Waiting To Exhale: The Increasing Crisis of Asthma

Asthma is defined as: recurring episodes of wheezing, breathing difficulties and breathlessness in varying degrees. It can be life threatening as breathing often becomes obstructed. Symptoms include choking sensations, chest tightness, rapid breathing, distress and coughing with increased mucus secretion (Stein, p.108). Attacks vary from day to day and can occur at night, during physical exertion or at times of emotional stress. In children, asthma usually begins with eczema and hay fever. In adult-onset asthma, it usually begins with emotional stress and anxiety. The immune system of asthma sufferers becomes unable to differentiate between life-threatening microbe invasions and mere irritants, and thus their systems over-react to substances such as dust and pets.

There has been an annual increase in the number of people afflicted with the ailment. The largest increase has occurred in Australia, where approximately a quarter of all children have been diagnosed with asthma. In the United States, the number of asthmatics has more than doubled in the past 15 years, swelling to 14.6 million (UniSci, p.1) and raising the number of Americans suffering from asthma to 17 million (Bourjaily, p.1).

Researchers point out that the highest increases of asthma have occurred in developed and 'modern' areas (Bourjaily, p.1). Among Palestinian children, associated symptoms are considerably higher in the urban areas. Dr. Ephraim Bar-Yishay, of Hadassah University Hospital in Jerusalem, surveyed a total of 970 West Bank children living in Ramallah and Anin. Of the 894 questionnaires returned, analysis showed that 16.4% of children in the urban areas suffered from wheezing, compared to 12.0% in the rural areas (Westport, Aug. p.1).

Dr. Abdul Rahman S. al Frayh, and his team at King Khalid University Hospital in Riyadh, also noted an increase in asthma sufferers in Saudi Arabia. They compared data from a 1986 survey of 2,123 school children with a 1995 survey of 1008 schoolchildren. Published in the Annals of Allergy, Asthma and Immunology, the team's findings showed an increase in the prevalence of bronchial asthma, and to a lesser extent, in the prevalence of allergic rhinitis (a runny nose all year round). The asthmatic rate increased from 8% in the earlier survey of the areas of Jeddah and Riyadh, to 23% in the later survey of Hail and Gizan. Allergic rhinitis also rose from 20%-25% (Wetsport, Apr. p.1).

The study cited increased exposure to environmental factors, such as tobacco smoke and pets, as possible reasons for the increase of asthma (al-Frayh, p.1). A complimentary study by Drs. Hijazi and Abalkhail seems to support this. It also shows a greater prevalence of asthma in the urban areas of Saudi Arabia as opposed to the rural ones. Furthermore, they found that male children were more likely to have respiratory symptoms to allergies, whereas females usually had more eye and skin symptoms (Hijazi, p. 2). The same team investigated dietary practices and other risk factors and found that family history, atopy (non-physically localized diseases), and fast foods were also contributors. Additionally, low intakes of milk, vegetable fiber, Vitamin E, calcium, magnesium, sodium and potassium were cited as reasons for the increase of asthma and allergies (Hijazi, p. 1).

Dr. Sunil Chhabra, and his team at Vallabhbhai Patel Chest Institute in India, reported a strong association between the current increase of asthma and a family history of atopic disorders (Westport, Dec. p.1). The study stated that 90% of asthmatic children suffer from allergies. But, allergists studying children living on small farms in Austria, Bavaria and Switzerland found that children who grow up drinking raw milk and living close to stables have 75% fewer allergies than children without those exposures. Children in the villages seemed to be more protected by vaccines and antibiotics (Bourjaily, p. 2). The study proposes that more frequent exposure to allergens is actually beneficial for the children.

This controversial notion of hygiene hypothesis proposes that the human immune system needs something to "keep it busy" in early childhood and that increased exposure to elements provides an infant's immune system with clear signals for proper development. It suggests that parents in industrialized areas are spreading the problem because the keep their children at home. Thus, exposing them to only minimal contact with other children (Sappa p.1).

This implies that when we surround ourselves with synthetic environments, we separate ourselves from that which Allah (swt) has created for us to be a natural part of. In Surat Al Haj, Allah says, "O people! If you are in doubt about the raising, then surely We created you from dust, then surely from a small seed, then from a clot, then from a lump of flesh, complete in make and incomplete that We cause what we please to stay in the wombs till an appointed time, then We bring you forth as babies, then that you may attain your maturity" (HQ, 22:5).

Another factor that contributes to the rise of asthma in the developing world, as well as in developed nations, is the frequent use of pharmaceutical drugs. Up to 20% of the asthmatic population is sensitive to aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), which can trigger: rhinitis, sinusitis (inflammation of mucous membranes in spaces of the skull above the eyes) and asthma.

To educate more people as to the causes of asthma, and how they can help prevent it, the Global Initiative for Asthma (GINA, a collaboration between the National Institutes of Health USA and the World Health Organization) and others, have implemented educational programs in many countries. Already, this initiative has shown positive results. For example, the cost-effectiveness of managing severe asthmatics in Shanghai, China showed an 80% reduction in cost with the implementation of the GINA regimen.

Sources:

• Babu, K. Suresh and Salvi. Sundeep, S. "Aspirin and Asthma" CHEST 118(5): 1470-1476, 2000. Medscape. 1,2. 5/7/01
• Bourjaily, Phillip. "Asthma On the Rise In The U.S." Environmental News Network. Sept 20 2000: 1,2
• Al Frayh, AR. "Increased Prevalence of Asthma In Saudi Arabia." Ann Allergy Asthma Immunol. Mar. 1986.
• GINA website
• Hijazi, N. & Abalkhail, B. and Seaton, A. "Diet & Childhood Asthma In a Society In Transition." Thorax, Sep. 2000: 775-9.
• Hijazi, N. Abalkhail, B. and Seaton, A. "Asthma and Respiratory Symptoms In Urban and Rural Saudi Arabia." Eur Respir J. July 1998. 12(1): 41-4.
• The Holy Qur'an
• Seppa, N. "Do More Infections Mean Less Asthma?" Science News. 8/14/99: 108.
• Stein, Diane. "The National Remedy Book for Women". US: The Crossing Press, 1992.
• "World Asthma Day Draws Attention To Growing Problem," Daily University Science News. 5/9/2001.
• Westport. "Asthma Prevalence Increasing In Saudi Children." Reuters Medical News. Ann Allergy Asthma Immunol. 2001: 86292-296.
• Westport "Asthma Prevalence Higher In Urban Than Rural Palestinian Children." Reuters Medical News. 2000: 37:353-360.
• Westport. "Multiple Factors Associated With Pediatric Asthma Risk In India." (req. registration) Ann Allergy Asthma Immunol. 1999:83: 385-390.
• Westport. "Psychological Factors May Influence Reported Asthma Morbidity." (req. registration) Thorax. 2001: 56:266-271.

Hwaa Irfan is a staff writer for Health and Science section of Islamonline