Asthma Deadly ... But Treatable

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You name it, and Olympic track star Jeanette Bolden, 32, is probably allergic to it. Household dust, cats, seafood. Just the smell of fish cooking on a grill is enough to make her eyes puff up and start to water. But Bolden's allergies are linked to a more serious problem. Like 15 million other Americans, she suffers from asthma, a chronic affliction of the airways in the lungs that can turn the simplest act of breathing into hard labor and leave a person gasping, coughing and wheezing for air. Last fall the gold medalist (100-m relay, 1984) was hospitalized for a severe attack in which her airways closed off altogether. "Imagine slicing an orange and squeezing all the juice out of both halves," Bolden suggests. "That's how my lungs felt -- as if someone or something was squeezing all the air out."

Not long ago, Bolden's asthma might have kept her from competing or even coaching. But asthma specialists have learned so much in the past few years that they now believe they can keep most potentially fatal attacks at bay. They have found that allergies play a dual role in causing asthma to develop in the first place as well as in triggering individual episodes of wheezing. By studying families in which asthma appears to be inherited, scientists hope one day to discover the genes that predispose people to develop it. And by controlling the underlying irritation and inflammation of the lungs, most asthma patients should be able to enjoy a full and active life.

Despite these advances in knowledge, both the incidence and severity of asthma appear to be growing worldwide. Epidemics have been reported in Britain, Australia and New Zealand. In the U.S., the number of asthma cases rose 70% from 1980 to 1989. Even more alarming, the death rate, which had been declining steadily during most of the 1970s, began inexplicably increasing, and is now rising 8% a year. Asthma accounts for $5 billion in medical costs each year in the U.S.

Acute attacks of asthma occur when the bronchial tubes of the lungs become partly blocked. For reasons that are not entirely clear, the lungs are overstimulated by viral infections, allergens or pollutants. The body responds by activating various defense cells from the immune system. Their mobilization causes the airways to swell. At the same time, the muscles surrounding the airways contract, cutting off airflow. When that happens, asthmatics must inhale an adrenaline-like substance to stop the muscle spasm and reopen their airways.

If the attacks recur enough times, however, the lungs do not return to normal. They continue to act as if they are being invaded by parasites. This constant state of inflammatory alert damages the bronchial walls, creating scar tissue. As a result, the airways can no longer clear the mucus that forms deep in the lungs. The ensuing buildup reduces the flow of air and sets the stage for the next attack. "In olden times, which was only about five or 10 years ago, we all concentrated on the bronchospasm and assumed the patients were all right between episodes," says Dr. Peter Konig of the University of Missouri. "Now we see that inflammation is there from the beginning even in mild or asymptomatic cases."