Waiting to Inhale 

It's a killer we seldom hear about, discriminating by race and locale and afflicting more people every year. So why don't we even know what causes asthma?

In the months before his death, things were looking up for Greg Michelson. He and his girlfriend of five years had decided to get back together after some time apart. Michelson had straightened out in middle age after overcoming his share of problems: he had grappled with drug addiction and come clean, ballooned in weight then lost it. Throughout it all -- from his days causing mischief at Brown University, to organizing workers at a waterbed factory, to his last job heading the science department of a small Christian college in Oakland -- he charmed the people around him with his brilliant scientific mind, sarcastic sense of humor, and quick wit. Michelson, the son of a Holocaust survivor, had always been rich in friends. But none of them were with him the day he most needed help.

On the Tuesday after Labor Day 1999, in the early morning hours, Michelson was alone in his Berkeley apartment on Benvenue Avenue when he began to wheeze. It was a strained, heaving noise that grew increasingly panicked -- the sound of someone trying to breathe who couldn't.

As usual, he had left the windows and doors in his home open so fresh air could circulate throughout. But that didn't help. The muscles enveloping his airways continued to squeeze hard: too hard. His chest retracted violently, his stomach sucking up into his ribs. Michelson kept an inhaler around for emergencies like this, but it was empty. He had run out of medication the previous evening after spending the holiday on the windy beaches of Point Reyes. Unable to talk, he banged on his neighbor's door for help, only to suffocate on her step before she opened the door. He was 41.

"For this to happen was such a tremendous shock," says longtime friend Stephanie Burns, who was so shaken by his death that she ended up in the hospital herself. "There's death when it's supposed to happen or when it's in its time. And there's death that's not supposed to happen. That's how this was. It wasn't supposed to occur at all. There was something really wrong about it."

His killer, asthma, isn't a disease most people think about. It rarely grabs headlines the way AIDS and cancer does. It has no ribbon campaign and most people don't think of it as fatal. But it is. Asthma kills about 5,400 Americans every year. While it is often regarded as a childhood disease, the mortality rate is higher for adults than children. And while it claims far fewer casualties than big hitters like AIDS, which killed 14,802 in 1999, AIDS deaths have slowed in the United States, while asthma fatalities have tripled since 1977 and continue to rise. The number of deaths is both alarming and tragic because no one should die from asthma; it is a relatively manageable disease.

It is also a serious public health issue in California, where dirty air exacerbates breathing difficulties for the nearly three million state residents who suffered from asthma symptoms last year, the California Health Interview Survey reports. The state dominates the American Lung Association's annual ranking of counties with the highest ground levels of ozone -- a pollutant that can trigger asthma attacks. Eleven of the nation's 25 worst counties for ozone contamination are in California.

In Alameda County, which ranks second in the state for asthma hospitalizations, this disease is the leading cause of hospitalization among children four to fourteen. The county also has more than its share of fatalities. While the national death rate averages less than two people per county per year, Michelson was one of 38 Alameda County locals who fell to a fatal asthma attack in 1999.

In spite of improved medications and treatment, the prevalence of this disease has doubled worldwide in the last fifteen years, according to the National Heart, Lung, and Blood Institute. Some 17.3 million Americans suffer from the chronic disease today, and if current trends continue, a recent Johns Hopkins University study warns, cases could double by 2020. Asthma also discriminates. Most at risk are African Americans and children. Blacks die from asthma at a rate twice that of whites and three times that of Latinos. And black children are four times more likely than white kids to die from asthma.

With an epidemic on our hands, local health departments and coalitions are cobbling together education and outreach programs. In West Oakland, residents are rallying around air quality and environmental justice. Yet, with so many people struggling to breathe, researchers still don't know exactly what, or whom, to blame for asthma's dramatic rise.

If you want to know what an asthma attack feels like, talk to Margaret Gordon. The 55-year-old West Oakland resident has had more than her fair share. "It feels like somebody's standing on your chest and everything feels squeezed," she says. Like the majority of asthmatics, Gordon also has allergies. It's a bad combo: Her throat swells up. Welts rise all over her body. Her hands turn red. And an unbearable urge to scratch overcomes her.

"I feel itchy, itchy, itchy! Like it's a thousand ants running all over you," she says, sitting in the hollow room that serves as the offices of the 7th Street McClymonds Corridor Neighborhood Improvement Initiative where she works as an outreach coordinator. Minutes later, she notices a trail of ants weaving across the carpet. She rummages on a shelf for a spray bottle and attacks with a mixture of vinegar and soap. Gordon can't use insecticides, certain cleaning products, or perfumes because they trigger her allergies, which in turn could trigger an asthma attack.

During an attack, the muscles around the bronchioles (the small breathing tubes in the lungs) constrict the flow of air. Emergency medications known as bronchodilators, such as Albuterol, loosen the grip instantly. But even when they're not suffering through an attack, asthmatics' lungs have another problem: inflammation. Cells inside the lining of the bronchioles overproduce mucus, clogging the passageways and causing constant irritation. For that reason, asthmatics should also take preventative anti-inflammation medications daily.

Gordon carries three different inhalers with her. But even though she keeps her asthma in check, it still controls many aspects of her life. It can keep her up at night and it limits her physical activities -- exercise triggers attacks in some people. Even something as simple as a turtleneck can bother her. "Tight clothes? Oh no!" she says with her eyes closed, as if summoning the words from deep inside her body. While Gordon now visits a doctor regularly, many of her West Oakland neighbors don't have access to proper health care -- one reason they frequently end up in the hospital.


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