It's the middle of the night. Suddenly you're wide awake, suffocating, gasping for air but unable to catch your breath. The whole world seems to be closing in around your throat and chest. The urgency to breathe that woke you in the first place is rapidly giving way to panic. You're having an asthma attack.
For millions of Americans, this is an all-too-frequent occurrence, a nightmare that can't be fully appreciated by those without the disorder. That was certainly true for me. Until late 1987 I had never given asthma much thought. Then I had a bout with viral pneumonia. Even after I recovered, a nagging cough lingered. The cough became chronic and, after several months, so did periods of breathlessness. After one particularly anxious episode, I went to the doctor. She diagnosed my problem as asthma.
Asthma comes from the Greek word for "panting." My doctor described it as a reversible, chronic lung disease characterized by coughing, wheezing, and inflamed airways. Though asthmatics always have some degree of inflammation, an asthma attack or "flare" occurs when some trigger provokes increased swelling, mucus production, coughing, and a tightening of the smooth muscle around the airways. As airways close, breathing becomes shallow, fast, and difficult. Symptoms can be mild, severe, or even fatal. This is the clinical explanation, but it hardly conveys the terror of an experience that leaves even the strongest person feeling out of control and helpless.
Upon my doctor's diagnosis, I became one of the 17 million asthma sufferers in America. Figures from the U.S. Department of Health and Human Services are sobering: Six percent of children under 5 have asthma (a 160 percent increase since 1980), and older children miss 10 million school days each year. Asthma accounted for nearly 2 million emergency room visits last year; more than $6 billion was spent on asthma care. According to the World Health Organization, the situation isn't much better throughout the industrialized world. In Australia, for instance, at least one in eight children has asthma. Annually, there are more than 180,000 deaths worldwide from the condition, and asthma seems to have become a more serious disease in recent years. Researchers are scrambling to figure out why.
Pollution is often cited as a cause, and with good reason: Airborne and environmental pollutants can trigger asthma attacks. But studies show pollution can't bear sole blame for the epidemic. Even where pollution rates are declining, asthma incidence continues its upward climb.
Other scientists theorize that perhaps we are too clean. Researchers at Columbia University are trying to determine if the important sensitization of the immune system that should take place early in life has been reduced by modern hygiene, leading to later hyperactive immune reactions that contribute to the occurrence of asthma.
Especially intriguing is the recent theory that the very drugs that revolutionized asthma care may be partly responsible for the increase in overall incidence, and especially for the growing mortality rate. This hypothesis is particularly compelling since the current epidemic indeed began at about the same time modern asthma drugs went on the market.