David Sadley and his parents didn’t let his cold keep them from a day trip to Waco. But at the Texas Ranger Hall of Fame and Museum, David’s wheezing became gasps. His lips turned a pale purple. He thought he was dying.
Terrified, his parents raced the 100 miles to Dallas, where David’s pediatrician gave him a shot to open his airways. The diagnosis: reactive airway disease.
Six months later, David had another attack. During a four-hour emergency-room visit, a half-dozen specialists finally managed to regulate his breathing. Only after that was David’s illness more specifically diagnosed: asthma.
“Before, it was this great unknown,” says Mark Sadley, David’s dad. “Now he has no fear. He’s in Boy Scouts now. It doesn’t hurt him to sit around a campfire with smoke, or to camp around a cedar tree.”
David, 11, is among 12 million to 15 million Americans — 4.8 million of them under 18 — who have the disease. Despite research and new medications, the number keeps growing, particularly among urban dwellers, minorities and children. Consider these statistics:
– Between 1982 and 1993, self-reported cases in all age groups increased 46 percent. Prevalence among children rose 80 percent.
– In 1990, there were 7.1 million doctor visits for asthma. Every year, the disease results in 1.8 million emergency-room trips.
– From 1972 to 1993, the last year for which statistics are available, asthma deaths rose 40 percent. About 5,000 people in the United States die of asthma annually. Doctors estimate that number could be reduced two-thirds to 90 percent with appropriate asthma care.
“We’re in the midst, in the last 15 years, of an unprecedented increase in the incidence of asthma,” says Dr. Mark Millard, medical director of Baylor University Asthma and Pulmonary Rehabilitation Center, where David was diagnosed. “It’s very clearly increased in urban areas. There’s no refuge for the wheezing, no environment that seems safe. The more we look into things, the worse the picture seems to get.”
What’s going on? Why so much asthma, and why now?
At one time, people thought the disease was psychosomatic, brought on by conflict in the home or overly protective parents. Doctors hesitated to diagnose asthma because parents would think it was somehow their fault. So doctors would use a euphemism, such as “wheezy bronchitis.” But now physicians know asthma has nothing to do with family dynamics.
“Asthma is felt to be a combination of genetic and environmental processes working together,” says Dr. Elliot Ginchansky, a Dallas allergist. “There has to be a mechanism that takes place to trigger the initial onset.”
That trigger can be allergies, vigorous exercise, cigarette smoke, sudden temperature change, excitement or stress.
“Usually we see at least two triggers in a patient,” says Dr. Gary Gross of the Dallas Allergy and Asthma Center. “A lot of people have symptoms and think they can’t possibly have asthma because it’s a childhood disease. But it can start at any age. Anybody can get it.”
One major cause seems to be pollution. According to the American Lung Association, about 10 percent of emergency-room visits and hospital admissions in 13 U.S. cities may have been caused by smog.
“In the old days, it was just pollen. You waited for your season to be over,” Dr. Millard says. “Now, July 4 not only marks the start of 100-degree days, but also ozone alerts seem to be on a regular basis. Half the country lives in an area where ozone levels are dangerous.”
Another possible cause is the breakdown of hydrocarbon products such as diesel and car fumes. They might cause what physiologists call “pro-inflammatory activity,” he says.
So to avoid asthma, just avoid the outdoors, right? Unfortunately not. The most common allergens that trigger asthma occur indoors. They include cockroaches — especially in urban areas — dust mites, cats and dogs.
Studies conducted in developing countries show that people living in open-air huts have less asthma. But when they move to homes and close themselves in, they have a tendency to develop the disease, says Gross.
Asthma symptoms include wheezing, fatigue, coughing, difficulty breathing and itchy throat. A full-blown asthma attack can be terrifying: The sufferer feels every breath is being drawn through a straw instead of lungs. Loved ones watch in horror as the simple act of breathing becomes an agonizing effort.
Asthma cannot be cured. But with new medications and knowledge, it can be controlled 95 percent of the time, estimates Millard.
