It's a striking image: Figure skater Tonya Harding soars and speeds through a demanding routine, and once off the ice heads straight for an inhaler. Whether or not she wins a medal, Ms. Harding represents a triumph over a disease that afflicts from 10 million to 15 million Americans -- asthma.
But while she and many asthmatics have their disease well enough under control to pursue regular activities, asthma apparently is growing in both number of sufferers and mortality -- both rose by about 30 percent between 1980 and 1987.
While there is no cure for asthma -- in which inflammation in the lungs constricts airways and causes difficulty in breathing -- recent research and the amount of attention it's receiving offer hope for better management of the disease.
Just last month, an international team of asthma specialists met at the National Heart, Lung and Blood Institute in Bethesda to develop a consensus on how to treat the disease. And, also in recent months, several research studies have emerged with promising results for future improvements in understanding and treating asthma.
"In the past 10 years, there's just been a revolution in asthma treatment," said Martha Dewey of Towson, who has become an advocate among parents who, like herself, have children with asthma. Her 8-year-old son Sam was diagnosed with asthma about three years ago, and, despite having a moderately severe case of it, has been able to control the disease through medication and a close partnership with his doctor, she said.
"I knew nothing about it. I had that common perception that asthma was what those kids had who, when they ran, started to wheeze," Ms. Dewey said of her knowledge of the disease when Sam was diagnosed.
Since then, she has learned enough to put out a quarterly newsletter for parents through the Asthma and Allergy Foundation of America, Maryland chapter. She is also active in its support groups for asthmatics or their parents, which meet monthly to hear speakers on the disease or simply share knowledge among themselves.
Doctors agree that the single best tool in fighting asthma is patient education: Which preventive anti-inflammatory drugs might lessen the number of asthmatic episodes. Which inhalants might help dilate the bronchial tubes and ease breathing during an episode. Which common triggers -- dust, smog, exercise, cats, etc. -- might set you off. How to monitor, on your own, the air flow of your lungs and the effectiveness of your drugs. When to call the doctor. When to go to the hospital.
The costs of not managing the disease are both human and financial. While some deaths are unavoidable, doctors say that many of the 4,000 annual asthma-related deaths could be prevented through better access to medical care and the proper medication.
Inner-city kids, especially blacks, hold a disproportionate share of serious asthma problems and fatalities. The asthma-related death rate for black boys, for example, is six times that of their white counterparts, said Dr. Floyd Malveaux, a professor of medicine and microbiology at Johns Hopkins' and Howard University's medical schools. For black girls, the death rate is five times that of whites, he said.
"They have decreased access to medical care," said Dr. Malveaux, currently working on two NIH-funded studies on how to better inform and care for young asthmatics in inner-city Baltimore and Washington. "Their asthma is treated episodically in the emergency room rather than on a continual basis."
Inner-city youngsters have a hard time getting specialists to treat them, so they rely on public health clinics, he said. And once those clinics close for the night -- which is when asthmatic episodes are more likely to develop -- the kids have no choice but to head to the nearest hospital emergency room, Dr. Malveaux said.
One of his studies is putting a health care worker in inner-city schools as a way of delivering information to students and their parents on how to better manage the disease. The other one is DTC seeking to identify which kids are at risk for severe or fatal asthmatic episodes and how that risk might be circumvented.
Asthma also exacts an enormous financial cost: Americans spent an estimated $6.2 billion in 1990 on asthma-related care, according to a study published in the New England Journal of Medicine last month, much of which researchers believe could be saved through better management of the disease. And, asthma is the No. 1 cause of school absenteeism -- American kids with the disease lost 10 million school days -- and adults who are asthmatics themselves or had to stay home to care for children with it lost almost $1.9 billion in missed wages.
Much of asthma's economic costs come from emergency room care and hospitalization. Doctors say some of those visits can be prevented through better everyday management of the disease -- taking the right medications regularly and properly using inhalants, they said.