be connected to a variety of serious diseases later in life. Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature. 8

It's a much simpler task to identify the problems and connections between negative health outcomes and inadequate housing than it is to fix them. Lowincome families often don't have the resources or access to information to make their homes safer for themselves and their children. Public housing advocates decry the lack of funding to take care of even the most basic public health defects in the housing units to which low-income families are assigned.

Landlords, whether public or private, have a responsibility to provide housing that is free from water leaks, mold, roach and rodent infestation, and other harmful defects that give rise to asthma and lead poisoning. In the case of privately rented housing, the landlords themselves often lack the resources to adequately maintain their properties. Those who do have the necessary resources often lack the desire or initiative, refusing to use them until significant legal action has been taken against them. 1 Poor and immigrant families are often afraid to complain, because living in substandard housing is better than being homeless. Too many families resign themselves to suffering in shame and watching their family's health deteriorate, with little hope for help.

MEETING THE DEMAND FOR ADEQUATE HOUSING

Grassroots groups and organizations across the country are gathering communities together to effect change in the health and housing outlook for poor families. Issues like access to adequate, affordable housing are at the forefront of the mission of some of these groups, while directly addressing the subsequent health issues that stem from lack of access is the focus of others. Increases in fair market housing costs in urban areas are far exceeding increases in income, particularly among low-income families.

Skyrocketing housing costs aren't limited to well-documented cities like New York, San Francisco, and Los Angeles. In areas that receive relatively little attention-like Salt Lake City, Utah, where housing costs have risen as much as 98.7% in the last decade 9 -fair market prices are forcing the average family to spend upward of 65% of their income on housing.

The acceptable standard for housing costs, approximately 30% of a household's income, can be a tough pill to swallow for low-income families. When families are forced not only to meet, but often to far exceed, standard spending on housing, other important needs suffer, such as food, health care, and insurance as well as family activities that provide exercise and emotional stability.

COMMUNITIES FIGHT BACK

In the United States and Europe, innovative efforts are being made at many levels to address the deteriorating social, physical, and psychological health of low-income families and individuals struggling with inadequate housing. These efforts include European experiments in social housing, international initiatives in public housing, and, in this country, Section 8 community housing initiatives and alternative nursing homes and senior living environments.

Some groups are working through legislation. The Office of Native American Programs (ONAP), for instance, successfully lobbied for the 1996 Native American Housing Assistance and Self Determination Act (NAHASDA). NAHASDA is designed to guarantee federal housing assistance for indigenous tribes in a manner that recognizes and respects tribal sovereignty. 10 ONAP's own Housing Resource Center works with individual tribes, researchers, businesses, nonprofits, and grassroots housing development groups to develop housing and promote economic growth on reservations and tribal lands.

San Diego's Lead-SALTA (Salud Ambiental Latínas Tomando Acción) Program, a project of the Environmental Health Coalition (EHC) Toxic-Free Neighborhoods Campaign, works to specifically address lead poisoning in its at-risk communities. Samples collected by the EHC found that over 80% of homes with children younger than 6 years exceeded both federal and state guidelines for lead content in at least one aspect. 6 In San Diego County, 84% of children reported to have elevated blood lead levels are Latino. This is increasingly alarming when it is understood that not all at-risk children are being tested, and of those tested, not all cases of high lead levels are reported. In addition to assessing the problem, the Lead-SALTA Program is working to secure funds from California's increased tobacco tax to promote the health of children at risk.

Established research entities are working with inner-city communities to study the effects of inadequate housing and increase awareness of both the dangers and the steps that can be taken to make homes safer. Tufts University, Harvard University, and Boston University worked with community leaders to survey housing conditions and health in the Boston, Mass, area. The survey found high rates of hyperthermia, alternating with periods of excessive hypothermia, that led tenants to rely on gas ovens for warmth, increasing the levels of chemical contaminants in the home. These temperature variations, in addition to widespread mold, water damage, and pest infestation, coincided with extremely high rates of asthma, leading researchers to suggest a causal relationship. 11

GETTING SPECIFIC

Some agencies are focusing on specific health outcomes, such as asthma, and directing their efforts at affecting positive change in that arena. The National Cooperative Inner-City Asthma Study (NCICAS) and the US Department of Housing and Urban Development (HUD) Roach Project are two such initiatives aimed at addressing asthma triggers both outdoors and in the home. The NCICAS found that 37% of children studied had cockroach allergies, while 50% of the children's bedrooms had dust containing excessively high levels of cockroach allergens. 12 The HUD Roach Project works to assess the levels of cockroach allergen contamination in the home while working to set up safe systems of elimination and cleanup.

In New York City, the Harlem Hospital Center's Department of Pediatrics, the Harlem Children's Zone, Inc., and the Harlem Health Promotion Center are working together on the Harlem Children's Zone Asthma Initiative: From Home to School to Hospital. The Harlem Children's Zone Project is a 24-block area in Central Harlem that has been shown to have one of the highest rates of childhood asthma in the country. The groups are working together to study children from birth to 12 years of age, testing for asthma, linking the children with primary care providers and health insurance, and providing social, educational, environmental, and medical interventions both at home and in the school.

PUBLIC HEALTH AND SOCIAL JUSTICE

Other agencies are fighting on the local level for housing rights, using the impact of substandard housing on public health as a prime lobbying point to gain the increased attention and funding needed to address the problem. In Los Angeles, grassroots organizations like ACORN (Association of Community Organizations for Reform Now) and Housing LA are celebrating the local government's recent commitment to create a $100 million trust fund to build affordable housing. Even with such a large sum, much of it earmarked from tobacco settlement funds, the city will struggle to build enough housing. California's housing stock is the third oldest in the nation and is in serious need of attention. Housing experts estimate that 4000 additional housing units must be built each year just to meet the demand. 13

The Community Environmental Health Resource Center (CEHRC) in Washington, DC, works with grassroots organizations engaged in the fight for social justice in low-income communities. The center's primary focus is empowering residents and increasing economic opportunities to address the environmental health hazards posed by substandard housing (including asthma, lead, carbon monoxide, and pesticides) that are faced by children and other vulnerable persons in low-income communities. 14

Barely a year old, CEHRC (a project of the Alliance to End Childhood Lead Poisoning) trains community members in safe and effective tools for identifying the environmental hazards created by substandard housing. After documenting hazards, CEHRC targets the hardest hit communities and works with the private sector to train contractors and workers to control identified hazards. By working to target a number of environmental health hazards, CEHRC addresses the major negative health outcomes of childhood asthma and lead poisoning. It also takes on the less studied hazards that contribute to increased risk for chronic illnesses like cancer and heart disease as well as depression and poor mental health.

A COMMUNITY IN CRISIS

Working in concert to address multiple issues at once is becoming a top priority as more communities face health crises of epidemic proportions in areas directly related to substandard housing. Cleveland, Ohio, found itself dealing with a double dose of trouble when studies showed that the prevalence of asthma, the most common chronic childhood disease, had increased by more than 100% in 20 years. Additionally, childhood lead poisoning had become a crisis among Cleveland's children. In 1998, 34% of children in Cleveland were found to have elevated blood lead levels, compared with 5% nationally. 15

Rather than stretch the capacity of already meager resources, the Cleveland Housing Network and the Cleveland Department of Public Health's Lead-Safe Housing Program decided to coordinate their efforts with the Lead+ Asthma Project, a joint program targeting the 2 deadliest environmental health hazards facing local children. The Lead+Asthma Project combined asthma trigger control intervention with existing lead poisoning prevention programs to conduct parent education, hazard assessment, and environmental intervention. ¹⁸

The project is based on the understanding that both asthma and lead poisoning are related to substandard housing, that both disproportionately affect poor and inner-city children and children of color, that the role of caregivers is critical to the success of programs addressing either problem, and that strategies to address both problems must focus on reducing moisture and dust contamination. Additionally, similarities were found in the number of children affected, the nature and immediacy of the impairments, and the strength of the evidence of direct correlation between negative health outcomes and substandard housing.

Cleveland's environmental health crisis also attracted the attention of the Center for Community Action for Primary Prevention (CCAPP), in Columbia, Maryland. Working together with Environmental Health Watch of Cleveland, CCAPP has begun the Cleveland Better Start Pilot Project. Identifying childhood asthma and lead poisoning as contributors to children's school performance, absenteeism, and ability to learn and participate in a full range of activities, the project focuses on pregnant women and infants in an effort to prevent exposure to lead hazards and asthma triggers before harm is done.

Once lead poisoning has taken place, the harm cannot be reversed. Similarly, asthma, once contracted, is a lifelong health concern. Both the Lead+Asthma Project and the Cleveland Better Start Pilot Project focus on primary prevention in high-risk communities, screening children, and providing access to appropriate health care to address the problem while also providing support and training to health care professionals so that they may best address the situation.

AT RISK IN RURAL AMERICA

Although urban areas are receiving increased attention and funding to address the health concerns associated with substandard housing, poor children in rural areas are also affected. In the Appalachian region of southeast Ohio, the Rural Action Development Corporation is entering its 20th year of working to train the community regarding issues of economic and environmental justice. The area's feast-or-famine economic cycle, based on its reliance on extraction-based industry, has led to unemployment, widespread poverty, illiteracy, ill health, and family instability. ¹⁹

Rural Action works with grassroots organizations, citizens groups, and individuals to improve the environmental and economic outlook of the community. Its HealthCorps utilizes AmeriCorps volunteers and Rural Action staffers to face environmental health hazards head-on by integrating the entire community into the effort. The Self-Help Home Repair Program hires local labor and materials purchased from local suppliers to perform emergency home repairs for low-income families while increasing local economic activity and community stability.

EFFECTING CHANGE FROM WITHIN

The focus on multi-issue approaches to home-based hazards, particularly in low-income and inner-city families and among families of color, is gaining agency in communities across the country. One of the most promising aspects of the many grassroots efforts to address home-based environmental health hazards is the focus on increasing community awareness of both the concerns and the methods of reducing risk.

Alerting parents and caregivers to the harmful effects of environmental tobacco smoke on children is one thing. Giving them tools they can use to prevent those hazards in the spirit of harm reduction is another. Because not all caregivers are going to give up smoking, suggesting alternatives-such as smoking outdoors or closing off a separate space for smoking so that children are not directly exposed to the smoke-is an important way that organizations, healthcare providers, and research teams can work to assure positive results in even the most challenging of environments.

Similarly, great strides are being made in integrated pest management to fight insect and rodent infestation, which remains a serious problem for both urban and rural at-risk families. It is important, however, that the community have access to information detailing not only what to fight but how to fight it. While insect and rodent infestation is a main trigger for asthma and a host of other ailments, the pesticides being used-and often misused-to fight infestation can contribute to the hazardous environment.

Although more and more research on the immediate health outcomes posed by home-based environmental hazards is being conducted, precious little is understood about the long-term health outcomes. What is known is that even the smallest positive change in health outcomes can have a large effect on the community. 3 While the studies continue, support for grassroots efforts is essential to the struggle to address and eliminate the environmental hazards posed by substandard and inadequate housing.

References

9. Verma N, Mangum G, Cookson C. Poverty in Utah 2000: A Snapshot of Income, Housing, Health, and Welfare Issues in Utah. 2nd ed. Salt Lake City, Utah: Utah Issues Center for Research and Action; 2001.

13. Stewart JY. Hahn plans trust fund for affordable housing. Los Angeles Times. January 17, 2002:B1.

17. Concern, Inc. Sustainability in Action. Trimble, Ohio: Rural Action; 1997: 79-80.

Articles from American Journal of Public Health are provided here courtesy of American Public Health Association

# data[].attributes.attachment_link.title
Home Is Where the Harm Is: Inadequate Housing as a Public Health Crisis

# data[].attributes.attachment_link.description
Overcrowding and poor-quality housing have a direct relationship to poor mental health, developmental delay, heart disease, and even short stature. You have to call it an epidemic because it is increasing, and it is becoming not only more common, but more serious.

# data[].attributes.body
Some causes that have been linked to respiratory issues like asthma or worsening the condition are pests, pesticides, and traffic pollution. Roadway pollution has had the greatest impact on people’s health resulting in death.

Which is a problem in public housing. The same issue exists in Bayview-Hunters Point public housing. Studies have shown that “more than half of public housing residents surveyed by the U.S. Department of Housing and Urban Development (HUD) in 2004 reported problems with rodents and insects indoors.”  It was also surveyed that “almost 10% said rodents and insects indoors were always a problem. ”Showing a strong correlation of pests in public housing that contribute to asthma.

Asthma Task Force - In Housing . SFGOV. (n.d.). Retrieved October 11, 2022, from https://sfgov.org/sfc/asthma/housing?page=718

https://nchh.org/resource-library/Case_Study_Conditions_10-14-07.pdf

# data[].attributes.headline
PG&E Power Plant and Toxic Pollutants Trigger Asthma

# data[].attributes.subject
PG&E Power Plant and Toxic Pollutants Trigger Asthma

# data[].attributes.body
Residing in Bayview-Hunter’s Point, PG&E installed a power plant back in 1929 which finally closed in 2006 after 77 years. This power plant created a toxic environment that polluted the air with various toxins and chemicals. “321 tons of nitrous oxides; 164 tons of carbon monoxide; 52 tons of particulate matter; 13 tons of ammonia; 13 tons of volatile organic compounds; and 12 tons of sulfur dioxide”

From surrounding potential sources of air pollution, gases (ex. carbon monoxide, sulfur dioxide, lead, particulate matter from industrial sites, etc.) and toxic molds (ex. Penicillium, Cladosporium, Stachybotrys, etc.) have been linked to problems related to indoor air quality and result in the trigger of asthma, lung issues, and other health concerns.

Pollution, health, environmental racism and injustice: A toxic ... (n.d.). Retrieved September 30, 2022, from https://greenaction.org/wp-content/uploads/2019/06/thestateoftheenvironment090204final.pdf

# data[].attributes.body
The Bayview housing population is home to the low-income community. Chronic stress from living in poor and unhealthy conditions can overload a child's stress response systems, resulting in "toxic stress." Toxic stress alters the development of the brain of a child, increasing the risk of poor physical, behavioral, and cognitive health. Children's physical health can suffer as a result of being exposed to a stressful environment. Asthma is well known to be triggered by stress and anxiety.

APA - Francis, L., DePriest, K., Wilson, M., & Gross, D. (2018, September). Child poverty, toxic stress, and Social Determinants of Health: Screening and Care Coordination. Online journal of issues in nursing. Retrieved October 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699621/

APA - WebMD. (n.d.). Asthma, anxiety, and stress: How to cope. WebMD. Retrieved October 11, 2022, from https://www.webmd.com/asthma/asthma-help-living-with-asthma

# data[].attributes.attachment_link.readable_text
What Is Asthma?

Asthma is a long-term disease of the lungs. It causes your airways to get inflamed and narrow, and it makes it hard to breathe. Severe asthma can cause trouble talking or being active. You might hear your doctor call it a chronic respiratory disease. Some people refer to asthma as " bronchial asthma."

Asthma is a serious disease that affects about 25 million Americans and causes nearly 1.6 million emergency room visits every year. With treatment, you can live well. Without it, you might have to go to the ER often or stay at the hospital, which can affect your daily life.

What Does Asthma Feel Like?

Asthma is marked by inflammation of the bronchial tubes, with extra sticky secretions inside the tubes. People with asthma have symptoms when the airways tighten, inflame, or fill with mucus.

There are three major signs of asthma:

Airway blockage. When you breathe as usual, the bands of muscle around your airways are relaxed, and air moves freely. But when you have asthma, the muscles tighten. It's harder for air to pass through.

Inflammation. Asthma causes red, swollen bronchial tubes in your lungs. This inflammation can damage your lungs. Treating this is key to managing asthma in the long run.

Airway irritability. People with asthma have sensitive airways that tend to overreact and narrow when they come into contact with even slight triggers.

These problems may cause symptoms such as:

Not every person with asthma has the same symptoms in the same way. You may not have all of these symptoms, or you may have different symptoms at different times. Your symptoms may also vary from one asthma attack to the next, being mild during one and severe during another.

Some people with asthma may go for long periods without having any symptoms. Others might have problems every day. In addition, some people may have asthma only during exercise or with viral infections like colds.

Mild asthma attacks are generally more common. Usually, the airways open up within a few minutes to a few hours. Severe attacks are less common but last longer and require medical help right away. It is important to recognize and treat even mild asthma symptoms to help you prevent severe episodes and keep asthma under better control.

When to see your doctor
Get medical help right away if you have serious symptoms including:

Fast breathing

Pale or blue face, lips, or fingernails

The skin around your ribs pulls inward when you breathe in

Trouble breathing, walking, or talking

Symptoms that don't get better after you take medication

What Is an Asthma Attack?

An asthma attack is the episode in which bands of muscle around the airways are triggered to tighten. This tightening is called bronchospasm. During the attack, the lining of the airways becomes swollen or inflamed, and the cells lining the airways make more and thicker mucus than normal.

All of these things -- bronchospasm, inflammation, and mucus production -- cause symptoms such as trouble breathing, wheezing, coughing, shortness of breath, and trouble with normal daily activities.

Other symptoms of an asthma attack include:

Severe wheezing when breathing both in and out

Coughing that won't stop

Very rapid breathing

Chest pain or pressure

Tightened neck and chest muscles, called retractions

Difficulty talking

Feelings of anxiety or panic

Pale, sweaty face

Blue lips or fingernails

An asthma attack can get worse quickly, so it's important to treat these symptoms right away.

Without immediate treatment, such as with your asthma inhaler or bronchodilator, it will become harder to breathe. If you use a peak flow meter at this time, the reading will probably be less than 50% of your usual or normal peak flow reading.. Many asthma action plans suggest interventions starting at 80% of normal.

As your lungs continue to tighten, you won't be able to use the peak flow meter at all. Your lungs will tighten so there is not enough air movement to make wheezing. You need to go to a hospital right away. Unfortunately, some people think that the disappearance of wheezing is a sign of improvement and don't get emergency care.

Without proper treatment, over time, you may be unable to speak and will get a bluish coloring around your lips. This color change, known as cyanosis, means you have less and less oxygen in your blood. It can cause a loss of consciousness and death.

If you have an asthma attack, follow the "Red Zone" or emergency instructions in your asthma action plan right away. These symptoms happen in life-threatening asthma attacks. You need medical attention right away.

How Is Asthma Classified?

Doctors rank how bad asthma is by its symptoms:

1. Mild intermittent asthma. Mild symptoms less than twice a week. Nighttime symptoms less than twice a month. Few asthma attacks.

2. Mild persistent asthma. Symptoms three to six times a week. Nighttime symptoms three to four times a month. Asthma attacks might affect activities.

3. Moderate persistent asthma. Daily asthma symptoms. Nighttime attacks five or more times a month. Symptoms may affect activities.

4. Severe persistent asthma. Ongoing symptoms both day and night. You have to limit your activities.

Your asthma may be getting worse if:

You have symptoms more often and they interfere more with your daily life.

You have a hard time breathing. You can measure this with a device called a peak flow meter.

You need to use a quick-relief inhaler more often.

Types of Asthma

There are several:

Adult-onset asthma. Asthma can start at any age, but it's more common in people younger than 40.

Status asthmaticus. These long-lasting asthma attacks don't go away when you use bronchodilators. They're a medical emergency that needs treatment right away.

Asthma in children. Symptoms can vary from episode to episode in the same child. Watch for problems like:

Coughing often, especially during play, at night, or while laughing. This may be the only symptom.

Less energy or pausing to catch their breath while they play

Fast or shallow breathing

Saying their chest hurts or feels tight

A whistling sound when they breathe in or out

Seesaw motions in their chest because of trouble breathing

Shortness of breath

Tight neck and chest muscles

Weakness or fatigue

Exercise-induced bronchoconstriction. You might hear this called exercise-induced asthma. It happens during physical activity, when you breathe in air that's drier than what's in your body, and your airways narrow. It can affect people who don't have asthma, too. You'll notice symptoms within a few minutes after you start to exercise, and they might last 10 to 15 minutes after you stop.

Allergic asthma. Things that trigger allergies, like dust, pollen and pet dander, can also cause asthma attacks.

Nonallergic asthma. This type flares in extreme weather. It could be the heat of summer or the cold of winter. It could also show up when you're stressed or have a cold.

Occupational asthma. This usually affects people who work around chemical fumes, dust, or other irritating things in the air.

Eosinophilic asthma. This severe form is marked by high levels of white blood cells called eosinophils. It usually affects adults between 35 and 50 years old.

Nocturnal asthma. Your asthma symptoms get worse at night.

Aspirin-induced asthma. You have asthma symptoms when you take aspirin, along with a runny nose, sneezing, sinus pressure, and a cough.

Cough-variant asthma. Unlike with other types, the only symptom of this kind of asthma is a long-term cough.

Asthma Causes and Triggers

When you have asthma, your airways react to things in the world around you. Doctors call these asthma triggers. They might cause symptoms or make them worse. Common asthma triggers include:

Infections like sinusitis, colds, and the flu

Allergens such as pollens, mold, pet dander, and dust mites

Irritants like strong odors from perfumes or cleaning solutions

Air pollution

Tobacco smoke

Cold air or changes in the weather, such as temperature or humidity

Gastroesophageal reflux disease (GERD)

Strong emotions such as anxiety, laughter, sadness, or stress

Medications such as aspirin

Food preservatives called sulfites, found in things like shrimp, pickles, beer and wine, dried fruits, and bottled lemon and lime juices

Asthma Risk Factors

Things that might make you more likely to have asthma include:

Things in the world around you before you're born or while you're growing up

Whether your parents have asthma, especially your mother

Your genes

Your race. Asthma is more common in people of African American or Puerto Rican descent.

Your sex. Boys are more likely to have asthma than girls. In teens and adults, it's more common in females.

Your job

Other conditions like lung infections, allergies, or obesity

Asthma Diagnosis

If you think you have asthma, see your doctor. They may refer you to a lung doctor, called a pulmonologist, or a specialist in allergy and immunology.

The doctor will start with a physical exam and ask about your symptoms and medical history.

You'll have tests to see how well your lungs work, which may include:

Spirometry. This simple breathing test measures how much air you blow out and how fast.

Peak flow. These measure how well your lungs push out air. They're less exact than spirometry, but they can be a good way to test your lungs at home, even before you feel any symptoms. A peak flow meter can help you figure out what makes your asthma worse, whether your treatment is working, and when you need emergency care.

Methacholine challenge. This and similar tests involve using triggers or challenges. Adults are more likely to have this test than children. You might get it if your symptoms and spirometry test don't clearly show asthma. During this test, you inhale a chemical called methacholine before and after spirometry to see if it makes your airways narrow. If your results fall at least 20%, it is possible that you have asthma. Your doctor will give you medicine at the end of the test to reverse the effects of the methacholine.

Exhaled nitric oxide test. You breathe into a tube connected to a machine that measures the amount of nitric oxide in your breath. Your body makes this gas normally, but levels could be high if your airways are inflamed.

Other tests you might get include:

Chest X-ray. It isn't an asthma test, but your doctor can use it to make sure nothing else is causing your symptoms. An X-ray is an image of the inside of your body, made with low doses of radiation.

CT. This test takes a series of X-rays and puts them together to make a view of your insides. A scan of your lungs and sinuses can identify physical problems or diseases (like an infection) that may cause breathing problems or make them worse.

Allergy tests. These can be blood or skin tests. They tell if you're allergic to pets, dust, mold, and pollen. Once you know your allergy triggers, you can get treatment to prevent them -- and asthma attacks.

Sputum eosinophils. This test looks for high levels of white blood cells (eosinophils) in the mix of saliva and mucus (sputum) that comes out when you cough.

Asthma Treatment

Many asthma treatments can ease your symptoms. Your doctor will work with you to make an asthma action plan that will outline your treatment and medications. They might include:

Inhaled corticosteroids. These medications treat asthma in the long term. That means you'll take them every day to keep your asthma under control. They prevent and ease swelling inside your airways, and they may help your body make less mucus. You'll use a device called an inhaler to get the medicine into your lungs. Common inhaled corticosteroids include:

Leukotriene modifiers. Another long-term asthma treatment, these medications block leukotrienes, things in your body that trigger an asthma attack. You take them as a pill once a day. Common leukotriene modifiers include:

Long-acting beta-agonists. These medications relax the muscle bands that surround your airways. You might hear them called bronchodilators. You'll take these medications with an inhaler, even when you have no symptoms. They include:

Combination inhaler. This device gives you an inhaled corticosteroid and a long-acting beta-agonist together to ease your asthma. Common ones include:

Theophylline. It opens your airways and eases tightness in your chest. You take this long-term medication by mouth, either by itself or with an inhaled corticosteroid.

Short-acting beta-agonists. These are known as rescue medicines or rescue inhalers. They loosen the bands of muscle around your airways and ease symptoms. Examples include:

Anticholinergics. These bronchodilators prevent the muscle bands around your airways from tightening. Common ones include:

You can get ipratropium in an inhaler or as a solution for a nebulizer, a device that turns liquid medicine into a mist that you breathe in through a mouthpiece. Tiotropium bromide comes in a dry inhaler, which lets you breathe in the medicine as a dry powder.

Oral and intravenous corticosteroids. You'll take these along with a rescue inhaler during an asthma attack. They ease swelling and inflammation in your airways. You'll take oral steroids for a short time, between 5 days and 2 weeks. Common oral steroids include:

You're more likely to get steroids injected directly into a vein if you're in the hospital for a bad asthma attack. This will get the medication into your system more quickly.

Biologics. If you have severe asthma that doesn't respond to control medications, you might try a biologic:

Omalizumab (Xolair) treats asthma caused by allergens. You get it as an injection every 2 to 4 weeks.

Other biologics stop your immune cells from making things that cause inflammation. These drugs include:

Tezepelumab-ekko (Tezspire) is a first-in-class medicine indicated for the add-on maintenance treatment of adult and pediatric patients aged 12 years and older. Taken by injection, it targets a specific molicule that causes inflammation in the airways.
Home remedies
Medication will probably be key to getting your asthma under control, but you can do some things at home to help.

Avoid asthma triggers.

Exercise regularly.

Stay at a healthy weight.

Take care of conditions that can trigger symptoms, such as GERD.

Do breathing exercises to ease symptoms so you need less medication.

Some people use complementary treatments such as yoga, acupuncture, biofeedback, or supplements like vitamin C and ding chuan tang. Talk to your doctor before trying any of these.

Asthma Complications

When it's not under control, asthma can cause problems with your daily life, such as:

Asthma can also lead to serious medical conditions including:

Pneumonia and other complications from common infections like the flu

Early delivery or the loss of a pregnancy

Permanently narrowed bronchial tubes in your lungs

Lung collapse

Respiratory failure

Asthma Attack Prevention

Your action plan will include different ways to keep your asthma under control and prevent attacks. These might include:

Know your triggers, and stay away from them.

Follow your doctor's instructions on taking your asthma medications. Let them know if you notice that you're using a quick-relief inhaler more often.

Keep track of your condition and learn the signs that it might be getting worse. A peak flow meter can help.

Know what to do if you think your asthma is getting worse.

Talk to your doctor about vaccines to lower your chances of certain conditions. You might get vaccinations for COVID-19, flu, pneumonia, shingles, or whooping cough (pertussis).

# data[].attributes.attachment_link.description
Asthma is a long-term disease of the lungs. It causes your airways to get inflamed and narrow, and it makes it hard to breathe. Severe asthma can cause trouble talking or being active. You might hear your doctor call it a chronic respiratory disease. Some people refer to asthma as " bronchial asthma."

# data[].attributes.body
Bayview-Hunters Point is home to low-income communities. Low-income communities are more likely to experience stress and anxiety, which can lead to the development of tobacco and alcohol addictions. Tobacco and alcohol use is especially prevalent among the unemployed, as well as people that live alone. Female loneliness, which is frequently accompanied by depression, raises the risk of cigarette smoking. Smoke irritates the air passages, causing them to swell, constrict, and fill with mucus, just like an asthma attack. As a result, smoking can make asthma flare-ups more frequent. Individuals who do not smoke may still be affected by smoking if they are around people who do frequently. Asthma is also known to be triggered by secondhand smoking.

APA - Knut-Olaf, H. (n.d.). Smoking and poverty. European journal of cardiovascular prevention and rehabilitation : official journal of the European Society of Cardiology, Working Groups on Epidemiology & Prevention and Cardiac Rehabilitation and Exercise Physiology. Retrieved October 11, 2022, from https://pubmed.ncbi.nlm.nih.gov/16926658/

# data[].attributes.attachment_link.readable_text
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

PubMed is a free resource supporting the search and retrieval of biomedical and life sciences literature with the aim of improving health-both globally and personally.

The PubMed database contains more than 36 million citations and abstracts of biomedical literature. It does not include full text journal articles; however, links to the full text are often present when available from other sources, such as the publisher's website or PubMed Central (PMC).

Available to the public online since 1996, PubMed was developed and is maintained by the National Center for Biotechnology Information (NCBI), at the U.S. National Library of Medicine (NLM), located at the National Institutes of Health (NIH).

About the Content

Citations in PubMed primarily stem from the biomedicine and health fields, and related disciplines such as life sciences, behavioral sciences, chemical sciences, and bioengineering.

PubMed facilitates searching across several NLM literature resources:

MEDLINE

MEDLINE is the largest component of PubMed and consists primarily of citations from journals selected for MEDLINE; articles indexed with MeSH (Medical Subject Headings) and curated with funding, genetic, chemical and other metadata.

PubMed Central (PMC)

Citations for PubMed Central (PMC) articles make up the second largest component of PubMed.

PMC is a full text archive that includes articles from journals reviewed and selected by NLM for archiving (current and historical), as well as individual articles collected for archiving in compliance with funder policies.

Bookshelf

The final component of PubMed is citations for books and some individual chapters available on Bookshelf.

Bookshelf is a full text archive of books, reports, databases, and other documents related to biomedical, health, and life sciences.

Additional Resources

Last update: August 15, 2023

Back to Top

# data[].attributes.attachment_link.keywords[]
national center for biotechnology information

# data[].attributes.body
Bayview is the location of numerous concrete plants, an animal rendering plant, data centers powered by large diesel generators, a wastewater treatment plant, and dozens of abandoned toxic waste sites. One of them is the Hunters Point Naval Shipyard. It is a superfund hazardous waste site, as designated by the federal government. As a result of pollution from polluting facilities, 86 percent of Bayview's children developed severe asthma before entering kindergarten. To make matters worse, the area is surrounded by the San Francisco port and two major freeways, both of which are heavily used by diesel trucks. The findings of this study provide significant proof that living near a freeway is linked to uncontrolled asthma. Patients in all baseline asthma severity groups who lived within 2 miles of a freeway were much more inclined to have uncontrolled asthma.

APA - Francis, L., DePriest, K., Wilson, M., & Gross, D. (2018, September). Child poverty, toxic stress, and Social Determinants of Health: Screening and Care Coordination. Online journal of issues in nursing. Retrieved October 11, 2022, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6699621/

APA - WebMD. (n.d.). Asthma, anxiety, and stress: How to cope. WebMD. Retrieved October 11, 2022, from https://www.webmd.com/asthma/asthma-help-living-with-asthma

# data[].attributes.attachment_link.readable_text
SAN FRANCISCO-Aliyah Dunn-Salahuddin still remembers riding the bus home from elementary school and smelling fresh-baked pastries and bread from the Parisian Bread Factory near Evans Street. She also remembers how quickly that scent would turn to one of sewage and smoke as the bus pulled closer to her home.

Dunn-Salahuddin grew up two decades ago in Bayview-Hunters Point, a neighborhood in the southeastern corner of San Francisco, jutting into the bay. It's under four square miles, just 8.5 percent of San Francisco's land mass.

This relatively small parcel of the city holds a disproportionate concentration of its toxic and polluting sites. For decades, state and local agencies have tried-halfheartedly, advocates say-to monitor and clean up the polluted air in Bayview. These ineffectual efforts have sown deep distrust among the residents for the polluters, and the government.

So, advocates launched their own community-owned air monitoring program in September to do what government agencies haven't been able to.

"It will put power in the hands of the people," said Bradley Angel, executive director of Greenaction, the nonprofit that helps run the air monitoring program.

The Marie Harrison Bayview Air Monitoring Project, named after a beloved community activist who died in 2019 of lung disease, consists of 10 air monitors placed in and around Bayview-Hunters Point. The final monitor will be installed next week, Angel said.

The Dylos air monitors are encased in white boxes, which also hold fans and a data chip, and they upload data in real-time to a website where residents can check the air quality and learn about the harmful pollutants they might be exposed to.

Angel said he hopes the project will hold government agencies and officials accountable for their inaction, since they're the ones who are supposed to be tracking and responding to the pollution crisis.

"All of these agencies, well, they're supporting the air monitoring projects we do," Angel said. But when it comes to perpetuating the environmental burden of pollution in the community, "a lot of them are as guilty as can be."

The air monitoring project did receive state funding and support from the California Air Resources Board through California Assembly Bill 617, legislation passed in 2017 that charged the air board and local air districts with supporting air quality tracking programs in low-income communities of color across California.

But a lot of these funding efforts have been mired in slow, bureaucratic processes that have resulted in little or no actual regulation, according to a report from the grassroots advocacy group California Environmental Justice Alliance.

The report describes a pattern-replicated across other "fenceline" communities that are adjacent to polluting facilities-that is familiar to Bayview residents. State and local agencies will identify a community as vulnerable to negative health outcomes linked to polluted air, and may even participate in outreach and engagement events. But these efforts rarely lead to "quantifiable, permanent, and enforceable emissions reductions," the report says.

A view overlooking Bayview-Hunters Point's industrial facilities and concrete plants is seen on Oct. 28, 2021. Credit: Elena Shao

California has publicly identified Bayview as a community "disproportionately burdened by multiple sources of pollution" in a 2021 environmental analysis.

The neighborhood is also considered an "overburdened community" by the U.S. Environmental Agency's definitions, meaning that Bayview residents may experience greater vulnerability to environmental harms and health hazards due to socioeconomic conditions. Bayview is home to over 21 percent of the city's Black population, according to the latest census data for Bayview's zip code 94124. Close to 19 percent of residents live below the poverty line, which is double the rate of the city at large.

"The issue is not awareness," said Raymond Tompkins, a Bayview resident and scientist. It's not that the city doesn't know that these polluting facilities exist, Tompkins added, it's that the city can get away with what he calls "deliberate negligence" because Bayview doesn't have the political influence other areas do.

"You don't see this in the Marina District," Tompkins said, referring to a neighborhood in northern San Francisco known for its affluence and high percentage of white residents. "They need to get some of these polluters out of Bayview and not burden this community with it."

Keep Environmental Journalism Alive

ICN provides award-winning climate coverage free of charge and advertising. We rely on donations from readers like you to keep going.

Bayview-Hunters Point, is precisely the kind of over-burdened community of color that led the Biden administration to put environmental justice at the center of the EPA's regulatory and cleanup efforts. The administration promised to spend 40 percent of all money appropriated for climate adaptation and resilience, and environmental remediation, to environmental justice communities under an initiative called Justice40.

With the president's $1.5 trillion infrastructure bill signed into law and his follow-on Build Back Better legislation nearing final votes in Congress, a moment could be fast approaching when the Biden administration will finally have a chance to put up or shut up on environmental justice, activists say.

Representatives from the Bay Area Air Quality Management District said in an interview that the agency takes the concerns of the community seriously and seeks to actively respond to them. For example, the air district has increased the number of air quality patrols in the neighborhood, said Simrun Dhoot, a senior air quality engineer at the air district, and it regularly sends a liaison to the neighborhood's monthly Environmental Justice Task Force meetings.

The air district has also proposed amendments to its regulatory process that would provide "an additional opportunity for the public to be able to comment on all of the projects that might be impactful in their community," Dhoot said. Specifically, the rule would require a public comment period any time a company seeks a permit to operate a facility in an overburdened community like Bayview.

Residents say they are still hesitant to trust that this will result in significant, noticeable change. They say that, over the decades, agencies like the air district have allowed Bayview to become the city's "dumping ground," despite a growing body of evidence that links polluting facilities with negative health outcomes.

Studies from as early as 1995 have pointed to higher-than-normal rates of cancer among Bayview residents. A 2006 survey from the city's own public health department found that 86 percent of babies born in Bayview developed severe asthma before they started kindergarten, and the neighborhood itself sees the highest rates of asthma hospitalizations in the city.

Living near a hazardous waste or Superfund site like the Hunters Point Naval Shipyard, located at the neighborhood's waterfront, is also linked to lower life expectancy, according to a 2021 study in Nature Communications. Lower-income, minority communities experience a disproportionate shortening of their lifespan, said Hanadi Rifai, the study's lead author and a civil and environmental engineering professor at the University of Houston.

The community-based air monitoring program is a good first step, but it's got several challenges ahead, Angel and other local activists say. The first is turning the data into "something that could influence policy, and actually reduce emissions and harmful development," said Anthony Khalil, a community organizer who helped launch the project.

But even if more robust policy does result from the project, there's no easy path to heal the relationship between Bayview and the government agencies that residents hoped would protect their health.

"It won't get rid of the past," Khalil added. "We have to live with that pain for our whole lives."

# data[].attributes.attachment_link.title
In San Francisco's Bayview-Hunters Point Neighborhood, Advocates Have Taken Air Monitoring Into Their Own Hands - Inside Climate News

# data[].attributes.attachment_link.description
SAN FRANCISCO-Aliyah Dunn-Salahuddin still remembers riding the bus home from elementary school and smelling fresh-baked pastries and bread from the Parisian Bread Factory near Evans Street. She also remembers how quickly that scent would turn to one of sewage and smoke as the bus pulled closer to her home.

# data[].attributes.body
1. Increase in the # of parents in Bayview-Hunters Point who know the adverse effects of secondhand smoking and how it triggers asthma (Knowledge)

2. Increase in the # of children in Bayview-Hunters Point who know how to manage asthma (Knowledge)

3. Increase the # of parents in Bayview-Hunters Point who know important management information about their child’s diagnosis. (Knowledge)