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The number of Americans diagnosed with asthma has grown dramatically, with high-crime cities being hit especially hard. In a joint report with The Detroit News, special correspondent Indira Lakshmanan examines emerging research that indicates stress, abuse and violence may play as big a role as physical factors in triggering both asthma attacks and the development of the chronic disease.
For more than a decade, the number of Americans diagnosed with asthma has grown dramatically, with a nearly 50 percent increase among African-American children.
Scientists are puzzling over why some communities are especially hard-hit and are investigating links to obesity, bacteria and chemicals.
But new evidence also points to a mind/body connection and the role of stress and trauma.
Special correspondent Indira Lakshmanan has our report from Michigan.
This story was produced in collaboration with The Detroit News.
VICKEY CARTER-IVORY, Mother of Cameron Carter: Cameron, get up. It's time to get up.
Cameron Carter wakes up every morning with the after-effects of her cousin's murder. When her cousin was 12, he was shot to death by a neighbor at a birthday party. Soon after, Cameron ended up in the E.R. herself, struggling to breathe from a severe asthma attack.
CAMERON CARTER, Asthma Patient:
When I worry, I start to, like, get scared and stuff, and when I get scared, my asthma, it starts to mess up.
Duncan Smith spent the first eight months of his life lying on his back in an Russian orphanage, often alone, before being adopted by a middle-class family in suburban Detroit. His parents say he sometimes struggled to breathe as a baby. Today, he has asthma, too.
DUNCAN SMITH, Asthma Patient:
Every time I breathe, I just feel a little bit of pain, because it's coming from my lungs and going up.
Malik Cole's family has been in and out of temporary housing for a year, because his father's income doesn't cover a rent. He and his four siblings were sleeping in their car with their parents when we first met.
On stressful days, his asthma gets so bad that he vomits or passes out.
MALIK COLE, Asthma Patient:
It feels like I'm hurting. Like I'm dying.
These children are part of a growing phenomenon. Nearly one in 10 children in the U.S. has asthma today. Doctors have long understood asthma as an inflammation of the airways, triggered by allergens like pets and pollen, and environmental irritants like pollution, smoke and mold. It's also often hereditary.
But across the country, in places like Detroit, where childhood asthma has reached epidemic proportions, new research shows that stress, abuse and neighborhood violence may play as big a role as physical conditions in causing kids who never had asthma to develop the life-threatening disease.
DR. ELIZABETH SECORD, Children's Hospital of Michigan: So, we like you, but we don't want to see you here.
While some stress is helpful in facing challenging situations, too much for too long can trigger the adrenal glands above the kidneys to overproduce cortisol and adrenaline. Those chemicals, in turn, can kick the immune system into overdrive and can fuel an array of health problems, including, according to new studies, asthma.
KAREN BOUFFARD, The Detroit News:
One in three Detroit children are living in extreme poverty…
Karen Bouffard of The Detroit News says the Motor City's alarmingly high childhood asthma rates map closely with some of the nation's most violent and impoverished neighborhoods.
And about a quarter of children under 6 in Detroit live in households where there is no adult working at all.
That must make for an incredibly stressful home life.
It does. There's a whole range of effects. Parents are worried about coming up with the rent or the electric bill, the gas money. And that kind of stress comes through for children.
The Henry Ford Health System has opened two mobile clinics to address soaring childhood asthma rates, and has seven school-based health centers in some of the city's poorest neighborhoods.
Raise your right hand if you have ever been told that you have asthma.
Asthma is the leading chronic condition causing kids to miss school in Detroit. Most don't even have access to inhalers. So medications are now being delivered directly to children at school, with pictures to remind kids how to use their inhalers even if there's no adult to help.
What are you going to do if you want to be breathing well?
Two puffs every morning.
And two puffs every night.
But as Cameron Carter and her mother, Vickey, know, asthma medication can't fix everything. The murder of Cameron's cousin is just one of the tragedies that has punctuated her young life.
VICKEY CARTER-IVORY, Mother of Cameron Carter: We had a house fire during a birthday party. We have had family members pass away. My best friend committed suicide. A really good friend of my husband's was murdered. We had another house fire. We have had financial difficulties.
Vickey noticed her daughter's asthma often spiked in periods of high stress. And Cameron's attacks got so bad that her mother started homeschooling her.
The two joined a National Institutes of Health-funded study on the connection among bad experiences, the stress hormone cortisol, and asthma.
After the study, it kind of was a light bulb moment, where it really made sense that stress caused asthma issues. Not all stress — I mean, not all asthma issues are stress-related, but it is a big issue.
A recent report in a leading journal on asthma, allergy and immunology found children exposed to just one traumatic experience at home, like divorce, death of a parent, or abuse, were 28 percent more likely to report having asthma during childhood.
Those who suffered four traumatic events were 73 percent more likely to have asthma.
DR. ROSALIND WRIGHT, Mount Sinai Health System:
You can't ignore it anymore. The data is there that says psychological stress is a factor, just like these other physical factors.
Dr. Rosalind Wright is a professor of pediatrics at Kravis Children's Hospital at Mount Sinai Health System in New York. Her latest work shows stress in itself, irrespective of poverty or environmental toxins, can cause asthma. Emerging research at other leading institutions is demonstrating the same cause and effect.
DR. ROSALIND WRIGHT:
And that's important why? Because if I'm talking to a patient, and I'm trying to make their asthma better, or I'm trying to think about how to prevent asthma from happening, I want to say, 'These are the things we know that can potentially lead to this, so these are things we want to try to help you minimize.'
ELIZABETH MILTON, Better Life Learning:
So, when you see the lips or fingernails turning blue or gray, that is a 911 situation.
But the stresses on Malik just keep adding up. Even though his mother has sought asthma education, his condition keeps getting worse. Sleeping in the car as the weather turned cold was making it harder for Malik to breathe.
Because most asthmatics have difficulty at night. There's a whole lot of reasons why that happens.
Are you having difficulty now?
Mom, you have his inhaler?
SIRETHA LATTIMORE, Mother of Malik Cole: Yes.
When I see kids like this, I know something, because it's not normal. And it kind of hurts to breathe like this.
Yes, I know he's stressed out, but he don't want to tell me. I don't know if he's scared, he's stressed. I don't know.
On the day we last saw them, Malik's parents, with heavy hearts, drove their four youngest children to child protective services to request the kids be placed in a temporary foster home until the parents can find affordable housing.
Their case drives home the challenge of treating asthma when life's stresses are so overwhelming. Getting medication can be the easy part, compared with the huge challenge of healing the underlying trauma. Programs that attempt to do that are rare.
Duncan Smith's parents turned to Easter Seals Michigan and its new trauma intervention program to help Duncan and his sister, Gabby, with emotional and physical challenges stemming from their abandonment as babies in Russia. The children are now undergoing a series of evaluations.
EASTER SEALS MICHIGAN STAFF MEMBER:
What helps you breathe? Great job.
And will be guided to individual and group counseling to help them better cope with stress and anxiety.
A year of counseling helped Cameron Carter and her brothers, who were standing on either side of their cousin when he was killed.
I learned that you should forgive yourself before you start blaming yourself for stuff. That it wasn't your fault.
Her brother, Alexander, who has gotten his asthma under control, is now a starting running back on the school's varsity football team. Cameron, who takes weekly dance classes, still struggles.
But, as she learns to cope with her anxieties, she's starting to better manage her asthma, one breath at a time.
For the PBS NewsHour, I'm Indira Lakshmanan in Detroit.
On our website, you can learn how stress-fueled health conditions like asthma may actually be passed from one generation to another, and find a link to the full report from The Detroit News, which includes more on the research and on each of the families profiled in our story. That's on our home page.
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