Three national health groups: Report — Asthma prevalence, high related costs likely to worsen in Wisconsin if Congress blocks Clean Air Act updates

New Analysis Shows Over $1 Billion in Asthma Costs, Over 500,000 Cases, Including 123,000 Children; Over 14,000 Annual Pediatric ER Visits and Hospital Visits Each Year in State.

WASHINGTON, D.C. – In a major first-ever report analyzing detailed asthma incidence and cost data, Health Care Without Harm (HCWH), the Alliance of Nurses for Healthy Environments (ANHE) and the National Association of School Nurses (NASN) conclude that the already staggering human and financial toll of asthma in Wisconsin is likely to increase if Congress acts to stop important updates to the Clean Air Act.

Over 500,000 Wisconsin residents — including 123,734 children – suffer from asthma, with direct costs of treating Wisconsin’s worsening asthma epidemic already exceeding $1 billion, according to the report. The report also finds that several members of Wisconsin’s Congressional delegation – Reps. Ryan, Kind, Sensenbrenner, Petri, Duffy, Ribble, and Sen. Johnson- have signed on as co-sponsors or voted for legislation to block needed updates to the Clean Air Act.

This week, the US House is scheduled to vote on Energy and Commerce Chairman Fred Upton’s bill to block EPA from reducing carbon pollution and the Senate may vote on one or more amendments that would block or delay EPA’s efforts. At the same time, Congress is negotiating with the White House to continue funding the federal government with a new spending measure, onto which some members of Congress hope to attach EPA-blocking “riders” that would also prevent the agency from reducing pollution.

The HCWH/ANHE/NASN report states: “Science has established that air pollution from cars, factories, and power plants is among the major causes of asthma episodes. Air pollutants that can contribute to asthma include ground-level ozone smog, sulfur dioxide, particle pollution, and nitrogen oxides Carbon dioxide pollution can also worsen asthma in several ways, such as by driving climate change (rising temperatures increase ozone smog concentrations) and by increasing production of airborne allergens like ragweed pollen (which is another trigger for asthma episodes). Legislation that would greatly reduce the authority of the Environmental Protection Agency (EPA) to reduce these air pollutants under the Clean Air Act would prevent improvements in air quality – stopping reductions in emissions of carbon dioxide, fine particles, soot, and other pollutants – and would make it harder for children and adults with respiratory problems such as asthma to breathe.”

The report is based on asthma prevalence and cost data from the American Lung Association and the Centers for Disease Control and Prevention and relevant peer-reviewed literature. Compiled by the consulting firm David Gardiner & Associates, the new report, titled “The Economic Affliction of Asthma and Risks of Blocking Air Pollution Safeguards,” outlines the cost of asthma for all 50 states. The report and related Wisconsin fact sheets are available online at

How bad are things for people with asthma today in Wisconsin and how much worse could things get?

* Number of Wisconsin adults with asthma: 401,531.

* Number of Wisconsin children with asthma: 123,734.

* The five Wisconsin counties with the most asthma cases today are: Milwaukee, Dane, Waukesha, Brown, and Racine.

* Pediatric emergency room visits in Wisconsin due to asthma: 12,250.

* Pediatric hospital stays in Wisconsin due to asthma: 1,980.

* Estimated direct cost of asthma in Wisconsin: $1.06 billion.

Nationwide, the report shows:

* More than 688,000 children had to go to the emergency room because of asthma in 2008.

* Asthma episodes keep children out of school (accounting for about 10.5 million lost school days in 2008) and take adults out of the workplace (accounting for more than 14 million lost work days in 2008).

* Asthma was responsible for nearly 2 million emergency-room visits in 2007. In severe cases, asthma episodes can be deadly; in 2007 alone, more than 3,400 people in the United States died as a result of asthma.

* The total estimated incremental direct cost of asthma in the United States is more than $53 billion a year. Who bears these costs? According to the U.S. Department of Health and Human Services’ Agency for Healthcare Research and Quality, almost 15 percent of the costs are paid out-of-pocket by the patient. That is equivalent to just under $8 billion a year. Private insurance covers more than 38% of the costs, equivalent to more than $20 billion a year. That leaves almost half of the cost of the asthma epidemic to be paid by taxpayer-funded federal programs such as Medicare and Medicaid.

According to a recent EPA analysis, the Clean Air Act amendments of 1990 currently prevent 1.7 million cases of asthma exacerbation and by 2020 will prevent 2.4 million. By blocking the EPA from making additional needed updates today, federal lawmakers would be allowing increases in soot, smog, carbon, and other air pollution that would cause asthma incidence to increase. The cost of these additional cases would also increase the taxpayer bill, and could lead to an increase in private insurance costs as well as increased out of pocket expenses.

Brenda Afzal, MS, RN, U.S. climate policy coordinator, Health Care Without Harm said: “Congress is literally talking here about taking the breath away from millions of American children and adults. Because they have a disease that is very susceptible to pollution, Americans with asthma provide members of Congress with 24 million compelling reasons for the EPA to be allowed to proceed with needed updates to federal Clean Air Act standards. By siding with polluters and against their constituents with asthma, Congress is ignoring the public health and financial implications of pollution-related illness. That’s why we were pleased to hear President Obama restate his opposition to these proposals and attempts to insert them into the budget debate. We think it is vitally important for Americans to understand what is at stake if these attempts to prevent the EPA from modernizing the Clean Air Act succeed.”

M. Kathleen Murphy, DNP, RN, FNP-BC, nurse and member of NASN, WI affiliate, and a member of the NASN board of directors said: “Students miss more than 10 million school days a year because of asthma. School attendance is strongly correlated with academic success and graduation, and so additional days lost will add to the toll asthma takes to not only its patients, but our society. With cleaner air, we could reduce the costs associated with asthma attacks, funds that could be better used toward education and wellness programs, to make sure all children succeed academically.”

According to Barbara Sattler, RN, DrPH, FAAN, the chair of the board of the Alliance of Nurses for Healthy Environments, “Nurses work every day with Americans dealing with asthma, a chronic, sometimes debilitating condition that affects millions of children and adults. The extent of the asthma epidemic and its related costs outlined in this report are staggering. Nurses are profoundly distressed about congressional efforts that would prevent improvements in air quality that have a direct affect on both people with asthma and what they must pay for care.”


Science has established that air pollution from cars, factories, and power plants is a major cause of asthma attacks. A research study published in 2002 estimated that 30 percent of childhood asthma is due to environmental exposures. Studies also suggest that air pollution may contribute to the development of asthma in previously healthy people. Key air pollutants that trigger asthma include ground-level ozone, sulfur dioxide, particulate matter, and nitrogen oxide.

Carbon dioxide pollution can also worsen asthma. One of the best-documented impacts of climate change is an increase in ground-level ozone smog concentrations, in response to rising temperatures (the hotter the temperature and the more incident sunlight, the more ozone tends to form). In 2004 and 2007, a multi-disciplinary team of experts showed that warming temperatures will cause more days with unsafe ozone levels.


Despite the negative impacts of air pollution on public health, there are several Congressional measures that would prevent improvements in air quality. During the week of April 4, several votes to block the EPA are in motion, and some members have been working to add EPA-blocking language to a new budget deal that has to be worked out this week in order to prevent a government shut-down.

The House is expected to vote on Energy and Commerce Chairman Fred Upton’s bill that would block the EPA from reducing carbon pollution. The bill, HR 910, would also throw out the EPA’s scientific finding that carbon is a health-threatening pollutant.

In the Senate, several proposals to block or slow down the EPA’s plans to reduce carbon pollution are being offered as amendments to the unrelated small business bills the Senate is expected to debate this week.

* Senate Minority Leader Mitch McConnell is using Upton’s HR 910 as an amendment. Like the original, it would permanently repeal the Clean Air Act’s authority to set limits on GHG pollution, threatening the CAA’s health benefits and increasing our dependence on foreign oil.

* Senator Jay Rockefeller has introduced an amendment that would delay implementation of EPA’s GHG standards for stationary sources under the clean air act for at least 2 years. Blocking EPA from updating Clean Air Act safeguards with new standards to reduce emissions of life-threatening pollution from power plants and other major sources– whether initially just one year or two – will be extended again and again.

* Senator Debbie Stabenow has introduced an amendment that would block enforcement of carbon pollution safeguards for two years, prevent accurate accounting of emissions from agricultural activities and allow large emission sources to be built or modified with no requirement to limit their carbon pollution.

* Senator Max Baucus Amendment: Would prevent accurate accounting of emissions from agricultural activities as well as allow large emission sources to be built or modified with no requirement to limit their carbon pollution.


Health Care Without Harm is an international coalition of more than 430 organizations in 52 countries, working to transform the health care industry worldwide, without compromising patient safety or care, so that it is ecologically sustainable and no longer a source of harm to public health and the environment. For more information see

The National Association of School Nurses is the expert voice for optimal student health and for professional development of school nurses. NASN believes every child should have access to a school nurse all day, every day. The National Association of School Nurses supports the health and educational success of children and youth by developing and providing leadership to advance school nursing practice by specialized registered nurses. For more information see

The Alliance of Nurses for Healthy Environments, launched in 2008 by a group of national nurse leaders from several nursing sub-specialties, works to promote healthy people and healthy environments by educating and leading the nursing profession, advancing research, incorporating evidence-based practice, and influencing policy. For more information see