Patti Marisa A, Henderson Noelle B, Phipatanakul Wanda, Jackson-Browne Medina
AJ Drexel Autism Institute, Drexel University, Philadelphia, PA.
Department of Environmental Health, Boston University School of Public Health, Boston, MA.
Chest. 2024 Dec;166(6):1309-1318. doi: 10.1016/j.chest.2024.07.143. Epub 2024 Jul 24.
Asthma is a common and complex lung disease in children, with disproportionally higher prevalence and related adverse outcomes among children in racial and ethnic minority groups and of lower socioeconomic position. Environmental factors, including unhealthy housing and school-based exposures, can contribute to increased asthma morbidity and widening disparities. This underscores a significant environmental justice issue and suggests the need for clinical interventions to reduce sources of environmental exposures and ultimately diminish the observed disparities in childhood asthma.
Unhealthy housing conditions, including secondhand tobacco smoke, allergen exposure, and indoor air pollution, can exacerbate asthma symptoms in children. Although unhealthy housing can occur anywhere, such situations most frequently occur in urban, low-income environments where renting is common. To reduce environmental triggers, clinicians can recommend smoking cessation, cleaning techniques to mitigate exposure, and even directly contacting landlords to address poor housing conditions. Children spend much of their time in schools, where this built environment is also a source of asthma triggers (eg, poor ventilation) and allergens (eg, mold and pests, chemicals). As such, a multidisciplinary approach is needed to adequately address the burden of childhood asthma to equitably reduce disparities to both harmful exposures and negative health outcomes.
Racial, ethnic, and socioeconomic disparities exist in asthma morbidity in children, and such disparities are driven in part by environmental factors at the housing and school level. Clinicians can make evidence-based recommendations to drive effective exposure reduction strategies to mitigate asthma morbidity and reduce observed disparities.
哮喘是儿童常见且复杂的肺部疾病，在种族和少数族裔群体以及社会经济地位较低的儿童中，其患病率及相关不良后果 disproportionately 更高。包括不健康住房和学校环境暴露在内的环境因素，可导致哮喘发病率上升及差距扩大。这凸显了一个重大的环境正义问题，并表明需要采取临床干预措施，以减少环境暴露源，最终缩小儿童哮喘中观察到的差距。
不健康的住房条件，包括二手烟、过敏原暴露和室内空气污染，可加重儿童哮喘症状。虽然不健康住房在任何地方都可能出现，但这种情况最常发生在租房普遍的城市低收入环境中。为减少环境触发因素，临床医生可建议戒烟、采用清洁技术以减轻暴露，甚至直接联系房东解决住房条件差的问题。儿童在学校度过大量时间，学校的建筑环境也是哮喘触发因素（如通风不良）和过敏原（如霉菌、害虫、化学物质）的来源。因此，需要采取多学科方法来充分应对儿童哮喘负担，以公平地减少有害暴露和负面健康结果方面的差距。
儿童哮喘发病率存在种族、族裔和社会经济差异，这些差异部分由住房和学校层面的环境因素驱动。临床医生可提出基于证据的建议，以推动有效的暴露减少策略，减轻哮喘发病率并缩小观察到的差距。
