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Breathe easy

Education and treatment are reducing the death toll from asthma

Education and treatment are reducing the death toll from asthma

July 29, 2002|by KEVIN CLAPP

kevinc@herald-mail.com

Alysha Hardman and Rachel Mohn are going to camp.

Not just any camp, either. Sure, there will be games and fun tomorrow at Camp SuperLungs.

But an overt air of educational purpose floating just below the surface will provide the 11-year-old friends and other campers with practical skills to manage a nagging medical condition that can burst their bubble at any time.

Neither girl has had trouble managing her asthma for more than a year, yet both are keenly aware of the condition's ability to attack under the right conditions.

"We were at Florida and I had a little bit of a cold," Rachel remembers. "And we were walking around at the parks and I had to belly breathe for a while."

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Belly breathing, a skill taught during the American Lung Association sponsored day camp, involves breathing in through the nose, holding the stomach and slowly breathing out through the mouth.

Alysha and Rachel are hardly alone in their ongoing battle with asthma. According to Hagerstown M.D. Nicholas A. Orfan, a board certified allergist, incidence of asthma in school-aged children has doubled.

According to National Center for Health Statistics figures, 17.6 million Americans have been diagnosed with asthma. Nearly three million more women than men suffer from it, though women more often develop it later in life.

Increases in asthma numbers are everywhere save one place: The mortality rate, on the rise during the 1980s and early '90s, has leveled out in recent years. In 2000, 4,426 people died from asthma, down from 5,438 in 1998. The reason may be better education.

Whether due to better diagnosis of the condition or a rise in the number of people with allergies, asthma, although incurable, is easily controlled with education and treatment.

Branching out


The respiratory system, says Washington County Hospital asthma case manager Peggy Kemp, is made up of the trachea, bronchus, bronchiole and alveoli. Think of them as an upside down tree; air passes through with each successive part becoming narrower, like branches.

"Under normal circumstances, these should be like straws. The bigger the straws, the easier it is to suck in air," Kemp says.

"As you get smaller and smaller and smaller, it doesn't take much to close that airway."

So while the inside of the airway should be pink and healthy with the muscle relaxed, in asthma patients the airway is hyper-reactive and can become inflamed.

Kemp returns to her analogy of a straw.

"The first thing people think of is chest tightness and being unable to get a breath," she says. "Just like a straw, if you squeeze it you can't get anything through."

Attacks, marked by shortness of breath and coughing among other symptoms, can be triggered by air pollution, secondhand smoke, dust mites, animal dander and allergies.

Breathless causes


While not linked in all cases, Orfan says 90 percent of those with asthma also suffer from allergies of some form.

What's tricky about asthma is that the trigger for one person may not be the trigger for another. And several triggers may be required to cause an attack.

Ironically, a better quality of life may play a role in the prevalence of asthma. Heated, insulated homes with pets, wall-to-wall carpeting and humidification are a playground for asthma triggers.

Another theory chalks up increased allergies to the healthier lives we lead.

"The challenge of recurrent infection in childhood has been greatly reduced," Orfan says. "So when the immune system doesn't need to contend with fighting infection, it may allow for the development of the allergic wing of the immune system that responds more to allergens rather than pathogens."

Preferred treatment


Whatever the cause, the treatment of choice remains the rescue inhaler, containing a bronchodilator that will open up breathing passages quickly.

Other options include shots, pills or liquid that can be ingested by smaller children not yet ready for the inhaler. New on the scene is medication in the form of a powder.

Daily treatment is used for patients who have symptoms more than twice a week or at night more than twice a month.

If using an inhaler, Kemp says asthma patients should go through no more than two refills a year, with each refill containing up to 200 doses of medication. Using more is an indication that asthma is not under control.

"We think virtually every death from asthma is avoidable if care is adequate and timely," Orfan says. "With all the advances in asthma care in the last 20 years, it's theoretically possible we could reduce asthma mortality to close to zero."

Possible, but not necessarily probable due to outside socio-economic factors related to proper education and treatment.

As important as treatment is in maintaining control of triggers, figuring out what causes an attack and doing as much as possible to eliminate it from an asthmatic's environment is the key to reducing attacks.

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