Childhood asthma affects 5 percent to 10 percent of children in the United States. And the number of children suffering from asthma has been increasing over the last 15 years. I was surprised to learn recently from Dr. Peyton Eggleston, director of pediatric allergy at Johns Hopkins, that inner-city children have been particularly hard hit. Mothers will want to know about his work with asthmatic children and what has been learned about childhood asthma over the last several years.
Q: What is asthma?
A: Asthma is a chronic inflammatory disease of the airways that can cause serious breathing problems. For about two-thirds of asthma sufferers, asthma begins with an allergy to something in the environment and becomes a chronic condition. No one is sure exactly how this happens. Asthma attacks can be caused by many things, such as colds, exercise and air pollutants, and the breathing problems that come with an acute asthmatic attack are frightening and dangerous.
In the past, treatment for asthma has focused on controlling these acute attacks. What we're now learning is that if the exposure to whatever is causing the allergy can be reduced early in the disease process, chronic asthma can be prevented.
Q: Who is at risk and what are the first signs?
A: It is generally thought that asthma has a genetic basis -- that is, some babies are susceptible from birth and then respond to environmental stresses by developing asthma. Symptoms usually begin before school age. An infant or toddler may develop coughs and wheezes with every cold, then gradually have the same symptoms every day when they exercise or are around smoke or other allergens. If environmental allergens are removed, the process can be reversed. Several studies have shown that symptoms improve over a period of months when children are removed from sources of household allergens.
Q: Can children "outgrow" asthma?
A: Absolutely. It is estimated that about two-thirds of the children who begin asthma in early childhood grow out of it by adulthood, approximately age 18. One of the most important determinants of whether a child will grow out of it is the severity of the condition. However, some people do experience a return of symptoms after young adulthood.
Q: What things can cause these allergic reactions?
A: Lots of things can cause allergies -- pets, house dust and pollen, for example. But, scientists have now identified a new allergen, one that is particularly problematic in inner cities -- the cockroach. More than 40 percent of children in inner cities with asthma are allergic to cockroaches, and the amount of cockroach allergen in inner-city homes is very high.
Q: Why are cockroaches allergens?
A: Actually, it's not the cockroach itself. It's something called "frass" that consists of roach saliva, feces and body parts. Frass gets into carpets, bedding, furniture and house air. So, it's not enough to kill cockroaches; the house must be cleaned of their leavings as well. If the house can be cleaned of this allergen, the majority of children will get better, and if asthma due to an allergic reaction to frass is controlled early, chronic asthma can be prevented.
Q: How can I control this problem?
A: There are several key steps to controlling cockroaches and the allergens they deposit all over the house -- exterminate, put food away quickly in tightly covered containers and wash used dishes and pans right away. Use allergy-proof mattress covers, wash bedding frequently (at least once a week) and vacuum well and often.
And go outside for fresh air. This may sound crazy to those who live in cities full of air pollution, but according to Dr. Eggleston, the air outside is always lower in pollutants and allergens than the air inside. One of the reasons asthma is increasing in children is thought to be the time they now spend indoors -- watching television in houses closed to the outside by air-conditioning and heating systems.
For more information about asthma and the allergens that contribute to its onset, call the Allergy and Asthma Foundation at (202) 265-0265. A particularly helpful book for mothers, according to Dr. Eggleston, is Dr. Thomas Plaut's book, "Children with Asthma: A Manual for Parents," available in bookstores or from Pedipress Inc., 125 Red Gate Lane, Amherst, Mass. 01002.
Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.