Kansas City Health Department director Rex Archer knows first-hand how scary it is to have a serious asthma attack.
Archer has had asthma since he was a kid and decades later, he still clearly remembers his chest tightening up after his football team suffered a rare loss.
“I didn’t get that normal psychological adrenaline surge of having won,” Archer said. “My lips turned blue and I had to go and get the equivalent of the bee sting kit to open up my airways.”
Archer ended up in the emergency room that day — an experience that more and more Kansas City kids seem to be having.
Data collected by Archer’s agency showed asthma-related pediatric emergency room visits trending up from 2006 to 2015, with children of color disproportionately affected.
From 2006 to 2009, Kansas City kids never had more than 1,653 emergency room visits due to asthma. In 2010 that number spiked to 1,988 and has stayed at 1,871 or above ever since. From 2012 through 2015, it was above 2,000 visits every year but one.
The health department doesn’t yet know why, but it has some theories:
▪ Climate change is creating more ozone alert days and longer allergy seasons, both of which may be triggers for asthma attacks.
▪ The push to make homes more airtight for energy efficiency may be trapping indoors increased concentrations of asthma attack triggers like dust, mold, pet dander and second-hand smoke.
▪ The “hygiene theory,” which suggests kids aren’t exposed to germs outdoors enough when young, preventing their immune systems from becoming properly attuned to them and worsening reactions.
▪ Lack of access to primary care and asthma maintenance medications like inhalers.
Bridgette Jones, a doctor who specializes in treating allergies and asthma at Children’s Mercy Hospital, said the hospital emergency rooms and clinics do seem to see spikes in asthma-related visits on ozone alert days.
“I do think environmental changes are contributing to the increased rates of asthma flare-ups we see,” Jones said. “But you know, asthma is multi-factorial. I don’t think we can blame it on one thing.”
She said there may be a genetic component as well, and access to care probably plays a role. There aren’t enough asthma specialists to go around, she said, and patients who can find a specialist sometimes run into insurance-related obstacles when it comes to medications.
But to get to the bottom of it will take more study and Jones said there’s a fundamental flaw in most asthma-related research: the demographic groups most effected — African-American and Latin kids — are underrepresented in clinical trials, if they’re represented at all.
“If we’re not even studying these children at all, we certainly can’t figure out that question: Is it environment? Are there social or demographic factors that are contributing?” Jones said. It’s “likely, but there are probably several other factors we don’t know about. We’re just not studying these children like we should.”
Jones said the research would be worth the cost. Asthma is common, affecting more than 8 percent of all Americans and it’s the leading cause of missed school days.
It causes more than 3,600 deaths a year, and a disproportionate number of the victims are children of color and most it not all of the deaths are preventable.
“Children die here in the Kansas City area from asthma, unfortunately,” Jones said. “So it is a really serious disease.”
Archer said it’s something the health department staff will continue to study. They’re hoping to get high-tech inhalers that record when they’re used into the hands of some kids in the city and planning to gather more current numbers on emergency room visits.
As an asthma sufferer himself, Archer said he’s acutely aware that the thousands of visits every year are more than just data points. Each one is a kid struggling to breathe, with a family that’s probably panicked.
“Sometimes, once you’re used to it, it can make you realize that you can overcome an awful lot of things because you lived through it,” Archer said. “But I can remember the first few times it was pretty scary, and that’s 55-plus years ago.”