Editor’s note: This is the first part in a series about the prevalence of asthma and disparities in diagnosis and treatment of the disease. Share your experience with asthma at Myrecordjournal.com/Voices.

Growing up, Aracelis Santos Torres never seemed to be able to catch her breath. The other kids in her Meriden neighborhood would play tag and hide-and-go-seek until they were all breathless and exhausted. Most of her friends were back on their feet and chasing each other again after resting for a few minutes, but Santos Torres would sit on the ground and cough.

After officially being diagnosed with asthma at six years old, Santos Torres had to be more vigilant of her environment and its potential impact on her breathing.

“I loved playing outside. I would play outside every single day, but I got sick so easily and it hurt to run around outside after a while,” she said. “I think that’s what mainly caused my parents to set that appointment.”

Santos Torres is just one of almost 450,000 Connecticut residents living with asthma, according to the state Department of Public Health.

An estimated one in 13 Americans live with asthma, making it one of the most common chronic conditions nationwide. However, national and state data show significant racial disparities in asthma diagnosis, hospitalizations, emergency room visits and deaths.

According to a 2020 report by the Asthma and Allergy Foundation of America, Black Americans are almost twice as likely to have asthma than white Americans. They are also nearly five times more likely to visit the emergency room and three times more likely to die from the condition. The report also found that Puerto Ricans have the highest rates of asthma compared to any other racial or ethnic group.

In Connecticut, Black and Latino residents have the highest prevalence rate for asthma, at 20%, compared to 14% for white residents, reported the state DPH.

Vice President of Corporate Affairs and Research for the Asthma and Allergy Foundation of America, Dr. Sanaz Eftekhari, explained that communities of color across the US are more prone to developing asthma because of their greater proximity to air pollution.

“Asthma is so impacted by somebody’s external environment. So their housing, their access to better indoor air quality in schools, the air pollution around their house … all of these are impacted,” Eftekhari said.

Why do some people have more severe asthma?

The Mayo Clinic defines asthma as a chronic condition that causes airways to narrow, swell or produce excess mucus. This narrowing makes breathing difficult, resulting in more coughing, wheezing and shortness of breath. Potential asthma triggers include secondhand smoke, air pollution, chemical products, dust, mold, pollen and pets.

The severity of symptoms and complications vary from person to person, but the most extreme cases can interfere with daily activities or lead to a nearly fatal asthma attack.

For example, some patients can suffer permanent damage if their asthma remains untreated and uncontrolled, said Dr. Mario Perez, a pulmonary critical care physician and assistant professor of medicine at the UConn School of Medicine.

“Patients can develop permanent, obstructive disease, similar to those smokers develop,” he said.

The direct cause of asthma and its disparate impact on minority communities is still being studied, but Perez said it is typically “multifactorial.” Genetics plays a small role in asthma prevalence, he said, but it is primarily driven by a person’s environment and exposure to pollution.

Perez added that asthma patients may experience fewer symptoms and attacks as they age. However, symptoms could reappear later in life if the person is suddenly exposed to their triggers.

Santos Torres was officially diagnosed at six, but her mother, Raquel Torres, said her daughter began presenting asthma symptoms by the time she was three years old. At six, doctors diagnosed her immediately and the family was sent home with a nebulizer, asthma pump and medication covered through state insurance.

Although the treatment helped, Torres was worried because something as simple as a cool breeze could trigger an asthma attack. She added that her daughter was taken to the emergency room at four years old because of her asthma.

“We had to be a lot more careful with [Santos Torres] and she always needed to be bundled up,” she said. “When she [got an attack] at night, I would have to bring her to my bed and warm her up.”

Santos Torres said her parents sat her down to discuss her asthma, her triggers and what she needed to do whenever she had an asthma attack. She had to carry her inhaler and memorized an action plan. Her school also had an extra inhaler and an action plan in case Santos Torres experienced a flare-up.

“Whenever we went outside for walks at school, I would have to take [an asthma pump] with me. At recess, I couldn’t play tag,” Santos Torres said. “I would just be on the swings while my friends would play in the field. I just had to be much more careful.”

It became routine for Santos Torres to miss school because she was sick. She said it would typically start with a stuffy nose that would worsen overnight. She would also be constantly sneezing and having migraines.

“When I get sick, it gets really, really bad and I can’t really do much because it’s just so constant,” she said. “I was just really, really messy.”

Santos Torres, now a young adult, doesn’t experience as many asthma symptoms but remembers how panic would immediately shoot through her when she started to feel an asthma attack coming on.

Her attacks would occur more often in the wintertime because her primary triggers were cold air, rain and dust. Sometimes doing “strenuous activities” outside for a long time, such as running, could also trigger an asthma attack.

“It feels like this really cold, icy sharp thing that goes into your lungs. A lot of times, you’re trying to breathe, but it’s lagged and you can’t keep up with what your lungs are trying to do. It makes it hard to function,” Santos Torres said. “It really is scary because even though it’s not as common, people can die from these asthma attacks.”

Outdoor pollution

Director of Advocacy for the American Lung Association of Connecticut, Ruth Canovi, said air pollution plays a significant role in the broad impact of asthma.

According to the 2023 State of the Air report by the American Lung Association, more than one in three Americans live in places with unhealthy levels of air pollution. However, Black and Latino communities are more than four times as likely to face pollution inequity than white communities.

Canovi explained that too much air pollution exposure could lead to many short and long-term health problems.

“The air pollution is an environmental issue, but it’s really a serious public health problem that we need to address,” she said.

According to Canovi, two primary pollutants increase the chances of developing asthma or worsening symptoms – particle and ozone pollution.

Particle pollution increases when there are tiny solid and liquid particles in the air that a person can inhale. The particle’s size depends on the source of the pollutant, such as gas cars, diesel trucks, factories and burning wood. When the pollution levels are high, the air appears thick and hazy.

Canovi explained that even minor particle pollution spikes could have serious consequences.

The report found that short-term exposure to these particles can increase hospital and emergency room admissions for people with chronic heart and lung conditions. It also can further irritate a child’s asthma, resulting in more asthma attacks and hospitalizations.

Long-term exposure also increases the likelihood of developing diabetes, being diagnosed and dying of lung cancer and increasing the risk of developing dementia.

Ozone pollution typically forms in the lower levels of the atmosphere, allowing ozone to mix and heat with other pollutants.

Canovi said this concoction could leave the equivalent of a “sunburn on the lungs” when breathed in.

For Connecticut, the DPH identified Waterbury, Meriden and New Haven as cities with the highest rates of emergency department visits due to high nitrogen oxide emissions over the past five years.

“There’s a lot of systemic issues around housing and placement of highways and power plants. It just increases exposure to especially low-income neighborhoods,” Canovi said.

Indoor pollution

Indoor air can also contribute to the prevalence of asthma, especially at schools, said Eftekhari.

“Asthma impacts breathing, so it’s really the most vital piece of life and it can impact everything else,” Eftekhari said.

She explained asthma is one of the most common chronic conditions in children. If schools don’t have proper ventilation or aren’t regularly cleaned with allergy-friendly products, students could experience asthma attacks. In addition, buses prove to be a major source of pollution.

Eftekhari added that the pandemic began a similar conversation about the importance of schools’ indoor air quality.

“There’s just a lot of areas in and around the schools that can lead to exposure to asthma triggers for children, for the students and for the staff,” she said.

According to the Department of Public Health, 13% of Connecticut students reported having asthma. About 21% of students reported having asthma in Meriden public schools, compared to 11% in Wallingford and Cheshire and 13% in Southington.

And while data show that the rate of asthma in Meriden schools is disproportinately high compared to even similar districts, it is not as high as it used to be. Meriden’s Associate Health Director Stephanie Denya explained that asthma rates have been decreasing in Meriden over the past five years.

“COVID has significantly increased awareness of asthma and the importance of following up with health care providers, taking medications as prescribed and avoiding triggers,” she said.

A variety of triggers can be found at home as well. As part of a state-sponsored program called Putting on AIRS Asthma Education Program, Wallingford Public Health Nurse Anne Bernick visited homes across town to help identify and address potential asthma triggers. The most common ones included dust mites, parental smoking, cleaning products, candles, mold, perfumes and laundry detergents.

‘It’s not over’

Santos Torres was on TikTok when she first learned that Black and Latino people are more prone to health issues than white people due to their environment. The short video sent Santos Torres into a deep dive into the causes and impact of these disparities on communities of color. She said most of her research focused on redlining and placement of factories and their proximity to communities of color.

So when she was assigned to write an essay for last year’s Hicks Speaking and Writing Contest at Platt High School, Santos Torres knew she needed to share her newfound knowledge.

Titled “It’s Not Over,” the essay explored the different forms of environmental injustice and highlighted some of the main causes of inequity. She then described how all of these factors disproportionately impact communities of color.

For example, Santos Torres described how her family in Puerto Rico can’t drink water directly from their tap. She also named several young environmental justice advocates fighting for the right to clean water as residents of Flint, Michigan.

“Today, the world is lacking justice in communities that are suffering from Environmental racism. From polluted air and water to poverty, these people are going through issues that are not discussed enough,” Santos Torres wrote.

Her speech offered solutions to address environmental injustice inspired by the work already being done in other states. For example, San Francisco created a landscaping training program in underserved communities to boost employment and improve the communities. Santos Torres wrote that this program could be used to plant new trees and combat air pollution in Connecticut.

Although the essay centered on environmental injustice, Santos Torres wanted to use her experience as a Black Puerto Rican living with asthma as an example of how the condition can impact a person’s physical and mental well-being. She said she was initially scared to share her experiences but ultimately found the writing process empowering.

“I started off the speech with my asthma because I believe it’s something that is not talked about enough. It gets thrown under the bus often,” Santos Torres told Record-Journal. “It’s not as seen even though it’s really common and the effects are really serious.”

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Health Equity reporter Cris Villalonga-Vivoni is a corps member with Report for America, a national service program that places journalists in local newsrooms. Support RFA reporters at the Record-Journal through a donation at bit.ly/3Pdb0re. To learn more about RFA, visit www.reportforamerica.org/.

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