Breathing lessons.

Is Air Pollution to Blame for the Asthma Epidemic?

Matthew Staron wants to be a professional football player when he grows up. Luckily, his asthma isn't usually a problem when he plays for the town league. But going into restaurants that Matthew says "are like smog pits" is another story. "The smoke makes it hard to breathe. It makes my asthma so bad that I have to sit down...I can't walk."

Not being able to have a birthday party at McDonald's and eating outside of Burger King in a cold car with his family was no fun. So at the age of 9, Matthew (with the help of his parents, a state senator and the American Lung Association), filed a lawsuit against Wendy's, Burger King and McDonald's for violating his right to equal access under the Americans With Disabilities Act. After putting up an initial fight, the chains capitulated and agreed to make all their Connecticut franchises smoke-free. Now at age 13, Matthew has escaped the smoke (though not the health effects of the fast food itself!). "My asthma isn't that bad anymore," he says.

Unfortunately, victories like this aren't making a dent in the escalation of asthma around the world. Since 1982, the prevalence of asthma in the U.S. increased by 49 percent; among children under age 18, the rate rose 78.6 percent. Hospitalization rates for asthma almost tripled between 1970 and 1980 and deaths have increased by 31 percent in the United States.

What's causing the asthma epidemic? Important factors include allergies, indoor and outdoor air pollution, genetics, psychological factors and a host of other medical reasons, including overuse of some treatments. Since asthma is a disease with many causes, working perhaps with a combination effect, it may be years before researchers fully understand it.

What's Going On?

It is still not completely clear what causes the initial onset of asthma. Genetic factors are known to play an important role. When both parents have asthma, there's a 50 percent chance of asthma occurring in their offspring. When one parent has it, there is a 25 percent chance.

Viruses, such as flus, colds, bronchitis, tonsillitis and sore throat are suspected forerunners of asthma. Allergies to certain foods, pollens, molds, dusts and animal danders (the list is almost endless) can lead to the "sensitization" of the airways and may promote the development of asthma. "When and how this sensitization occurs, nobody knows," says Dr. Brian Leaderer, an asthma researcher with the John B. Pierce Laboratory at Yale University. "However, it may be most important in the first years of life."

Smoking is a big factor. Babies born to women who smoked during pregnancy have abnormally small airways that may predispose them to asthma and other respiratory disorders. In fact, children of smokers are twice as likely to develop asthma, and they have more frequent asthma attacks.

Once asthma develops, many other factors besides allergies, viruses and cigarette smoke can trigger subsequent asthma attacks, such as air pollution, exposures to chemicals, dusts, and fumes at home and work, cold air, exercise, stress and laughing too hard.

Because everyone is exposed to air pollution, it's under intense scrutiny as a contributing factor. "There is no evidence that air pollution 'causes' asthma. But an aggravating effect has been fairly decisively shown," says Dr. Shankar Prasad, a health-effects researcher with South Coast Air Quality Management District.

Pollutants do their damage by reacting chemically with body tissues, inflaming the lining of the nose and the throat. They "prime" the airway for allergens. These effects are particularly serious for asthmatic children (and healthy children as well) because they tend to spend more time outdoors during the summer months when ozone levels are higher, and because their lungs are still maturing.

Another aggravating factor for both children and adults is overuse of dairy products. According to Dr. Andrew Nicholson, director of preventive medicine at the Washington-based Physicians' Committee for Responsible Medicine (PCRM), "A wealth of medical research links dairy intake with allergy symptoms in both children and adults. Patients with severe emphysema, when taken off dairy for one year, show much-improved breathing, less need for medication and less occasion for hospitalization. And children with runny noses, after being taken off dairy, experience significant relief as well."

Asthma is becoming more common and more severe yet, ironically, our air is generally getting cleaner because of the Clean Air Act of 1970 and the Amendments of 1990. But despite such progress, the magnitude of the air pollution problem still remains. From 1991 to 1993, more than 50 percent of the population was exposed to unhealthy levels of ozone, reports the Department of Health and Human Services.

Taking Charge

While asthma isn't going to go away, there are steps people can take to reduce its severity. Living with asthma and allergies will never be easy in our industrialized society, but it doesn't have to be impossible. Until the more global causes for asthma are understood and addressed, people with asthma don't have to passively accept their fate. Here's how to be proactive:

* Pinpoint your asthma triggers. Record when asthma symptoms start, where you were, what activities you were doing, who and what was around you, what you ate and any medications you were taking in the hours before the symptoms began.

* Asthma tends to get worse at night (airways may become narrow and collect mucus while you sleep), so free your bedroom from asthma triggers. Buy mattress and pillow casings which are impermeable to dust mites and avoid feather comforters and feather pillows.

* Eat a proper diet, one with moderate or no dairy intake.

* Don't smoke and avoid second-hand smoke.

* Talk to your doctor about natural remedies for asthma. "In the short term, the best thing for asthma is conventional medicine, such as inhalants that open the airways," says Dr. Chis Meletis, chief medical officer at the National College of Naturopathic Medicine. But studies on natural alternatives, such as vitamin C and magnesium, have improved breathing for people with asthma.

* Finally, write your congresspeople about implementing stronger air pollutant standards, particularly for ozone, and stricter smoke-free policies for restaurants, workplaces and public spaces.

CONTACTS: American Lung Association, 1740 Broadway, New York, NY 10019-4374/[phone]; National College of Naturopathic Medicine, 11231 SE Market Street, Portland, OR 97216/[phone]; Physicians Committee for Responsible Medicine, 5100 Wisconsin Avenue NW, Washington, D.C. 20016-3404/[phone].

ALYSSA L. BURGER is a graduate student in public health and E's former advertising director.