Study finds ‘prevalent’ link between asthma, domestic violence

Researchers at a leading U.S. hospital for respiratory care say they have found a “prevalent and under-recognized” link between asthma and intimate partner violence after studying responses in the nation’s foremost survey on health risks.

Nearly two out of every five survey respondents who suffer with asthma reported that they also were being abused by a partner or had been hurt by one in the past, according to Dr. Eileen Wang, an allergist and immunologist at Denver-based National Jewish Health, which ranked as the No. 2 best hospital for pulmonology care in U.S. News & World Report’s 2021 ranking.

“Intimate partner violence is unfortunately a very prevalent issue, and this study demonstrates that it remains an under-recognized characteristic of uncontrolled asthma and poor asthma outcomes,” Wang said. “These results were evident even after accounting for confounding factors including socioeconomic status, smoking, and more.”

Wang was the lead author of a paper on the connection between asthma and intimate partner violence published in The Journal of Allergy and Clinical Immunology: In Practice, an official journal of the American Academy of Allergy, Asthma & Immunology.

Her team of four decided to delve into data from the Behavioral Risk Factor Surveillance System, which the U.S. Centers for Disease Control and Prevention launched in 1984 to survey Americans about health-related risk behaviors, chronic health conditions and use of preventive services.

Every year, through this surveillance system, the CDC has roughly 400,000 adult Americans interviewed by telephone about conditions that pose key public health concerns, but not every health condition is surveyed every year.

What particularly excited Wang and her colleagues was that, in 2005, the surveillance survey had questioned respondents on both intimate partner violence and asthma, Wang said. She had worked with survivors of domestic violence in the past and was keen to know whether there would be any overlap of the conditions among the 1,934 people who had answered those questions.

In addition to finding that there was an overlap, Wang said her team also discovered that people who reported a history of abuse were roughly twice as likely to report uncontrolled asthma or worse asthma symptoms than respondents with no such history.

What this means, Wang said, is that escaping the relationship does not automatically result in improvements in asthma symptoms or disease management.

Asthma is a respiratory condition in which airways narrow and swell when inflamed, compromising a person’s ability to breathe in oxygen, according to the CDC, and those who suffer with it experience chest pain, coughing and wheezing during attacks. It can be life-threatening.

One in 13 Americans suffer with asthma, according to a recent online presentation by the CDC’s Dr. Joy Hsu, and about 10 people in the U.S. die daily as a result of the disease. Each year, she noted, roughly 1.7 million visits to emergency departments and 439,000 hospitalizations are related to the illness.

The CDC estimates that asthma accounts for roughly $82 billion in medical costs, missed school and work days and early deaths, said Hsu, the acting chief medical officer for the CDC’s Asthma and Community Health Branch.

The CDC survey data point to a group of people whose overall health could be compromised because doctors don’t know about or don’t sufficiently understand the connection, Wang said. She said she hopes that her research will raise antennae in the health care community and spur further research about the relationship between both these health challenges.

“Health care professionals should consider these factors while working with their patients, and how violence in the home could be impacting chronic health conditions such as asthma,” she said.

Beth Hassett, a veteran Sacramento-area advocate for people in abusive relationships, said that her agency, WEAVE Inc., has long urged health providers to institute a policy that ensures patients will be seen alone to give them a chance to report domestic violence.

Roughly two of five women and one in five men in the 2005 CDC survey reported having experienced intimate partner violence, Wang said. Domestic violence affects people of all income levels, races, religions, genders and sexual orientations, Hassett and other experts have told The Bee.

Wang noted that health care leaders should also recognize that the very nature of the medical system, with a hierarchy based on status and authority, may pose an obstacle to reporting for people who are being abused by their partners. WEAVE’s Hassett noted that her agency has embedded counselors in health care settings and police agencies to consult with individuals believed to be at risk.

Because intimate partner violence also has been associated with a risk of traumatic brain injury, Wang said, patients may face challenges adhering to their doctor’s directions on medications. Abuse may include physical injuries from blows and strangulation.

In a report to Sacramento County supervisors earlier this year, Joyce Bilyeu of the Sacramento Regional Family Justice Center noted that strangulation, or choking, has become a common tool among those inflicting harm, yet it is one that many victims may not recognize or report as abuse. Choking can result in some serious symptoms such as loss of memory or consciousness, medical experts say.

While asthma attacks often are associated with poor air quality, dust, allergens or infections, Wang noted that stress and even community violence also have been linked to flare-ups with the disease.

“We’ve evolved in our understanding of asthma. Asthma is a very diverse disease state,” she said. “It’s no longer a one-size-fits-all type of asthma.”

Plenty of asthmatics take their medication as directed and control the allergens in their environment, Wang said, but they still end up with debilitating attacks. It’s time that research looked further into other potential triggers, Wang said.

6 strategies for asthma control

Dr. Joy Hsu with the U.S. Centers for Disease Control and Prevention offers up six evidenced-based strategies that can help people with asthma control their condition. It’s part of the agency’s EXHALE initiative.

Educate yourself about what asthma is, what can cause it, how to use medication to control symptoms and how to reduce triggers.

X stands for extinguishing smoking and exposure to secondhand smoke. Tobacco smoke is one of the air pollutants that can cause asthma attacks.

Home visits: While not everyone will need help at home, people who have had an ER visit or hospitalization could benefit from having a health professional assess potential causes in the home.

Achieve proficiency at managing your medications. Find a physician who will prescribe your medications according to medical guidelines. Ensure you always have access to your medication and adhere to directions on how to take it.

Link people with asthma to both health care and community services they need to control their disease. Establish and maintain a line of communication between those groups to support the person with asthma.

Environmental policies: Follow and advocate for practices that will reduce asthma triggers from indoor, outdoor and occupational sources. Would your home qualify for no-cost or low-cost programs that would update energy efficiency? Could you advocate for a smoke-free policy in your apartment building or clean-energy buses at your child’s school? Does your employer know that certain products can trigger asthma attacks?

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Cathie Anderson covers health care for The Bee. Growing up, her blue-collar parents paid out of pocket for care. She joined The Bee in 2002, with roles including business columnist and features editor. She previously worked at papers including the Dallas Morning News, Detroit News and Austin American-Statesman.