European Stars and Stripes (Newspaper) - April 02, 1991, Darmstadt, Hesse To to it or health baffles experts cases outpace gains in treatment by Lawrence k. Altman the new York times. Asthma treatment has vastly improved Over the last 20 years. Doctors Are More aware of the breathing disorder Are Able to diagnose it better and sooner and can. Provide a larger Arsenal of therapies to relieve the wheezing gasping and struggle for. Breath that each attack brings. A a a a a a a a. A a a a a. V yet around the world More people Are. Dying of asthma the trend has been seen Over the last two decades and asthma is apparently alone among chronic disorders experiencing such an increase in. The United states. A at least 10 million americans or 4 percent of the a a a a. Nations population Are asthmatics up from 3 percent in 1979. The frequency with which americans Are released from a Hospital with a diagnosis of asthma nearly tripled from 1970 to 1987. V. For children under 15, the Quot rate Rose 43. Percent to 28.4 per 10,000 children from 19.8. Blacks Are More a than twice As Likely As Whites to be hospitalized although asthma is not a leading cause of death in the United states the number of deaths in All age groups Rose to 4,600 from 2,600 from 1980 to 1987&Quot worsening statistics have also been recorded in a a Canada England Denmark Sweden Australia an new zealand Only Japan for unknown reasons. Appears to have escaped the trend. A a a -. Another Puzzle is the differing patterns in the a United states the largest increase in deaths has been among those 65 and older. Elsewhere children Are. Predominantly at risk a a a a a a a. Quo there is a lot of head scratching going on because the situation does t make said or William Busse who Heads the allergy program at the a. University of Wisconsin. A a. a a i solving the problem is All the More difficult because asthma is a disease of unknown cause. So factors that account for. The rising number of cases May be unrelated to factors making Case More severe indeed some experts believe asthma has become a More virulent disorder though they Lack re a Quot. Documentation. But even proponents of that View Are unable to. Explain How a disorder like asthma that a seems behaved the same Way for centuries could suddenly change its nature Many diseases Are. Cyclical but they Are mostly the ones caused by microbes. After infecting Many a people the microbes must mutate like influenza to outwit the immune system or. Await the birth of new generations of people who Are susceptible before they can strike again. To by contrast asthma is generally considered an a. Allergic disorder that can be set off by Dander pollen -. _ viral infections and occasionally by Industrial to. A a pollutants. For example an outbreak in Barcelona a a t. Spam was linked to release of airborne dust from a ships unloading soybeans. T a / .7 a a but a local exposure cannot explain s worldwide / a. Phenomenon. Also the worsening trend of asthma. Has been noted in Urban and Rural areas making it. More difficult to indict a particular pollutant or allergen. A there is Little doubt that some of the reported increase in fatal and non fatal cases results rom a improved ability to distinguish asthma from ailments v Tike bronchitis and recurrent croup that can also Quot 7 produce wheezing. A. And doctors have Learned to identify subtypes of _ a asthma. For instance individuals a who have polyps in the management of asthma breathlessness is caused by inflammation and constriction of the Small airways in the lungs. As lungs collapse to expel air these Bronchioles Are further narrowed. When an attack occurs drugs can help open the airways but the goal of treatment is also to head off further attacks. Drugs help. Open / airways and prevent further clogging. Self monitoring to avoid hospitalization patients Are advised to Monitor their breathing with flow meters and to use drugs Tike inhaled steroids to Stop the Esca tation of inflammation. Source. Quot american medical association encyclopedia of a Medicine Quot random House not their nose can die suddenly from an asthmatic attack if they take aspirin. \ a a. A most asthma experts discount changes in. Diagnostic criteria and classifications As explanations a of the Paradox though. A a a. The concepts of Good asthma care have also changed in . For chronic management a doctors now stress the need for continuous a a a a a a monitoring and therapy hot just episodic care of asthmatic attacks and flare ups. Doctors warn patients that delays in seeking treatment can aggravate asthma making it fatal. A a a. Health officials Are focusing attest Ion non the problems of Access to. Health care in part because studies have identified pockets of asthma among children in the inner cities of new York and Chicago a children in families who rely on emergency rooms for care because they do not have personal a a. ,. Physicians or Lack health insurance May have worse 7 asthma attacks that Lead to More frequent admission to hospitals. A a. a a a. But asthma Aiso worsening in a countries Tike England and Sweden that offer National health insurance -. / a. _ asthma drugs have shown impressive sales v increases in Many countries. The Arsenal has been expanded to include a class of drugs known As Beta agonists Cro Molyn sodium and inhaled steroids a which help reduce the inflammation. Quote doctors also encourage everyday use of a device a Peak flow meter that enables asthmatics to Monitor their ability to exhale. A. A. Editorials in medical journals have raised questions about the Overall effectiveness of current management of asthma. A a.7 / a. A. Scientists have yet to find the perfect asthma drugs and experts have pointed to the need for Large scientifically Weli designed studies to determine the most effective of existing therapies. A a v a. While studies have shown the immediate beneficial effects of licensed asthma drugs there is concern that a some might have delayed Adverse effects that Are not yet known. Occasionally years pass after a drug is. Marketed before unsuspected Long term hazards Are detected. A Quot Beta against drugs Are a mainstay in the treatment of asthma. But an important unresolved question is whether Beta agonists should be used to prevent. Asthma attacks or Only when symptoms flare. Another unresolved question is whether regular use of them make asthma worse. A a a a the possible one class of drugs alone cannot explain the global asthma problem because. Pharmaceutical practices differ throughout the world. Some critics say that researchers have concentrated on the biology of asthma and neglected environmental aspects they Point to recent research identifying allergies to cockroaches and household a / mites As triggers of asthma researchers Are now. Focusing on indoor pollutants and allergens that May a have been introduced As part of modern housing. The need for imaginative thinking is greatest when research is stymied. One area that seems to have escaped attention Are the foods and drugs that women take during pregnancy and the pollutants to which they Are exposed. A / a a a about 20 years ago scientists were surprised to learn that a drug lbs could cause vaginal cancer among daughters born to women who took it in pregnancy. A a. 7 / a similar Factor might explain part of the a Paradox of asthma. Page 14 the stars and stripes tues i
