How Black parents are dealing with the asthma epidemic

IT'S a call that sends chills down a parent's spine: The day care center says the baby is sick, come quickly. When Kristina and Shannon Smith-Ross reached their then 2-yehr-old daughter, Karmyn, she was in the middle of a massive asthma attack.

"It came out of nowhere," says Kristina Smith-Ross of south suburban Chicago. And that is the most insidious thing about the new asthma--this isn't your mother's asthma, this is new-school asthma. And what the Smith-Ross family learned in their continuing and successful struggle against the disease is a matter of life and death to Black parents to understand the difference between the old and the new asthma.

What is asthma? It is an incurable chronic inflammatory disease of the airways to the lungs, and it is the most common chronic disease of childhood, affecting an estimated 5 million children. Why is it increasing? Experts can't pinpoint why the disease is exploding in cases and severity, but they point to a combination of more air pollution, earlier exposure to irritants that trigger the disease, like food allergies or cigarette smoke, and better methods of diagnosing the disease.

Asthma rates increased 160 percent in the United States among children 4 and younger since 1980 and 80 to 90 percent of children who develop asthma experience symptoms before 5 years of age.

It is the leading cause of school absences, accounting for more than 10 million missed school days a year in 1999.

Asthma can sometimes be a fatal disease; more than 5,000 people die of asthma annually. Children and minorities suffer most. In fact, death rates for asthma are highest among Black youth ages 15 to 24 years old. In 1997, 65 percent of the asthma deaths in the Chicago area occurred in Blacks. "Nationally, asthma hospitalization rates are also highest among Blacks and children," says Dr. James W. Mitchell, a fellow of the American Academy of Pediatrics and currently an assistant professor of clinical pediatrics at the University of Chicago. A recognized expert in children's asthma, Dr. Mitchell says he sees at least one asthma patient daily at his pediatric practice on Chicago's South Side. "I'm considered an aggressive asthma manager," he says. "If treated properly, asthma can almost always be kept under control."

The good news is that children with asthma are now able to live fully active lives without many of the physical limitations they experienced in the past. More than 16 percent of all of the U.S. athletes in the 1996 Summer Olympics in Atlanta had a history of asthma.

The biggest obstacle for treating asthma in children is re-educating parents and health professionals about modern asthma and replacing old notions and beliefs.

Despite the common old wives' tale, children do not "grow out of asthma." Although some children's asthma may improve over time, Dr. Mitchell says "it is also true that if left untreated, many asthmatic children will develop irreversible lung damage in only a few years." That is why it is so important to diagnose asthma as soon as possible and begin treatment.

The major change in modern asthma is that the new primary symptom is not a wheeze but a cough. The cough sounds more like a dry, hacking cough and does not produce much mucus, says Dr. Anne C. Beal, co-author of The Black Parenting Book: Caring for Our Children in the First Five Years and currenfiy senior program officer for the Commonwealth Fund in New York.

The major problem is inflammation of the airways in asthma. Too many parents and caregivers think of everything but asthma when they hear their child coughing, Mitchell adds. "Often by the time the cough first appears there has been at least several days of inflammation developing," he says.

Children, Dr. Beal says, need immediate attention if a parent notices any of the following, "breathing faster than normal, flaring of the nostrils, sucking in of the stomach or pulling in between the ribs."

She says asthma is very sensitive and tricky to diagnose in the first year of life. One reason for this, she says, is that the disease is often confused with other respiratory conditions common at this age, such as respiratory syncytial virus (RSV), which can cause a type of pneumonia in young children, bronchitis and croup (a cold virus that causes a barking cough).

Dr. Beal says there is a strong connection between asthma and allergies, including both hay fever and eczema. She advises African-American mothers in particular to breast feed as long as possible--up to 12 months. "It's a very, very simple thing, but we feed our babies too early and that is likely to contribute to allergies," she says. She advises holding off on solid foods until the baby is 6 months, which is difficult to do, she says, because well-meaning relatives and friends push feeding a baby solids almost from birth. "Even as a physician, my mother would ask me, `When are you going to start giving the baby cereal?'" she says. "It's difficult, but hold off as long as possible."