Mold contributor to asthma in low income adults finds community study

Community health workers have identified mold as a contributing factor to higher rates of asthma-related hospitalization and death among low-income adults.

A recent study used survey results from community health workers in Philadelphia. Many adults on low-incomes in the city live in rundown row homes built in the late 19th century. Mold is a common issue in such properties and residents suffering from asthma and various comorbidities often can't afford expensive mold remediation work that would improve their health (please see '5 Step Environmental Mold Removal' for our guide to an affordable approach). 

Researchers from the Community Asthma Prevention Program (CAPP) at Children's Hospital of Philadelphia (CHOP) and the Perelman School of Medicine at the University of Pennsylvania, who conducted the research, state that nationally the highest rates of asthma-related deaths and hospitalizations are among low-income minority adults, but most existing research doesn't focus on these patients.

In particular, studies may not investigate patients where they live, in complicated, difficult circumstances. Many adult asthma patients have multiple diseases and exposure to tobacco smoke, mold and other negative environmental factors, but much research reflects the convenience of recruiting patients in clinics and on the relative simplicity of studying patients who do not have accompanying diseases such as hypertension, diabetes, and obesity.

The study, published in the December 2016 issue of the Journal of Allergy and Clinical Immunology, focused on 301 adults living in low-income Philadelphia neighborhoods. Participants had all been prescribed an inhaled corticosteroid for asthma and required oral steroids for an exacerbation and/or had an emergency or inpatient visit within the previous six months.

Community health workers visited patients in their homes and found 71 percent rented, with many living in one-room apartments or overcrowded spaces with multiple family members within poorly maintained old buildings, as described above. These patients were identified as being routinely exposed to common indoor asthma triggers, such as mold, rodents, and roaches.

Community health workers reported their impressions of these stark, and sometimes bleak, living conditions, stating that "homes are in poor repair. Some are just unlivable." 

"Many of these patients start to feel a sense of hopelessness, especially the very sick," says Tyra Bryant-Stephens, MD, corresponding author and medical director of CAPP at CHOP. "They feel there is very little possibility of changing their current living situation, which includes poor housing, exposure to violent crime, and limited access to transportation. Some of these living conditions make it difficult or impossible for patients to get to their medical visits, which results in a further decline of their health."

"Medical personnel no longer make house calls, so this research gives us a view of how poverty, unfavorable home conditions, and lack of social resources limit patients' ability to access healthcare," says Andrea J. Apter, MD, MSc, MA, principal investigator of the study and Chief of the Section of Allergy & Immunology at the Perelman School of Medicine at the University of Pennsylvania. "Without the knowledge of these barriers, health providers do not have the information needed to create a tailored and empathetic approach to asthma management."

Bryant-Stephens adds, "As long as there is poor housing, health disparities will continue to exist, despite medical advancements being made in the fight against asthma. The issue is not limited to Philadelphia and needs to be addressed on a national scale. Without addressing poor housing, we will never be able to truly eliminate disparities in outcomes among adult asthma patients."

Doctors and other healthcare professionals now have much needed information regarding environmental factors including mold exposure which can have a hugely significant influence on patient outcomes in asthma. The researchers deserve much credit for highlighting the role of environmental and social factors in asthma and chronic illness. No matter any advances in medical treatments, without a living environment free from mold and other allergens and toxic influences, patients will always struggle to get well, and may even develop other mold-related illnesses such as chronic sinusitis.

This study provides a model for future research that would benefit treatment of a multitude of chronic illnesses through a more holistic approach tailored to each patient and their individual circumstances.

Source: Bryant-Stephens T, Reed-Wells S, Canales M, Perez L, Localio AR, Apter AJ (2016) Home Visits are Needed to Address Asthma Health Disparities in Adults Journal of Allergy and Clinical Immunology http://dx.doi.org/10.1016/j.jaci.2016.10.006