July 6, 1997 in Nation/World

Asthma Deadly Serious Despite Clean-Air Awareness, Cases And Fatalities Are Mysteriously Rising

By The Spokesman-Review
 

Kimberly Kreb, who beat down a heart defect and fought off allergies and asthma, knew for years she would be a genetic researcher.

She bought a $60 genetics textbook when she was 17 and read it like a dime novel, trying to unlock how things are passed from generation to generation.

Kreb just earned a science degree from Eastern Washington University, but her fiance picked up the diploma. The asthma caught up with her last October when Kreb, a drug inhaler her constant companion, couldn’t catch enough air.

She died after her second major asthma attack.

“People have underestimated that this is a killer,” said Deborah Kreb, Kimberly’s mother. “We didn’t know. Our daughter was 22. She had allergies all her life, developed asthma. It’s not that unusual. What is unusual is that it’s killing us.”

Asthma deaths are relatively rare. But Kreb is part of a growing paradox. Despite pollution controls that have cleaned up the nation’s air, asthma cases and deaths are increasing. And no one’s sure why.

Asthma rates are doubling in some age groups. The number of people suffering from asthma grew from 7.9 million in 1982 to 14.6 million in 1994 - an increase of about 84 percent. That’s 6.7 million people, more than the population of Washington and Idaho combined.

The disease hits more than one in 20 people nationwide but rarely garners headlines. It’s not flashy and doesn’t claim a large body count. The deaths are preventable yet most sneak up like a sneeze.

The problem is particularly acute in the Inland Northwest. The rate of asthma in Spokane County is almost double the national rate, according to one study. Here, people point fingers at suspected causes, and research is just starting to look at the reasons.

“We can’t really blame it on pollution,” said Dr. Betty Wray, a professor at the Medical College of Georgia and the president of the American College of Allergy, Asthma and Immunology. “We just have to admit that we don’t know why this is happening.”

The deaths started rising in the early 1960s in Wales and England, spreading in the 1970s to Australia and New Zealand. In 1977, deaths started to increase in the United States as well. They’ve jumped by 227 percent from 1977 to 1994, when 5,487 people died nationwide.

In Idaho, deaths jumped from 17 in 1984 to 28 in 1996, an increase of about 65 percent.

In Washington state, 83 people died in 1982 from asthma, compared with 128 in 1994, a 54 percent increase. Twelve of those 1994 deaths were in Spokane County.

“Asthma is one of the most tragic diseases,” said Jane Koenig, a professor of environmental health at the University of Washington who is studying emergency-room asthma cases in Spokane.

“It affects young people so much, and fatalities shouldn’t occur. If you have the proper medical attention at the right time, you can prevent it. It’s so frustrating when you lose someone.”

Asthma is signaled when a person’s immune system becomes overly sensitive to an irritant, often an allergen such as dust mites. When the irritant enters the asthmatic’s body, the bronchial tubes become inflamed and start narrowing.

Breathing can feel like trying to suck an egg yolk through a tiny straw.

Allergies and asthma are often related.

Kimberly Kreb was first diagnosed with allergies when she was 13. Born in Japan with a congenital heart defect, her battle for life started with birth. She was a survivor, though, walking away from three car wrecks, overcoming the heart problem, and battling allergies while starting a flag team at Medical Lake High School.

Kreb was diagnosed with asthma in her senior year, in October 1991, when she just couldn’t breathe, couldn’t shake a cold and couldn’t stay awake. After a hospital trip, she started collecting inhalers, stored in lockers, cars and her backpack.

The family gave away its two poodles. Kreb started studying science at Eastern Washington University, and her parents moved from Fairchild Air Force Base to Wilbur. They still had a cat. Kreb learned about asthma and even took part in allergy studies.

In October 1995, she had her first major attack. Kreb was given a nebulizer, a machine that delivers concentrated inhaled medicine. One year later, she wasn’t feeling well. She went to the doctor on Oct. 23, 1996, and was handed some new prescriptions.

Still, the Krebs don’t remember ever hearing that the disease could be fatal.

“Not once, not once in that whole last couple of weeks when she wasn’t feeling good did she - or we - suspect her life was in danger,” Deborah Kreb said.

Doctors like Spokane’s Richard Gower say that’s not unusual. Young people think they’re immortal, and they rarely pay attention to preventive medicine like the anti-inflammatory drugs now recommended for asthmatics.

Fatal attacks usually are sudden, lasting three hours or less. Many deaths happen before the victims can even reach the hospital, their asthma inhalers still clutched in hand.

A third of deaths nationally involve mild to moderate asthmatics, like Kreb or Krissy Taylor, a promising 17-year-old model who died at her Florida home two years ago after an asthma attack. She had never been diagnosed with asthma before.

Sandpoint’s Sharon Buck was a severe asthmatic. She died last August from respiratory trouble related to asthma. Clean-air advocates blamed the death on the first day of annual field burning by bluegrass growers.

Deaths are concentrated in California, New York City and Chicago - particularly in the inner cities. More women die than men. The disease cuts across all ages but especially children from 10 to 14 and the elderly. It hits the poorest hardest, especially young black males.

Gower has treated asthma for 20 years in Spokane. It’s his favorite thing to treat, because it’s so treatable.

“Unfortunately, the severity, the life alterations that result from having asthma tend to be underestimated by the patients, the families and even the health-care providers,” said Gower.

While major headway is being made on treating asthma, with new drugs arriving all the time, it’s still unclear what causes the disease.

The suspects are everywhere, from diesel fuel to dust mites, from antibiotics to grass smoke. People spend more time indoors now, in homes sealed tight against air exchanges.

Swirl in carpets, cigarette smoke and indoor pets, and there’s a recipe for asthma.

A recent study in New York state linked asthma deaths to the ozone. Cockroaches have been definitively linked to the rise of asthma in inner cities.

Another study points to children suffering fewer childhood infections because they’re taking more antibiotics.

The study suggests that some infections may train the immune system not to react to irritants such as pollen and dust mites. Lacking the infections, the body remains sensitive to the allergens, which can cause asthma and other allergic reactions.

In Spokane, researchers are struggling to explain the reasons for the high asthma rate. Cockroaches really aren’t a problem. Temperature inversions are, trapping brown haze in the area. And there’s burning.

University of Washington researchers are finding a pattern that suggests an association between emergency room visits for asthma and larger combustible particles in the air, like from oil heating or grass and wood burning.

“Something’s going on in Spokane,” said Dr. Roe Roberts, one of the EWU researchers studying asthma.

Most likely, Kimberly Kreb will end up a statistic in the UW study.

She got home about 11:15 p.m. on Oct. 25, after baby-sitting with her fiance. She couldn’t carry a basket of laundry up the stairs. She took one dose of medicine on her nebulizer, and it didn’t work. She took another, and said call for help. She took the third dose - her last available - and she panicked.

Her boyfriend called for help. Paramedics arrived as Kreb passed out.

Her parents drove the 60 miles from Wilbur to Spokane in 40 minutes, even after a police officer stopped them once.

She was rushed to Deaconess Medical Center, but she never really woke up, dying five days later with an unfilled prescription for nebulizer medicine in her purse.

Her parents are now encyclopedias of asthma. They want people to know what the disease can mean.

“If you can, minimize the ‘Feel sorry for us,”’ Deborah Kreb told a reporter. “I want this (story) to have purpose. I want my daughter’s life to stand for something.”

“Asthma kills,” her husband added. “If you try to cheat it, you lose.”

, DataTimes ILLUSTRATION: Color photo


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