Coping with asthma

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Coping with asthma

Millions must focus on struggle to breathe

5-04-99

By Starr, Post staff reporter

Even on her good days, a Pryor takes her medicine. She breathes in

medication from two different inhalers, she uses a nasal spray to open her

sinus passages and she takes a pill. She also checks her ''peak flow,'' to

see how much oxygen she can force out of her little lungs.

She says hello to the family dog from afar, stores her clothes in sealed

plastic tubs and - as long as her lungs are working well - rides her bicycle

around her Madisonville neighborhood, practices with her drill team and goes

to school like any other 11-year-old.

But on her bad days, a suffers. She can't breathe easily. Her chest

feels as if someone is punching her. She breathes into a special machine

that sends vapors and medication into her lungs. She stays home from school.

About every six weeks or so, her mother rushes her to the emergency room.

Occasionally, the hospital admits her.

Like more than 14 million other American children and adults, a Pryor

has asthma.

''An apple a day does not keep the doctor away,'' she says.

But a, whose asthma is severe, is far from just a statistic. Her life is

focused around a costly and time-consuming war against a serious illness.

Her medication alone costs $300 a month. In the first three quarters of the

current school year, she was absent 32 days. Her mother, Vicki Bush, missed

an equal number of days of work.

Asthma, an inflammatory disease affecting the airways of the lungs, is

complex, incurable and rampant, and scientists do not completely understand

its causes. It affects 6 percent of all Americans, and there are 25,000 new

cases of asthma every year. More than 5,000 Americans can be expected to die

from asthma in 1999, and children can expect to miss more than 10 million

school days.

One-third of asthma sufferers are children under 18, and African-Americans

are especially hard hit. About 60 of every thousand African-Americans has

asthma (compared to 50 of every thousand whites). African-Americans also are

three times more likely than whites to die from the disease.

''The overall incidence of the disease has increased dramatically within the

last 30 years,'' said Dr. Bernstein, an allergist and clinical

immunologist at the University of Cincinnati Medical Center, during a

regional symposium on environmental health earlier this year. ''There has

been almost a quadrupling of cases of asthma in the United States and other

parts of the world.'' The disease is on the increase in developing and

industrial countries alike, even in areas where there is little air

pollution.

In 1997 the National Institutes of Health set ambitious guidelines for

asthma care, but they are far from being met. In 1998 the direct health

costs of asthma were $7.5 billion, according to the American Lung

Association. Lost productivity among adults was another $4.5 billion, while

lost productivity of parents of children with asthma exceeded $1 billion.

The tendency to develop asthma is in part genetic. According to

Leikauf, a researcher and director of the toxicology division at UC's

Department of Environmental Health, one major gene accounts for 20 percent

of asthma cases. But environmental factors also are at work. Leikauf said

the remaining 80 percent of asthma cases involve genes that have been

''turned on by environmental exposure.''

''If you look at identical-twin studies, even though the twins have same

genes, the concordance rate for developing asthma is only 50 percent,'' said

Dr. Lierl, a professor in the division of allergy and immunology at

Children's Hospital Medical Center.

Allergies, close cousins of asthma, also play a role. More than 80 percent

of people with asthma also have allergies, according to the Lung

Association, and people with allergies are more likely to develop asthma

than those without. Though allergies are often inherited, the chance of

developing an allergy increases the more often a person is exposed to the

allergen.

There is speculation, according to Dr. Lierl, that immunizing children

against childhood diseases has made them more susceptible to developing

allergies.

Can asthma be prevented in some people by minimizing exposure to allergens?

Scientists are pursuing that question with vigor. In particular, they are

trying to determine whether the development of asthma can be prevented by

limiting exposure to dust mites, microscopic insects that feed on the scales

of human skin. Some research suggests that people who have exposure to high

numbers of dust mites early in life have an increased chance of getting

asthma.

''We know the dust mite is an important allergen,'' said Dr. Lierl. ''There

is almost universal exposure to it, but there are some high-altitude, dry

climates where it doesn't breed. In these climates you see less asthma.''

Exposure to a variety of other substances also can promote inflammation in

hypersensitive lungs and can trigger an asthma attack. They include:

Tobacco smoke : Studies have shown that children of smoking parents are

three to four times more likely to develop asthma than children of

nonsmoking parents.

Pets in the home : The more pets you have in your home, the more likely you

are to develop allergies and asthma later on, doctors say.

Mold spores : People who develop allergies to mold spores are linked to the

development of asthma. Hospitalizations skyrocket during the mold season,

roughly June through November.

Occupational substances: 240 substances in the work environment are known to

cause occupational asthma.

Air pollution : Those living close to highways seem to have a higher risk of

wheezing and developing asthma.

Respiratory infections, including the flu and cold bugs, also can inflame

the airways and cause asthma attacks. So can exercise and weather changes.

While doctors are focusing on treatment and prevention, and while

researchers are striving for better drugs, parents like Vicki Bush cope as

best they can. Ms. Bush vacuums regularly, dusts only when her daughter is

sleeping, keeps only plastic plants indoors and maintains a detailed log of

a's illnesses.

''I deal with it,'' she said.

''It is a burden on the family,'' Dr. Lierl said. ''Parents aren't used to

that situation. They're used to giving medicine for 10 days and having the

child get getter. It's a big adjustment for parents and children to deal

with for the rest of their lives. With good compliant families, and

monitoring and medication, we usually can keep children happy and healthy

and in school. It takes daily work to keep them that way.''

Scientific studies have shown that putting dust-proof casings on mattresses,

box springs and pillows can reduce exposure to dust mites.

''I don't let my patients take teddy bears to bed,'' Dr. Lierl added.

''Otherwise, they're breathing that dust mite all night.''

Although asthma strikes across economic and racial lines, inner-city

residents are most at risk. Physicians believe indoor sensitizers, including

dust mites and roach droppings, are largely to blame.

''In inner-city areas, more people are developing high levels of asthma,''

said Dan sen, a private consultant and former toxicologist with the

Hamilton County General Health District. While indoor substances can trigger

asthma attacks, outdoor pollution is also a problem. At least 63 percent of

asthma sufferers live in areas that fail to meet at least one federal

air-quality standard, according to the Lung Association.

A recent study found that visits to Cincinnati Health Department clinics for

respiratory difficulties were 85 percent higher on high-ozone days than on

low-ozone days, sen said.

Dr. Lierl puts the blame on particulate air pollution, not ozone. In a

recent study, she concluded that asthma attacks requiring hospitalization or

visits to the emergency room are ''associated with elevated concentrations

of airborne particulates and pollens.''