A variety of factors come into play when treating asthma—and environmental respiratory triggers go beyond the obvious.

Many interventions exist “to target the variety of exposures,” according to Elizabeth Matsui, MD, MHS, professor of pediatrics, Johns Hopkins University School of Medicine, in an interview. “There’s been a lot of controversy about whether [allergen exposures] are actually effective in terms of improving asthma symptoms and reducing asthma morbidity.”

Studies on the topic have yielded conflicting results, but one overarching theme Dr. Matsui pointed to was interventions reducing allergen exposure among pediatric patients are very effective.

“[Interventions] that are done in adults—or that don’t have a very robust effect on the allergen exposures in the home—are much less effective,” she explained.

Environmental impacts pose two primary challenges for physicians, according to Dr. Matsui.

“The biggest [challenge] is that there is no mechanism in our health care system or in healthcare payment models that exist now to provide the resources or support to families in acquiring the resources in order to implement some of these environmental interventions,” she said. These interventions can range from air purifiers to pillow and mattress encasements to pest control. Specialized bedding is not generally covered by insurance, and pest infestations are sometimes the result of a much larger problem (such as structural issues within the home) that warrant significant repairs.

“We have non-medical approaches to reducing asthma symptoms and morbidity in children, and yet there’s not a good mechanism to implement them,” Dr. Matsui said, adding that some environmental triggers affecting children have been in motion since before they were born. Looking back on history, Dr. Matsui said, structural racism has existed nationwide, and segregationally charged policies have played a large role because children in low-income, urban neighborhoods live in poor housing structures.

“Ultimately looking in a broader view at health disparities and asthma disparities, we will need policy interventions to address that very longstanding and deep-rooted problem,” Dr. Matsui concluded.