The New Asthma Epidemic

THIS CONDITION IS STRIKING MORE WOMEN THAN MEN AND HITTING US HARDER, TOO. SO WHY AREN'T WOMEN GETTING THE HELP WE NEED?

Prepare to read something that will take your breath away: The number of women who have asthma has more than doubled in the past 20 years, with women now making up two thirds of the 14 million adults with the condition. Almost as surprising is that few people—neither doctors nor patients—seem to know it's become such a huge problem for women, says allergist Joan Gluck, M.D., of Miami, chair of the women's health committee for the American College of Allergy, Asthma & Immunology.

"A lot of people don't know asthma can strike for the first time in their 20s and 30s," Dr. Gluck says. "So they may not think to tell their doctors about symptoms." At the same time, general practitioners don't test women's lung function unless asked because it's not usually part of a routine physical exam.

That's particularly disconcerting given that research shows women with asthma have more severe symptoms than men, yet many don't receive proper help. In fact, nearly half of women aren't being treated according to the federal guidelines, reports a study of 5,107 asthmatic nurses published in the Archives of Internal Medicine. Part of the problem is compliance—not all women take the drugs they're supposed to—but equally as often, patients aren't prescribed the medication they need. "There are very tangible consequences to this lack of good care," says Rita Cydulka, M.D., an emergency room physician at MetroHealth Medical Center in Cleveland. "Are women even dying? Yes, they certainly are."

WHY WOMEN HAVE IT WORSE

For more than 20 years, Jennifer Johnsen, 32, accepted that her asthma attacks were inevitable. Around every other month, she'd suddenly find herself wheezing and gasping for oxygen and could do little except rush home, stay in bed and spend the next day or so doing nothing but concentrating on breathing. Then, a few years ago, Johnsen, a public health researcher in New York City, saw a medical journal article that suggested some women suffer their worst symptoms right before their period. "Something just clicked," she says. "I realized that all this time, that's exactly what had been happening." It was like clockwork: She had attacks only during the three days leading up to her period. "Many doctors don't know there's a connection," Dr. Gluck says. And scientists don't yet understand how or why hormones make a difference in some women. "There hasn't been any research until very recently, and the data is only now starting to come out."

One new study found that significantly more women are hospitalized with near-fatal attacks on the first day of their period than on any other day, according to a report published in the Journal of Allergy and Clinical Immunology. Those same women also needed to use more medication than others to manage symptoms in the week before menstruation.

Though not every woman has more difficulty breathing in the days around her period, the number who do is substantial: roughly one in three. But hormones aren't the only reason women with asthma have it bad: Women's lungs are 10 to 15 percent smaller than men's, says William J. Calhoun, M.D., director of the Asthma, Allergy and Airway Research Center at the University of Pittsburgh Medical Center. Normally, the airway walls expand and contract to regulate airflow. But most people with asthma are hypersensitive to everyday allergens and irritants such as pollen, mold, dust, animal dander, cigarette smoke, car exhaust, even cold air. And when their lungs are aggravated, no matter what the cause, an attack may occur. The lung muscles contract, which narrows the breathing tubes, and the airway walls swell and churn out mucus. With little airway room to begin with, even a small amount of irritation may quickly trigger a dangerous inflammation, Dr. Calhoun says.

"We also have to think of the environment where women live and work," adds Lynda M. Cristiano, M.D., a pulmonologist at Brigham and Women's Hospital in Boston and coauthor of The Harvard Medical School Guide to Taking Control of Asthma (Free Press). Women tend to have more exposure to attack triggers than men, especially because they often get stuck with the cleaning, which equals more contact with dust mites, cockroaches and harsh detergents.