Asthma tops childhood illnesses

Asthma affects one in eight children in New England, eclipsing all other chronic illnesses of childhood and flooding emergency rooms and clinics with hacking, wheezing youngsters, according to a report scheduled to be released this week.

The study from a coalition of federal and state public health agencies provides the most comprehensive assessment ever of asthma in the six-state region. It found that more than 400,000 children have been diagnosed with the condition and that its consequences fall disproportionately on the poor.

A stew of environmental and health factors have contributed to the epidemic of asthma, specialists said, with everything from leaky roofs to cockroach droppings blamed for a disease that results in US children missing 14 million school days a year.

Public health authorities, long alarmed by reports of more and more children suffering with asthma -- a nationwide survey showed a 75 percent increase from 1980 to 1994 -- decided to get a clearer snapshot of how widespread the illness is in the region.

The report, issued by the New England Asthma Regional Council, is the starting point of a campaign to develop strategies to ease the triggers of asthma attacks, with representatives from health, housing, environmental, and education agencies banding together to address a disease whose root cause remains a mystery.

"On the one hand, these findings were shocking," said Laurie Stillman, executive director of the Asthma Regional Council. "On the other hand, they confirmed what many people had feared and suspected. This disease imposes an incredibly high burden."

That burden falls squarely on parents such as Mary White, who has three sons suffering with asthma. The youngest is 6, the oldest 18. Before the family moved from an apartment coated with mold and mildew in Boston's South End, White would find herself and her gasping children in emergency rooms or clinic waiting rooms up to four times a week. During asthma attacks, inflammation and muscle spasms narrow the victim's airways and if untreated, attacks can be fatal.

"It's very scary having children with asthma," said White, who has the respiratory illness herself. "When we started going so often to the medical center, they came to know us by our first names and they would say, `Oh, Miss White, you're here again.' "

The story of White and her sons is illustrative both of how asthma affects families and how the sources of its misery can be relieved. With the aid of physicians, White identified her apartment as a prime contributor to her children's bouts of asthma, and so a year ago, mother and sons moved to a new home in Dorchester. "My children are so much better," White said. "I used to be up a lot at night listening to make sure my children were breathing safely."

White's sons are among more than 185,000 children diagnosed with asthma in Massachusetts alone. The study found that Maine had the highest rate of childhood asthma in New England, followed by Connecticut and Massachusetts. Across the region, 12.3 percent of children have been diagnosed with the ailment.

Comparisons to other states are difficult, authors of the report said, because New England was the only region to ask about childhood asthma as part of a 2001 health review known as the Behavioral Risk Factors Surveillance System. More than 10,500 New England families with children were questioned in the telephone survey.

"Asthma drains the quality of life these kids can enjoy," said Mike Milner, regional health administrator for the US Department of Health and Human Services. "Wouldn't it be great to improve the lives of these kids and let them go on and lead productive lives?"

Asthma typically exacts the greatest toll in poor, urban neighborhoods. The New England study found that children from the poorest families were almost twice as likely to have the illness as youngsters from the richest families. And asthma rates were 50 percent higher in black and Hispanic families than in white families.

"We really need to be able to address those disparities if we are going to reduce the burden of the disease," said Margaret Reid, director of the Asthma Prevention and Control Program at the Boston Public Health Commission.

Reducing the burden of asthma involves research in the laboratory as well as review of the environmental sources believed to ignite attacks.

In the lab, scientists are hunting for the genetic causes of a disease that appears to run in families. And on the street and in the clinic, doctors, nurses, and social workers are looking for the culprits responsible for triggering the deep wheezing and chest tightness that herald an asthma attack.

Researchers have identified cockroach droppings as a particular peril, said Dr. Wanda Phipatanakul, an asthma specialist at Children's Hospital Boston. Scientists are also examining how idling buses outside of schools and decrepit housing conditions contribute to the asthma epidemic.

"There's a lot to learn about the complex interchange between environment, genetics, and all the other factors," Phipatanakul said. "We know about the symptoms of asthma, and we know environment is important. But we don't have a cure for asthma. Everyone is looking for it."

That quest is crucial to Toby Marshall. Her 3-year-old daughter Adina has asthma that has meant daily doses of medicine and repeated trips to the emergency room. "I myself have asthma, and my parents both have asthma," said Marshall, who lives in Billerica. "Believe me, it's not something you would wish for your child."

Stephen Smith can be reached at stsmith@globe.com.