BREATHING EASIER: PATIENTS LEARN TO MANAGE ASTHMA CARE

White tufts from cottonwood trees drifting through the air can trigger more than just attacks of sneezing and runny eyes. For some people it can be the beginning of an asthma attack.

Billy Thatcher likens it to sipping through a coffee stirrer after being accustomed to using a large straw.

"You can't exhale or inhale," he said. "It takes longer to exhale your breath and you're struggling."

Thatcher, a respiratory therapist at Southeast Missouri Hospital, has had asthma since childhood.

Asthma is a chronic disease that affects a person's ability to breath. When an asthma attack occurs, the lung muscles or mucus linings tighten up making it difficult for air to pass through. Asthma affects 26.3 million people in the United States, including children.

Researchers have been struggling to discover what causes asthma and how to keep it under control, particularly among children. Statistics compiled from the American Lung Association show that nearly half the people with asthma are children under age 18.

The percentage of children with asthma continues to grow in the United States. Asthma attacks accounts for nearly one in every six pediatric emergency hospital visits in the United States.

Dr. Robert Sacha, who specializes in allergy treatments, said about 60 percent of his patients are children. Sometimes adults who suffered from asthma as children can be without symptoms but still have tight lungs like they did with asthma, he said.

Most childhood asthma sufferers will outgrow the disease. Administering spirometer tests are an objective way to screen patients who might feel like they have asthma symptoms, said Sacha. The test series measures the amount of air that passes through a person's lungs.

Allergy sufferers feel like they might develop asthma because their symptoms are worsen in the spring and fall. But asthma sufferers also have problems in winter, particularly with viral infections in their chest, Sacha said.

Sacha said studies have shown that regular allergy treatments actually helps prevent the onset of asthma in some cases.

Weather triggers attacks

May has been declared allergy and asthma awareness month. It is often one of the most difficult months for asthma sufferers because of high pollen and mold counts.

"Any climatic change is difficult for anyone with a breathing disorder," said David Stagner, manager of respiratory care at St. Francis Medical Center. Summer can also be tough because humidity is high and the air feels thicker.

While doctors don't know exactly what causes asthma, they have found some things that trigger the attacks and have found medications -- mostly steroids -- that help keep it under control.

Southeast Missouri Hospital offers a monthly asthma education course for families learning to manage asthma care. The course includes information about asthma medications, tips for using nebulizers and peak flow meters and what asthma attacks do to the body.

"If you have asthma and have it under control, you will feel more like you have control of your life," Thatcher said.

For years, he treated his own asthma with an inhaler that he used three or four times a day. Once he became a respiratory therapist and started teaching other people how to manage asthma, Thatcher realized he needed to "practice what I preached."

He and his doctor talked about a daily dose of medicine from a steroid inhaler and a pill that works to block inflammation in the lungs.

"I've gone for years without using my inhaler," Thatcher said. "I used to have to know where it was all the time because to be without it would cause me to have an attack."

Having asthma shouldn't have any negative impact on a person's life, if it's under control, said Stagner. His wife has asthma and she runs regularly and stays active.

Learning to manage care

Parents are sometimes overprotective of a child with asthma, he said. "That's counterproductive because if you follow the instructions of a physician and manage it medically, then it's a controllable problem."

It's good for children to know that asthma can be controlled. "You handle it better if you're in better shape," Thatcher said.

Exercise-induced asthma is the most common form and many times children aren't diagnosed with asthma until they begin playing in an organized sport, Sacha said.

"Whey they start running hard they cough," he said. Nearly 80 to 90 percent of asthma cases are exercise induced.

Thatcher encourages children to continue playing sports or be involved in activities but not until they have their asthma under control. "It used to be that you didn't do things because it would bring on an attack but now the issue is getting the asthma under control first."

The easiest way to do that is to keep track of when asthma attacks occur and try to find what might be causing them.

Other triggers for asthma attacks are pet dander, dust, mold and pollens. Other things like weather changes, infection, certain foods and stress can also trigger an asthma attack.

Treating asthma is different for every person. "When you have asthma, doctors put you on treatments that are suited for your lifestyle." Some medications reduce the symptoms of asthma and others work to prevent attacks from occurring.

Quick-action medicines like bronchodilators can stop an asthma flare-up once it starts and other medications work as anti-inflammatory drugs and are inhaled.

Inhaled steroids are usually the treatment given to children and new drugs have simplified taking medication and offer it in lower doses. But getting children to take their medicine is still the dilemma. "They don't want to be different. With teen-agers it's an attitude," Sacha said. "Compliance is a problem."

Asthma facts * More than 26.3 million people have been diagnosed with asthma. More than a third of them are children under 18.

* The estimated costs for treating asthma in children each year is $3.2 billion.

* Asthma accounts for 10 million lost school days each year. It is the leading cause of absenteeism attributed to chronic diseases.

* Asthma is the No. 1 cause of hospitalization among children 15 and younger. It accounts for one in every six hospital emergency room visits per year.

* Asthma medications have been used to reduce inflammation in the airways and better control symptoms. Two kinds of medicines are used: anti-inflammatory and bronchodilators.

* Only a quarter of the children that suffer from asthma will be symptom free as adults.

* Asthma deaths have increased by 109 percent from 1979 to 1998. There were 2,598 deaths in 1979 and 5,438 deaths in 1998.

* More people in the South have asthma than in any other region of the United States.

* Guidelines from the National Heart, Lung and Blood Institute of the National Institutes of Health recommend that anyone with mild, persistent asthma receive daily medication. A study released last October showed that inhaled cortisteroids offer superior asthma control.

Factors that can trigger asthma:

* Respiratory infections and colds.

* Allergic reactions to things like pollen, mold, dust, animal dander, feathers, food and cockroaches.

* Vigorous exercise.

* Exposure to sudden weather changes.

* Cigarette smoke and secondhand smoke.

* Stress.

Source: American Lung Association, National Institutes of Health

On the Net

Visit these Web sites for more information about asthma and asthma care.

* National Heart, Lung and Blood Institute

www.nhlbi.nih.gov

This site provides information about studies on childhood asthma and reports about asthma management.

* National Center for Health Statistics

www.cdc.gov/nchs/fastats/asthma.htm

This site includes reports on the prevalence of asthma and links to related sites.

* American Lung Association

www.lungusa.org/asthma/

This site provides information about asthma warning signs, medications and helping children learn to control their asthma.

* Asthma and Allergy Foundation of America

www.aafa.org

This site provides information from allergists, and adds details about steroid use and seasonal changes in asthma.