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The Invisible Epidemic

The rise of asthma in urban communities is beginning to reach epic proportions. It is a disease that is not limited to the United States, but is endemic to all developed nations and is especially prevalent in urban communities. The drastic rise in asthma and related pulmonary illnesses is surprising because benchmark studies have resulted in an as yet unknown understanding of the disease. All scientists agree, however, that this is a pathology whose etiology can be traced as an overt effect of a modern Western culture. The effects of asthma are wide reaching and can be studied from many viewpoints. From a societal perspective, sociologists and public health officials cringe when they read the statistics for asthma in children in a poor urban area of New York, versus the national average. The Mott Haven neighborhood of The Bronx, which has a median household income less than one-third of the U.S. median, has an asthma-related hospitalization rate eight times higher than the national average. From an environmental perspective, environmental scientists are discovering that vehicle exhaust can acerbate asthma’s symptoms. In Mott Haven a local newspaper counted 550 passing trucks passing one street corner near a school in one hour. In Tehran, Iran, the worlds eighth largest city, levels of industrial pollutants from fossil fuel combustion have risen to four times higher than the standards adopted by the World Health Agency, in only ten years, and asthma related hospitalizations have also risen dramatically. From a cultural perspective the research is also frightening. Research from the Albert Einstein College of medicine indicates that asthma rates may be rising as a direct result of our western lifestyle. Findings show that the national rates of asthma hospitalizations may be increasing at a high rate because children are spending more time indoors than ever before, and are being exposed to dust-mites and allergens that are prevalent inside houses and apartments. That lack of physical conditioning along with a 1997 study published in the New England Journal of Medicine which found that 40% of asthmatic children are very allergic to cockroach feces is another clue why asthma incidents are so widespread in inner-cities. The only aspect of our environment, technology and society that seems to be unaffected by this disease and turns a blind-eye to asthma is our political leaders.Even though the Clinton administration has made asthma research funding a top priority, most scientists agree that there should be more money ear-marked towards comprehensive long-term studies such as those that discovered the risk factors behind heart disease and lung-cancer. Our leaders and future leaders need to take heed, though. Between 1980 and 1994 the prevalence of asthma among U.S. children five to 14 has almost doubled. Even more frightening is that in the past twenty years, when medical technology has grown at an unprecedented rate, asthma deaths have more than tripled. Education-minded leaders need to be aware that asthma is now the most common chronic illness among children, and as of this year it has become the leading cause of school absences.

Although the etiology of asthma is complex and poorly understood, the progression of symptoms is better understood. Bronchial asthma is an allergic reaction in the bronchi and bronchioles of the lungs. An allergic reaction like the kind found in asthma occurs when the body’s specialized germ fighters, white blood cells called lymphocytes, react over-aggressively to a harmless, or moderately harmless allergen-a foreign substance. Spasmogens, and vasoactive substances such as histamines, leukotrienes, and prostaglandins are released locally causing an inflammation of the lung-tissue, which decreases the circumference of the bronchioles through spasmodic smooth muscle contraction, and also releases mucus, which can further restrict the passage of air. The mechanism of this response has been well understood for decades, and an albuterol inhaler and intravenous magnesium solutions can alleviate the symptoms. Although there is dissention in the ranks of researchers over what the primary causes of asthma actually are, most scientists agree that it is a pathology with many different aggravating factors. Research has suggested that asthma hospitalizations show a direct correlation, with high levels of industrial pollutants, and vehicle exhaust. A study conducted in Tehran, Iran, where there are no emissions standards, showed a 16 percent increase of asthma hospitalizations, and a 10% higher level of retarded pulmonary growth verses rural Iranian communities. This study also measured specific levels of industrial pollutant by-products, and showed a correlation between asthma and high levels of sulfur oxides, nitrogen oxides, carbon monoxide, and particulate matter. Evidence has also been collected which shows links between maternal smoking during pregnancy, and smoking in general. Dust mites and cockroach feces have been listed as aggravating factors, as well as lead based paints. Children with low levels of physical activity show a decrease in pulmonary lung function and are at a higher risk of developing asthma. A recent paper has even found a genetic link for asthma: children of asthmatics are three to six times more likely to develop asthma than children of non-asthmatics.

Among all of these frightening statistics it seems that nothing is being done to help contain the asthma epidemic. Although asthma hospitalization rates continue to climb, there are some grassroots urban health initiatives designed to help treat asthma. Among the most successful of these is the Asthma Passport Program (APP) conducted at Montefiore Medical center in New York City (the hospital that serves the Mott Haven neighborhood). In the APP, communication between primary care physicians and home-based care is emphasized. Parents of asthmatic children are given a personalized “passport”, a record of hospital visits, and specific treatments, as well as home management techniques. Participants in the APP were 18% less likely to visit the hospital over the one-year duration of the study. The prevalence of asthma in our society is indicative a trend that will likely increase in the future. It is likely that the mystery that will not be solved anytime soon. The general conclusion that can be drawn is that asthma seems to be an indirect, possibly overt result of our western lifestyle. There is no pill that can be taken that will decrease the by-products of fossil fuel combustion. It is not an overgeneralization to assume that asthma related illnesses will act as an early indicator of the more broad-based problems inherent in modern civilization.

Bibliography: Works Cited Alpert, Mark. The Invisible Epidemic. Scientific American. November 1999. P19-20 Asgari, M; Dubois, D: et al. Association of ambient air quality with children’s lung function in rural and urban Iran. Archives of Environmental Health. May-June 1998. V53 n3 p222(9).

George, MR; O’Dowd, LC; et al. A comprehensive educational program improves clinical outcome measures in inner-city patients with asthma. Archives of Internal Medicine. 9, August 1999. P1710 Goodman, DC; Stukel, TA; Chiang, Chiang-hua. Trends in pediatric asthma hospitalization rates: regional and socioeconomic differences. Pediatrics. Feb 1998. V101 n2 p208(6) Henderson, Charles. Primary care-based intervention in inner-city children with Asthma. World Disease Weekly Plus. 10, May 1999 pNA