Breathe Easy: Overcoming Asthma

by Molly M. Ginty

Alice Melendez was wheezing again. Surrounded by moldy moving boxes and dusty pillows, she clutched her inhaler as she sat on the couch of her new apartment in the Bronx, New York. Her two school–aged sons, also asthmatic, coughed quietly. As if the family’s two–year wait for public housing were not hassle enough, they now had to contend with triggers that can cause asthma attacks: mold, dust mites, car exhaust from outside — and the bitter cold of their winter moving day.

"Winter is the hardest time for us," says Melendez, one of the 20 million Americans with asthma and one of the 10 million with allergy-induced asthma. "Cold air and respiratory infections make the problem worse, so my kids are more likely to miss school, and I’m more likely to take sick days off work."

This season can be especially challenging for people with asthma, a chronic breathing disorder that is caused by genetic and environmental factors. And the number of cases has nearly doubled in the last 25 years. As Melendez’s story illustrates, asthma is on the rise among minorities, city–dwellers, people with low incomes — and women.

"Asthma is nearly 30 percent more common in women than men, and asthma–associated mortality is increasing faster in women," says Dr. Marianne Frieri, an allergist/immunologist at Nassau University Medical Center in East Meadow, New York. "Women experience more severe symptoms and require more frequent hospital visits."

Why does asthma affect women disproportionately? Researchers point to women’s hormonal cycle, which can make the condition worse. Hormone therapy or birth control pills can exacerbate asthma as well. And women are more sensitive to air pollution, which is causing asthma to spike in the general population.

Another concern for women? Pregnancy. Women with asthma have a 30 percent chance of passing the condition on to their children, and uncontrolled asthma in the mother can cause low birth weight and preterm birth.

“If you’re pregnant and have asthma, keep it under control with your doctor’s help,” says Dr. Linda G. Tanaka, a pediatric allergist in Jackson, Mississippi. “Stay away from highly allergenic foods such as peanuts; remember it’s safer for your baby if you take inhaled instead of oral medication; and note you can lower your baby’s risk of developing asthma if you breast–feed.”

Like asthma’s gender disparity, its ethnic, geographic, and socioeconomic disparities are also cause for concern. Among the general population, 6 percent have asthma, but the condition affects 13 percent of Puerto Ricans (such as Alice Melendez and her children), 10 percent of Native Americans, and 10 percent of African Americans. Researchers believe that genetic differences may play a part, but also note that people of color are more likely to be poor, less likely to have adequate health care, and more likely to live in polluted areas, where residents have a 50 percent higher risk of developing asthma.

Just as asthma’s prevalence varies from population to population, so too does its severity.

Some sufferers experience only mild occasional chest tightness, wheezing, and nighttime coughing and need to use their inhalers only once or twice a month. Others need daily doses of oral corticosteroids, daily air–flow readings to monitor their condition, and regular immunotherapy shots to make them less sensitive to allergens. Otherwise, they would be debilitated by this breathing disorder.

Whether mild or severe, asthma attacks can be sparked by a number of triggers, including animal dander, cigarette smoke, cockroach droppings, vigorous exercise, strong odors, and certain medications (including acetaminophen, aspirin, and beta blocker heart medications).

When the body is exposed to these triggers, the muscles lining the airways contract, and cells there produce mucus that further narrows these passageways. "During an asthma attack, you feel like you’re running a marathon and suddenly you have to breathe through a straw," says Dr. Charles Plopper, a cell biologist who studies asthma at the University of California, Davis.

The leading cause of students’ absence from school, asthma causes adults to lose 14.5 million days of work per year. The cause of one–quarter of emergency room visits, the disorder accounts for $11.5 billion in medical bills and 5,000 deaths annually.

The good news is that if you do have asthma, you can ward off attacks by taking precautions. Watch the weather reports for ozone alerts and stay inside when pollution is highest at midday.

Clean often and keep the humidity in your home low. Change the filters in your air conditioner and furnace regularly. Use dust mite covers on beds, and remove carpeting. Take time to relax. And when your symptoms are under control, take 30 minutes a day for moderate exercise, which can help keep asthma at bay.

Studies show that 60 percent of asthma hospitalizations — and 80 percent of asthma deaths — could be prevented if patients take their medications as directed. "As a nurse, I’ve seen people die of asthma because they’ve waited too long for treatment," says Melendez. "My work is a daily reminder that I should always carry my inhaler. I know asthma never goes away, but I also know it can be controlled."

Molly M. Ginty lives in New York. Her work has appeared in Ms., Marie Claire, Redbook, and Women’s eNews.

For more information
Contact the American Academy of Allergy, Asthma & Immunology at their Web site, www.aaaai.org

Contact the Asthma and Allergy Foundation of America at www.aafa.org

Article published in Lutheran Woman Today, Jan/Feb. 2007