So, I’m sitting here, almost breathing normally. (Trust me, my normal breathing is when you feel you are struggling for breath.) Having escaped 14 months without a visit from Streptococcus pneumomiae, my “friend” came for an extended stay. Given the fact that I was born with a compromised respiratory system, such diseases are the norm.
Over the decades, researchers have been seeking the genetic cause(s) of asthma and COPD. But, there seem to be associations with some 400 different genes- and there’s a vast difference between correlation and causation. Given that more than 330 million folks around the world [25 million, or about 8% of Americans, are part of this total] suffer from asthma, this is an important step in truly dealing with the deadly disease. Especially when 25% of all emergency room visits are due to asthmatic issues, plus 1/2 million hospitalizations, and 3500 to 10000 deaths per year. (The incidence of asthma has been increasing in black youth over the past two decades, where the census now approaches 17%.)
But, asthma is not simply a “genetic” disease. No, it results from a combination of inheritance and environmental factors. Genetics contribute only 1/2 of the risk of developing asthma. This accounts for the finding of so many “false positives” when seeking the genetic cause(s).
It’s the reason why places like Boston and Baltimore (which have the two zips codes with the highest incidence of the disease, 21223 in Baltimore wins hands down) are working hard to alleviate the incidence and severity of asthma attacks. Believe it or not, eradicating rodents, having clean carpets, removing cigarette smoke can dramatically reduce the incidence of attacks. One hospital admission for asthma runs about $8700- which would be better spent to buy air purifiers, effect pest control, and have community health officers work with folks in those neighborhoods. (Over the cost of three years, the 50 most frequent asthma patients have incurred some $ 6 million in hospital fees! But, we don’t have a system to use that money for prevention. We deal with paying for treatment- and not prevention- instead.)
Which is why, Dr. Andrew DeWan (Yale University), along with some post-docs and doctoral candidates, heads up one such group involved in this research. While the team has whittled the number of genes down to 100 or so, they believe ADAM33 and ORMDL3 may be the true genetic culprits. The problem is that large segments of the population need to be studied to continue to whittle down the suspects.
But, we shouldn’t confuse what we term “exercise induced asthma” with true asthma. As a matter of fact, prescribing asthma medications to those folks only exacerbates the problem. Too often, this affliction is laryngeal obstruction- the vocal cords are blocking one’s ability to inspire air. (For such cases, instructing one in the proper breathing techniques is the best approach. And, if my respiratory issues are “typical”, then I can also vouch that learning proper breathing techniques have proven most useful. I haven’t been rushed to the hospital for an attack in over 20 years.)
(There may be also be an association between asthma and obesity. It’s thought this relationship exists because the metabolic pathways are coincident. One of DeWan’s team members is examining this factor more closely.)
Once we find out the causative genes, we can predict- and treat- those so afflicted. So, even if the environmental factors are present, such treatment should be able to avoid full-blown asthma symptoms and etiology.