Altering home environment is critical in trying to control asthma


September 06, 1994|By Dr. Genevieve Matanoski | Dr. Genevieve Matanoski,Medical Tribune News Service

Parents with asthmatic children know what a particularly debilitating and frustrating disease asthma can be. It seems especially unfair to watch youngsters, normally full of energy and enthusiasm, struggle with this condition. The breathing problems that come with an acute asthmatic attack are not only frightening, but also dangerous.

According to my colleague Dr. Peyton Eggleston, director of pediatric allergy at Johns Hopkins, 5 to 10 percent of children in the United States suffer from asthma. The incidence of asthma has been increasing in the last 15 years, with inner-city children being particularly hard-hit. I discussed this topic with Dr. Eggleston, in addition to the latest developments in the fight against childhood asthma.

Q: What is asthma?

A: Asthma is a chronic inflammatory disease of the airways that can cause serious breathing problems. For about two-thirds of asthma sufferers, it begins with an allergy to something in the environment and progresses to a chronic condition. How this happens is not entirely understood. Asthma attacks can be caused by such diverse factors as colds, exercise and air pollutants.

In the past, treatment for asthma has focused on controlling these acute attacks. What is now being learned is that if the exposure to whatever is causing the allergy can be reduced early in the disease process, chronic asthma can be prevented.

Q: Who is at risk, and what are the first signs?

A: It is generally thought that asthma has a genetic basis -- that is, some people are susceptible from birth and then respond to environmental stresses by developing asthma. Symptoms usually begin before school age. An infant or toddler may develop coughs and wheezes with every cold, then gradually have the same symptoms every day when exercising or around smoke or other allergens. If environmental allergens are removed, the process can be reversed. Several studies have shown that symptoms improve over a period of months when children are removed from sources of household allergens.

Q: What factors can cause allergic reactions?

A: Numerous factors can cause allergies: pets, house dust and pollen, to name a few. Researchers recently have identified a new allergen, one that is particularly problematic in urban areas: the cockroach. More than 40 percent of children with asthma living in inner-city areas are allergic to cockroaches, and the amount of cockroach allergen in inner-city homes is especially high.

Q: Why are cockroaches allergens?

A: The cockroach itself is not the culprit. It is a substance called "frass" that consists of roach saliva, feces and body parts. Frass gets into carpets, bedding, furniture and house air. So it is not enough to kill cockroaches; the house must be cleaned of their leavings and remains as well. If the house can be cleaned of this allergen, studies have shown, the majority of affected children will get better. Moreover, if asthma due to an allergic reaction to frass is controlled early, chronic asthma can be prevented.

There are several key steps to controlling cockroaches and the allergens they deposit all over the house. Exterminate, put food away quickly in tightly covered containers, and wash dirty dishes and pans promptly. Also, use allergy-proof mattress covers, wash bedding frequently and vacuum often.

Q: What about city air?

A: Contrary to popular belief, the air outside, even in large cities, is always lower in pollutants and allergens than the air inside. One of the reasons asthma is increasing in children is thought to be the time they spend indoors -- watching TV in houses closed to the outside by air-conditioning and heating systems.

Q: Is it possible to outgrow asthma?

A: It not only is possible, but also common. It is estimated that about two-thirds of the children who develop asthma in early childhood grow out of it by adulthood (about age 18).

One of the most important determinants of whether a child will grow out of a case of asthma is the severity of the condition. However, some people do experience a return of the symptoms after young adulthood.

For more information about asthma and the allergens that contribute to its onset, call the Asthma and Allergy Foundation of America at (202) 466-7643. A particularly helpful book for parents is Dr. Thomas Plaut's "Children with Asthma: A Manual for Parents," available in bookstores or from Pedipress Inc., 125 Red Gate Lane, Amherst, Mass. 01002.

Dr. Genevieve Matanoski is a physician and epidemiologist at the Johns Hopkins School of Hygiene and Public Health. She is a founding director of the school's Institute for Women's Health Research and Policy.

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