Extreme Weather Impacts and Interventions for Childhood Asthma

Children represent a critically vulnerable, yet understudied, population within the context of extreme weather and health. They are more susceptible to environmental exposures because of their rapid growth, dynamic developmental programming, compromised thermoregulatory function, and the necessity of breathing more air relative to their body weight than adults. Asthma is the most common chronic lung disease in children and adolescents. Some environmental exposures that are worsening over time, such as air pollution, are associated with pediatric asthma exacerbations, while others, such as extreme heat and precipitation, have had mixed evidence for an association with asthma exacerbations. This may be because other clinical and social determinants play a role in this relationship or because of imprecise exposure characterization. Thus, understanding the interplay between social, environmental, and clinical factors is critical to identifying pediatric populations most at risk for extreme weather-induced asthma exacerbations and designing strategies to mitigate this risk. While a variety of interventions have been undertaken in communities across the U.S. to mitigate the impacts of extreme weather (e.g., green infrastructure for extreme heat and flooding), there is a dearth of rigorous evidence on their effectiveness to mitigate adverse health outcomes, particularly related to childhood asthma. The research project “Extreme Weather Impacts and Interventions for Childhood Asthma” will (1) estimate the association between extreme heat, air pollution, and extreme precipitation/flooding on pediatric asthma exacerbations, as individual exposures and compound events, for all children in the Baltimore metropolitan area; and b) determine how the associations vary by demographic and neighborhood determinants of health; (2) assess the impact of extreme weather intervention strategies (vacant lot greening, street tree planting, and cool roof installation) on pediatric asthma exacerbations; and b) quantify the number of asthma exacerbations avoided through implementation, based on current and future conditions; and (3) Define individual-level risk profiles and protective factors that confer susceptibility or resilience to asthma exacerbations associated with single and compound extreme weather events leveraging granular individual-level clinical, biologic, physiologic, social, and environmental data available through the electronic health record of children. This project brings together a transdisciplinary team of researchers and capitalizes on multiple rich data sets of pediatric patient outcomes, exposures, and interventions. Our focus on understanding how adaptive strategies can mitigate the health risk posed by extreme weather-related exposures is solutions-based and will produce evidence that can inform recommendations public policy and clinical practice.