Anthony Shadid’s death highlights dangers of asthma

By Deborah Kotz, Globe Staff

Intrepid foreign correspondent Anthony Shadid wasn’t felled by the bullet he took in the shoulder or the brutality he experienced at the hands of those holding him hostage; he died yesterday of a condition that affects some 25 million Americans: asthma.

While traversing the Syria-Lebanon border on assignment for the New York Times, the former Globe reporter started wheezing after having an allergic reaction to horses in his caravan. Within moments, he collapsed and died after his heart stopped beating, according to Times photographer Tyler Hicks, who was accompanying Shadid.

“Asthma deaths are pretty uncommon, though not as uncommon as you might think,” said Brigham and Women’s Hospital asthma researcher Dr. Michael Wechsler. It causes about 4,000 deaths in the United States every year.

Whether Shadid’s life could have been saved had he experienced the attack near a big city hospital, rather than at a remote border crossing, isn’t known, but Wechsler said Shadid clearly had a severe case that may not have been well controlled by his medications.

Those with frequent attacks of wheezing or shortness of breath -- a few times a week during the day or more than once a week at night -- usually benefit from anti-inflammatory medications such as inhaled corticosteroids administered twice a day or a once-daily pill such as montelukast (Singulair) to reduce the number of asthma attacks, according to clinical guidelines from the National Heart Lung and Blood Institute.

Bronchodilator inhalers including albuterol work temporarily to open lung passages, making it easier to breathe and are used as needed when symptoms occur.

Shadid reportedly had asthma medication with him in Syria, but if he was relying only on a bronchodilator to manage wheezing and not also taking an anti-inflammatory drug, that could have made his condition worse. “It could have masked the inflammation that led to his death,” Wechsler said, “but this is pure speculation.”

On the other hand, he may have been taking his medications exactly as his doctor prescribed and still not have had his disease well controlled. Wechsler and his colleagues are conducting research to determine why 15 percent to 20 percent of asthma sufferers continue to experience frequent bouts of wheezing despite taking anti-inflammatory medications on a long-term basis.

“There could be genetic or biological differences, but we just don’t know at this point,” he said.

Allergies to animals, pollutants, or pollens can trigger an asthma attack, and Shadid had experienced a milder attack after encountering horses upon initially crossing the border into Syria, which probably primed his body for a stronger attack the next time he was exposed to horses. The amount of stress he was experiencing at the time might have contributed as well. Stress can aggravate asthma -- and the dangerous border crossing was, no doubt, tension-provoking, even for a man used to putting his life at risk.

For more information, read our health guide entry on asthma.

Deborah Kotz can be reached at dkotz@globe.com. Follow her on Twitter @debkotz2.