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DOCTORS CLEAR THE AIR ON ASTHMA

Every year, asthma kills an estimated 5,000 Americans, hospitalizes many times that number and sets the country back $6.2 billion in health-care costs.

Worse, the toll in sickness and deaths caused by this chronic ailment has increased more than 30 percent in the past 10 years. Yet asthma actually is a controllable disease, said Dr. John P. McGuire, an allergist at Intermountain Health Care's Salt Lake Clinic, 9500 S. 1300 East, Sandy.McGuire and a fellow allergist, Dr. Jan Bernhisel-Broadbent, will answer questions from the public about asthma, allergies and related disorders on Saturday during the IHC/Deseret News Health Care Hotline.

McGuire is also on the medical staffs of Alta View Hospital and Primary Children's Medical Center. Bernhisel-Broadbent is on the staffs of LDS Hospital and IHC's Bryner Clinic.

This is a good time to learn about asthma - which is characterized by periodic tightness in the chest, coughing, wheezing and difficulty in breathing - since May is National Asthma Awareness Month.

"It really is a significant problem," McGuire said of the disease. The expense of treating asthma "turns out to be a little over 1 percent of our total health-care cost - just a huge amount of money."

Beyond the giant price tag, asthma carries heavy burdens for society in terms of suffering and loss.

"We believe as asthma specialists that the reason why this asthma morbidity and mortality are rising is because of underdiagnosis and undertreatment," he said.

Most family doctors who treat asthma would agree that it is an inflammatory disease, but many might not realize how subtle and serious it is, he said.

McGuire posed this question: Suppose you ask doctors and asthma victims about a patient who uses a short-term inhaler two or three times a week. Would they say the patient is a mild or a moderate asthmatic?

"I think most asthma sufferers and most primary care physicians would answer that's a mild asthmatic," he said. "In fact, that's a moderate asthmatic."

That level of affliction means the patient probably should be using a prescription inhaler that prevents inflammation, he said.

"People underappreciate their symptoms," McGuire said. Someone might wheeze two or three times a week and use an inhaler bought over the counter in a drugstore and think the asthma is no big deal. He might get used to it soon, and his doctor might dismiss it as nothing serious because it seems to be under control.

Wrong, McGuire said.

"These are the kinds of patients who typically are going to get worse over time. . . . Those symptoms are the tip of the iceberg of what's truly going on in the patient's lungs."

The inflammation the patient suffers is likely to worsen as time passes. Asthma specialists view "a mild asthmatic as potentially becoming a severe asthmatic, unless they're aggressive in controlling the patient's disease," he said.

A specialist may prescribe more than one inhaler, he said. "Most people with asthma should take a short-action bronchial dilator," which opens the bronchial passages by relaxing the muscles around the air tubes, relieving muscle spasms. Then they may use an anti-inflammatory inhaler that treats the inflammation associated with asthma.

Why has asthma been increasing?

Nobody is sure, McGuire said, but air quality could affect the problem. Also, some sort of extra stress factor might cause asthma to increase in inner cities.

The best tack is to look for asthma aggressively and then aggressively manage the disease, he said. In Utah, the American Lung Association is launching a program in the schools called Open Airways, in which experts talk to schoolchildren about asthma. IHC is starting an effort to better educate physicians about the danger.

One recommendation he has is that doctors refer patients to asthma specialists.

"It takes time to teach an asthmatic how to use an inhaler." More time is needed to teach a patient how the medicine works and what to do in case of an asthmatic flare-up.

"What we're hoping is that primary physicians will begin to utilize asthma specialists for the patients that they feel they cannot manage in their office."

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ADDITIONAL INFORMATION

Call News hotline

Dr. Jan Bernhisel-Broadbent and Dr. John P. McGuire, allergists on the staffs of hospitals and clinics in the Salt Lake area, are scheduled to answer questions from the public about allergies, asthma and related problems.

On Saturday, they will answer telephone queries during the monthly Deseret News/-Intermountain Health Care feature, Health Care Hotline. The hotline is open for two hours, from 11 a.m. to 1 p.m., on the second Saturday of every month.

Callers can reach the doctors on this toll-free number: 1-800-925-8177. They need not give names, and the program isn't broadcast. An article summarizing some of the questions and replies will be prepared for Sunday's paper.