What is the reason for the recent increase in asthma cases in Wisconsin?

Increased Asthma in Wisconsin: Environmental and Lifestyle Factors

The recent increase in asthma cases in Wisconsin is primarily due to air pollution exposure, including traffic-related emissions and industrial sources, combined with seasonal environmental triggers and high obesity rates in the population. 1

Environmental Factors Contributing to Wisconsin's Asthma Increase

Air Pollution

• Research shows that Wisconsin residents exposed to higher levels of fine particulate matter (PM2.5) have significantly increased odds of asthma, with a 5μg/m³ increase in annual mean PM2.5 resulting in 3.58 times higher odds of having asthma 1
• Living within 300m of an interstate highway is associated with a 3-fold increase in asthma risk 1
• Proximity to industrial sites (within 800m) increases asthma likelihood by 47% 1

Indoor Environmental Triggers

• Water-damaged buildings and homes contribute to increased respiratory symptoms including asthma 2
  • Dampness promotes dust mites, endotoxin, and fungal components (glucans)
  • These can trigger IgE antibody-mediated responses causing allergic rhinitis and asthma
  • Mucous membrane irritation from endotoxin or fungal glucans can directly cause cough and asthma symptoms

Seasonal Factors

• Wisconsin's climate conditions may be exacerbating asthma triggers:
  • Outdoor air pollutants like ozone can increase airway inflammation and trigger asthma symptoms 2
  • Individuals with poorly controlled asthma are particularly susceptible to these effects
  • Fungal spores, which are common in the Midwest, can trigger asthma episodes 2

Population Risk Factors

Obesity Epidemic

• Obesity is strongly linked to asthma development and severity 2
• Over 75% of patients visiting emergency departments for asthma are obese or overweight 2
• The relationship between obesity and asthma is particularly strong in females, with an estimated 28% of asthma developing in women after age 9 attributable to being overweight 2
• Obesity-related asthma may be mediated through:
  • Chronic low-grade systemic inflammation
  • Increased serum leptin (a pro-inflammatory cytokine)
  • Mechanical effects on lung function

Demographic Disparities

• Wisconsin has significant disparities in asthma prevalence:
  • African American residents have asthma hospitalization rates 6.6 times higher than whites 3
  • Milwaukee County has the highest county-specific asthma hospitalization rate in the state 3
  • Children aged 0-4 years have the highest asthma-related hospitalization rates 3

Management Gaps Contributing to the Problem

• Wisconsin's asthma management falls short of meeting national guidelines 4
• Over 80% of Wisconsin adults with asthma reported experiencing symptoms in the past 30 days 4
• 14% of asthma patients reported emergency department visits in the past year 4
• Key clinical management activities that need improvement include:
  • Proper classification of asthma severity
  • Scheduling routine follow-up care
  • Recommending measures to control asthma triggers
  • Treating or preventing comorbid conditions 4

Occupational Considerations

• Work-related asthma is a significant contributor to adult-onset asthma (10-23% in the United States) 2
• Occupational exposures to sensitizing agents or irritants can cause new-onset asthma or worsen existing asthma 2
• Wisconsin has industries with known asthma-inducing exposures, including:
  • Manufacturing with chemical exposures (isocyanates, acids)
  • Healthcare settings (cleaning agents, latex)
  • Agriculture (animal proteins, grain dust)

Increased Susceptibility to Infections

• Asthma is associated with a form of immunodeficiency that increases susceptibility to respiratory infections 5
• Infections can both trigger asthma exacerbations and promote disease progression 5
• This creates a cycle where asthma predisposes to infections, which further worsen asthma control

Recommendations for Addressing Wisconsin's Asthma Increase

1. Implement stronger air quality monitoring and regulations, particularly near high-traffic areas and industrial zones
2. Develop public health campaigns about indoor environmental controls, especially regarding dampness and mold
3. Improve clinical asthma management through provider education on guideline-based care
4. Target obesity prevention and treatment programs as part of asthma management
5. Address disparities through targeted interventions in high-risk communities
6. Enhance occupational health surveillance and workplace controls for asthma-inducing exposures
7. Improve vaccination rates and infection prevention strategies in asthmatic patients

The Wisconsin Asthma Plan provides concrete steps for improving provider and patient asthma management to reduce this growing burden 4.