Reported on Aug. 15, 2009

On a recent summer afternoon, a heavy layer of air weighed on the Astoria Houses housing project like a down comforter. The only thing that seemed to cut through its thickness were the sounds of children playing, and intermittent coughing, in the distance.

“My grandson and I were walking and talking, and then he started spitting,” said Carmen Ocasio, a longtime resident of Astoria Houses and caretaker of her grandson.

“And suddenly it’s ‘Grandma I can’t breathe.’”

As the season changes from summer to fall, families of asthmatic children in low-income areas of Astoria once again struggle with in-home allergens, inconsistent treatment, and the inability to afford medications. These children strain the already overcrowd hospitals throughout Queens, and they continue to suffer because there are no support groups to address the issue.

“Asthma taxes our emergency room, doctors office, and unfortunately is something people often don’t address,” said Michael Gianaris, assembyman for District 36, which includes Astoria.

Astoria and its multiple public housing projects, Astoria Houses, Ravenswood, and the largest one in North American, Queensbridge Housing, are part of “asthma alley,” a stretch of New York City that starts in the South Bronx , goes through western Queens, and into Brooklyn.

Asthma alley contains six power plants like the old Poletti Plant and the Ravenswood Plant with its 400-foot high smoke stack that roars alive with hot greasy film every couple hours.

It contains LaGuardia airport with airplane engines that pour out exhaust, the Queensboro Bridge littered with diesel trucks spewing out black soot filled with nitrous oxide, and barges slogging through the East River.

Not only are these transportation hubs loud and disruptive, their exhaust creates the thick air in asthma alley that sometimes makes it tough to breathe, especially on hot days in the summer.

Research studies and asthma prevention programs pay a lot of attention to areas like the South Bronx, but Astoria is often forgotten according to Queens officials.

“We are separated by a few hundred feet, and the air in both locations has been deemed some of the worst in the nation,” said Peter Vallone Jr., city council member for Astoria and honorary chairman of C.H.O.K.E., the “Coalition Helping Organize a Kleaner Environment.”

In the Community Health Profiles put out by the New York City Department of Health and Mental Hygiene, childhood asthma is considered one of the top three issues in the South Bronx because asthma prevalence is measured by hospitalization rate.

Although hospitalization rates are one indicator of the burden of asthma in a neighborhood, these rates alone do not reflect the level of disparities that exist among communities with different socioeconomic backgrounds, according to the study of “Prevalence of Childhood Asthma in Urban Communities: The Impact of Ethnicity and Income” conducted by the Department of Community and Preventive Medicine at the Mount Sinai School of Medicine.

Because a large portion of Astoria is middle class and more likely to address the daily issues of asthma, families with low income are averaged into this group and are often overlooked.

“The south Bronx and East Harlem are less well-to-do than Astoria, which is why they get more attention,” said Gianaris.

Asthma is not just in asthma alley, it is all over New York City. Over 180,000 children suffer from asthma and nearly 28,000 were hospitalized overnight between 2005 and 2007, according to a report from U.S. Senator Kirsten Gillibrand’s office released in August.

Children in New York City were almost twice as likely to be hospitalized for asthma as children in the United States as a whole in 2000, according to the New York City Department of Mental Health and Hygiene Asthma Initiative Facts.

“Asthma is the leading diagnosis that brings children into the emergency rooms,” said Dr. Adriana Matiz, who has a medical degree in pediatric care and is director of the Win For Asthma or the Washington-Heights Inwood Network program, a hospital-community partnership designed to improve outcomes for children uncontrolled asthma at the New York-Presbyterian Morgan Stanley Children’s Hospital.

But within the highly polluted region of New York City, asthma alley is at the core.

Many people have adapted to the air pollution. But others, like residents in Astoria Houses, have issues right in their homes that make dealing with asthma incredibly difficult.

“There’s never been a real study on our area to my knowledge,” said Claudia Coger, 75, a lifelong resident of Astoria Houses and President of the Astoria Houses Tenants Association.

Basic issues like mold, cockroaches and rodents, coupled with a lack of day-to-day care throw many children from Astoria Houses into severe asthma attacks. As a result they are constantly rotated though emergency rooms all over Queens like Jamaica Hospital, Mount Sinai Queens, and East Elmhurst Hospital.

“One time my grandson got real sick and was admitted to the ICU,” said Ocasio, a longtime resident of Astoria Houses and caretaker of her grandson.

“The doctor and I had a long talk, and she told me to go back and look at my home. And do you know what it was? Mouse droppings.”

It is commonly accepted that asthma is a disease that can be inherited, however the genes that are involved have not been scientifically identified, according to “Asthma: Causes” from National Jewish Health, the number one respiratory hospital in the U.S. according to U.S. News and World Report.

There is a large amount of evidence that supports environmental exposure as a primary cause of asthma. A large proportion of the racial/ethnic differences in asthma prevalence is caused by income, area of residence, and level of education, according to the article “Race, Socioeconomic Factors, and Area of Residence are Associated with Asthma Prevalence,” by researchers at the Channing Laboratory at Brigham and Woman’s Hospital in Boston.

“The best thing people can do is educate themselves about all the risk factors and try to avoid them, both for themselves and for any children they may have or be thinking of having,” said Amy Anaruk, creator of theasthmamom.com, a website that provides extensive information on asthma, and mother to an asthmatic child.

In other areas of New York City there are asthma programs that seek to make life easier for children and reduce asthma triggers in homes, educate parents, teachers and doctors to be more aware of asthma sensitivity.

In the South Bronx in particular, the high number of emergency room visits raised a red flag to doctors at New York-Presbyterian hospital. These doctors recognized that gaps in appropriate asthma care and support systems perpetuate health risks for asthmatic children and put stress on their families.

The hospital addressed the problem at the very core: inside the homes. In May 2006, NewYork-Presbyterian hospital, led by Dr. Matiz, initiated the Washington-Heights Inwood Network or WIN for Asthma program.

The program has community health workers work directly with families on a personal level, and help them with asthma education and referrals for services like housing and mental health.

“There was a genuine need to service the families of asthmatic children in northern Manhattan,” said Matiz. “There is nothing in place in Astoria at the moment but I would not hesitate to put support in place.”

The strength of the network is that it enables hospitals, clinics and doctors to engage families in the education process. In the long run everyone will be better equipped to deal with this disease on a daily basis.

Another resource is a manual on the New York City Department of Health and Mental Hygiene website that gives guidance to clinics to prepare for the adoption and implementation of the Creating a Medical Home for Asthma program, or CMHA, in the health care setting.

Like the WIN for Asthma program, this manual also encourages clinics to engage families in the education process.

Asthma education is hopeful because at the end of the day, asthma management programs will enable people to care for themselves. This care will not only improve the health of low-income children, it will alleviate the strain on Queens hospitals for all residents.

Now the help needs to come to Astoria.

“Around here it would be nice if there was a support group,” said Ocasio. “There’s a lot of parents with kids who get sick, and they don’t know what to do about it.”