Dr. Carrie Buchanan
Tim Russert Department of Communication and Theatre Arts
John Carroll University
Question Everything

Attacking asthma

Attacking asthma

Air pollution creates and kills more asthmatics every year. Now parents are fighting back.


Originally published as a freelance article in:

The Ottawa Citizen

Tuesday, November 17, 1998

Page: G1 / FRONT

Section: Health

Byline: Carrie Buchanan

Source: The Ottawa Citizen

Illustrations: Color Photo: Pat McGrath, The Ottawa Citizen


By Carrie Buchanan


In the still of the night, between midnight and 4 a.m.,

Pam Fitzgerald and her son Nickolas Hoogers, 6,

huddle in a ritual they share with hundreds of

thousands of other families throughout North



Nickolas is having an asthma attack. He coughs and

struggles to breathe, his little lungs gasping so

strenuously, they sometimes suck the skin up under

his breastbone. His mother places her hand on his

chest to feel its rapid rise and fall.


``I count. I get out the clock with the second hand, in

the middle of the night, and I count his respirations.

And I've gotten to the point that I can do it in the

dark,'' she says.


She must decide whether to take her son to the

hospital -- it's advised if his respiration rate exceeds

about 40 breaths a minute. But there are other factors,

too. ``I bought myself a stethoscope so that I can

listen to the wheezing ... in the lungs,'' she says.


Counting and listening also give her something to do,

other than sitting helplessly by. She certainly can't

sleep. ``It's difficult to watch,'' she admits, her voice

breaking, ``to see your own child not being able to



Sometimes, after a few hours, the attack subsides and

they get some sleep. Or they bundle into the car and

head off to the Children's Hospital of Eastern



At the hospital, they're no longer alone.


``I've been at CHEO emergency ward when it's been

filled with nothing but asthmatic children,'' Ms.

Fitzgerald says. ``We've only had to go a few times. I

know other parents that go regularly to the hospital.''


In fact, asthma now accounts for about 2,500

emergency room visits and 300 admissions per year

at CHEO, says Dr. Tom Kovesi, pediatric

respirologist at the hospital. He also teaches at the

University of Ottawa medical school, works with the

Ottawa Lung Association's Asthma Education

Centre, and writes the asthma information on

CHEO's web site.


``Asthma is the commonest chronic disease in

children. About one child in 10 has asthma,'' Dr.

Kovesi says.


It hasn't always been that way. Ms. Fitzgerald

remembers, in her childhood, knowing one child who

had asthma. Now, she says, many of the children in

her son's Grade 1 class carry puffers for asthma.


Federal government statistics show a huge increase in

asthma during the last 20 years. In 1978-79, a federal

Canada Health Survey found 2.5 per cent of children

under 15 had asthma. Twenty years later, the

commonly accepted figure is 10 per cent, says Dr.

Kovesi. ``It's the commonest reason for admission to

CHEO. It's the commonest reason for admission to

every other children's hospital in Canada and the U.S.

So it's certainly a big, big problem.''


And it's potentially fatal. In Canada, about 20

children and 500 adults die from asthma attacks

every year.


Things have changed, even in the five years Ms.

Fitzgerald has been going to CHEO with Nickolas,

whose attacks began when he was 16 months old.


``They've got one room now that is filled with

masks,'' says Ms. Fitzgerald. These ``bronchodilator

masks,'' about a dozen of which can be pulled down

from the wall, are placed over the child's face,

administering immediate medicine to relieve

asthmatic attacks. For many Ottawa-area children,

they're a lifeline.


This is one family's story of childhood asthma, a

chronic disease that afflicts about 500,000 children

from birth to 19 years of age in Canada, and about

five million in the U.S.


Its prevalence in children has been rising more

quickly than in adults, for reasons that aren't fully

understood. It is known that children's lungs are less

developed and that the growing tissue in their lungs is

more sensitive to noxious substances. Also, children

breathe more rapidly than adults, exchanging more

air in proportion to their body weight.


At most, one-third of asthmatic children have attacks

severe enough to send them to hospital emergency

wards at least occasionally, says Dr. Kovesi. The

majority, he says, have milder forms that may flare

up only during vigorous exercise or when they're

exposed to cold air. Most of the milder cases can be

treated by improving their home environment,

avoiding things they're sensitive or allergic to, such

as dust or pets or second-hand smoke. Most use some

kind of medication, though in mild cases, it's not used

every day.


As with Nickolas, 90 per cent of the asthma attacks

among children in this region are ``triggered'' by

viruses such as colds and the flu, Dr. Kovesi adds. In

this sense, he says, Nickolas has ``classical, textbook

childhood asthma. That's the commonest form that

you're going to see.'' It usually happens in the middle

of the night, triggered by a cold, and in this region,

it's most common between September and May.

Asthma has become the leading cause of school

absenteeism, accounting for one-quarter of all days

missed, says the Canadian Lung Association. The

potentially life-threatening disease affects twice as

many boys as girls in childhood. But more girls

develop asthma as teenagers, so by adulthood, male

and female incidence is evenly balanced.


For Ms. Fitzgerald and Nickolas, each asthma attack

brings several sleepless nights in a row, for up to a

week at a time, every time her son picks up a cold or

the flu. And as an asthmatic, Nickolas is susceptible

to colds. Like many parents, Pam Fitzgerald is

exhausted by the asthma nights and worried about the

medication her son must inhale from a complex

apparatus, twice each day throughout the school year

-- more often during asthmatic episodes.

After reading scores of studies and attending

countless meetings and presentations, she's convinced

that to stop asthma's relentless rise, Canadians have to

get serious about cleaning up air pollution, indoors

and outdoors.

There are many instigators, or ``triggers,'' for asthma,

ranging from dust mites to pets to second-hand

smoke. ``I think probably the single biggest factor in

the rise of asthma, as crazy as this sounds, is better

insulation in our houses,'' says Dr. Kovesi. ``Because

as you make buildings more and more airtight, any

kind of pollutant that is in the building gets trapped

there.'' Probably the two biggest culprits he says, are

tobacco smoke and dust mites.


Dust mites are microscopic creatures that live in

house dust, and they are what you're really allergic to

if you're allergic to dust. They thrive on humidity,

which is why cities that are damp -- and those

situated on water, such as Ottawa -- are cities where

asthma thrives.


Furry animals, pollens and moulds are other common

allergens that can trigger asthma. Then there are

``irritants'' such as cigarette smoke and odours such

as paint, hair spray and pesticides, which can worsen

asthma's severity. Many are things in the home that

families can fix themselves, though it can be costly

and difficult to eliminate carpets, mouldy basements,

pets and smoking. Medications are also costly.

But air pollution -- which has been shown to have

dramatic effects on the frequency and severity of all

respiratory illnesses -- is a matter for government to

deal with, Ms. Fitzgerald says. If air pollution is

affecting asthmatic children, it's probably having an

impact on everyone else, too, she adds. ``These kids,

they're a bit like canaries in the coal mine. They're

indicating what's happening to all of our lungs.''

For Pam Fitzgerald, the air pollution epiphany came

at a recent forum, held by the David Suzuki

Foundation at Carleton University, on a new report

reviewing new scientific evidence on the health

effects of air pollution, co-authored by three

Canadian experts: Dr. John Last, an epidemiologist

and professor emeritus at the University of Ottawa

medical school; Dr. Konia Trouton of Health

Canada's bureau of reproductive and child health; and

Dr. David Pengelly, who teaches at McMaster

University and the University of Toronto medical



Mounting evidence attributes up to 16,000 premature

deaths every year in Canada to air pollution, said Dr.

Pengelly. ``That's equivalent to one airliner crashing

every week,'' he said. ``Where is the action? If we

had an airliner crashing every week, there might be



The studies cited in the foundation's report, most of

which are Canadian, show sharp rises in hospital

admissions and deaths due to respiratory illnesses,

whenever outdoor air pollution levels rise. This

occurs in cities across the country, including Ottawa.

The main culprits appear to be ground-level ozone

and tiny airborne particles, both primarily from motor

vehicle exhaust and other burning of fossil fuels.

Yet there has been little public outcry, and hence

little government action, to stem the rising use of

fossil fuels in Canada, Dr. Pengelly and the other

authors noted.


But it was David Suzuki's question that stung Pam

Fitzgerald, prompting her to rise from her seat that

night: ``Where are the angry parents?'' he asked. If 10

per cent of Canadian children have asthma, he

wondered, why aren't their parents up in arms?


``You have to understand, we spend a lot of our

energy taking care of our children,'' an exhausted Ms.

Fitzgerald responded, going to the microphone to

describe her sleepless nights. Parents of asthmatics

would certainly take action, she said, ``if we could

get a bit of energy.''


After the meeting, Ms. Fitzgerald began telephoning

other parents of asthmatic children. She found a

group interested in pressuring the federal

government, in particular, to set and enforce strict

standards on air quality, indoors and out. They have

chosen the name Clear the Air, and will hold a first

meeting at Fisher Park Community Centre tomorrow


``I think a lot of parents of asthmatic children have

felt very isolated,'' Ms. Fitzgerald says. ``You're up at

night, putting out the fire, dealing with (the asthma

attacks), and you don't realize there are so many other

children that have it too, and so many other parents

that are going through what you're going through.

You think, `Maybe if I get him on medication, maybe

that's the answer. Maybe they'll find a cure for it.'


``But what I think we as parents should be doing is

saying it's not a matter of putting everybody on

medication, to deal with our air quality.


``There's a smoking gun and there are kids dying.

And I don't feel that we, as parents, can sit back.''




- The Ottawa Lung Association has an Asthma

Education Centre at 3 Raymond St. in Ottawa.

Staffed by a registered nurse and a respiratory

therapist, it offers educational materials, individual

help and small-group programs for asthmatics and

parents of asthmatics. Call 230-4200,

9 a.m.-4 p.m.

- The Lung Association also has an information

campaign called Clean Air Now, or C.A.N.-DO,

about air quality and respiratory diseases. It provides

educational kits for teachers, community groups or

students doing projects. Call 1-800-97-CANDO

(1-800-972-2636) or visit the Ontario Lung

Association web site: www.on.lung.ca/first/html

- Clear the Air, Pam Fitzgerald's new group,

dedicated to improving air quality. It will hold its

inaugural meeting tomorrow at the Fisher Park

Community Centre, 250 Holland Ave., at 7:30 p.m.

Call 730-3193.

- The Children's Hospital of Eastern Ontario's web

site has lots of information about asthma:


- Pollution Probe and the Canadian Institute for Child

Health report, The Air Children Breathe: The Effects

on their Health, is available from Pollution Probe's

Ottawa office for $25. Call 237-8666. Other literature

on air quality also available.

- The David Suzuki Foundation report, Taking Our

Breath Away: The Health Effect of Air Pollution and

Climate Change, is $5. Other resources on air quality,

climate change also available. Call: (604) 732-4228.

e-mail: solutions@davidsuzuki.org

Web site: www.davidsuzuki.org

- The Allergy & Asthma Information Association has

literature you can buy. Contact Lois King at