out isn't simple. Although
asthma is usually thought of as
a childhood affliction, close to 60
percent of asthmatics are adults.
Although the disease's severity
varies from person to person,
asthmatics share a chronic dis-
ease that has no cure — not yet.
Tragically, almost 4,000 peo-
ple in this country die each year
from this disease. Many under-
estimate it as mere wheezing or
as a minor, temporary ailment.
Thankfully, however, advances
in asthma management have
made it possible to reduce the
severity and frequency of symp-
toms so that more people are
better able to manage the dis-
ease.

RUTHAN BRODSKY

SPECIAL TO THE JEWISH NEWS

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WHAT HAPPENS IN THE
ASTHMATIC LUNG

Asthma is a chronic lung dis-
ease, often described as a reac-
tive airway disease, with varying
levels of obstruction. Recent re-
search shows that inflammation
of the lining of the bronchi, the
large air passages to the lungs,
is the most common symptom of
asthma. This causes the airway
lining to swell and narrows the
airway opening. Sometimes, the

inflammation and swelling can
last for weeks following an
episode. Most asthmatics have
some degree of inflammation all
of the time.
The unpleasant sensation of
not being able to breathe occurs
when someone with asthma is
exposed to a stimulus known as
a "trigger," such as pollen, mold,
viral infections or cold weather.
The bronchi of people with asth-
ma are so sensitive to one or
more of these stimuli that when
they're exposed, they experience
an asthma attack.
Air enters the lungs through
the trachea, which branches
into the right and left bronchi.

Aaron
Charfoos

PHOTO BY L ISA JACKIE R

he word asthma is derived
from a Greek word meaning
"to breathe hard" or "gasping."
To understand what it feels like
to be an asthmatic, imagine
tightness in your chest and
wheezing when you breathe.
You can pull some air into your
lungs, but you can't fully expel
it.
Or, breathe in very deeply,
hold for a second, and then try to
take another breath. You can't.
Now add to that coughing and a
feeling of panic because you're
suffocating during an asthma
attack!
For some 15 million Ameri-
cans, breathing in and breathing

In some people,
asthma causes
only mild
wheezing;
in others, it can
be deadly.

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Those passages, in turn, are
subdivided into smaller and
smaller bronchial tubes and
bronchioles, which finally end
in air sacs called alveoli. In the
alveoli, inhaled oxygen enters
the bloodstream and carbon
dioxide is removed to be ex-
haled.
During an asthma attack, the
muscles that line the airways
tighten, constricting the route
through which air goes in and
out. The lining of the bronchial
tubes swells and becomes in-
flamed, blocking the passage of
air even more. The mucus that
usually lubricates the airways
becomes thick and sticky and
may plug up the airways. It be-
comes harder and harder to
breathe out because air deplet-
ed of oxygen is trapped in the

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hospital, the National Jewish
Center has grown into an inter-
nationally recognized medical in-
stitution for patient treatment,
rehabilitation, teaching and clin-
ical research. Since the mid-
1950s, National Jewish scientists
SYMPTOMS AND TRIGGERS
have
focused much of their effort
Asthma symptoms can be any
one or a combination of cough- on asthma, including pioneering
ing, wheezing, shortness of the use of inhaled bronchodila-
breath, chest tightness and mu- tors over adrenalin injections.
cus production. Symptoms can One of its largest research pro-
vary at different times and range grams, funded by the National
from mild to severe. Some asth- Institutes of Health, centers on
matics have only occasional or inflammation and airways reac-
seasonal symptoms. Others have tivity.
The history of asthma took an
a more chronic form of the dis-
unsettling
turn about ten years
ease and experience symptoms
daily. Some have asthma attacks ago when the fatality rate in-
when symptoms develop sud- creased sharply. Deaths from
this disease had been rising
denly.
There are many different trig- slightly until the end of the
1970s. Since then, the death rate
gers and they vary from person
from
asthma has gone up 30 per-
to person. In some, the mecha-
nism is primarily allergic, al- cent. Women have been affected
though not all asthmatics are somewhat more than men, and
allergic and not all people with older people in all groups have
allergies have asthma. Symp- the highest fatality rate. Al-
toms are triggered by pollen or though death from asthma
dust. Other asthmatic patients remains uncommon, these sta-
are free of allergic reactions, but . tistics are sobering.
Since then major changes in
find that their wheezing is pri-
marily linked to infection. A cold the medical understanding of
or flu can lead to a prolonged asthma have taken place. Previ-
ously treatment centered on the
bout.
Other people have asthma at- relief of an acute attack. Today,
tacks brought on by a sensitivi- the focus is on preventive strate-
ty to aspirin or food additives, or gies to thwart the narrowing of
irritants such as cigarette smoke, the air passages to the lungs well
excessive air pollution, insecti- before it progresses to a full-
cides and chalk dust. An asthma blown asthmatic attack. The new
attack may also be generated by concept is of management, em-
strenuous exercise or exposure phasizing more careful daily
monitoring.
to cold air.
The drug treatment of asth-
"When asthma runs in a fam-
ma
has usually been aimed at
ily, particularly if it begins in
childhood, the trigger is often an the relief in the constriction of
allergen, something that pro- the bronchial tubes. The most
duces an allergic reaction," says commonly prescribe anti-asth-
Dr. Kamran Zakaria, a family ma drugs are called bron-
practitioner at Sinai Hospital. chodilators because they open
"Asthma has a strong genetic the air passages by relaxing the
component, and a child with one muscles of the walls.
If you suffer from asthma, you
asthmatic parent has a 20 per-
cent chance of developing the probably use bronchodilators to
disease. Fortunately, most chil- relieve your symptoms. But if
dren have sustained periods of this is your only treatment rou-
remission during which they are tine, your approach is considered
essentially asymptomatic and re- outmoded — and may even lead
quire no ongoing medical treat- to lung damage.
Indeed, researchers have
ment."
questioned
the reliance on bron-
Strong emotions may also
bring on asthma symptoms but chodilators for some years. Some
that doesn't mean the disease believe that the increase in
is psychological in origin. Con- deaths is due to a delay in seek-
trary to an old myth, no amount ing help on the part of asthmat-
of stress will bring on an attack ics who receive a false sense of
unless someone already has the security from the drugs.
New research shows that re-
symptoms. Asthma begins in the
peated
episodes of asthma can
lungs, not in the head.
cause the bronchi to become in-
flamed and permanently con-
TREATMENT
stricted, which results in a
The National Jewish Center gradual decline in respirator),
for Immunology and Respirato- function. According to Dr. Za-
ry Medicine in Denver, Colo., is karia, it's no longer enough to fo-
the world's only facility exclu- cus exclusively on relieving
sively devoted to the study and symptoms during an acute
care of chronic lung and im- episode; this is when lung dam-
mune-system diseases. Found- age is most likely to occur. To-
ed in 1899 as a tuberculosis BREATH page 60

lungs and leaves no room for
fresh air.
After repeated episodes, lung
tissue loses elasticity causing a
gradual decline in function.

(— /