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Alex coughed all night. It wasn't a loud cough, but a dry, consistent one coming every few minutes. Darleen Scope knows that cough; she knows it can mean weeks in the hospital. So she gave her son a breathing treatment. She hooked a clear plastic mask with a purple rhino nose over Alex's face and turned on the nebulizer. Four hours later she gave him another treatment. But the medicine didn't work. Two-year-old Alex kept coughing.
In the morning Darleen called the asthma clinic at Memorial Hermann Children's Hospital.
Is he breathing rapidly? a nurse asked.
No, Darleen said.
Is his chest retracting?
No, but his nose is running.
They both know that a runny nose is a warning sign of an impending asthma attack. The nurse told Darleen to bring Alex in immediately. The clinic had been through this before with him. Because Darleen didn't think her son was that sick, she didn't call an ambulance. Being without a car, she called a cab instead. Traveling from their one-bedroom apartment near Hobby Airport, the usually playful Alex was lethargic. Then things got worse: His stomach sucked up into his ribs as he strained to breathe.
At the clinic they checked the oxygen level in Alex's blood. It was low, too low. His breathing slowed down, and he was cranky, inconsolable. All he did was cry, and the only person he wanted to touch him was his 20-year-old mother. He tried to breathe but couldn't.
His hands went limp, and his coughs got shallower. His dark brown skin got darker. Everything that should have been soft and pink -- his palms, his lips, the rims of his eyes -- turned bluish-black coal.
Then he stopped breathing.
The physician, Dr. Giuseppe Colasurdo, picked up Alex and started running.
Nationally more than 100,000 asthmatic children, like Alex, are hospitalized each year. Despite new medications, increased prescriptions for antihistamines and reduced pollution in most cities, the childhood death rate due to asthma has doubled in the last 15 years, according to the American Lung Association. And even though their risk for getting asthma is only slightly higher than that of non-Hispanic whites, African-American children are four times more likely to die from asthma. Fortunately, last October Alex was not among them.
In Houston, nine asthmatic children died last year at home or in the emergency rooms at Texas Children's, Memorial Hermann and Ben Taub hospitals. That's three times the number of children who died of HIV in the same places. One asthmatic dies every week in Texas, says Dr. Lynnette Mazur, medical director of general pediatrics at Memorial Hermann Children's Hospital.
"It's a national disgrace that we have so much morbidity and mortality from asthma," says Dr. Lawrence Thorne, of the McGovern Allergy and Asthma Clinic in Bellaire. "It's a mistake on somebody's part almost anytime an asthmatic gets in the hospital."
The number of deaths is alarming because no one should die of asthma. It's a manageable disease. Although there isn't a "cure," treatments can counteract the course of the disease -- and one-fourth of asthmatic kids "grow out of it," since the airways expand and grow with the child. With proper treatment, asthma shouldn't stop kids from playing outside, exercising or attending school.
But proper treatment costs money, and many lower-income parents are uninsured and can't afford the continuous care and medicine to control and prevent attacks. Some parents don't realize their child's cough is something serious. Some overuse and abuse inhalers. Others simply aren't educated in the many environmental triggers that can start an asthma attack.
Asthma attacks children across all socioeconomic levels. Anyone can get it. Not everyone can afford to treat it.
Having an asthma attack is like being strangled. Attacks occur when the lining of the airways gets inflamed, which stimulates the mucus glands (and asthmatics make six times as much mucus). Mucus clogs the airways, then the surrounding muscles tighten, spasm and close the windpipe, so air can't get through. A high-pitched wheezing, asthma's hallmark, is the sound of air forcing its way through bronchial tubes deep in the chest. It's like drowning without water.
"They feel like a little elephant is standing on their chest," Thorne says. "You're having to pull harder to breathe."
Breathing is already difficult for many lower-income asthmatic children whose homes usually lie in polluted areas. Typically they live where land is cheap: near downtown and factories pouring out smoke, sulfur and acid.
Many inner-city parents keep their kids indoors, not just because of the bad air but also because they're scared their children will encounter bigger troubles in the streets. Yet staying inside isn't safe either, since most projects built in the '70s and '80s are "tight buildings" that trap stale air.
"You think pollution's bad outside -- inside is even worse," says Ed McDaniel, an occupational health specialist with the Public Health Environmental Services Department of the Harris County Health Department.
Researchers investigating inner-city dwellings have discovered a host of triggers for attacks: peeling paint, cockroach droppings, roach carcasses and stale secondhand smoke. They've seen mildewed showers, vents covered in mold and dust-coated carpets. Even the psychological stress of being poor can contribute to asthma's severity. Combine that with the usual triggers -- changes in weather, glue, gasoline, viruses, aspirin, paint, perfume, pressed wood, pets, the things every child is exposed to -- and the poor are obviously far more susceptible to asthma.