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Dr. Zorba Paster: Asthma treatment is improving, but it is still important to control risk factors

UPDATED: Wed., Sept. 30, 2020

By Dr. Zorba Paster For The Spokesman-Review

We talk a lot about heart disease, stroke, cancer and, of course, COVID-19, but we don’t spend as much time talking about asthma and how to control it.

Asthma is on the rise. It continues to grow year by year. One in 12 people, or 25 million in the U.S., have asthma. Back in 2001, it was 1 in 14 in a significantly smaller population.

So where might this be coming from, how can we prevent it, and how can we treat it?

First up, treatment options have improved over the last decade. Inhaled steroids, medications that reduce inflammation and mucous production, have improved dramatically.

Asthmatic wheezing can interfere with everyday and sports activities, which are so vital for kids growing up. The wheeze, the cough, the difficulty catching your breath often respond to “rescue” inhalers, but they have side effects if they’re used too much.

That’s where long-acting steroid inhalers – steroids that coat the bronchial tubes and are, for the most part, not absorbed into the body – can keep the airways open and allow you to breathe normally. Still, 10 Americans die from asthma every day. In 2017, 3,564 people died from asthma, with many of these deaths being avoidable given proper treatment and care.

So preventing asthma in the first place is really what we want, just like we prevent heart attacks by eating right and exercising.

What causes asthma can be elusive. That’s where a British Medical Journal study comes in, showing that pollution, smoking and other curious factors fit into the asthma puzzle.

In Denmark, there is one health insurance company, the government. So the statistics they have are really good. They examined records for more than 3 million children born between 1997 and 2014 looking at who got asthma and who didn’t, who developed persistent wheezing – not a one-and-done affair.

An estimated 123,000 kids identified with asthma, most developing it by age 2. Then researchers looked at where these children lived. The Danish have really good information on where air pollution is – from cars, factories, power plants, home heating, etc.

They further looked at whether or not the parents smoked, what their level of education was, how much they made – all the other things we know affect health and wellness. By the way, the missing link in many studies are the socio-economic factors that affect health care. The Danes wanted to measure this, trying to figure out the asthma puzzle. Keep in mind that all Danes have excellent access to medical care and a stronger social net than we have.

They found that moms who smoked during pregnancy were more likely to have asthmatic kids. Somehow, the smoke the moms inhaled while the baby was developing in the womb made that baby more likely to be an asthmatic child and, therefore, an asthmatic adult.

It wasn’t just smoking in the house after the kid was born that had an effect, something we’ve known for years. But the effect of tobacco smoke in a pregnant woman somehow went through the placenta, making the child more like to become a wheezy kid.

This prenatal pollutant is important to recognize, reminding women again and again that smoking during pregnancy is bad, bad, bad for a baby.

But the next factor they found was that kids who lived in areas with more air pollution were more likely to develop asthma. The fine particles in the air affected their lungs, producing a lifetime of problems.

It wasn’t just outside pollution but inside pollution such as heating with wood. Many in Wisconsin heat with wood, though not as many as in Vermont, where 38% of all houses burn wood for heat. A wood stove not properly vented can be one source of air pollution that’s part of the asthma mystery.

My spin: Change the risk factors you can control. No smoking during pregnancy, no smoking around your child ever. If you burn wood, make sure the stove is well vented so you don’t spew fine particles into the air.

The other factors including education, income and where you live are not an easy fix. But it reminds me that staying in school in order to get a better job has far-reaching effects for you and your family. Stay well.

Dr. Zorba Paster is a family physician and host of the public radio program “Zorba Paster on Your Health.” He can be reached at

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