News-Sentinel.com

Thursday, 05/04/2000

ASTHMA: THE BATTLE TO BREATHE

Varying symptoms, causes make diagnosis very tricky

By Jennifer L. Boen of The News-Sentinel

Asthma does not have just one symptom or one cause. "As many people in the world who have asthma — there's about that many types of asthma," said Dr. William Smits, a Fort Wayne pediatric pulmonologist who is also board-certified to treat asthma and allergies.

"You can have asthma that happens just once, and it can begin in infancy and end at puberty, or it can affect someone their entire lifetime," said Smits.

Although asthma affects the lungs, a simple chest X-ray cannot reveal airway or bronchial tube inflammation associated with it.

Blood oxygen levels drop during an asthma attack, but no one blood test proves a person has asthma, which affects nearly 150 million people in the world and causes 144,000 deaths annually.

"Diagnosing asthma is not always so simple," says Dr. Chris Tallo. The Fort Wayne pediatrician and his 2-year-old twins are sufferers, one reason he says he has a "passion for treating kids with asthma."

And symptoms common to one asthmatic may not exist in another.

"I tell my patients, not all children who wheeze have asthma, and not all children with asthma wheeze," said Tallo.

Asthma is often initially diagnosed in children as reactive airway disease, explained Smits. It also can be confused with a variety of other diseases: bronchitis, allergic rhinitis, sinusitis, pneumonia, croup, heart disease, cystic fibrosis, even an anxiety or a panic attack.

Yet any of the above conditions can be present along with asthma and exacerbate, or worsen, the disease.

"Like (multiple sclerosis), the first spell you may wonder, `Is this MS?' It's that way with asthma. You may not be sure at the beginning," said Dr. Terry Gaff, an emergency room physician and president of the Indiana affiliate of the American Lung Association.

When a course of treatment using asthma medications leads to the patient improving, a physician then diagnoses the illness as asthma, physicians said.

Part of the process for diagnosing the illness is examining a patient's family medical history. Such a history is important because a parent with asthma is more likely to have a child with the disease.

One study of Australian twins showed that genetic factors account for up to 50 percent of an individual's susceptibility to asthma. For other families it seems to appear out of nowhere.

"When I tell parents their children have asthma, a common response is, `I don't know where he gets this, because no one in my family has asthma,' " Tallo said.

A family history of asthma or allergies can falsely lead to a diagnosis of asthma, one family learned.

Such was the case for Ricky Conz, a Carroll Middle School eighth-grader. In January 1997, the 14-year-old passed out at school one day in gym class. His mother, Penny Conz, has had asthma most of her life. A year before the youth's fainting incident, she had suffered a severe attack.

A pulmonologist diagnosed Ricky Conz with "life-threatening asthma."

"It was so easy to say he had exercise-induced asthma," Penny Conz noted. "His symptoms mimicked asthma, and the doctor knew I had it."

The doctor prescribed inhalation medication and an epinephrine injection he was to carry with him at all times. In March 1997, Conz collapsed again, this time at a hockey game. An epinephrine shot brought him around, so Penny Conz figured her son was on the right medicines.

"He told me that he wasn't feeling better. I wished I'd listened to him. I should have taken him back to the doctor," she said regretfully.

On Oct. 19, 1997, Conz was playing in a hockey tournament in Indianapolis when he collapsed on the ice. His parents and coach assumed it was his asthma. His dad helped carry him to the locker room, where he injected Conz with epinephrine.

The shot revived him for a short time, but the boy soon went into full cardiac arrest and died. The Conz family had memorials for their son sent to the American Lung Association.

Then, weeks after the funeral, the family learned that an autopsy showed he died of a congenital heart defect, not asthma.

"I want people to know it can be difficult to know when it's asthma," Penny Conz said. "He fought me about his asthma medication. He said, `Mom, I'm not like you.' I wish I'd taken him back to the doctor or got another opinion. Maybe he'd be here today."

Gaff said there may be reluctance to label a person with the disease because of the stigma it carries. The diagnosis can affect the ability to get health insurance and lower-cost life insurance. It may even deter a person from certain career paths, Gaff said.

"I just got a note from a kid I'd seen in 1985, at age 6. He was wheezing and coughing. I diagnosed him with asthmatic bronchitis," meaning he had asthma symptoms brought on by an infection in the bronchioles, Gaff said.

"He's now trying to get into the Air Force. He needed a letter from me saying he had not been treated for the condition since."

And he hadn't.

Gaff said the military is right to be concerned about an asthmatic undertaking the rigors of military training.

However, he asked, "If someone can control their asthma with medicine, is it fair to label them with asthma?"