‘What are these kids breathing?’

OTTAWA-A decade ago, Dr. Thomas Kovesi, a lung disease specialist at the Children’s Hospital of Eastern Ontario, didn’t know much about Baffin Island.

So he was dumfounded by the hospital’s sudden influx of seriously ill children from the eastern Arctic after CHEO assumed responsibility for the region in the late-1990s.

Kovesi worried about the dislocation suffered by his Inuit patients and about the hospital’s ability to deal with so many respiratory tract infections.

“My first reaction was, ‘Help!,” he recalls. “I felt we had to figure out why they were getting so sick and fix it.”

So began what Kovesi calls the most important research of his career. For the past 10 years, he has sought to explain why the children of Baffin Island have the world’s highest rates of hospitalization for pneumonia, bronchiolitis and other lower respiratory tract infections.

In Ottawa, an average of 10 infants out of every 1,000 babies born in the city are admitted to CHEO with serious lung infections. On Baffin Island, hospitalization rates for infants are vastly higher: as many as 484 infants out of every 1,000 are admitted to hospital, according to a study published in 2001 by Canadian researcher Dr. Anna Banerji.

The study confirmed Kovesi’s impression that lung disease was rampant in the North and left him wondering, “What are these kids breathing?”

It was well known that Nunavut had high smoking rates, but Kovesi was convinced the problem had to go beyond that since parts of Asia and Africa had similar smoking rates, but not the same kind of pediatric lung disease.

So he led a research team that set about testing air quality inside Nuvavut’s homes. In one study that tested air quality inside 49 homes in four Baffin Island communities, he recorded smokers in 94 per cent of residences.

“Exposure to environmental tobacco smoke was nearly universal,” the 2007 study, published in the Canadian Medical Association Journal, concluded.

What’s more, the study found that the homes tended to be tightly sealed and poorly ventilated, which increased the concentration of environmental tobacco smoke, carbon dioxide and airborne viruses such as RSV. Respiratory syncytial virus, or RSV, is a common respiratory virus that infects lungs and breathing passages. Most healthy people recover from RSV within weeks, but the virus can cause bronchiolitis — inflammation of the small airways in the lung — and pneumonia in infants.

The CMAJ study found that reduced ventilation was associated with an increased risk of serious respiratory infections in Inuit children.

The average home in Nunavut is about three times smaller than the typical Ottawa house, but serves twice as many people. Most homes in the territory have six people or more living in them.

“I think that is a big piece of this because proximity transmits viruses,” says Kovesi.

CHEO still treats an average of 150 Inuit children every year from Nunavut, a number that has changed little in recent years.

Kovesi believes the territory’s chronic housing shortage must be addressed alongside its smoking epidemic, which combine to put Nunavut’s children at risk. (There is no known “safe level” of exposure for children to tobacco smoke, he notes.)

In addition to those measures, Banerji believes more must be done to support the health of Nunavut’s mothers and their infants.

She wants the federal government to subsidize the cost of healthy food for mothers — fruits and vegetables are often twice as expensive in Nunavut — and establish wellness centres. She argues, too, that all Inuit infants in communities outside of Iqaluit should receive injections of palivizumab, a prescription medication that contains virus-fighting antibodies to RSV.

Progress is being made on the housing front.

Nunavut has added 725 homes in the past three years, and the federal government recently pledged another $100 million to expand the housing stock. New homes are also being equipped with heat recovery ventilators, which have been shown to improve indoor air quality.

Says Kovesi: “If you can separate people it will help a lot of things — and infections disease is one of them.”