Understanding the Asthma Epidemic
Air Date: Week of August 16, 1996
Host Steve Curwood discusses the urban asthma epidemic with Dr. Mike Lenore, head of the Allergy Service at San Francisco General Hospital.
CURWOOD: I'm Steve Curwood with an encore edition of Living on Earth. This year, 5,000 people in the US will die from asthma, many of them children and many of them in the inner city. Asthma is up sharply in the past decade, and according to doctors, many of these deaths are preventable if people recognize the signs of an acute asthma attack in time to get the victim medical help. Doctor Mike Lenore heads up the allergy service at San Francisco General Hospital. I asked him how parents can tell if their child is developing asthma.
LENORE: Well I think most parents recognize the seriously ill child with asthma because that's a child that's difficult to ignore. That's a child who has air hunger. You can see them working to breathe; you can hear the wheezing sometimes audibly. Where we see children who have had asthma who, their parents have not recognized, the symptom is almost always chronic cough. A child who coughs when he runs or coughs when he laughs or coughs incessantly or all the time at night, that's the child that we often miss with asthma.
CURWOOD: What causes this? Does this come from air pollution? Does it come from infectious disease? Where does it come from?
LENORE: Well I think the first thing we'd have to say is it comes from your parents, because most people with asthma have either an immediate family member or another family member who also has asthma. So that's one thing. The second thing is that a number of people who have asthma develop it because they become allergic to certain things: things like pollens, grasses, trees and weeds, house dust, mold, animal dander and in some cases even foods. And then once you have the sensitization to asthma, once you have the problem, there are a number of different things that could aggravate you. Infections of any type can make people with asthma much worse: smoke, smog, changes in weather, even emotional upset can trigger asthma symptoms.
CURWOOD: I see. So this is really a " the connection between pollution and asthma is one that if you've already got it and there's some pollution, then you're in trouble.
LENORE: Absolutely. With the, whenever we have these inversion layers all over the country, you notice that a number of people with asthma, the number of people in the emergency room and the number of people in the hospital, those numbers increase.
CURWOOD: So why has there been such a rise in asthma among the young, and particularly among African Americans in the city?
LENORE: Well, I think there's been a rise among young people and African Americans for a number of socioeconomic reasons. There is no data to suggest that, from a genetic point of view that African Americans or Hispanics have an increased predisposition to asthma. But it is true that if you look at the statistics for who gets sick and who dies, the numbers in many instances across America are shameful. In most instances, African American children die three times more often from asthma. There are some studies to suggest that even in the same city, that an African American male in East Harlem has 10 times the death rate than other males in New York City. Now the reasons, I think, are, I think, if you analyze the dynamics in an urban inner city, you see that there's more crowding. There's more pollution. There's more smoking. There's more increased exposure to allergens like cockroach, especially, tends to be a very difficult one. And importantly, there's decreased access to quality health care.
CURWOOD: People are allergic to cockroaches?
LENORE: Cockroach is a real big one. You know, I grew up in Texas, where we always gave great credence to the cockroach.
CURWOOD: You have Texas-size cockroaches there, I suppose.
LENORE: We had Texas-size cockroaches there. But, and I always felt that they would be a major contributor to allergy and in fact, over the last 15 years we've started to recognize how important they are in developing sensitivity that leads to asthma.
CURWOOD: What can parents do to cut down their child's risk of getting asthma?
LENORE: Well I think that's a very interesting question and one that we haven't quite answered yet in medicine. Because we do know that if you take young children that tend to have asthma on, basically from 2 different, 2 major reasons. One is that they get viral infections, which somehow change the airway. The other cause is certain types of allergens: house dust and food. Now let's take the food and the allergen situation first. It's pretty clear that breast-fed infants have less problems with allergy as infants. You can reduce some of the symptoms by keeping their bedroom dust-free, keeping that favorite animal out of the toys, out of the child's face, and also not buying animals that tend to cause problems with asthma, particularly cats. In terms of viral infections, it's very difficult in a modern society to get away from viral infections because of the crowding. But you also have to look at the kind of daycare center you select for your child, the number of children in that daycare center, who is around that child on a regular basis. And in households that smoke, the seriousness of symptoms, the increase of symptoms with asthma and deaths from asthma is very significant. A child who lives with asthma who lives in a house where anyone smokes, even outside, has many more emergency room visits and many more hospitalizations.
CURWOOD: Well, thanks for taking this time with us. Dr. Mike Lenore is Chief of the Allergy Service at San Francisco General Hospital. Thank you, sir.
LENORE: Thank you for asking me.
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