Asthma
 
Although street pollution, food additives and pollen seem to bring on asthmatic attacks, no one is sure why the lungs' bronchi react so aggressively, and sometimes fatally Published: The Globe and Mail, August 10, 1991, FOCUS BY DEBORAH JONES, DARTMOUTH, N.S. MICHAEL Manuel wheezes from the exertion of just getting up and answering the door. Even walking up the single flight of stairs in his home leaves him short of breath, as it has for almost all his 18 years. His doctors say that he should be getting better. Instead, says Mr. Manuel, "it's getting worse as I'm getting older." A growing numbers of asthmatic adults are finding that their condition is deteriorating. At the same time, doctors are noticing that more and more people are getting the chronic respiratory disorder for the first time as adults. Perhaps most worrisome of all is the fact that more people are dying from asthma. "Asthma no longer plays by the rules doctors have been used to since the disease was first described almost 2,000 years ago," writes Toronto physician Brian Goldman in a recent article in the Canadian Medical Association Journal. "We were taught that asthma begins in childhood and ends in adolescence . . . today, in a disturbing number of cases, the problem worsens as the patient ages." Mr. Manuel, who recently graduated from high school, plays keyboard in a band, and hopes to study music in university and eventually teach. He missed two months of school last year because he was in the asthma ward of the Victoria General Hospital in Halifax. He is 50 pounds overweight because of a steroid medication that causes his face to puff up. The drugs he needs (mostly paid for by his parents' health plan) cost $500 a month. Like other sufferers, he finds that many of the substances that trigger an attack - cigarette smoke, car exhaust and pollen - are also substances to which he is allergic. A near-fatal attack last summer finally brought home to him how vulnerable he is. "Hey, asthma does kill people and this was a scary situation," Mr. Manuel says. "Not being able to get your breath is quite frightening. The only way to describe it is it's like having a tape bound around your chest." Each week about 10 Canadians die from asthma. Death is caused by suffocation when their airways constrict and an accumulation of mucous prevents them from breathing. For people between the ages of 15 and 34, the death rate from asthma has increased 163 per cent over the past two decades. Doctors estimate that between 500,000 and one million Canadians are asthmatic, about 80 per cent of them children. The numbers are imprecise because physicians differ about what constitutes asthma, but the lung ailment is widely believed to be on the rise in every industrial country in the world. Though environmental causes - poor air in buildings, pollution, food additives - are suspected, no proof has been offered. Indeed, researchers point out that despite New Zealand's relatively clean air, death rates from asthma have been much higher there than anywhere else. LINDA Wrightson, a paramedic in Kamloops, B.C., became convinced that pollution is responsible for asthma attacks after noticing that emergency calls from asthmatics increased when air pollution was particularly bad. Ms. Wrightson and her 11-year-old daughter, Sophia Babcock, neither of whom are themselves asthmatic, are planning to ride their tandem bicycle to Vancouver on Aug. 25 to raise awareness about automobile pollution and raise money for the B.C. Lung Association. "A person can actually have an attack and die in minutes," says Ms. Wrightson. The Canadian Lung Association defines asthma as an illness in which there are repeated episodes of breathing difficulties due to narrowing of the airways to the lungs. Symptoms range from a slight cough to the characteristic asthmatic wheeze. Dr. Dennis Bowie, a physician at the Victoria General Hospital, explains the central question bedevilling asthma researchers: "God gave you lungs and he gave you pipes to carry air into your lungs. He was smart enough to give you a defence mechanism to prevent bad things getting into your lungs. When you are exposed to something (noxious), you shut your airways down, you cough and you secrete mucous. The difference with asthmatics is they have a hyperprotective mechanism. What we don't know is what makes an asthmatic different." A great deal of research is aimed at understanding what causes inflammation of the cells in the airways, a characteristic of the disease. Much of the information available is skewed by the opinions of doctors and researchers toward asthma. If the data were taken at face value, Prince Edward Island, for example, would have the highest incidence of childhood asthma in Canada, says pediatrician Daniel Hughes, a respiratory specialist at the Izaak Walton Killam Hospital for Children in Halifax. He suspects that the high rate is a reflection of the attitude toward asthma of the tiny province's sole pediatrician. Another factor contributing to the apparent rise in the disease is a broadened definition of asthma. Dr. Hughes points to an old book with a drawing of an extremely red-faced, teary-eyed, distraught girl on the cover. Parents used to immediately envisage such severe cases when asthma was mentioned, he says. Now even mild symptoms are diagnosed as asthma. ANOTHER reason for more frequent diagnosis is that asthma no longer takes a back seat to diseases of previous decades that were deemed more serious and have since been conquered. This is why asthma is underreported in the Third World. Most asthma researchers think the disease is on the rise. Certainly, it is being accorded more attention. One indication is the opening this fall of the Alberta Asthma Centre in the William Aberhart Hospital in Edmonton. The $3.5-million centre, developed by the Alberta Lung Association with financial help from drug companies, will devote itself to asthma research. In recent years, treatment of asthma has changed dramatically, largely because of the introduction of new drugs. But drug treatment has become increasingly controversial. Some asthma researchers criticize family physicians for not prescribing sufficient doses of medication. Other researchers have suggested that misuse of drugs may be responsible for deaths. A report published this summer in the British magazine New Scientist suggested that inhaled beta-2 agonists, the most widely prescribed asthma drugs, can mask the seriousness of a patient's condition. The drugs relax the muscles of the bronchial passages, thus allowing the patient to breathe more easily. The drugs are meant to be taken only during an attack, but doctors often prescribe them for regular use. A New Zealand study last year found that many patients deteriorated when treated regularly with a beta-2 agonists. A new study by Canadian researchers at McGill University, to be published this year, is expected to support those findings. "We as physicians may contribute (to asthma problems)," says Dr. Bowie. "I use lots of drugs and I see side effects from them. Every once in a while I try to withdraw them. Most of the people get into trouble, which reassures me that they need them." Dr. Bowie adds that most of the asthma deaths he hears of involve people who put themselves in situations where they would be prone to having an attack, underestimated the severity of an attack and failed to seek medical attention. "It is my belief that if asthmatics keep themselves in control, they won't get into trouble." Copyright Deborah Jones 1991 About this website: Text and photos by Deborah Jones except where otherwise noted. Please contact me for reprint rights. All material copyrighted ../About.htmlshapeimage_1_link_0
Lung disease hits longer and harder
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