A report in the Naples, Fla., News by Drs. Esteban Gonzalez Burchard, Matthew S. Perzanowski, Akshay Sood and Sally Wenze, who are experts in asthma research.There’s an old protest song that begins, “There’s something happening here. What it is ain’t exactly clear.”
It could have been the theme song for the California Asthma Research Summit this past December in San Francisco. After hearing from all the experts, reviewing all the research and trying to make sense of the findings, we agreed that asthma has suddenly exploded as a major and growing health problem in recent decades, and for all our research, we’re still not sure why.We know that more people are getting sick and becoming disabled from asthma than ever before. And the deaths, sometimes in the very young, are persisting tragedies. But the reasons, and the solutions, continue to elude us.
In the United States, 22 million people now suffer from asthma, including 7 million children. That’s an increase of 75 percent among all Americans, and a stunning 160 percent increase among children in just 14 years. It is now the most chronic disabling disease of childhood. Four thousand to 5,000 people die of asthma in a year, and a half million are hospitalized, at an annual cost of $16 billion.
The summit’s presentations made this much clear: There’s not one simple explanation for what’s happening. There are many, many factors involved: genetic predisposition, exposure to indoor and outdoor pollutants, stress, obesity, diet and lifestyle seem to be related to asthma in some way. There even seem to be connections to birth order, the age of a person’s home, the proximity of a home to a road, childhood exposure to pets and farm animals, and the time of year a child is born. None of these factors exists in a vacuum, of course, but each interacts with all the others.
Presenters provided us with some tremendously compelling information that cries out for more research.
For example, rates of growth of asthma among different demographic groups vary widely. In the United States, low-income people and those in urban areas suffer most. African-Americans and Puerto Ricans have much higher rates of asthma than whites and Mexicans. In New York City, there are huge differences in asthma rates even among adjoining neighborhoods. And counter intuitively, rural Australians and New Zealanders have also experienced a sharp spike in asthma occurrences.
Much research suggests a person’s future susceptibility to asthma is determined in early childhood, possibly even before birth. For example, children delivered by Caesarean section are more likely to get asthma than those who are not. Perhaps those children are denied exposure to helpful bacteria, through a natural birth, that would increase immunity.
Children born in October are the most likely to develop asthma, possibly because they reach the age of 4 months — when antibodies they received from their mothers have ebbed, but their own immune function hasn’t matured — in February, when viral exposure is greatest.
Children with older siblings, and children born around pets, or growing up around farm animals, seem to develop some protection from asthma that older siblings, or those in households without animals, appear to lack.
Interestingly, evidence also suggests people in newer homes, which for purposes of energy efficiency are built to be sealed off from the outside air, are therefore subject to greater harm from indoor pollutants such as cleaning agents, wood smoke or gas stove emissions, than a person in an older home where indoor and outdoor air mix more freely.
While most people like a clean house, is it possible to be too clean for our own good? It appears we could be jeopardizing our health by being overly hygienic and removing helpful bacteria from our environment.
We also are coming to believe that living near a roadway, any roadway where any vehicles pass by, leads to greater respiratory difficulties.
There seem to be connections between asthma and nutrition, amounts of exercise and obesity. There is compelling evidence that high levels of stress can weaken a person’s immune system and cause a greater propensity for asthma.
There certainly seems to be a connection between allergies and asthma. But why does it appear so much more striking now than just a few decades ago?
All of these things, in interaction with each other, are probably factors in the tremendous growth in asthma. But we can’t win the fight against asthma without knowing much, much more about what’s going on.
The summit showed we’re not there yet. We’re not preventing asthma. We can get there, but only through much more research about all these factors and how they affect each other. Only through research can we find the answers that will allow for better public policies that will make people healthier and asthma rarer.
