Clearing the air: Health professionals tackle Detroit's asthma epidemic

Night was the scariest time of the day for DiAné and Lateef Townsel. That's when their son, Raye, would most frequently have an asthma attack, waking up in the middle of the night, choking down air.

"Being up at night with Raye was not uncommon," says DiAné Townsel. "It's terrible to see your son when they can't breathe, not sure if he's gonna make it."

Raye's case was mysterious: the Townsels had no family history of asthma and neither DiAné nor Lateef smoked. Yet their son had to get rushed to the hospital on several occasions, regularly missed school, and used an albuterol inhaler, among other medications.

The Townsels also lived in Detroit until Raye was three years old. It's probably not a coincidence that Detroit has one of the highest rates of asthma in the country.

Raye taking Asmanex

 
But awareness of asthma's severity in the city has been steadily growing, and action is being taken to confront the problem by some of Detroit's most important health professionals.

Detroit's asthma problem

Raye's situation is not unique in Detroit, especially among African-Americans.

According to a 2016 Newsweek article titled, "Choking to death in Detroit," "[M]ore than 15 percent of Detroit's adults have asthma, a 29 percent higher rate than the rest of Michigan. Detroiters are hospitalized for their asthma three times more frequently than other Michiganders. Being black ups the rate significantly: Black Detroiters are hospitalized for asthma at a rate more than 150 percent that of their white neighbors."

While the exact causes of asthma—why some people in similar environmental conditions develop it and some don't—are still largely unknown, scientists are confident about some factors.
Dr. Christine Joseph
"It has something to do with exposure to environmental triggers," says Dr. Christine Joseph, an epidemiologist at Henry Ford Health System (HFHS). "It could be dust mites, household pests, exposure to weather conditions—they all may contribute to the development of asthma and allergies. You also have to consider family history. And that's just a start. It's quite a long list, actually."

When you're exposed makes all the difference. Joseph says an infant is more likely to develop an allergy during a crucial period in the formation of the immune system. But scientists still aren't sure exactly when that is. "Research is looking at what happens to a baby in utero, during breast feeding, or how early you expose child to solid food," says Joseph. "There a myriad of things under investigation."

It is, however, known that allergies develop during early childhood—well before the time three-year old Raye left Detroit. And continued exposure to those allergens only exacerbates the problem.

Airborne pollutants from Detroit's industrial legacy are likely a significant source of allergies, and therefore asthma, in the city. 48217, the zip code located near Zug Island, the Marathon refinery, and other polluters, has the notorious distinction of being Michigan's most polluted zip code.

Marathon Oil Refinery

 
Another source is poor quality housing stock, which tends to have higher incidences of pests—dust mites, cockroaches, rodents—that are common sources of allergies. Most factors relating to asthma, like higher stress levels and less education around asthma management, can be traced back to living near the poverty line.

The director of the City of Detroit's Health Department, Dr. Abdul El-Sayed, believes this is a crucial issue for the city to tackle. "For starters, a large number of children die every year because of asthma attacks," he says. "But it's also one of leading causes of school days missed. If you're coughing uncontrollably, you can't attend school. That's days not learning. It's unfair to suffer from asthma later in life because you didn't get same amount of schooling."

And it's impossible to quantify the trauma inflicted on a family with an asthmatic child. "Asthma is a frightening disease," says El-Sayed. "It comes out of nowhere and seems like there's nothing you can do. A child unable to breathe, struggling to exhale, is one of the most frightening things a parent see."

Getting asthma under control

Many of the same people blaring the warning siren about the scale and dangers of asthma are the same ones working to combat it.

Joseph has participated in numerous studies that not only try to locate the causes of asthma, but also learn the most effective means of treating it. Because while asthma is not yet curable, it can be controlled. "The best thing for families to understand is how to manage the condition," says Joseph. "To be very proactive about preventing exposure to things that are going to trigger an asthma episode."

Joseph was one of the principal investigators for Puff City, a web-based tool and study to help urban teens deal with their asthma. Youth got tailored treatment and messages based on their diagnoses and behavior, in addition to being assigned a referral coordinator for more hands-on management.

"The idea is that teens in particular exhibit behaviors that sometimes prevent them from operating in the best way possible," says Joseph. "Helping and motivating these adolescents to change their behaviors is important."

The Townsels actually participated in another HFHS study on which Joseph was a co-investigator, The Wayne County Health Environment Allergy and Asthma Longitudinal Study (WHEALS), which looked at risk-factors for asthma.

The Townsel family

 
Raye hasn't had an asthma attack since he was five-years old, in part because of their participation in WHEALS, which helped them come to terms with the illness, medication, and triggers. "We changed his meds and that made all the difference," says Townsel. "That and teaching him the signs and symptoms. It was just so simple. He's a lot better, able to focus in school, and his breathing is good."

El-Sayed, too, has helped develop a range of programs to help mitigate the city's asthma epidemic. His department is working to gather funding for sensors placed on inhalers that gather information about triggers and usage, and would even over time help map harmful air patterns in the city.

The director also worked with doctors like Joseph at HFHS to develop "Breathmobile," a mobile clinic that provides asthma care to children.

Perhaps most crucially, the Health Department was instrumental in negotiating with some of Detroit's largest operators to reduce emissions.

When Die-Casting company Sakthi Automotive wanted to build a factory in Detroit, they came to the Health Department. "We had a number of conversations," says El-Sayed, "and they opened one of cleanest facilities in the country."

Earlier this year, Detroit's Marathon refinery sought permits from the Michigan Department of Environmental Quality to increase emissions of sulfur dioxide by 22 tons per year. Amid vocal protests from residents and the city, the refinery actually ended up reducing its emissions of SO2.

"The Health Department has taken a much stronger stance on issues of environmental justice under the leadership Mayor Duggan," says El-Sayed. "Air is part of the environment. And a human right."

This piece is part of a series highlighting the role science plays in Detroit. It is supported by the Michigan Science Center.

All photos, except of Dr. Christine Joseph, by Nick Hagen.