Despite Community Efforts, Childhood Asthma Worsens in East Harlem

As the weather grows colder, parents of children with asthma in New York are on notice; the cold can be a trigger.

“She’s the type of kid where nothing will stop her,” Concepcion Arellano says about her daughter, Esperanza, 9. “She enjoys playing soccer, climbing up and down the gym bars and running around all the time.” But since Esperanza developed asthma three years ago, she often has to stop and catch her breath.

“She had a clean bill of health until she got COVID, and then her breathing got bad,” Arellano says, explaining that Esperanza was rushed to the emergency room in 2021 with her first asthma attack.

The family lives in East Harlem, a neighborhood with some of the highest rates of childhood asthma in New York City, according to data from the Statewide Planning and Research Cooperative System.

Children’s emergency room visits in East Harlem dropped from 506.3 per 10,000 in 2018 to 147 in 2020. However, the levels are returning to pre-pandemic numbers: 296.5 per 10,000 in 2022. The city average in 2022, by comparison, was 127 per 10,000.

Dr. Joel Brooks, an allergy specialist and pediatrician at Columbia University’s Vagelos College of Physicians and Surgeons, warns that this drop in emergency room visits might be “misleading” and may not indicate less asthma among the neighborhood’s children.

“I still have plenty of patients that will not go to the ER because of the risk of getting COVID,” Brooks says. They may also want to avoid exposure to other communicable diseases like measles and mpox.

City data, too, shows that “the start of COVID-19 in Spring 2020 reduced the overall volume of ED visits, including those for asthma.”

Brooks believes that childhood asthma remains a serious issue in low-income neighborhoods like East Harlem and “can increase the risk for developing chronic diseases” in later life.

Children in East Harlem are disproportionately affected by factors like air pollution and mold, cockroaches, mice and other asthma triggers in their homes, compared to children elsewhere in the city, Brooks says.

The neighborhood’s poverty level, another leading contributor to asthma, also remains high at almost 32%, compared to the city average of 17%, according to census data.

Esperanza (right), with her mother, Concepcion Arellano
(Credit: Concepcion Arellano)

With consistent treatment and care, Esperanza’s asthma has become manageable, her mother says. When she was first admitted to the Mount Sinai Hospital, doctors referred her to the East Harlem Asthma Center of Excellence. The center, operating under the city health department, is a free clinic providing specialized services to help families in East Harlem and neighboring areas control childhood asthma.

“The asthma center has been excellent. They’re very helpful,” Arellano says. At the center, she received information about keeping her home safer and cleaner, fiber cloths for cleaning, and a kit to make her own sanitizing solution. The staff also taught her how to tackle seasonal changes that affected Esperanza’s health.

The services Esperanza received are part of the center’s asthma counselor program. “We run a number of asthma initiatives, which are all focused on tending to the needs of children with asthma as well as their families,” says Dr. Sire Sow, clinical director of asthma initiatives at the center.

Its asthma counselors provide education and individual case management, and address environmental triggers, especially in homes. The center also provides pest management, partners with schools to teach children self-management, and facilitates conversations in which patients share information to reduce the burden of asthma.

A 2022 study that analyzed the center’s impact on 136 enrolled children found that those who completed the program reported a 50% decrease in asthma-related hospitalizations, and a 57% decrease in asthma-related emergency room visits. However, about 37% of the enrolled children became “lost to follow up.”

“We have a number of avenues to stay in touch with the families,” but sometimes, it becomes tough to follow up with them. “Our counselors do everything within their power to contact the families and touch base with them,” Sow says, including consistent contact with schools, calls, text messages and invitations to the center.

The asthma center is understaffed, however, “as a result of the pandemic,” Sow says. “When fully staffed, we have six social workers who operate not only in our building, but in some other areas as well.” The center recruits patients from hospitals, primary care practices and inpatient units.

But not all East Harlem families have been able to take advantage of the center. Karisma Malave, an East Harlem resident, has three children, all of whom have had asthma since birth. Despite living in the neighborhood for four years, she has not heard of the center or its services.

Since Malave lives in public housing, she cannot control the temperature in her apartment. The excessive heat and humidity irritate her children’s airways, leading to nose bleeds, severe coughing and difficulty breathing.

Due to maintenance issues, public housing in the city is twice as likely to contain asthma triggers as other types of housing citywide, data shows.

Weather changes and the approaching cold season also pose challenges for kids like Esperanza. “These past two weeks, she’s been having a really hard time where she just wakes up and she’s out of breath,” Arellano says.

Malave agreed, “It gets really bad during the fall and winter.”

Developing asthma at a young age has “huge ramifications” for the child’s adult life, Brooks says. It “predisposes you towards other health conditions. You tend to live a more sedentary life, so obesity and diabetes become a problem.”

For children like Esperanza, Brooks says, letting go of a favorite pastime like playing soccer could damage the child’s mental health too, and is associated with depression.

Despite being understaffed, the East Harlem Asthma Center of Excellence manages to help about 200 children annually, Sow says. The city health department reports that it has assisted over 2000 families since 2008*. The “overall plan is to reduce asthma-related ED visits and asthma-related hospitalizations,” Sow says.