The mission of the U.S. Environmental Protection Agency (EPA) is to protect human health and the environment. Working from this mission, EPA contends with a wide array of activities, including not only regulatory activities, but also scientific research and development. Because basic science shows us that an unhealthy environment leads to unhealthy citizens, it is no surprise that most environmental laws are ultimately designed to protect human health.
EPA is considering ways of placing the results of its scientific research with people who can use it. A recent prototype initiative sought to explore the relationship between EPA?s research and the medical community. Specifically, EPA science related to asthma was compiled, organized and presented to the University of Texas Southwestern Medical School in Dallas, Texas (Southwestern). The project explored the need for transmitting results of science, as well as discussed opportunities that could exist between EPA and the medical community. More importantly, the project was designed to help introduce EPA science to the medical community in ways that would benefit patients and serve to meet hospital research needs.
According to the Centers for Disease Control and Prevention, more than 20 million Americans have been diagnosed with asthma. The impact of asthma can be reduced by avoiding exposure to substances or conditions that may trigger asthma, working with medical professionals, and improving education about the disease. The Dallas/Fort Worth area has a population of approximately 6 million, with nearly 500,000 asthmatics.
While Southwestern is a nationally recognized medical facility, it primarily serves the Dallas/Fort Worth Metroplex. To combat asthma, the facility has established the Inner City Asthma Study, where medical doctors have worked to enlighten both medical students, residents, and patients about environmental interventions with asthma. A review of the non-EPA scientific literature suggests that some information exists concerning environmental conditions relating to asthma, but completed and on-going EPA research concerning environmental triggers for asthma totals over $25 million in EPA grants over the last decade. In addition, approximately three dozen studies are being conducted in EPA laboratories. Using Southwestern as a prototype, EPA sought to explore the positive implications of bringing these many asthma-related studies to the attention of the medical community.
EPA?s Asthma Research
Asthma episodes are often the result of exposure to certain environmental contaminants and conditions. During the fall of 2002, EPA released an asthma research strategy, which describes the agency?s approach to asthma research. In part, EPA seeks to identify the many environmental contributors that can cause asthma. A closer look at a few of the EPA studies illustrates how this research is of interest to the medical community.
EPA?s Science To Achieve Results (STAR) program has provided approximately $25 million in funding to 80 projects studying asthma, many of which address children?s health.
Within EPA, scientists are currently studying the impact of automobile emissions on asthmatic children in El Paso, Texas. The experiments compare traffic density data and correlate it over time to other variables, for example, home dampness, mold, exposure to cigarette smoke, gas stoves and pets.
Other EPA laboratory studies follow a variety of research topics, ranging from the respiratory impact of airborne particles ("soot and dust") on children living in urban environments to the development of management programs for reducing the risks of asthma in children. For example, working with families in Boston EPA scientists are assessing the development of a home intervention study in public housing. Further efforts are utilizing technologies to identify various contaminant species that can trigger asthma, while other scientists' study the economics associated with asthma-related medical costs.
The agency funds research grants to universities and research centers through EPA?s Science To Achieve Results (STAR) program. As noted above, $25 million has funded close to 80 projects studying asthma, many of which address children?s health. For example, the University of California and the University of Massachusetts are attempting to better answer questions related to what steps one can take to prevent asthma triggers in the household. EPA funding to several sets of researchers (including Emory University, the Fred Hutchinson Cancer Research Center and New York University) supports an examination of the relationships between asthma-related emergency room visits to daily outside air pollution monitoring data. Related studies identified soot and dust as dramatically impacting the ability to breathe, while ozone exposure was associated with specific airway inflammation and cell injury (which is also a common lung response to cigarette smoke).
The Anatomy of Asthma
In another example, Michigan State University researchers are using rodents to assess the impact of soot and dust on the lung, while the Harvard School for Public Health is using mice to study the effects of ozone on airway hyper-responsiveness (a condition in which the functioning of human lungs is impacted), both thought to be possible environmental triggers for asthma in humans. One conclusion found that breathing high levels of air pollution could cause sensitivity to allergens. Building on other studies, scientists at the University of California, Berkeley, concluded that asthmatic children more often use inhalers during the spring season on days when ozone levels were elevated.
Other universities, such as the University of California at Los Angeles, are studying the automobile, truck and bus emissions related to the different sizes of soot, hoping to link this information with airway inflammation for people who live near freeways. A related study concluded that lung function is related to the different particle sizes of dust, soot, and smoke.
Beyond the highly technical science projects related to the impact of air pollution on public health and asthma, Columbia University received an EPA grant to prove that a well-designed community education program -- especially aimed at mothers with infants -- will raise awareness towards preventive behavior, reducing the risk of asthma. Researchers at Johns Hopkins University seek to recommend procedures modifying inner city homes to reduce environmental exposures and the related asthma triggers.
Southwestern -- The Prototype
Educating the medical community is vital in the prevention of asthma, since it is often the doctors and nurses who can most easily instruct patients on simple precautions to be taken at home. Because EPA is mostly viewed as conducting "environmental" sciences, many medical doctors overlook the opportunities and benefits to be derived from EPA?s study of environmental factors that relate to disease. Referring to the adage that unhealthy environments yield unhealthy citizens, one doctor at Southwestern commented, "It makes sense that EPA engages in such research, and hospitals should become more aware of EPA science related to preventive techniques for asthma."
Whether the research is in EPA laboratories or in EPA grant-funded studies, universities across the United States and top EPA scientists have significantly contributed to the scientific knowledge related to asthma.
Throughout the spring of 2003, EPA representatives visited with medical doctors and research associates in Southwestern?s Inner City Asthma Study. The University?s asthma group serves several purposes. First, it is a hospital staff treating patients with asthma. Second, it serves as a teaching staff associated with a medical school, and third, it is a nationally recognized medical research facility. Keeping up with all the available research is a tremendous undertaking for the hospital. However, staying abreast of current scientific literature addressing asthma provides material for educating medical students, and provides for the most current advice that can be provided to patients. A related benefit for the medical research facility is that by becoming aware of EPA?s grant process, a possible new source of funding for research can be established for environmentally relevant work.
More meetings between EPA and Southwestern may prove fruitful. The concept of public outreach into the medical community is new to EPA and the idea will be analyzed further by the agency. Likewise, the notion of incorporating EPA science into the medical community?s teaching and practice is new for many medical facilities. Regardless, Southwestern believes that knowing more about EPA science will be of benefit to its programs, and could become important to medical centers across the nation.
Beyond Medical Doctors
While the medical community is a potentially enormous end user of EPA science, such applied studies can also help in the prevention of asthma by providing important research to other groups. Greater interaction with builders, transportation and urban planners, and architects and engineers could help benefit communities. For example, buildings and homes could be designed in ways that reduce exposures to the environmental triggers affecting asthma. Studies discussing highway planning and placement within communities could also serve to aid in smart growth plans, removing future populations from environmental triggers, which exacerbate asthma in susceptible individuals. Additionally, hospital planners and health insurance professionals may be able to utilize research in ways that can maximize health benefits and save insurance dollars. Most importantly, by educating patients and clients on methods to avoid environmental triggers, asthma impacts such as emergency room visits could be reduced, as well.
EPA funded research is extensive and relevant to the prevention and study of environmentally induced asthma triggers. Whether the research is in EPA laboratories or in EPA grant-funded studies, universities across the United States and top EPA scientists have significantly contributed to the scientific knowledge related to this subject. Although the exchange between the University of Texas Southwestern Medical Center and EPA was an exploratory prototype, it shows that a potential market exists in the mass application of health-related environmental science. Only time will tell the true benefits of such an exchange, but the foundation is set for Southwestern to consider EPA science in its day-to-day dealing with the challenge of asthma.
The author would like to acknowledge the following contributors: Michael Brown, Sarah Bauer, Ann Brown, Michael Callahan, Dr. Evelyn Daniels, Robert Fegley, Dr. Jane Gallagher, Dr. David Klauder, Maryellen Radzikowski, Dr. Erik Svendsen and Estella Waldman.The author also would like to thank Southwestern's Inner City Asthma group.
This article originally appeared in the 09/01/2003 issue of Environmental Protection.