The chronic lung disease asthma hits children especially hard. Today, about 5 million American children -- about 1 in 15 -- have intermittent bouts of coughing, wheezing, chest tightness and shortness of breath caused by constricted, inflamed bronchial airways.
"When I cough too much," says Elliot Handkins, 7, whose Ohio family is featured in this issue, "I have this thing, an inhaler, and I put my mouth on this tube, and I breathe. And it helps."
More help is on the way for asthmatics like Elliot. "The picture for asthmatics is brighter than ever," says Martha White, an allergist from Wheaton, Md., and spokeswoman for the American Academy of Allergy, Asthma and Immunology. "As we know more about it and treat it aggressively early on, 95% of asthmatics should be able to have mostly symptom-free days and do essentially whatever they want to do."
Complex causes
Asthma is an interplay between genes, environment and other factors.
It runs in families, and children with one asthmatic (or allergic) parent have a 40% to 50% chance of developing the disease (or other allergic disorders). Two parents with asthma increase the risk to 80% or more.
But a child won't develop the disease unless triggered by an infection or allergen. Doctors are studying whether pollution, cigarette smoke and other environmental factors can also trigger the disease. Once asthma is initially set off, any of those elements, as well as exercise, can cause an asthma attack that lasts a few minutes or several hours.
"A lot of parents used to keep their kids out of preschool and day care to keep them from developing [colds that might trigger] asthma," White says. "But we've now learned that the second-, third- and fourth-born, or kids who go to day care during the first six months of life, are less likely to develop asthma than kids who are sequestered at home."
Why? A baby's white blood cells are waiting for instructions on how to become specialists in either fighting infection or creating allergic reactions. If a baby has to fight a lot of other children's germs, the white blood cells will focus on that. As a result, fewer white blood cells specialize in becoming sensitive to allergens, and the baby grows up less allergic.
As for allergens, doctors still suggest curbing exposure to them. Indoor allergens can be controlled by cleanliness, plastic-covered mattresses and HEPA air filters. Outdoor allergens are more difficult, but closing windows and doors will help keep out pollen and mold spores. Playing outdoors in smoggy air may be hazardous: A study published in the Feb. 2 issue of The Lancet, a scientific journal, found that children living in high-smog areas of Southern California were much more likely to develop asthma if they were hard-playing, hard-breathing athletes than if they didn't play sports. In low-smog areas, athletes did not have a higher rate of asthma, leading researchers to conclude air, not activity, was to blame.
Best treatments over time
Doctors once thought airway constriction was the main component of asthma, so fast-acting muscle relaxers were their main weapon.
Then they discovered that the underlying inflammation of the lungs was the real problem. Doctors prescribe anti-inflammatories now, when the disease has progressed beyond a certain point. And they're considering using them even sooner.
In all, there are three types of anti-inflammatories. Cromolyn, a mild medication often administered to infants and toddlers, usually is given via a nebulizer, which turns the medicine into mist to be inhaled. Leukotriene modifiers are a new class of asthma medication, introduced in 1996. But steroids are considered the gold standard of anti-inflammatories, although physicians are concerned that long-term use can cause bone loss, adrenal damage and other problems.
White hopes a new drug, anti-IgE, will be approved by the Food and Drug Administration this year. The immunologically based asthma drug prevents the immune cells from releasing antibodies that cause allergic reactions. Studies have shown the drug to be effective in cases of allergic asthma, and it may work wonders without the worry of harmful steroids.
