Winning Olympic gold can leave anyone breathless, but that word has a whole different meaning for U.S. medalists Amy Van Dyken and Tom Dolan. Both swimmers suffer from asthma, a potentially deadly lung problem that can cause wheezing, coughing, and a real need for air. Van Dyken, who suffered from severe asthma through grammar and high school, won her four gold medals in spite of needing medication four times a day. Dolan, whose asthma is actually triggered by the sport he loves, took Atlanta’s gold in the 400-meter individual medley even though his finish left him “definitely gasping for air.”
The lesson from both of these great Olympians is that, as the Asthma and Allergy Foundation says, “Asthma is a controllable disease [in which] a normal, even extraordinary, physical life is possible.” The bad news is: Asthma kills about 5,500 people every year–up 58 percent since 1979–and more of us are getting asthma than ever before.
What Is Asthma?
Asthma is a chronic inflammatory lung disease. It is the most common chronic illness of young people today, affecting 4.8 million Americans under age 18. Asthma usually begins in childhood, almost always before age 5, and is the most common reason for chronic absence from school (on average, 4 to 7 days each year).
How does asthma work? Basically, people who suffer from asthma breathe through lung passageways that are always inflamed and swollen. Sometimes, due to irritants and allergens that doctors call “triggers,” this inflammation and swelling gets worse, and muscles along the airways become hyperreactive or “twitchy.” The result is an asthma attack–the airway muscles contract suddenly, narrowing the diameter of the breathing passages and cutting down air flow. As asthma progresses, mucous glands along the airways produce gobs of sticky secretions that narrow the breathing passages even more. To use a real-life example, Amy Van Dyken’s airways on a “good” day are only about 65 percent as wide as those of someone without asthma. On a “bad” day, they constrict to only about 30 percent of normal diameter.
Triggers and Treatment
The triggers that set off an asthma attack are not the same for all who suffer from asthma. A viral respiratory infection (common cold) is a big culprit, but a sinus infection caused by bacteria can have the same effect. Allergies often set off an asthma attack, too, including allergies to foods (especially sulfites used to preserve frozen foods such as french fries) and medicines such as aspirin and ibuprofen. Outdoors, allergies to grass and tree pollen can prompt an asthma attack, while common indoor triggers include pet dander, secondhand tobacco smoke, rodent urine, and the molds that live in the dark, damp corners of basements. Even ordinary house dust–which is really a microscopic garbage heap of insect feces, cockroach antigen, and tiny dust mites–can trigger an asthma attack. Its irritating particles, only 5 percent to 10 percent the width of a human hair, can lurk in rugs, under beds, and in the tufts of mattresses.
Outdoor pollution is another potent asthma trigger, especially summer’s ozone or the fumes from paints, gasoline, or industrial plastics. In winter, a cold, fresh breeze can be just as bad if its chill temperature irritates the lungs.
In some people with asthma, including Tom Dolan, an attack is triggered by exercise. This is because heavy aerobic workouts, especially in sports that involve lots of running, call for faster breathing. Rapid breaths pull cold, dry, irritating air into the lungs without enough warming and humidifying time in the nose.
To treat asthma, doctors prescribe two different types of medicine: anti-inflammatory agents (to give long-term control and quick relief) and bronchodilators (to open larger breathing passages called bronchi). Because asthma symptoms vary from person to person, everyone with asthma follows an individual treatment plan developed by his or her doctor. This treatment plan contains specific directions for daily asthma management, along with a special game plan in case of a severe attack.
An Asthma Epidemic?
Between 1980 and 1994, the rate of asthma deaths increased by about 200 percent among young Americans ages 15 to 24. African-American and inner-city teens were especially hard hit. Although scientists don’t know the exact reason for this dramatic increase, they do have a few good guesses. Some blame environmental factors that increase young people’s exposure to the triggers that start an asthma attack. They point out that a number of children in the United States live in areas where irritating ozone levels are almost always too high. Other experts suspect an increase in indoor pollution, especially in the newer, more tightly sealed, energy-conserving buildings.
The most important reasons for this increase, however, may have more to do with people than pollution, according to researchers at the National Institute of Allergy and Infectious Disease (NIAID). Especially in America’s big cities, people with asthma may not be getting the medicines and medical care they need.
As part of a five-year study, researchers at the NIAID matched city families with a social worker trained as an asthma “counselor.” This counselor helped patients learn to recognize their asthma triggers and to cut down on exposure to indoor and outdoor pollution (including cigarette smoke). Counselors also encouraged patients to take charge of their own medication, and to know when and where to go for emergency help during an asthma attack.
At the end of the study, children in families who had used an asthma counselor had fewer asthma symptoms, fewer doctor visits, and a healthier quality of life.
By following a clear treatment plan that spells out when and how to use asthma medication, many young people with asthma can breathe easier today. Others, however, seem to be losing the race against asthma simply because they need better coaching. Like Olympic athletes, these teens may need an asthma counselor to guide them through the toughest laps of their illness.
If you, or someone you know, would like to know how to breathe easier with asthma, here are a few of many places to go for answers and for help.