There's no easy breathing in the Washington area, which a survey to be released today identifies as one of the top five "most challenging" places in the country for people with asthma to live.
Blame some of the worst air quality in the United States, high pollen levels much of the year and myriad other factors for the ranking by the Asthma and Allergy Foundation of America, a nonprofit advocacy organization.
Asthma Rankings: The Asthma and Allergy Foundation of America released its 2005 ranking of the 100 most challenging places in America for people with asthma.
A year ago, the metropolitan area sat squarely in the middle of its peers in the 100-count lineup. Its ignominious ascension to fifth -- behind Knoxville, Tenn., at first, and three Midwestern cities -- came largely because of the continued dearth of public indoor smoking laws here and restrictive or inconsistent statutes addressing children's access to their inhalers while in school.
Elsewhere, jurisdictions are passing smoking bans for workplaces and restaurants and allowing students with asthma to carry and administer their medications.
"It's not so much what the metro area is doing but what it's not doing," said foundation spokesman Mike Tringale.
The impact is felt by such asthma sufferers as Betsy Farley, 53, of Centreville. Since she was diagnosed with the chronic respiratory disease a decade ago, the swimming and aerobics she used to enjoy have been replaced almost completely by such sedentary activities as knitting and sewing. "I can barely exercise now," she said yesterday. "I can't run and play with my grandchildren."
An asthma attack, in which air passages are simultaneously inflamed and constricted, squeezes Farley like a fiery vise: "It's as if all of a sudden, there's no air. Your lungs begin to burn, and you've got nowhere to go."
Her attacks are triggered by such allergens as pollen, mold, dust and pet dander; for other people, such irritants as tobacco smoke and pollution can set off an episode. Asthma affects more than 20 million Americans -- more than have coronary heart disease and cancer -- and kills 5,000 people annually. It results in significant workplace absenteeism and keeps children home from school more than any ailment, according to the foundation.
Physician Sheryl E. Lucas, a longtime allergy specialist with Kaiser Permanente who practices in the District and Northern Virginia, said she is seeing more affected families these days. "It's really a challenge," she said.
The national capital region scores poorly on:
Prevalence -- led by the District, where nearly one in 10 adults suffers from asthma.
Air quality -- with dirty air. The District, Maryland and Virginia are in violation of federal smog standards.
"Rescue medications" per patient -- with the average area asthma patient annually prescribed four medications for a sudden attack, higher than a year ago and nearly one drug higher than the national average.
Public smoking laws -- with Montgomery County one of the few local jurisdictions to prohibit smoking in restaurants and bars.
School inhaler access laws -- with Virginia the only area jurisdiction with a statute (which allows individual interpretation by a school system, according to Tringale).
Laurel parent Pam Welch can attest to how quickly having an inhaler out of a student's range can turn a bad moment into a near-emergency. She remembers the cold afternoon several years ago when her son had an attack while waiting for his school bus. Jesse's medicine was in the school nurse's office, but the nurse was gone and the principal, who had a key, was out of pocket for several minutes.
Welch got a call at work. By the time she reached the middle school, the attack had passed and her son was fine. "I think I was the one who needed to be transported," she said, laughing.
For a look at the survey, go to www.asthmacapitals.com.