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?

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Mindy Benson, a nurse practitioner at Children's Hospital Oakland, coordinates the asthma program at the hospital's ambulatory clinic on Claremont Avenue. "It's a rare patient who comes here for the first time that hasn't been hospitalized," she says of the program's clients. "It's fairly unheard of that they haven't gone to the ER once." She estimates that ten percent of the ten thousand Oakland kids who visit the clinic have asthma.

Local asthma sufferers of all ages are most likely to end up at Children's, which registers the highest number of asthma hospitalizations of any Oakland facility. Hospitalization records, however, represent only the most acute cases and provide an incomplete picture. Though the government keeps close tabs on other illnesses, no surveillance system exists for asthma. The state will soon collect emergency-room data but currently only tracks hospitalization. Short of knocking on doors, there's no way to know precisely how many people suffer from asthma.

The best indication comes from the California Health Interview Survey, which conducted phone interviews with more than 55,000 households in 2001. From this data, the researchers estimated that 11.9 percent of Californians have been diagnosed with asthma at some point in their lives, compared to a national average of 10.1 percent. At the county level, the study found that Solano and Marin had the Bay Area's highest prevalence. However, unlike Alameda County, both counties register fairly low when it comes to hospitalization.

Genetics play a part. If one or both parents have asthma, their kids are significantly more likely to have it. Still, because the gene pool changes very slowly, genetics alone cannot explain the rapid rise in its prevalence.

"I've seen not so much an increase in families who have asthma, but an increase in the number of kids who come from families who don't," Benson says. "I ask, 'Do the parents have asthma?' 'No.' 'Do the grandparents?' 'No.' Nobody in their family has asthma. God! What's going on? Why are all these kids getting asthma who have no family history? I think we all know what's causing it. It's pollution. Our immune systems are not working so well because of our polluted world."

Though she makes an educated guess, it's just that -- a guess. Several studies have linked air pollution and the nasty stuff in it -- ozone, sulfur dioxide, and particulates, to name a few -- to respiratory problems and decreased lung capacity. One study, conducted by the Centers for Disease Control and Prevention, found that when Atlanta reduced traffic during the 1996 Summer Olympic Games, the number of children needing emergency care for asthma fell dramatically. Yet little definitive evidence exists to prove air pollution actually causes asthma.

"We don't have any objective data," Benson explains. "We have anecdotal data, like when a container ship comes in and all the trucks are sitting all night long with their engines on, the next day the ER is filled. All that diesel was in the air. But that's subjective. No one is out there measuring carbon particles."

Only one study to date, conducted by the University of Southern California and released this year by the California EPA's Air Resources Board, has gathered evidence that smog causes asthma. The researchers tracked 3,535 Southern California children with no history of asthma for more than five years. Those who lived in high ozone areas and played three or more sports developed asthma at a rate three times higher than those in low ozone regions. Because exercising can cause a child to draw up to seventeen times the usual amount of air into the lungs, young athletes were more likely to develop the disease.

The rise in asthma rates probably has several causes. The most likely explanation is a complex interaction between environmental and genetic factors. Studies have identified indoor allergens and tobacco smoke exposure at a young age as risk factors, and researches have postulated all sorts of theories -- from diet to hygiene.

One hypothesis contends that because kids spend more time indoors with their TVs and PlayStations these days, they are more likely to become obese, a risk factor for asthma. Other researchers believe unhealthy eating habits are to blame and that certain foods make for a cleaner immune system, protecting children from asthma.

The theory that seems to have gained the most acceptance in the medical community is the so-called hygiene theory. "Basically the concept is that infections early in life -- including respiratory and gastrointestinal -- stimulate the immune system in a way that tilts it away from developing asthma and allergy," says Michael Lipsett, associate clinical professor at UCSF School of Medicine. "So if you live in an environment where there is better overall hygiene -- not just in your kitchen or bathroom, but where it's a cleaner environment socially, for instance with clean drinking water distribution systems -- in theory you're not going to get as many serious infections in early life. And therefore you don't get the boost to the immune system. Thus the increased risk of developing allergy and asthma may represent an ironic consequence of improving public health."

Monsa Nitoto has his own theories on why asthma so plagues his West Oakland neighborhood. "Here's where the trucks line up," he says, driving swiftly along a stretch of road that serves the Port of Oakland. He then maneuvers his Jeep over curbs and around gates to get to the port's new lots, currently half- constructed and barren. Nitoto is not the kind of person who does as he's told. If a street sign says "No Entry," he'll find another way in. As director of the Coalition for West Oakland Revitalization, Nitoto has to be resourceful.

"We're going to have a new game that you might call Truck Tag," he says cheerfully in his raspy voice. The game targets the many trucks doing business with the port that travel illegally down West Oakland's residential streets, spewing fumes. Nitoto's game goes like this: When a truck rolls through the neighborhood, residents jot the license plate number down and report it to the authorities. Whoever makes the most reports will win a prize to be given away at the annual neighborhood Clean Air Festival in September.


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