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These triggers have been around for years, yet asthma keeps getting worse. Why are children getting sicker? Why did the Texas Children's Hospital emergency room admit more than 5,150 children with asthma attacks in 1998, twice as many as in 1993?
One theory postulates that the decline of serious illnesses causes underutilized immune systems to overreact to lesser irritants. Another idea is that kids raised on Nintendo and MTV are stuck inside breathing bad air. Others suggest that children in day care get respiratory viruses early on, which leads to asthma. Some studies indicate that breast-feeding prevents asthma and that more working moms are bottle feeding. Researchers also argue that asthma is genetic, yet they don't know how such a widespread genetic breakdown could have happened in the last 20 years.
The only thing they do know is that the numbers are increasing: In 1988 almost seven million Americans had asthma. Now the numbers are close to 15 million, according to the Centers for Disease Control's Asthma Prevention Program.
Nationally, between 5 and 8 percent of kids are asthmatic. Here in Houston, as in other major metropolitan inner cities, the numbers are between 10 and 12 percent, says Dr. Stuart Abramson, associate director for clinical research and health professional education for the Children's Asthma Center at TCH and chair of the regional advisory board of the ALA.
"There is very bad asthma in Houston," concurs Colasurdo. "Very bad."
An estimated 60,000 children under 18 have the chronic respiratory disease in Harris, Fort Bend and Montgomery counties, according to the Houston Chapter of the ALA. Asthma is the number one reason kids miss school and are hospitalized.
One reason for the hospitalizations and chronic absenteeism is that many parents let asthma attacks last too long without treatment.
Working at a nonprofit clinic in the Fourth Ward, Lynnette Mazur saw an asthmatic child who had coughed all weekend. Her mother waited until the girl was breathing so hard that she couldn't eat before she brought her into the clinic Monday evening. Mazur immediately called an ambulance and gave the girl oxygen.
She lived, but Mazur has seen children die because parents thought that the asthma would just go away or that they could treat it at home. Some parents use alternative treatments, such as coffee or tea (which are natural bronchodilators). Many parents simply pray and hope that God will heal their child. Other parents buy their children Chihuahuas, one of the few breeds that can get asthma, Mazur says. They believe that the child's asthma transfers to the dog.
Then there are the parents who rely too heavily on Western medicine. They figure if two puffs of the bronchodilator albuterol work great, then 12 would work even better. What they don't know is that overusing inhalers can be deadly. Albuterol temporarily relieves the symptoms but doesn't treat the disease. It dilates the airways but doesn't decrease inflammation, so the airways can still get plugged. Plus, some over-the-counter inhalers can cause heart attacks if overused.
But even the most diligent and cautious parents may not realize their children have asthma; that's because the disease is still often misdiagnosed for lack of an accurate test. Doctors can measure lung function or X-ray a patient's chest or check oxygen levels in the blood, but there is no simple you-have-asthma blood or urine test. Pediatricians often mistake a child's asthmatic cough for a cold or bronchitis.
Once a child is diagnosed, though, parents sometimes don't understand that they have to give their child the medication every day, no matter how the asthmatic is feeling.
"One of the hard messages to get across is 'This is a chronic disease, even when they're feeling well,' " Abramson says. "A lot of people think asthma should be treated from crisis to crisis."
Asthma's chronic nature can take its toll: Some parents can't afford to take a day off from work and sit in the doctor's office when their kid seems healthy. Or sometimes they don't want to give their kids daily doses of steroids, since some studies indicate steroids stunt children's growth. Or sometimes the steroids don't work.
Recent studies indicate that African-American children may have a genetic resistance to steroid treatments, according to the National Jewish Medical and Research Center in Denver. As African-American children's asthma worsens, their sensitivity to the steroid treatments decreases. They get sick, and standard medicine can't save them.
Darleen Scope has battled Alex's asthma every day since he was four months old. At first Darleen thought he just had a bad cold, but when his stomach started retracting she got scared and rushed him to the emergency room. Her son's severe attacks have taken him to ERs all over Houston; sometimes he stays for a night, sometimes for weeks. The sickness creates an extra financial burden on an already burdened household. Darleen wanted to get a job in December, but she postponed interviews because Alex was sick. Alex needed her more than she needed the money, so she stayed home.
Darleen and her two older brothers grew up in the Almeda Mall area, not far from where she lives now. She dropped out of high school in the tenth grade, got her G.E.D. and five years ago met Alex's father at a Texas Southern University football game. She was living at home with her mother, a licensed vocational nurse, and her father, who is now a welder in Trinidad. Darleen didn't know what she wanted to do with her life. She wanted to go to college, maybe be a nurse like her mom, maybe a pharmacist, maybe a computer programmer; she wasn't sure.