ARTICLE - ASTHMA - WORLDWIDE THREAT

ASTHMA THREATENS CHILDREN WORLDWIDE
(Columbus Dispatch) - By Dr. Diane Gorgas

I nearly ran into the pediatric nurse practitioner as she bolted from the patient-evaluation and treatment rooms in our rudimentary clinic in Haiti last month. She was oblivious to anything but her quest for a paper cup.

It seemed like an odd thing to get all wound up over until I saw her rip a hole in the bottom of the cup and shove an asthma inhaler through the tear. An involuntary sigh escaped me.

I followed her back into the treatment room to see if I could help. A mother and her infant daughter were on the bed. The girl clearly was struggling to breathe.

When I listened to the patient’s lungs, I could barely hear the faintest wheezing.

The paper cup was pushed firmly over the girl’s mouth and nose, and a quick puff of the aerosol was expelled into the low-tech mask the nurse had made.

The child’s startled response to the cold mist precipitated just the treatment she needed. There was a second of quiet as she took in a huge breath and began to cry.

That huge breath sucked the powerful stimulant into her lungs, and the resultant crying and coughing were the sweetest music to our ears. It told us that her lungs were beginning to open.

The impact of asthma in the United States is huge. It is responsible for 14 million lost school days each year, according to the federal Centers for Disease Control and Prevention, and costs employers 12 million work days. The disease also is responsible for nearly 2 million emergency-room visits a year.

For decades, asthma rates in developing nations were severely underestimated. That began to change when a multicountry study on asthma prevalence was formed in 1991.

Westernized countries thought that pollutants such as ozone, sulfur dioxide and nitrogen oxide were the big catalysts in a population’s rapidly growing prevalence of asthma. These components are emitted in industrialized nations by autos and coal-fired power plants.

This worldwide study showed us that developing nations struggle with some of the same burdens. They have fewer autos and power plants than we do, but their pollution-control technologies are not as stringent as those in the United States.

Particulate matter is the other component that triggers breathing diseases. It covers a wide range of pollutants, including dust, soot, fly ash, diesel exhaust, wood smoke and sulfate aerosols.

Developing countries have plenty of those.

A study published in 2002 estimated that 30 percent of childhood-asthma cases in the United States are caused by environmental exposure. The cost of the disease is $2 billion per year.

The big advantage that Haiti has in its fight against asthma is its relatively low rate of tobacco use. Only 10 percent of Haitians smoke, compared with nearly 20 percent of Americans. Smoking is one of the largest predictors of the development of asthma in children and of the severity of the disease.

It doesn’t matter whether you don’t smoke around your children. Cigarette smoke sticks around and can work its way into growing bronchioles, causing a lifetime of pulmonary compromise.

Our brave little asthmatic girl did well. She didn’t require second-, third- or fourth-line interventions that we sometimes have to pull out of our bags here in the United States.

She didn’t require steroids, antibiotics, a ventilator or powerful intravenous medications to reverse her symptoms. She needed only a few puffs of a strong bronchodilator and the shock of a cold mist to her cheeks to improve her breathing.

At least for now.

The dirt roads, the open brush fires and the dirty vehicles crowding the streets of Haiti could send invaders into her airways again.

You might think that sounds bad, but is it really any better along the I-71 corridor or in the home of a smoker?

Dr. Diane Gorgas is an emergency physician at the Wexner Medical Center at Ohio State University.