FEATURE
By Nayaab Punjani
A
sthma is an inflammatory lung condition that affects one in four Canadian children.1,2 Certain triggers may increase the incidence of asthma attacks - which involve wheezing and shortness of breath - resulting in hospital admissions.1 Currently, 2.3 million Ontarians are diagnosed with asthma, with 50 000 new cases in 2020 alone.2 These statistics prompted Dr. Teresa To’s research pursuit into the epidemiology of respiratory diseases, with an emphasis on childhood asthma. Dr. To is currently a professor of Biostatistics and Epidemiology at the Dalla Lana School of Public Health with an IMS cross-appointment. She is a Senior Scientist in the Department of Child Health Evaluative Sciences at The Hospital for Sick Children, while also serving as a Senior Adjunct Scientist for ICES, an organization that compiles databases examining patterns of healthcare access and use in Ontario. When Dr. Teresa To was first hired by ICES, no one was focused on pediatrics, so Dr. To partnered with The Hospital for Sick Children to study the conditions responsible for hospital admissions. While examining the data from emergency department admissions, she mentions, “One of the top reasons for children being admitted, 10 | IMS MAGAZINE SPRING/SUMMER 2021 PUBLIC HEALTH
was asthma…I repeated my analysis to ensure findings were accurate, and it came out the same and it sort of blew my mind, why would kids, even in the late 90s… be admitted for something so treatable?” Over the years she realized the situation is quite complex, requiring consideration of social determinants and access to Canada’s healthcare system. Dr. To’s research began through the examination of asthma epidemiology to understand factors relating to the incidence of cases, hospital admissions, and causes of death. Dr. To features findings of this research in a website known as OASIS–the Ontario Asthma Surveillance Information System (https://lab.research.sickkids.ca/oasis/). Dr. To found that one of the key factors contributing to asthma is socioeconomic status. Despite having universal health care access in Canada, we do not have a universal drug plan. She explains,
“Even if you have a drug to treat asthma, if you do not have the money or a drug insurance plan to pay for it, or do not have means to support adherence to the disease management, it is difficult to gain control of [a] condition like asthma.” Dr. To’s passion for health care access, policy, and environmental impacts fuel her
involvement as a Tier 1 Canada Research Chair for Asthma, and a Lead for the Environmental Health Platform of the Canadian Respiratory Research Network. The environmental focus of her work aims to examine the influence of air pollution on the exacerbation of asthma symptoms. One of her published studies found that when exposed to air pollutants, people with asthma were three times more likely to develop chronic obstructive pulmonary disease (COPD), also known as asthma-COPD overlap syndrome (ACOS), which is associated with worsened lung functioning and a significantly higher need for health care services.3 For children, Dr. To aimed to study early life exposures to air pollution and lung health, as the lungs continue to mature until the early 20s. Early life exposure to pollutants - such as nitrogen dioxide and ozone - resulted in a 17% elevation in the risk of asthma development among a cohort of newborns that were followed for an average of 17 years.4 Therefore, Dr. To suggests that being aware of the conditions of the ambient environment (such as air quality level and temperature) will help guide the time and level of outdoor activities. For example, simple lifestyle changes such as avoiding walking with children in high-traffic streets during poor air quality hours, may help protect these children’s delicate immature organs. Graphic design by Katrina Hass
