Saint Raphael Healthcare System

Cindi MacAulay

I am not alone. I share this feeling with millions. According to the American Academy of Allergy Asthma & Immunology, the number of people with asthma has doubled since 1980. About 17 million people nationwide have the condition. And that number is expected to double again, to more than 29 million, by 2020.

Here in Connecticut, more than 267,000 people have asthma, including 87,000 children. The number of youth cases is so high, in fact, that earlier this year health officials declared an “asthma epidemic” in the state. Nationwide, more than one-third of asthma sufferers are under 18 years old.

Asthma is the leading cause of missed school days, as well as the No. 1 reason pediatric patients are admitted to hospitals. Medical care for asthma, and lost time from school and work, annually cost more than $11.3 billion. It can also be a fatal disease. Although many people — even those affected by asthma — don’t always perceive it as such. However, more than 5,000 people die each year from asthma, says the Centers for Disease Control. “Few people realize the severity of the illness,” says Brett Gerstenhaber, M.D., a pulmonologist at the Hospital of Saint Raphael, who’s board-certified in pulomonology and internal medicine. “But it’s not something anyone should take lightly.”

A severe asthma attack caused 16-year-old Robert Simington of Milford to spend a week in the hospital earlier this year. An ambulance took him to the emergency department. But even with high doses of medication and oxygen, the lung inflammation and wheezing wouldn’t let up. “Finally, doctors got it under control. But it was really, really scary,” says Simington, a junior at Jonathan Law High School.

It was roughly the 16th time he’s been in the hospital for asthma over the past 10 years. “I take my medicine every day like I’m supposed to, but it doesn’t always help,” says Simington. “Sometimes I wonder whether it’s going to be this bad forever.”

To help increase awareness — and give parents, especially, the information they need to care for children with the disease — the Asthma and Allergy Found-ation of America named May “Asthma and Allergy Awareness Month” and is in the midst of an aggressive PR campaign.

The fourth annual “Asthma Awareness Day” sponsored by the Allergy and Asthma Network-Mothers of Asthmatics will also take place Wednesday, May 2, on Capitol Hill in Washington, D.C. The event is designed to educate Congress and the public about asthma and how it affects daily living.

“Asthma is not an easy disease to manage,” says Mary Worstell, executive director of the AAFA. “You can’t just take a pill and hope it disappears. It requires lifestyle changes, daily monitoring and ongoing treatment.” Here’s what else you need to know:

Asthma is a disease that affects the lungs and the airways that lead to them. At one time, people thought it was a psychosomatic illness. Now, although its exact cause is unknown, many health experts believe it’s a combination of genetics and environmental triggers, such as allergies, vigorous exercise, cigarette smoke, sudden temperature change, excitement or stress.

Pollution also seems to be a major trigger. According to the American Lung Association, about 10 percent of emergency room visits by asthma sufferers may be caused by smog or inflammation from diesel and car fumes. Indoor “pollutants,” more properly called allergens, include dust and dust mites, cockroaches, perfumes and pets.

Symptoms vary among people, but usually include wheezing, fatigue, coughing, difficulty breathing and an itchy throat. And a full-blown asthma attack can be terrifying. It can make you feel like every breath is being drawn through a straw, instead of the lungs, and that you are not getting enough air to survive.

Medically, what happens is this: An asthma attack occurs when the airways in the lungs become inflamed by a trigger, such as dust or cold weather. This inflammation causes disease-fighting cells to accumulate, and the lungs to swell. Airways may become blocked or obstructed as the muscles surrounding the lungs tighten and spasm. Mucous may clog and narrow the airways, making breathing even more difficult.

Because air cannot flow in and out of the lungs freely, a whistling or wheezing sound may be heard. In severe attacks, wheezing may stop because there is too little air moving to make any noise.

While many asthma attacks last only a few minutes, some can last a few hours or several days. Sometimes, there are no warning signs. Asthma may also be chronic. “There’s no doubt asthma is definitely a major, major health concern,” says Kevin Twohig, M.D., a pulmonologist at the Hospital of Saint Raphael who’s board-certified in pulmonology, internal medicine and critical care. “People need to learn how the disease works and how they can control it.”

Although asthma cannot be cured, it can usually be controlled with medication and education, says Saint Raphael allergist Bernard Adelsberg, M.D., who’s board-certified in allergy, immunology and diagnostic laboratory immunology. Acute asthma, meaning individual attacks, is commonly kept in check with a bronchodilator, which opens swollen breathing passages, allowing air and medication into the lungs. Chronic asthma is often treated with a combination of bronchodilators and anti-inflammatory drugs, usually in the form of a steroid inhaler. Anti-leukotriene drugs, which go by the brand names Accolate, Zyflo and Singulair, are also used to block or inhibit the formation of leukotrienes, powerful inflammatory substances that contribute to blocked airways.

A strict self-management plan is also essential, experts say. This plan should include regular doctor visits and faithfully taking medications as directed. Many health experts recommend keeping an asthma symptom diary to help track triggers. For example, you may find that coming into contact with pollen, tobacco smoke or animals with fur makes your asthma worse. Also essential are daily tests with a peak flow monitor. It’s a tool you breathe into to measure the volume of air passing into the lungs, and thus the severity of asthma symptoms.

Perhaps the most important part of this plan, however, is eliminating the known triggers — pets, cold air and cigarette smoke, for example — that can cause asthma attacks to strike or worsen. According to a study published in the March issue of Pediatrics, getting rid of known triggers could help prevent asthma in more than 500,000 children a year — “a huge and significant number of cases,” says Twohig. This study also underscores the important role environmental factors play in development of the disease, he adds.

To help prevent attacks, Simington keeps his bedroom clear of all potential triggers. He has no curtains or carpets — only pull-up shades and hardwood floors — and hypoallergenic sheets and pillow cases. He dusts several times week, and most of the time has an air purifier running.

“I’m pretty much allergic to everything, so I have to be careful. It’s not worth it not to be,” says Simington.

When asthma becomes severe, oral steroids, like predisone may be used to reduce inflammation. However, because of severe side effects, one of the goals of managing severe, chronic asthma is to reduce the number of episodes that require the use of oral steroids.

Margaret LaCroix, vice president of communications for American Lung Association’s Connecticut chapter, offers this advice: “Listen to your doctors, take your medications and keep yourself informed about the disease.”

“And don’t hesitate going to a hospital emergency department if an attack seems really severe,” adds Twohig.

Mary Ellen Cody, who lives in Glastonbury and works for United Illuminating, says she’s been dealing with asthma all her life — “or at least as long as I can remember.” But by taking her medications and following doctor’s orders, she’s always been able to control her asthma, rather than have asthma control her.

“It never stopped me from leading an active life. I played volleyball and was on the swim team,” says Cody, 37.

She’s planning the same kind of life for her 3-year-old son, Patrick, who has asthma as well. “We’ve been lucky that so far, his asthma has never been so acute to require emergency care. But there have been nights when he’s needed to wake up every four hours for medicine,” says Cody. “As a mom, it’s scary to see my son go through this. But because I’ve dealt with it, I think I stay pretty calm.”

One of my biggest asthma-related mistakes happened shortly after I was diagnosed in the mid-’90s. I was a student at the University of Florida and stopped taking my medications because I felt better. But then I had my worse asthma attack ever. I couldn’t breathe. At all. And ended up in the hospital emergency department.

It’s a mistake lots of young people make, LaCroix says, and often stems from a youth not wanting to be different from his or her peers. What I soon learned, however, is that many asthma medications are preventive, designed to control asthma by keeping symptoms at bay.

Unfortunately, not everyone is able to take that control. Consensus among medical practitioners is that family and socioeconomic issues — which young children certainly can’t control — play a huge role in asthma rates rising, and the severity of pediatric asthma cases. Not all families have health insurance and can afford prescription medication or doctor visits. Many people also don’t take the disease seriously — despite articles like this one and national education campaigns.

All this said, I consider myself one of the lucky ones. My asthma has never led to an overnight hospital stay. And aside from two emergency department visits, I’ve maintained a good handle on the disease. I lead an active lifestyle with racquetball, hiking and aerobic classes among my favorite pastimes —although I’m always mindful of the need for caution, and always alert for possible triggers around me.

I see my physician regularly for checkups. I take my medications exactly as prescribed. I don’t smoke, and do my best to stay away from those who do. And because of all this, asthma has never stopped me from doing anything I wanted to do.

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