Children living in green neighbourhoods are less likely to develop asthma



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Several studies have shown that spending time in nature is good for health. Now new research has looked specifically at asthma and found that living in green neighbourhoods protects children from developing the condition.
from http://www.shutterstock.com, CC BY-SA

Jeroen Douwes, Massey University and Geoffrey H. Donovan, United States Forest Service

Since the pioneering work of architecture professor Roger Ulrich, who found that patients with a view of a natural scene recovered more quickly from surgery, research has shown that exposure to the natural
environment is associated with a wide range of health benefits.

We have focused our work on asthma, and our research, published today, shows that children who live in greener neighbourhoods are less likely to develop it.

Not all greenness was equally effective, however. If a child was exposed to a broader range of plants, they were even less likely to get asthma. Exposure to landscapes with low plant diversity, such as gorse and exotic conifers, on the other hand, were a risk factor for asthma. Thus, greenness is good, but more biodiverse greenness is even better.




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How nature protects against asthma

One intriguing explanation is provided by the hygiene hypothesis, which proposes that for children’s immune systems to develop properly, they need to be exposed to a broad range of microbes in early life. Without this exposure, children may be more susceptible to immunological diseases, like allergies and asthma.

The hygiene hypothesis explains why children living on farms, where they are exposed to a wide range of animals, are less likely to develop asthma. However, it’s not only farm children who benefit from exposure to animals. Having a pet in the house can also help protect against asthma. Similarly, children with more siblings are less likely to be asthmatic.




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Living around a more diverse range of plants may also increase a child’s exposure to microbes. In fact, past studies have shown that people who live in more biodiverse areas have more diverse skin bacteria. Exposure to the natural environment may, therefore, improve our health by increasing the diversity of microbes living on our skin and in our gut.

This, in turn, may promote a healthy immune response and reduce the risk of allergies and asthma. Reduced stress and increased physical activity, associated with living close to green space, may be another reason for the observed protective effects.

Tracking children’s environment

This study used the Integrated Data Infrastructure (IDI), which is a large database of individual-level data maintained by Stats New Zealand. Currently, it contains 166 billion pieces of information on education, benefits, tax, families and households, health, justice and migration.

Using these data, we were able to track where children lived from birth until age 18, calculate the greenness of their neighbourhoods using satellite imagery and land-use data, and link to health records throughout each child’s life. This was all done anonymously, in a secure data lab, to safeguard the children’s privacy.

This study is an unusual collaboration between economists at the US Forest Service and epidemiologists in New Zealand. It contributes to our understanding of why asthma is on the rise.

Our results may lead to some innovative strategies to combat asthma, although there is a need to elucidate the underlying immunological mechanisms.

Improved prevention and treatment options for asthma are urgently needed as the burden of asthma is considerable, with 334 million people affected worldwide. Asthma prevalence in English-speaking countries such as New Zealand, Australia, the US and the UK is particularly high, with approximately one in six people suffering from it.

Good for people, good for the planet

Showing a link between biodiversity and human health may also change how we manage natural resources, especially in cities. Unfortunately, biodiversity is declining around the world due to population growth, climate change and intensive agricultural practices. Our work suggests that this is not just an ecological problem, but may also present a significant threat to public health.

The ConversationOther studies have suggested that the exposure to the natural environment also protects against low birth weight, heart disease, mental health disorders and breast cancer, although results have not always been consistent. Therefore, as the diversity of our natural environment and resultant microbial exposure declines, we may see further increases in diseases, such as childhood allergies and asthma.

Jeroen Douwes, Professor of Public Health; Director, Centre for Public Health Research, Massey University and Geoffrey H. Donovan, Economist, United States Forest Service

This article was originally published on The Conversation. Read the original article.

Your asthma puffer is probably contributing to climate change, but there’s a better alternative



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There is an environmentally friendly option.
from http://www.shutterstock.com

Brett Montgomery, University of Western Australia

I breathe all the way out. There’s a quiet puff of gas from my inhaler, and I breathe all the way in. I hold my breath for a few seconds and the medicine is where it needs to be: in my lungs.

Many readers with asthma or other lung disease will recognise this ritual. But I suspect few will connect it with climate change. Until recently, neither did I.

In asthma, there is narrowing of the airways that carry air into and out of our lungs. The lining of the airways becomes swollen, muscles around the airways contract, and mucus is produced. All these changes make it hard to breathe out.

The most commonly used medicines in asthma are delivered by inhalation. Inhaling gets the medicines straight to the airways, speeding and maximising their local effects, and minimising side effects elsewhere compared to, say, swallowing tablets.

Some medicines (“relievers”) work quickly to relax the airway muscles. Others (“preventers”) work more slowly but do more good, preventing asthma’s swelling and inflammation of the airways.




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These medicines are available in various sorts of inhaler devices. The devices fall into two broad types: “metered dose inhalers” and “dry powder inhalers” of various shapes and sizes.

In metered dose inhalers, the medicine and a pressurised propellant liquid are mixed together in a little canister, and then sprayed out of the inhaler in a measured puff of fine mist. This is inhaled, often after passing through a “spacer” which allows more of the medicine to reach the lungs. While the medicine is absorbed by the body, the propellant, now a gas, is exhaled unchanged.

In dry powder inhalers, the medicine is in the form of a fine powder which is swept into the lungs as the user breathes in — there is no spray and no spacer.

Powder inhalers don’t release any gases at all.
Author provided

It’s feasible for many (but not all) people to use either sort of device. Young children do better with metered dose inhalers and spacers, as do people who struggle to inhale. But most asthmatics can inhale well from dry powder inhalers.

The two types of inhaler seem to work just as well as each other; if anything the dry powder ones might be a little better.

Metered dose inhalers are more often prescribed than dry powder devices in many countries, but this has more to do with history and familiarity than effectiveness.

What about those gases?

You might remember hearing, years ago, about “CFCs” — chlorofluorocarbons — and their dire effect on the ozone layer. A successful international treaty, the Montreal Protocol, led to their phase-out from various uses, including medical inhalers. And with that, I thought, the environmental problems of inhaler gases had ended.




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But CFCs were replaced with “HFCs” — hydrofluorocarbons — which are safe for the ozone layer, but which are potent global warming gases. HFCs are better known in their role as refrigerant gases in air conditioners and refrigerators.

A recent amendment to the Montreal Protocol has now planned a phase-out of HFCs, too, but it’s slow, with deadlines decades away. Earlier prudent management of these gases could make a big difference to climate change.

The one most often found in asthma metered dose inhalers, norflurane, is 1,430 times more potent than the best-known warming culprit, carbon dioxide. Another, apaflurane, is 3,220 times more potent than carbon dioxide.

Such warming power explains why even the small amounts in an inhaler are significant. Globally, tens of millions of tons of carbon dioxide equivalent are attributable annually to these inhaler gases.

How much pollution are inhaler gases responsible for in Australia? I wrote to several companies marketing asthma inhalers in Australia, asking them how much of these gases are present in their products. Some gave straight answers, but some hedged on grounds of commercial confidentiality. This makes it hard for me to be exact.

But based on some reasonable assumptions, and multiplying these by the number of inhalers dispensed on our Pharmaceutical Benefits Scheme last year, I tallied nearly 116,000 tonnes of carbon dioxide-equivalent pollution.

That’s equivalent to the emissions of about 25,000 cars annually. And this is surely an underestimate, as it doesn’t account for reliever inhalers sold over the counter. A person using a preventer inhaler monthly, plus the odd reliever inhaler, could easily release the annual equivalent of a quarter of a ton of carbon dioxide — that’s like burning 100 litres of petrol.




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How to change

The good news is, for many people with asthma, there’s an easy solution: shifting from metered dose inhalers to dry powder inhalers. As above, this won’t suit everyone, but will be possible for many.

I am both a doctor and a person with asthma. As an asthmatic, I’ve found changing inhalers to be easy — if anything, my dry powder inhalers are simpler to use. And as a doctor, I’ve been pleasantly surprised by how open my patients have been to this topic. I worried people might find it weird their GP was raising environmental issues at their appointment, but my fears were unfounded.

If you have asthma, a chat with your doctor or pharmacist would be a good way to gauge whether a dry powder inhaler is feasible for you. Don’t be surprised if they haven’t heard of this gas issue — awareness still seems limited.

The ConversationIf metered dose inhalers are a better choice for you, please don’t panic or quit your medicines. These gases probably won’t be the biggest contributor to your personal carbon footprint. Asthma control is really important, and these medicines work really well. But consider changing if it’s an option for you — when it comes to reducing our footprint, every little bit counts.

Brett Montgomery, Senior Lecturer in General Practice, University of Western Australia

This article was originally published on The Conversation. Read the original article.