FREE ESSAY ON THE INVISIBLE EPIDEMIC

THE INVISIBLE EPIDEMIC

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The rise of asthma in urban communities is beginning to reach epic proportions. It is a
disease that is not limited to the United States, but is endemic to all developed nations
and is especially prevalent in urban communities. The drastic rise in asthma and related
pulmonary illnesses is surprising because benchmark studies have resulted in an as yet
unknown understanding of the disease. All scientists agree, however, that this is a
pathology whose etiology can be traced as an overt effect of a modern Western culture. 
The effects of asthma are wide reaching and can be studied from many viewpoints. From a
societal perspective, sociologists and public health officials cringe when they read the
statistics for asthma in children in a poor urban area of New York, versus the national
average. The Mott Haven neighborhood of The Bronx, which has a median household income
less than one-third of the U.S. median, has an asthma-related hospitalization rate eight
times higher than the national average. From an environmental perspective, environmental
scientists are discovering that vehicle exhaust can acerbate asthma's symptoms. In Mott
Haven a local newspaper counted 550 passing trucks passing one street corner near a
school in one hour. In Tehran, Iran, the worlds eighth largest city, levels of industrial
pollutants from fossil fuel combustion have risen to four times higher than the standards
adopted by the World Health Agency, in only ten years, and asthma related
hospitalizations have also risen dramatically. From a cultural perspective the research
is also frightening. Research from the Albert Einstein College of medicine indicates that
asthma rates may be rising as a direct result of our western lifestyle. Findings show
that the national rates of asthma hospitalizations may be increasing at a high rate
because children are spending more time indoors than ever before, and are being exposed
to dust-mites and allergens that are prevalent inside houses and apartments. That lack of
physical conditioning along with a 1997 study published in the New England Journal of
Medicine which found that 40% of asthmatic children are very allergic to cockroach feces
is another clue why asthma incidents are so widespread in inner-cities. The only aspect
of our environment, technology and society that seems to be unaffected by this disease
and turns a blind-eye to asthma is our political leaders. Even though the Clinton
administration has made asthma research funding a top priority, most scientists agree
that there should be more money ear-marked towards comprehensive long-term studies such
as those that discovered the risk factors behind heart disease and lung-cancer. Our
leaders and future leaders need to take heed, though. Between 1980 and 1994 the
prevalence of asthma among U.S. children five to 14 has almost doubled. Even more
frightening is that in the past twenty years, when medical technology has grown at an
unprecedented rate, asthma deaths have more than tripled. Education-minded leaders need
to be aware that asthma is now the most common chronic illness among children, and as of
this year it has become the leading cause of school absences.
Although the etiology of asthma is complex and poorly understood, the progression of
symptoms is better understood. Bronchial asthma is an allergic reaction in the bronchi
and bronchioles of the lungs. An allergic reaction like the kind found in asthma occurs
when the body's specialized germ fighters, white blood cells called lymphocytes, react
over-aggressively to a harmless, or moderately harmless allergen-a foreign substance.
Spasmogens, and vasoactive substances such as histamines, leukotrienes, and
prostaglandins are released locally causing an inflammation of the lung-tissue, which
decreases the circumference of the bronchioles through spasmodic smooth muscle
contraction, and also releases mucus, which can further restrict the passage of air. The
mechanism of this response has been well understood for decades, and an albuterol inhaler
and intravenous magnesium solutions can alleviate the symptoms. 
Although there is dissention in the ranks of researchers over what the primary causes of
asthma actually are, most scientists agree that it is a pathology with many different
aggravating factors. Research has suggested that asthma hospitalizations show a direct
correlation, with high levels of industrial pollutants, and vehicle exhaust. A study
conducted in Tehran, Iran, where there are no emissions standards, showed a 16 percent
increase of asthma hospitalizations, and a 10% higher level of retarded pulmonary growth
verses rural Iranian communities. This study also measured specific levels of industrial
pollutant by-products, and showed a correlation between asthma and high levels of sulfur
oxides, nitrogen oxides, carbon monoxide, and particulate matter. Evidence has also been
collected which shows links between maternal smoking during pregnancy, and smoking in
general. Dust mites and cockroach feces have been listed as aggravating factors, as well
as lead based paints. Children with low levels of physical activity show a decrease in
pulmonary lung function and are at a higher risk of developing asthma. A recent paper has
even found a genetic link for asthma: children of asthmatics are three to six times more
likely to develop asthma than children of non-asthmatics.
Among all of these frightening statistics it seems that nothing is being done to help
contain the asthma epidemic. Although asthma hospitalization rates continue to climb,
there are some grassroots urban health initiatives designed to help treat asthma. Among
the most successful of these is the Asthma Passport Program (APP) conducted at Montefiore
Medical center in New York City (the hospital that serves the Mott Haven neighborhood).
In the APP, communication between primary care physicians and home-based care is
emphasized. Parents of asthmatic children are given a personalized passport, a record of
hospital visits, and specific treatments, as well as home management techniques.
Participants in the APP were 18% less likely to visit the hospital over the one-year
duration of the study. 
The prevalence of asthma in our society is indicative a trend that will likely increase
in the future. It is likely that the mystery that will not be solved anytime soon. The
general conclusion that can be drawn is that asthma seems to be an indirect, possibly
overt result of our western lifestyle. There is no pill that can be taken that will
decrease the by-products of fossil fuel combustion. It is not an overgeneralization to
assume that asthma related illnesses will act as an early indicator of the more
broad-based problems inherent in modern civilization.
Bibliography
Alpert, Mark. The Invisible Epidemic. Scientific American. November 1999. P19-20
Asgari, M; Dubois, D: et al. Association of ambient air quality with children's lung
function in rural and urban Iran. Archives of Environmental Health. May-June 1998. V53 n3
p222(9).
George, MR; O'Dowd, LC; et al. A comprehensive educational program improves clinical
outcome measures in inner-city patients with asthma. Archives of Internal Medicine. 9,
August 1999. P1710
Goodman, DC; Stukel, TA; Chiang, Chiang-hua. Trends in pediatric asthma hospitalization
rates: regional and socioeconomic differences. Pediatrics. Feb 1998. V101 n2 p208(6)
Henderson, Charles. Primary care-based intervention in inner-city children with Asthma.
World Disease Weekly Plus. 10, May 1999 pNA