Rising Asthma Deaths Puzzle Doctor Roger Signor Most Victims Live In Inner City "Nationwide, there were

5,000 deaths from asthma in 1992 - 5,000 deaths that should have been avoided..." Dr. H. ALLEN WEDNER, of Washington University Dispatch Science-Medicine Editor Five years ago, Scott Cristal of St. Peters noticed that his lungs were working harder than usual. An asthma sufferer since his teens, Cristal used an inhaler to make breathing easier. "But my breathing came more labored as the day wore on," he said. He was supposed to meet a doctor for dinner, so he decided to wait and ask his advice. He never made his super date. Just before quitting time at the computer business that he owns, Cristal passed out from lack of oxygen. He survived only because paramedics responded quickly and forced oxygen into his lungs. Cristal, now 37, never repeated his rush brush with death. Like most people with asthma, he's paying close attention to his symptoms. Deaths from asthma - a treatable illness that shouldn't kill anyone have been climbing steadily in Missouri, Illinois and nationwide since the early 1980s. About 75 percent of deaths occur in those 55 and older. Here are a few sobering statistics: * Missouri had confirmed reports 102 asthma deaths last year - since 1984's total. * Illinois had 257 asthma deaths in 1991 - 32 more than in 1987. * The number of children in the St. Louis metropolitan area given emergency room treatment for asthma jumped to 4,622 last year - 500 more than in 1984. "Nationwide, there were 5,000 deaths from asthma in 1992 - 5,000 deaths that should have been avoided - we knew exactly why they occurred," says Dr. H. Allen Wedner, Chief of Washington University Medical School's division of allergy and clinical immunology. Wedner's group and St. Louis University Medical School are collaborating in a nationwide, $2.5 million study of asthmatic children who live in inner cities. "All we do know is that most of the deaths are occurring in the inner cities," Wedner said. Poor residents of inner cities may not go to the doctor frequently as more affluent people, he said. "But asthma isn't an under diagnosed illness - and because its symptoms are so frightening, most people, who get them seek medical help." The increase in deaths from asthma is puzzling because treatment has

improved since the 1980s, said Rita Rooney, nurse and education specialist at the Asthma and Allergy Foundation in Washington. Asthma is caused by a spasm of the bronchial tubes or by swelling of their mucous membranes; sometimes the illness is related to an allergic reaction. Often, people rely too heavily on inhalers that relax the lining of muscles in their bronchial tubes, Rooney said. "But over time, these broncho-dilators don't help patients who have chronic inflammation of the lungs," she said in a telephone interview Friday. Such inflammation is one root cause of asthma, she said. "Today, more doctors prescribe differently for asthma treatment," she said. Now, doctors recommend less reliance on broncho-dilators and tend to be more aggressive in prescribing anti-inflammatory inhalants and medicines. But some poor people may depend on broncho-dilators because they're cheaper than other medicines, said Dr. Ellen Garibaldi, an asthma expert at St. Louis University Medical School. Instead of using broncho-dilators sparingly, some people may use seven or eight puffs to get through an asthma crisis, she said. "They may limp along fine during the day but then have a really bad attack in the evening when it's hardest to get care," she said. Robert C. Strunk, professor of pediatrics and asthma specialist at Washington University Medical School, said dependence on broncho-dilators fell short of explaining the growing number of cases nationwide. "There's no single trigger that accounts for all the intractable cases," he said. "The number of deaths from asthma among blacks is about four times greater than among whites, so inner city residents may have extra asthma factors placing them at higher risk for severe attacks. But no group is immune, young or old, rich or poor." Strunk and Dr. Edwin B. Fisher of Washington University are studying asthma and the quality of life among young, inner city blacks. Strunk's studies show that stress exacerbates asthma attacks, but Strunk added, "No one has the answer." Cristal said he is controlling his asthma with fewer medicines - plus exercise. "I don't know why, but aerobic exercise in the pool helps a lot," he said. "Once, I was on three or four bronchial sprays to control my asthma, but now I'm down to one." Allergies can shift over several years, he said. "House dust used to give me asthma, but now it just makes me sneeze," Cristal said. "I can live with that." ST. LOUIS POST-DISPATCH 01-02840