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TWENTY-SIX-YEAR-OLD Stephen Leak lives with the constant dread of death. He does not mention drunken drivers or a lunatic's fury among his worries. He's no hoodlum or wanna-be-gangster wondering if he'll catch a bullet for living on the edge. Instead, the young entrepreneur speaks of his lifelong struggle with asthma, a respiratory ailment that affects nearly 15 million Americans. With the innocence of boyhood still fresh on his face, Leak says he fears that his next labored breath could be his last.

The Chicago man still remembers his first major asthma attack at age 15.

"I never felt anything like it before," says the local party promoter. "I sounded like a dog crying. I started wheezing and I couldn't breathe. My mother had to help me out to the car."

He describes the sensation as similar to having just run a 100-yard dash and then having someone bind your mouth and nose with a scarf.

"You try to gasp for air, but you can't," he says. "You just stay out of breath."

More African-Americans are living with asthma, a chronic lung disease that inflames and swells the linings of the airways, than ever before. According to the American Lung Association, the number of people of all races who have been diagnosed with asthma soared 61 percent between 1982 to 1994, reaching what some experts are calling an epidemic. African-Americans are among the hardest hit: Blacks are three times as likely to be hospitalized for asthma as Whites. We are four times more likely to be rushed to the emergency room for care.

"I've seen about a 10 to 15 percent increase of patients with asthma over recent years," says Dr. Frank J. Cook, assistant professor in the Morehouse School of Medicine's division of pulmonary diseases who was in private practice for 17 years. "In the last two months, I've seen three deaths from asthma. [The illness] seems to be affecting our people more often from the oldest to the youngest."

Asthma is the most common chronic illness of childhood, according to American Lung Association statistics. But for young African-Americans, who are diagnosed with asthma twice as often as Whites, the consequences can be particularly devastating.

More than 5,000 people died from asthma in 1995, nearly double what the toll was two decades ago. The grave situation facing Blacks becomes apparent when you consider the disproportionate number of Blacks dying from the disease. While African-Americans make up just one in eight of the population, we compose one of every five of asthma-related deaths.

In recent years, more Blacks have felt the ache of losing loved ones to asthma, including author Terry McMillan whose mother died of asthma in the early '90s and Chicago political leader John H. Stroger Jr. whose 22-year-old son Hans died from an asthma attack in 1982, just seven months after graduating from Xavier University.

"My son had been an asthmatic all his life," says the first Black president of the Cook County Board of Commissioners. "The severity of asthma in this country seems to be getting worse at a time when we have advanced so much in medical technology."

What's behind the new asthma epidemic and why is it targeting Blacks? Answers to those questions depend on whom you ask.

"We have a disproportionately large number of people who are poor and who don't have the access to health care systems, medications and the specialists that can help them manage this disease," says Dr. Floyd J. Malveaux, dean of Howard University's College of Medicine and vice president of health affairs. "If you look at the numbers where deaths occur, you'll see they often happen in areas with large concentrations of the poor. It's the same thing when you look at emergency-room visits."

Malveaux, a leading asthma expert, says poor Blacks may face graver threats from asthma because of lack of money and education. Those who work part-time or lack insurance coverage can be left with the difficult choice of paying for costly medicine that can range between $100-$200 a month and rent or food.

"If you are poor, you can spend up to one-third of your income managing a sick, asthmatic child," Dr. Malveaux says.

Other experts say patients forget to take their medicine or neglect to continue the doses when they feel fine. Some follow the untested advice of friends who tell them they can become addicted to their inhalers -- devices that deliver a mist of medicine to clear the airways. Still others underestimate the seriousness of asthma, or mislabel asthma as a "children's disease," thinking they cannot get the respiratory illness because they are old.

Dr. Malveaux, Dr. Cook and others agree that a complex web of triggers like stress, environmental pollution, cigarette smoke, dust mites, mold, cockroaches, and constant exposure to animal dander contribute to the devastating trend.

While the cause of the surge is still debated, the dynamic of asthma is no mystery. The suffocating effects of asthma occur when the lung's bronchial tubes become hypersensitive to a trigger or allergen like dust, pollen or smoke, causing the body's immune system to spew inflammatory chemicals into the airways. These chemicals cause the air passages to swell and fill with thick, sticky mucus, leaving the asthma sufferer gasping for air.

# posted by Medical Information : 3:43 AM