=======================Electronic Edition========================
RACHEL’S HAZARDOUS WASTE NEWS #374
—January 27, 1994—
News and resources for environmental justice.
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ASTHMA: PREVENTION MAY BE THE ONLY CURE
In 1990 the JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION (JAMA)
observed that death rates from asthma have been increasing in the
U.S., Canada, England, France, Denmark and Germany. [1] Other
sources report increasing death rates from asthma in Wales and
Australia. [2] A new study of 10,526 asthma deaths in California
during the period 1960-1989 confirms the U.S. trend. [3]
In the U.S., the increase has been rapid. Asthma death rates
increased 31% between 1980 and 1987 (from 1.3 per 100,000
population to 1.7 per 100,000). The biggest increase occurred
among children between the ages of 5 and 15.
These averages hide important facts about the people hardest hit.
Among African-Americans, the age-adjusted death rate from asthma
climbed from 1.9 per 100,000 in 1979 to 2.6 per 100,000 in 1984,
a 37% increase in 5 years. Among whites, the age-adjusted
increase during the same period was 25% (from 0.8 per 100,000 to
1.0 per 100,000). [4] The asthma death rate is nearly three times
as high among African-Americans as among whites, and is worsening
more rapidly.
In addition to asthma deaths, the PREVALENCE of asthma has been
increasing steadily in the U.S. and elsewhere. According to
JAMA, the best information on asthma prevalence comes from the
National Health and Nutrition Examination Surveys (NHANES).
NHANES data indicate that, among children ages 6 to 11, the
prevalence of asthma increased from 4.8% in 1971-74 to 7.6% in
1976-1980, a 58% increase in a short period.
According to a 1988 study, among U.S. children ages 3 to 17, 9.5%
(or 5.01 million) had been diagnosed by a physician, at one time
or another, as having asthma, and 6.7% (3.54 million) currently
have physician-diagnosed asthma. Among those currently having
physician-diagnosed asthma, the prevalence of disease is 54%
higher among African-American youths compared to all others (9.4%
vs. 6.1%). [2]
All told, according to the American Medical Association (AMA), an
estimated 9.9 million Americans suffer from asthma. [5] However,
this number is flexible, depending upon who is defining the
disease. By some estimates the number is as low as 7 million or
as high as 20 million. [6] (In children, wheezing is likely to be
caused by asthma; however, among adults, there may be several
possible causes of wheezing, giving rise to differing estimates
of asthma among adults.)
In any case, there is general agreement that asthma is
increasing. Various studies have tried to explain away the
increase: changes in the way the disease is defined; better
diagnosis; better access to hospitals. The AMA says none of
these reasons is persuasive: there really is more asthma
occurring, and more people are dying of asthma.
No one knows for sure what is causing the increases. Asthma is a
disease of the immune system. The immune system is an
exceedingly complicated set of organs, tissues, and fluids,
which, together, protect the body from outside invaders, such as
bacteria and viruses. The immune system also protects against
internal threats, such as cells that go haywire and start
multiplying uncontrollably (i.e., cancer). In an asthmatic, the
immune system overreacts to the presence of an external agent and
ends up doing more harm than good. The bronchial tubes (which
connect the throat to the lungs) become inflamed, produce
excessive mucous, and also may constrict by muscular spasm. As a
result, the person feels like he or she is drowning for lack of
air, which is in fact the case. It is a nasty, debilitating
disease. In inner cities, asthma is the leading cause of
hospitalization among children ages 5 to 15. [7]
Although we know asthma is an immune system disease, this does
not mean anyone knows much about its causes. The U.S. has been
focused on cancer for two decades, spending $25 billion searching
unsuccessfully for the holy grail (a cure), largely ignoring
prevention. [8] As a result, research on the immune system has
lagged behind.
Asthma in industrialized countries may be worsening because (a)
there are more strange substances in the environment each passing
day because of “better living through chemistry,” and the immune
system goes berserk responding to them (b) immune systems are
knocked out of kilter by something new in the environment and
then overreact to common substances like house dust or dog hair.
Perhaps both are true.
It seems certain that asthma is triggered by common air
pollutants, such as street-level ozone and nitrogen oxides, which
are increasing as time passes. Fine particles definitely make
asthma worse (see RHWN #373, but also see RHWN #131, #132, #134 and #136). [9] Fine particles are pieces of soot or dust or smoke
so small that they bypass the natural pollution traps in our nose
and throat. In addition, the presence of fine particles in the
air increases the incidence of non-asthma illnesses among
asthmatics: chronic cough, bronchitis, and chest ailments
increase among asthmatics as the concentration of fine particles
increases. [10]
Furthermore, exposure to nitrogen oxides, sulfur oxides, and
ozone are associated with increased asthma. [11] This should not
be surprising since there is strong evidence that these air
pollutants cause an increase in bronchitis, persistent cough, and
chest ailments among people who do not suffer from asthma. [12]
On the other hand, there may be something more fundamental at
work than mere pollutants irritating hyper-sensitive bronchial
tubes. SCIENCE magazine, the voice of the American Association
for the Advancement of Science, flatly attributes the asthma
increase to damaged immune systems:
“In the 1980s, human immune systems were first faced with the
blatant, destructive power of AIDS. Now, in the 1990s,
humans–and immunologists–are encountering dramatic increases in
yet another disturbing, though far more subtle, problem:
Environmental pollutants are having a deleterious effect on
immune systems. Indeed, everywhere these days doctors are seeing
increasingly severe cases of immune-related diseases,” said
SCIENCE, specifically mentioning asthma. [13] What hope is there?
Asthma is one of those diseases that offers an opportunity to
reassert our commitment to a prevention philosophy. The immune
system is about as complicated as the nervous system, though not
so well understood. It may take decades or longer before the
physiological mechanisms of asthma are clarified. After that,
many more decades of research will be needed to pin down which
chemicals cause which effects. Interactions between multiple
chemicals and immune systems will probably NEVER be understood:
the problem is simply too complex for science to solve. In the
meantime, asthma grows worse. The most realistic hope for
reducing the costs of asthma is to reduce pollution and exotic
chemicals in the environment. This means resurrecting a 19th
century view of public health: curing most disease is impossible
or impossibly expensive whereas prevention is often possible and
affordable. Politicians and political appointees today say many
of the right words about prevention, but so far this has not
translated into deeds.
                
                
                
                
    
–Peter Montague, Ph.D.
===============
[1] A. Sonia Buist and William M. Vollmer, “Reflections on the
Rise in Asthma Morbidity and Mortality,” JOURNAL OF THE AMERICAN
MEDICAL ASSOCIATION October 3, 1990, pgs. 1719-1720.
Descriptor terms: asthma; morbidity statistics; mortality
statistics; us; canada; england; debmark; france; germany;
australia; wales; ca; children; respiratory disease;
african-americans; race and health; nhanes; american medical
association; ama; immune system; air pollution; ozone; nitrogen
oxides; sulfur oxides; sulfur dioxide;