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Asthma on the Rise in U.S., World

By Roland Owens

There are approximately 17 million asthmatics in the United States, and asthma prevalence, morbidity and mortality are increasing, not only in the U.S., but around the world. That was the theme of the sixth annual John Diggs Lecture, presented recently by Dr. Floyd Malveaux, interim vice-president for health affairs and dean of the College of Medicine at Howard University, in his lecture, entitled "Disparity of Asthma Mortality and Morbidity in Low Socioeconomic Groups." Malveaux has been a grantee of both NIAID and NHLBI, and is a nationally recognized expert on asthma and allergic diseases. He was also a close friend of the late Dr. John Diggs, a former NIH deputy director for extramural research, whom the series honors.

He began his seminar by explaining that asthma is a chronic inflammatory disease of the airways of the lungs. This leads to closure of the airways in response to certain triggers. These triggers can include exercise, tobacco smoke, air pollutants, odors from paints, certain medications, anxiety, pollen, cockroach allergens and cat dander; as well as other allergens and irritants. About 80 percent of asthmatics have symptoms by age 4, suggesting a genetic predisposition.

Dr. Floyd Malveaux

According to Malveaux, since 1980 there has been a greater than 100 percent increase in annual asthma-related deaths in the U.S. Although the reason remains elusive, there appears to be a correlation with urbanization. There is also an increasing disparity in asthma mortality between African-Americans and white Americans. In 1980, the asthma-related death rate for African-Americans was twice that of whites. By 1990, the death rate for African-Americans was about three times that of whites. "African-American males, between the ages of 25 and 34, have a [asthma-related] death rate 7 times higher than their white counterparts."

Although there does appear to be a genetic component to asthma susceptibility, a study of asthma-related hospitalizations, conducted in the state of Maryland, showed that for asthma morbidity, there is a stronger correlation with poverty than race. Malveaux suggested that factors such as socioeconomic status, poverty and access to medical care, especially to asthma specialists, may play a greater role than genetics in asthma-related morbidity and mortality. In spite of the fact that we now know more about asthma than at any other time in our history, Malveaux asserted that "it still remains an under-treated disease." He advocates the use of aggressive intervention strategies to educate patients and their families about how to reduce environmental and behavioral risk factors. There is also a need to inform both patients and health care providers about the importance of following established guidelines for the treatment of asthma. These guidelines include the regular use of anti-inflammatory drugs to treat moderate or severe asthma. As Malveaux put it, "The smart expenditure of resources is in prevention, rather than...managing crises."

The seminar was cosponsored by the NIH Black Scientists Association, NIAID's Office of Special Populations and Research Training, NIAID minority scientists advisory committee and NINDS.

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