Glenn Ellis

*For many people the mere mention of the word “cockroach” makes one’s hair stand on edge. We associate these small insects with indoor dirt and decay, and we know how hard it can be to rid one’s home of an infestation of roaches once they settle in. But roaches are a fact of modern urban and suburban life. For some of us, exposure to roaches is an important cause of our asthma. For all of us, an important lesson can be learned from understanding the emerging information about the relationship between cockroach exposure and asthma.

Cockroaches are some of the nastiest bugs to have invading your home. In the summer, they present a much larger indoor problem than they do in the cooler spring and fall months. Too much heat outside actually drives the cockroaches indoors, causing them to seek out the moist areas of your home.

Cockroaches are insects with 6 legs and 2 pairs of wings that are common throughout the United States, but especially in the South and in crowded cities. Cockroaches give off proteins, mainly in their saliva and droppings, that trigger strong allergic reactions. In roach-infested apartments, these so-called antigens are densest in the kitchen, but they get tracked into other rooms and become ground into rugs and furniture.

Asthma is a growing concern in this country, particularly in inner-city African-American and Latino populations. Inner city children have the highest prevalence and the highest mortality rates for asthma in the United States. Children exposed to high levels of air pollution during their first year of life run a greater risk of developing asthma, pollen allergies, and impaired respiratory function.

The nasty, lowly cockroach has been found to be the leading cause of severe childhood asthma in the country’s poorest city neighborhoods, like those throughout Philadelphia, where asthma is worst.

Asthma is on the rise in cities and suburbs alike, but it is especially bad in the inner cities, with rates often double those found elsewhere. A major study attempted to learn the reason for this burden. It found that cockroaches are the most common trigger of inner-city asthma, and children who live in roach-infested homes have the most severe cases.

When most people think of allergy “triggers,” they often focus on plant pollens, dust, animals and stinging insects. In fact, cockroaches also can trigger allergies and asthma. In the 1970s, studies made it clear that patients with cockroach allergies develop acute asthma attacks. The attacks occur after inhaling cockroach allergens and last for hours. Asthma has steadily increased over the past 30 years. It is the most common chronic disease of childhood. Now we know that the frequent hospital admissions of inner-city children with asthma often is directly related to their contact with cockroach allergens—the substances that cause allergies. From 23 percent to 60 percent of urban residents with asthma are sensitive to the cockroach allergen.

To the surprise of many, as far back as 1997, a large study supported by the National Institute of Allergy and Infectious Diseases (NIAID) concluded that the combination of cockroach allergy and exposure to the insects is an important cause of asthma-related illness and hospitalizations among children in U.S. inner-city areas.

Now who can say they knew about this?

Asthma affects about 20 million Americans. Inner-city children (many of them disproportionately African American and Latino) suffer disproportionately from the disease, and exposure to high levels of multiple indoor allergens and tobacco smoke is a contributing factor.

Cockroaches live everywhere, but are found at higher levels in the older, multi-storied, and poorly maintained areas of the inner city. They’re a given in year-round tropical climates, but with the prevalence of central heating, roaches can live anywhere in any season. The older the housing the more likely there will be remnants of cockroaches. Studies show that 78 percent to 98 percent of urban homes have cockroaches. Each home has from 900 to 330,000 of the insects.

The study found that children who were both allergic to cockroaches and exposed to high cockroach allergen levels were hospitalized for their asthma 3.3 times more often than children who were allergic but not exposed to high levels of cockroach allergen, or children who were exposed to high levels of cockroach allergen but who were not allergic.

The scope of the health care problem caused by asthma lies not only in the large number of African Americans and Latinos with the disease, but also in the limitations that asthma can impose on daily life. Asthma is the leading cause of school absenteeism due to chronic illness and is the second most important respiratory condition as a cause of home confinement for adults. Each year, asthma causes more than 18 million days of restricted activity, and millions of visits to physicians’ offices and emergency rooms. A recent study found that children with asthma lose an extra 10 million school days each year; this problem is compounded by an estimated $1 billion in lost productivity for their working parents.

Children who were both allergic and heavily exposed to cockroach allergen also missed school more often, needed nearly twice as many unscheduled asthma-related medical visits, and suffered through more nights with lost sleep.

Cockroach allergy is more common among poor African Americans. Experts believe that this is not because of racial differences; rather, it is because of the disproportionate number of African Americans living in the inner cities.

Allergic reactions cause asthma symptoms to flare up. This can be annoying for some people and a medical emergency for others. You can help limit flare-ups by reducing contact with your known allergy triggers. Sometimes allergy medicine is prescribed for people with asthma who have allergies. Asthma is a chronic inflammatory disease of the airways that causes shortness of breath, tightness in the chest, coughing and wheezing. During an asthma attack, the airways narrow and become obstructed, making it hard for air to move through – thus making breathing difficult. Asthma can be very scary – and when not controlled, it can be life threatening.

Although allergies and asthma are separate entities, they are related. People who have allergies– particularly allergies that cause symptoms of the nose and eyes – are more likely to have asthma. About 75 percent of children with asthma also have allergies. Many people with asthma find their symptoms get worse when they are exposed to specific allergens. In addition, the conditions tend to run in families, so if you have allergies or asthma, your child is more likely to have one or both of the conditions.

At the end of the day, what makes the statistics about minority children and asthma remarkable is that there is actually no mystery to asthma management. This is not “rocket science”. As a society, we need to be committed to improving the living conditions, diets, and the ability to have adequate physical activity.  Even though we don’t know how to prevent asthma, we really do know how to control the symptoms.
Trivia Fact: There are approximately 5,000 species of cockroaches worldwide!

Remember, I’m not a doctor just sound like one.

Take good care of yourself and live the best life possible!

The information included in this column is for educational purposes only. It is not intended nor implied to be a substitute for professional medical advice. The reader should always consult his or her healthcare provider to determine the appropriateness of the information for their own situation or if they have any questions regarding a medical condition or treatment plan.

Glenn Ellis,  is a Health Advocacy Communications Specialist. He is the author of Which Doctor?, and is  a health columnist and radio commentator who lectures, and is an active media contributor nationally and internationally on health related topics.

His second book, “Information is the Best Medicine”, is due out in Fall, 2011.

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