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#218 - Asthma Is Increasing Among U.S. Children, 29-Jan-1991

Asthma is a serious breathing disorder. During an asthma attack,
the tissues lining the windpipe swell, closing off the airways
and leaving the person feeling as if he or she is drowning, which
is pretty much the case. Asthma is characterized by wheezing,
but more importantly by difficulty exhaling, which leaves stale
air in the lungs, depriving the person of oxygen.

Asthma affects at least 9.6 million people in the U.S. and, in
1987, it killed at least 4360 of them.[1] (People who have asthma
but don't visit a physician for treatment are not counted; people
who die of it but are reported as dying of something else, like
bronchitis or flu, also aren't counted.) The underlying causes of
asthma are not understood but doctors do know some of the things
that trigger it in susceptible individuals. A U.S. Public Health
Service pamphlet says, "There are irritants in the environment
such as cigarette smoke, cooking odors, and aerosol sprays that
can adversely affect a person with asthma. These should be
avoided as much as possible. An asthmatic should not smoke nor be
active outdoors for prolonged periods of time during air
pollution alerts."[2] Dr. R. Michael Sly, a Washington, DC,
asthma expert says flatly, "Air pollution is an established cause
of increased morbidity [illness] from asthma, and intense air
pollution has caused increased mortality [death]."[3]

Asthma can be triggered by allergic reactions to many
substances,[4] some common and some uncommon, and unfortunately
the number of uncommon substances in our environment is
increasing rapidly each year. Asthma is an immune-system
disorder; the immune system overreacts to a chemical stimulus.

The prevalence of asthma increased 29% in the U.S. during the
period 1980-1987, from 31.2 per 1000 population to 40.1 per 1000.
(Thus we can calculate that the prevalence of asthma is doubling
every 20 years--see RHWN #197 and #199.) In 1987, some 9.6
million Americans were suffering from the disease. U.S. deaths
from asthma increased 31% during the 1980-87 period, from 1.3 per
100,000 population to 1.8 per 100,000 population. The actual
number of Americans who died of asthma in 1980 was 2891; by 1987
it had increased to 4360.

The official position of the U.S. Environmental Protection Agency
(EPA) is either that asthma isn't related to pollution or that
asthmatics are such a small fraction of the population that
setting pollution standards to protect them isn't worth the
effort.

There is widespread agreement among physicians that one air
pollutant--sulfur dioxide (SO2)--causes asthma attacks in
susceptible individuals. The federal government's present
standard for SO2 is now set for a 24 hour period; very high
levels can legally occur during short periods so long as the 24-
hour average does not exceed 0.14 parts per million (ppm) or 365
micrograms per cubic meter of air. During the Reagan
administration, environmentalists tried to get EPA (U.S.
Environmental Protection Agency) to put a limit of 0.4 ppm [or
1062 micrograms per cubic meter] on SO2 averaged over any
one-hour period. EPA opposed the tighter regulation, saying that
asthma is a "transient and reversible" condition (even though it
kills more than 4000 Americans each year) and it's simply not
worth it to force reductions in SO2 to benefit asthmatics. (NY
TIMES April 15, 1988, pg. A16.) The electric power industry
applauded.

Sulfites added to food to prevent discoloration can also trigger
asthma attacks. Sulfites are added to all sorts of foods without
having to clear it with the U.S. Food and Drug Administration
(FDA), which regulates most food additives. (Sulfites have been
in use on U.S. foods for so long that in 1958, without testing
the safety of sulfites, FDA placed them on a list known as
"Generally Recognized As Safe" [the "GRAS list"] and thus
exempted sulfites from all safety testing.) In 1986 consumer
advocates forced FDA to prohibit the use of sulfites on fresh
fruits and vegetables because of the hazard to asthmatics; health
advocates urged FDA to ban all uses of sulfites on food, but in
1988 someone within FDA leaked a memo to the Associated Press in
which FDA officials said they knew that a million asthmatics were
endangered by sulfites in food but that FDA had decided, after
much thought, not to do anything about the problem. (NY TIMES
July 21, 1988, pg. A17.) The food industry applauded.

The increased prevalence of asthma during the 1980s struck
children, especially female children, particularly hard. As noted
above, the average increase in asthma among U.S. residents of all
ages was 29%, but among persons aged less than 20, the increase
was 40% and among females younger than 20 the increase was 69%.
Despite the rapid rise among females aged less than 20, males
under 20 continued to have more asthma than females (59.9 per
1000 vs. 41.0 per 1000, respectively). These numbers draw a
picture in which boys have more asthma than girls, but, as time
passes, girls are catching up.

Asthma is not just a physical ailment; it has psychological
consequences for children. The U.S. Public Health Service says,
"The importance of emotional factors cannot be ignored; the
mental suffering and loss of initiative and confidence that
result from repeated asthma attacks can hinder the normal
development of children."[5] The divorce rate is increased among
parents of asthmatic children.

Consistently, African-Americans have about a 10% higher
prevalence of asthma compared to whites (44.2 per 1000 vs. 40.3
per 1000 in 1987). Socioeconomic status does not seem to be the
cause.

The death rate for asthma, on the other hand, is four to five
times higher among African-American males than it is among white
males. Here socioeconomic status may well be the cause because,
in general, adequate medical care is more readily available to
whites. In addition, African-Americans seek treatment from
hospital emergency rooms more than whites do, and hospital
emergency rooms are often not well-equipped to treat asthma,
which requires careful evaluation of each individual.

Asthma is described as chronic but reversible obstruction of the
airways; it is chronic in the sense that it can occur at any time
but it is reversible in that the obstruction can be alleviated
either by medication or simply by waiting it out (assuming the
person survives the very unpleasant waiting-out period). Doctors
say that many asthmatics may not realize their condition can be
fatal, thus may seek medical help too late.

In 1988, asthma-related health-care expenditures by Americans
exceeded $4 billion. It is the leading cause of absenteeism among
schoolchildren, and it accounts for an estimated 5 million lost
work days each year.

An earlier survey of asthma revealed that asthma increased among
U.S. children ages 6 to 11 from 4.8% to 7.6% between the periods
1971-74 and 1976-1980.[6] During this same period,
hospitalizations for asthma increased much more rapidly,
indicating that there's not only more asthma among American
children but perhaps also that it's becoming more severe as time
passes. Although there have been changes in the way asthma is
defined during the past two decades, the studies we cite (below)
considered these changes and still concluded that asthma is
increasing rapidly among American children.

This is just one more good reason why we must control the glut of
strange new chemicals entering our environment. They really are
making more and more of us sick, especially our children.

--Peter Montague (National Writers Union, UAW Local 1981/AFL-CIO)

=====

[1] U.S. Public Health Service, National Institutes of Health.
ASTHMA. (Washington, DC: U.S. Government Printing Office, 1983.)
[NIH Publication No. 83-525. USGPO Stock. No. 017-044-00033-8]

[2] R. Fulwood and others, "Asthma -United States, 1980-1987,"
MORBIDITY AND MORTALITY WEEKLY REPORTS Vol. 39 No. 29 (July 27,
1990), pgs. 493-497. Single copies available free from Centers
for Disease Control, Atlanta, GA 30333; phone (404) 332-4555.

[3] R. Michael Sly, "Mortality From Asthma, 1979-1984." JOURNAL
OF ALLERGY AND CLINICAL IMMUNOLOGY, Vol. 82 No. 5 (November,
1988), pgs. 705-717.

[4] Francois Haas and Sheila Sperber Haas, THE ESSENTIAL ASTHMA
BOOK (NY: Scribner's, 1987).

[5] U.S. Public Health Service (cited above), pg. 6.

[6] Peter J. Gergen and others. "National Survey of Prevalence of
Asthma Among Children in the United States, 1976 to 1980."
PEDIATRICS, Vol. 81 (Jan., 1988), pgs. 1-7. See also Richard
Evans III and others, "National Trends in the Morbidity and
Mortality of Asthma in the US; Prevalence, Hospitalization and
Death from Asthma Over Two Decades: 1965-1984." CHEST Vol. 91 No.
6 (June, 1987) Supplement, pgs. 65S-74S.

Descriptor terms: asthma; phs; aerosol spray; air pollution;
immune system; statistics; epa; sulfur dioxide; ronald reagan;
sulfites; fda; generally recognized as safe; allergies; mcs;
children; age; gender; females; emotional disorders; mental
illnesses; race; mortality; health care; nih;