A recent series of articles in the Journal of the American Chiropractic Association (JACA) delves into this question and offers advice from doctors of chiropractic and allergists who have helped control asthma symptoms in many patients.

People in their 30s and older can remember that when they were young, it was very unusual for even one child in school to have asthma. Schoolchildren now often know several kids with asthma in a single class. The rapid increase in the number of young people with asthma was brought home to Dr. Scott Bautch, past president of the American Chiropractic Association's (ACA) Council on Occupational Health, when he went to a football game with his 13- year-old son: "Someone on the field had a breathing problem. It was hard to see whose son it was, and 15 parents ran to the field with inhalers." TOP

So far, researchers don't know why cases of asthma are increasing at such an alarming rate. They hypothesize that a combination of genetics and some non-hereditary factors -- such as increased environmental exposure to potential allergens -- play a role. "Thirty years ago, Windex was the only cleaning solvent used by a few people. Now, we have a special cleaning solvent for every object," says Dr. Bautch. "In addition, furniture and carpets are produced with formaldehyde as a preservative, and people breathe it," he says.

Decreased air quality is coupled with the allergy-friendly modern house design, says Dr. William E. Walsh, MD, FACC, an allergist practicing in Minnesota: "Fifty years ago we lived in old, drafty houses, and the breeze dried and freshened the air, and cleared out mold and other allergens. Nowadays, our super-insulated houses don't breathe adequately. Making basements into a living space increases mold exposure because mold grows in any basement."

Food has become another source of exposure to allergens. "Food manufacturers put more preservatives in foods now to store them longer," says Dr. Bautch. Researchers hypothesize that an increase in vaccinations, cesarean births, and antibiotic intake may be playing a role, too.

Asthma is a chronic disease; it can't be cured -- only controlled. For best treatment results, both the primary care physician and an asthma specialist, such as an allergist or pulmonologist, should be involved. According to experts interviewed for the article, the treatment program, in addition to medication intake, should include reducing exposure to the substances that induce acute episodes and identifying specific allergens that affect the patient. TOP

Allergens aren't the only culprit. Stress factors -- such as moving to a new home, or changing jobs -- may induce or aggravate asthma attacks. Even emotional expressions such as fear, anger, frustration, hard crying, or laughing can cause an attack as well. To reduce the patient's stress level and improve the patient's quality of life, alternative treatments should be incorporated into the treatment program. Various relaxation techniques, such as biofeedback, meditation, yoga, and stress management, as well as massage, chiropractic manipulation, breathing exercises, and acupuncture can be helpful.

A multi-site clinical trial on chiropractic management of asthma is underway in Australia. "The preliminary data are very encouraging. Chiropractic patients are showing decreases in physical asthma symptoms and cortisol levels," says Dr. Anthony Rosner, director of education and research for the Foundation of Chiropractic Education and Research.

"Doctors of chiropractic can give a full-scale evaluation to asthma patients; assess their physical and neurological status, their lifestyle, diet, and stressors; and help the patients increase motor coordination, and improve the work of respiratory and gut muscles to increase the quality of life," says Dr. Gail Henry, a chiropractic neurologist, who practices in Houston, Texas. "Doctors of chiropractic can be a great addition to the healthcare team treating the asthma patient." TOP

Asthma experts offer the following
tips for asthma patients:

1. Use air filters to help clean air in your home.

2. Cover mattresses and pillows with dust covers and use hypoallergenic bed clothing to reduce exposure to dust mites.

3. If your condition is getting worse, get checked for viral respiratory infections and different medical conditions, such as flu, rhinitis, sinusitis, and gastroesophageal reflux. When those are treated and eliminated, asthma symptoms improve. Endocrine factors, such as menstruation, pregnancy, and thyroid disease, may exacerbate asthma, as well.

4. Some medications -- aspirin; beta-blockers, including eye drops; nonsteroidal anti-inflammatory drugs, etc. -- can also precipitate or aggravate asthma symptoms.

5. If your asthma is exercise-induced, an individually prescribed exercise program carefully chosen under the guidance of your primary health care provider or doctor of chiropractic should be incorporated into the treatment plan.

6. Avoid sulfites or monosodium glutamate (MSG) in foods. Since both additives are used in a wide variety of foods, carefully read processed food labels and choose MSG-free foods when eating out.

7. Choose a more vegetarian-type diet. Animal proteins found in meat include arachidonic acid -- a precursor for inflammation.

8. Include foods with omega-3 fatty acids in the diet -- such as fish or fish oil.

9. Supplement with vitamin C, which helps reduce allergic reactions and wheezing symptoms.

10. To reduce stress in your children, spend quality time with them and limit their exposure to TV programs that include violence. TOP

For more information, a copy of the two-part series "Asthma: an Enigmatic Epidemic," or to find a doctor of chiropractic near you, call ACA at 800-986-4636 or visit ACA's Web site at http://www.acatoday.com

Source: American Chiropractic Association

Asthma at School is
Disruptive to Routine,
Under-diagnosed, and Often Poorly Understood,
Survey Suggests

NEW YORK, Sept. 10, 2003-- According to a national sample of members surveyed from the National Association of School Nurses, asthma is more disruptive of school routines than any other chronic condition, has a significant impact on absenteeism and many school staff may lack awareness of the causes of an asthma attack. The NASN and the American Lung Association are working together to improve communications between parents, school nurses and health care professionals in an effort that may help reduce the number of asthma episodes or attacks children experience each year.

Results from the Asthma in Schools survey suggest that an overwhelming majority (85%) of school nurses believe that there are students with undiagnosed asthma in their schools. More than half found asthma more disruptive to the student body routine than any other chronic health condition, with more than a third of nurses having to respond to an acute asthma attack or episode at least 11 times in the last school year.

"We recognize the damage that can be done to the education process when 14 million school days are lost annually due to asthma," said Dorothy Reilly, RN of the National Association of School Nurses. "This survey suggests that when it comes to asthma management as it impacts a child's educational experience, there is definite room for improvement." TOP

Asthma is a serious illness, affecting more than 5.2 million school-aged children, according to the American Lung Association. However, with proper treatment and preventative care, it is very controllable, particularly if parents take an active role. Although more than half of nurses reported that parents routinely update them at regular intervals about children with asthma in their care, still 43% said parents rarely provide updates about their children's condition.

"Communication is critical. The key is to have an Asthma Action Plan developed by the child's physician and parents and shared with the school nurse. School nurses are highly capable and professional -- they will be able to assist children with asthma if they have been alerted to the condition and the specific needs of the child," said Adrienne Weiss-Harrison, MD of the American Lung Association. "Asthma conditions can be dynamic; as a treatment plan changes, the parents need to inform the nurse. Just as they do at home, parents can take simple steps to ensure their children with asthma are safe at school." TOP

Effective school asthma management can help prevent an asthma attack, according to Dr. Weiss-Harrison. This includes:

* Keeping children with asthma away from potential triggers, such as mold, dust, chemicals, strong odors or furry or feather animals;

* Ensuring children take their medication at regular intervals, as prescribed;

* Guaranteeing ready access to medications in case of an asthma episode, and

* Allowing children to pre-treat with medications prior to exercise to prevent breathing problems associated with exercise-induced asthma.

One very important issue is access to rescue inhalers-medication that can stop an asthma attack and help save a child's life. Although 70% of nurses reported that their schools have policies allowing children to carry rescue inhalers with them at all times, approximately 40% say that parents are not aware of the school's policy.

"When an asthma attack occurs, having a rescue inhaler in hand -- not sitting in the nurse's office -- can mean the difference between life and death," said John Kirkwood, President & CEO of the American Lung Association. "We believe children have the right to easily accessible quick relief inhalers. We want to encourage students who are responsible and developmentally able to carry their inhalers and self-administer medications so that they become independent in their asthma management." TOP

According to the American Lung Association, asthma among students from minority or underserved populations such as Hispanics, African-Americans or Asian Americans is seen as an increasing problem. More than two-thirds of the school nurses surveyed think that there are insufficient resources in place to address health concerns among these students.

Overall, the survey results suggest a need for more awareness of both asthma triggers and strategies for managing asthma attacks. More than half of the nurses said student and staff awareness of asthma triggers was fair or poor. Likewise, more than half the school nurses rated parent's awareness about managing their child's asthma as fair or poor.

The American Lung Association offers several educational programs to help manage asthma, including "Indoor Air Quality Tools for Schools," a program designed to assess indoor air quality and provide recommendations for improvement, and "American Lung Association Open Airways for Schools," a student-focused program proven to decrease the number and duration of children's asthma episodes. TOP