Breath theft: How climate change is impacting asthma in Puerto Rico

Puerto Rico, a United States Caribbean territory known for its sunny climate and beautiful beaches will take your breath away, but for all the wrong reasons. With disproportionate rates of mold and asthma, the islands have a breathing problem. Difficulty breathing is nothing new to Puerto Ricans who suffer from an estimated 300% higher rate of children contracting respiratory ailments compared to their white non-Hispanic counterparts living in the continental United States. 

According to the US National Allergy Bureau’s scale, due to Puerto Rico’s tropical location, high humidity levels, and constant flooding, the territory suffers from extreme concentrations of fungal spores, ranging as high as 110,000 spores per cubic meter of air—nearly double the “very high” National Allegory Bureau benchmark. This spore growth has led to disproportionately higher rates of asthma among Puerto Rican adults whose asthma rates are currently 1.3 times higher than in the continental US. A similar trend has been identified in the islands’ children who are twice as likely to contract asthma when compared to their white non-Hispanic peers living on the mainland. According to Dr. Esteban Gonzalez Burchard, “Asthma is huge in Puerto Rico … compared to other populations, it’s extremely high”. 

According to the US Centers for Disease Control and Prevention, Puerto Ricans have 2.5 times the death rate stemming from asthma as those on the mainland. It’s no surprise that nearly 30% of children in Puerto Rico are diagnosed with asthma, a rate that increases by 40% among children living in public housing according to Dr. Floyd Malveaux. In addition, the islands’ children are unable to use the number one medication prescribed for asthmatics, Albuterol, because they do not respond as well compared to children with only European ancestry. 

Asthma is not just a health concern, but an economic one as well. It costs the US economy roughly $80 billion per year as a result of increased medical expenses, missed work or school, loss of productivity, and transportation expenses. The impact of this respiratory ailment is especially burdensome to the islands since 40% of residents live at or below the poverty rate. This not only reflects the heavy economic impact that Puerto Rico faces but also the territory’s inability to conduct large-scale studies of the sources of asthma and its implications which would cost millions of dollars. 

Although scientists have been researching for years to discover the root cause, most point to fungal spores as the culprit of this “breath theft.” In especially wet years, mold flourishes in Puerto Rico’s humid and wet climate. When the islands were struck by the heavy rains and flooding that accompanied Hurricane Maria in September 2017, the problem only grew. Four years later, Maria’s effects are still felt all across Puerto Rico, especially in the form of increased fungal growth and subsequent asthma rates. According to one study, within two months of Hurricane Maria’s landing, the mold spore count in Puerto Rico reached a record-setting 176,978 per cubic meter.  “Since Maria, we have had an average of over 50,000 spores per cubic meter during September to November, but also for the first time ever in December, January, February, and March,” said Benjamín Bolaños, a contributor to the same 2022 study. Dr. Bolaños noted that it may not just be Hurricane Maria, but rather, there may be other contributing factors including unusual increases in rainfall during the traditionally dry months of January and February have resulted in rising mold counts far exceeding 110,000 spores per cubic meter. The increase in rainfall during the dry months can be attributed to climate change as the planet warms and more hurricanes develop in the Caribbean. As a result, Puerto Rico will remain a target for tropical storms thereby increasing fungal growth and respiratory diseases. Global warming, coupled with a lack of planning, supplies, and funds when disasters strike will further exacerbate fungal growth leading to a continued increase of asthma among Puerto Ricans. 

Today, as climate change worsens and more hurricanes hit Puerto Rico, outbreaks of fungal spores and asthma will continue and worsen. According to two studies done in 2007 and 2009 by the territory’s Department of Health, every year an average of 25,000 asthma-related emergency room claims are filed, and nearly 90,000 Puerto Rican adults are unable to work and participate in regular activities yearly due to asthma. If this continues, Puerto Rico’s ‘breath theft’ will further undermine both its health and economic stability leaving the Islands’ residents vulnerable to future natural disasters and a vicious cycle of hurricanes, fungal spores, and asthma.