Asthma: the suffocating disease.

My interest in writing about asthma stems from harrowing personal experiences with an asthmatic daughter. So severe were some of her attacks when she was a child that her lips turned a grayish-blue while struggling to breathe. She's 26 years old now and has practically "outgrown" her asthmatic episodes, but she still has her occasional bout. During the past 15 to 20 years we have learned much about asthma--how to reduce the likelihood of an episode and how best to treat the disease. Here is some of what we know.

Who gets asthma? People of all races, ages, and nationalities, both rich and poor, are at risk. Anyone can get asthma. However, asthma is more prevalent among children than adults. Gender appears to be of little difference, but Blacks are at a slightly greater risk than Whites.

A disease on the rise. In the 10-year period between 1979 and 1989 asthma cases increased by 60 percent. No one has been able to explain this upward trend, but several factors have been suggested, such as increasing exposure to infections and air pollutants and the quality of the air we breathe outdoors and indoors.

Asthma is rarely fatal, but it can be very disruptive to the lives of asthmatics and loved ones. Living with asthma or with those who have the disease requires understanding that the disorder can be treated and controlled but that there is no cure.

What is asthma? The experts cannot agree on a single definition of asthma. The clinician, the physiologist, the immunologist, and the pathologist all have different perspectives of asthma, and these perspectives are difficult to merge into a comprehensive definition.

One definition that has emerged from the National Asthma Education Program, U.S. Department of Health and Human Services, is as follows: "Asthma is a lung disease with the following characteristics: (1) airway obstruction that is reversible (but not completely so in some patients) either spontaneously or with treatment; (2) airway inflammation; and (3) increased airway responsiveness to a variety of stimuli."

Clinton Young, M.D., a recognized expert on asthma, defines it as "the general term for a group of airway disorders characterized by episodes of smooth muscle spasm, mucosal edema, and thick retained secretions."

The attack: a series of events. We used to think that an asthma episode was a single event--contraction of the muscle layer in the airways, making it difficult for a person to breathe. Today, however, we know that an attack is more complicated.

The beginnings of an attack occur when something irritates the lungs. Ordinarily the lungs take in air and distribute oxygen throughout the body. The air leaves the lungs and circulates through the bronchial tubes. Small fine, hairlike projections within the bronchial tubes (known as cilia) carry out mucus and irritants, such as smoke particles and dust, to be coughed up and out of the lungs.

At the end of the bronchial tubes, small elastic air sacs, called alveoli, expand to take air in, contract to expel it. Surrounding the alveoli are the capillaries, the small blood vessels that receive oxygen from the alveoli and give up carbon dioxide to be breathed out.

During an asthma attack, things don't work the way they should. The person typically feels a tightness in the chest, experiences wheezing, coughing, restlessness or difficulty sleeping, or trouble breathing. It's difficult to breathe air in, even more difficult to get stale air out.

In the asthmatic there is a hyperactive response of the breathing tubes. The cells that line the air passages begin to secrete more mucus than normal. This mucus is very thick and sticky and therefore tends to clog the breathing tubes. And because the air passages are irritated, they tend to swell. All these events--the constricted air passages, the thick mucus, and the swelling--make it difficult to breathe.

If you want to get an idea of what the asthmatic experiences during an attack (also called an episode), try this experiment. First take a deep breath and hold it for a couple seconds. Now, without exhaling, try to take in more air. Not exactly a pleasant feeling, is it? In some people it evokes a panicky feeling. Imagine how the asthmatic must feel when fighting desperately to get fresh air into lungs that won't cooperate!

What causes asthma? We don't know the answer to that question, but we know most of the common "triggers." The most common ones are pollen, dog or cat dander, viral infection, dust or mold, strong odors, cigarette smoke, cold weather, physical exertion (so-called exercise-induced asthma), and emotional stress.

The bronchi of those with asthma are so sensitive to one or more of these irritants that when exposed, they contract, become inflamed, and clog up with mucus. Persons with asthma have often had viral infections prior to the first onset of asthma. Flu, colds and viruses, bronchitis, tonsillitis, and sore throats often trigger or are forerunners of attacks.

Managing asthma: treating more than just the symptoms. Controlling asthma takes a team approach. Medical care is essential, but it is equally important that people with asthma and their families learn how they can play a vital role in the management of the disease. To lessen the likelihood of an attack:

* Avoid smoke--smoke from cigarettes, wood fires, burning leaves, or other sources.

* Avoid using analgesics if you are sensitive to them. Some asthmatics, for example, experience severe attacks if they take aspirin. In general, the asthma sufferer should watch out for nonsteroidal anti-inflammatory drugs taken for pain and arthritis.

* Watch out for dust. Overstuffed furniture and carpets, as well as draperies, are prime sources of dust.

* Condition your source of air. Air-conditioning helps filter airborne pollens and molds in the home, office, and car. Be sure to change filters often.

* Avoid animals if you discover that attacks occur when in close proximity.

* Be on guard for certain foods that may trigger an episode. About 8 percent of asthma sufferers are sensitive to sulfites.

The best medications. The most important advance in asthma therapy is the use of inhaled corticosteroid drugs pioneered in Europe and Canada during the past 20 years. The corticosteroids prevent inflammation and limit potential damage to bronchial tissue with very little risk of side effects. They are now considered first-line therapy for anyone with moderate to severe asthma (more than two attacks per week). (For milder forms of asthma, the recommended therapy is inhaled [beta.sub.2]-agonist.) To be effective, the corticosteroids must be taken daily--regardless of whether or not there are symptoms.

It's important that the asthmatic know how to use an inhaler properly to administer the steroid to prevent the medicated mist from remaining on the tongue and the back of the throat, where it will do no good to the bronchi.

Future treatments. In 1995 a ban will begin on fluorocarbons--the gas used to propel the medication from the inhaler. Fluorocarbons pollute our environment and have been the source of much controversy for many years.

The new generation of inhalers will deliver medicated mists even more efficiently. They will be "breath-activated" devices that eliminate the need to coordinate breathing in and simultaneous pump activation.

A final word of caution. Because the new line of drugs works so well in bringing almost immediate relief to the asthmatic, there is the risk of believing that the drugs are a magic elixir. It's very important to keep in mind that this chronic disease is best managed when the sufferers and their families learn about the triggers to their episodes. The control of these events is extremely important to the comanaging approach essential for effective safe management of asthma.