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by Owen Davies Those firefighters are far from alone. For no reason anyone fully understands, asthma rates have been soaring all over the world for almost 20 years. Over 17 million Americans suffer from asthma, according to the Centers for Disease Control and Prevention, in Atlanta, Ga.; perhaps 5 million of these are children. Asthma is a chronic inflammation of the lungs and airways, which swell and become clogged with mucus. Its symptoms can range from mild wheezing to a constriction of the airways that can make it nearly impossible to breathe. Here in the United States, the number of asthma sufferers skyrocketed in the 1990s. Only 3.6 percent of children suffered from asthma in 1980, reports Dr. Lara Akinbami, at the National Center for Health Statistics, in Bethesda, Md. By the late '90s, the figure was as high as 6.2 percent, where they have remained since 1997. Asthma now kills nearly 5,000 Americans each year. Despite its frequency, asthma remains a remarkably mysterious disease. About three quarters of cases are linked to allergies, but it seems there is more to asthma than that. In California, Dr. Rob McConnell and his colleagues at the USC School of Medicine, in Los Angeles, found that ozone-filled smog seemed to cause the disease. Athletic children, who were likely to gulp in deep breaths of toxic air, developed asthma three or four times as often as their sedentary classmates. Parents who smoke are another potent risk factor for childhood asthma, and pets often take the blame for breathing problems - though some studies say that having more than one pet actually reduces children's chances of developing asthma. Firstborn children are more asthma-prone than their younger siblings - a tendency that appears to begin in the womb, according to Dr. Wilfried Karmaus and colleagues at Michigan State University. Since the underlying cause of this complex illness remains unknown, doctors just treat the symptoms. The treatments of choice are bronchodilators like albuterol, which open up constricted airways, and corticosteroids or chromolyn sodium, which ease the inflammation that afflicts asthmatic lungs. These treatments are a lot better than nothing. Epidemiologist Michael J. Abramson of Monash Medical School, in Australia, found that oral steroids cut asthma deaths by 90 percent. However, steroids also trigger osteoporosis in women who take them, and scientists would like to find better alternatives. Several candidates appear promising: a compound called omalizumab cut the number of allergic asthma attacks in half in an international study involving more than 500 patients. Omalizumab is a synthetic antibody that blocks the effects of immunoglobulin E (IgE), which plays a key role in allergic reactions. At the University of South Alabama, meanwhile, scientists have used genetic engineering to block the function of respiratory syncitial virus (RSV), a major cause of asthma and other lung diseases that kill an estimated 1 million people around the world every year. Yet other research involves a gene-spliced protein called GE2, which attaches itself to receptors on the surface of cells involved in allergic reactions. It will be years before the first human patients receive these genetically engineered anti-asthma drugs. Yet until scientists figure out more about what causes asthma, they may represent the best hope of bringing more effective asthma treatments to the millions of people who need them.
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A year after the terrorist attacks of September 11, hundreds of firefighters remain on medical leave. Of these, 358 - and five emergency workers - are out of work because they are out of breath. Thanks to the polluted, dust-filled air at Ground Zero, they wheeze, cough and struggle to get enough oxygen. In short, they have asthma. The CDC reports that around 500 of them may qualify for disability retirement because of persistent respiratory conditions. 