Prather Pediatric and Allergy Center - Ask Doctor Brent

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Category: Lagniappe - a little extra

Despite numerous advances in the diagnosis and treatment of asthma, its prevalence and mortality rates continue to climb.

The scope of this health care crisis lies not only in number of people with asthma but in how it affects our daily lives. Children with asthma lose 10 million school days each year due to associated illnesses. Their working parents lose an estimated $1 billion in productivity. In terms of asthma-related health care expenditures, Americans spent $6.2 billion in 1990.

So why is asthma on the rise? Why are people still dying?

According to David L. Rosenstreich, MD, an allergist / immunologist at the Albert Einstein College of Medicine and co-author of a recent article in the New England Journal of Medicine on inner-city children with asthma, no one really knows for sure.

There are educated guesses, though. One is what Rosentreich calls the "television" theory of asthma. "The average American spends 23.5 hours indoors everyday, counting being in a car as indoors," he said. "So people are virtually never outside anymore. Kids spend their time in front of a television, maybe lying on a rug, and breathing in all the indoor allergens, sensitizing them[selves] to asthma." In the inner city poor air quality and greater exposure to cockroach allergens in attached dwellings contribute to high asthma rates.

Then there's the "infectious immune" theory. "Children used to get a lot of infection which strengthened their immune systems," Rosenstreich explained. "The idea now is that the artificial immunizations we give for mumps, chicken pox and rubella are not as potent an immunization as natural infection and this may be skewing the immune system toward allergies."

Rosenstreich also describes the "Automobile exhaust" theory. Even though air pollution is getting better, there are more and more cars on the roads. "There's data to suggest that if you're exposed to diesel particles, they tend to make you allergic to other things," he said. Some experts speculate that additives and preservatives in the food chain may also make people more allergic."

Rosentreich believes there may be more asthma deaths because proportionally, there is more asthma in our population. Another factor is that some asthma patients don't keep their follow-up appointments after receiving their medications. Sometimes asthma is misdiagnosed altogether as chronic bronchitis -- or in older adults, congestive heart failure. "The point is that we know so much about asthma that nobody should be dying from it," Rosenstreich said. "It's very troubling."

From 1990 to 1994, the number of people with self-reported asthma in the U.S. increased from 10.4 million to 14.6 million. In 1994, 5,400 deaths were attributed to asthma, an 82 percent increase since 1979. Deaths among 5- to 24-year-olds nearly doubled during that period.