T A B L E++T A L K

Is there hope for the cleaning impaired? Mothers who don't mop discuss solutions to their dilemma in Table Talk

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R E C E N T L Y

Shunning and shaming
By Fiona Morgan
Berkeley rallies around a mother and her murdered child
(08/28/98)

Your call is important to us. Not.
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The real message of the insincere recordings that have invaded our lives: Stop complaining
(08/27/98)

I want you so bad
By Carol Lloyd
Now that our president has confessed to adultery, will the American people follow him to the pillory?
(08/26/98)

Drama Queen
Green eggs and Spam: Meals that make kids barf -- and other culinary delights
(08/26/98)

The heat is on
By Lisa Moskowitz
Soothe your savage summer beast
(08/25/98)

BROWSE THE MOTHERS WHO THINK FEATUREARCHIVES

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Mamafesto
By Camille Peri
Why it's time
for Mothers Who Think

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BREATHING LESSONS | PAGE 1, 2
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If one of the country's leading pediatric allergists has to wrestle with the system, small wonder that children in Southeast D.C. tend to deal with their asthma alone until they suffer an attack bad enough to get them admitted to an emergency room. "Asthma can't be treated episodically," says Dr. Floyd Malveaux, Thornton's boss and dean of the Howard University College of Medicine. "Being poor creates barriers to managing a chronic disease, whether it's asthma or diabetes or whatever. When you're poor, you've got other challenges to deal with." In other words, says Thornton, "You can't afford to let that $7.50 an hour go if the kid ain't coughing. What it boils down to is, the reality of life is crisis management."

Isaiah, a fourth grader in a white Bugle Boy T-shirt, pipes up during Thornton's Q-and-A session.

"How come there's no cure for asthma?"

"They're working on it," she says wearily. "They're working on it."

Back in the early 1980s, after a diagnostic manual redefined asthma to include any kind of recurring wheeze and physicians began to realize how prevalent it was becoming across America, a British scientist named Thomas Platts-Mills theorized that the disorder is caused by infestations of dust mites, microscopic critters that collect in the shag carpets and plushly upholstered couches of the modern, double-paned American house. It was a compelling theory, but incomplete, as a coordinated U.S. study showed. It turned out that asthma rates were roughly the same in Virginia, a humid climate where mites thrive, as they were in Denver or Los Alamos, N.M., where there were none. In Los Alamos, asthma tended to correlate with the presence of animal dander. Families in the mountainous suburbs of that city kept their cats and dogs inside to keep coyotes from getting them. The pets would be uneaten, but the children got asthma. There were neither dust mites nor coyotes in Atlanta and Baltimore, but asthma rates in those cities were also high. With asthma flourishing in disparate locales, a general theory of indoor environmental aggravants took shape in the field, which went like this: Kids, rich and poor, in the city and the suburbs, were spending more time inside air-tight, centrally heated and air-conditioned houses that were comfortable for people but were also breeding grounds for the microorganisms. While there is likely a genetic component in most kids who get asthma, not everyone with this genetic predisposition suffers from it. By avoiding exposure to allergens, you can prevent a person who is genetically susceptible to asthma from ever having the symptoms.

It was a generally plausible theory, but it had some holes. For one, most of the changes in U.S. housing construction were in place by the mid-'70s, so why did asthma rates continue to climb around the country, while remaining low in most of the developing world? To this question, various answers sprung up. The most obvious one was that maybe asthma wasn't well-diagnosed in the third world, where health care was focused on lethal maladies of childhood, things like malnutrition and chronic gastrointestinal infections. But there were other answers. Margie Profet, a Los Angeles theoretical biologist and a MacArthur grantee, believed that the biochemical channels leading to allergies had evolved to battle parasites. With no parasites in our bodies, instead we get overstimulated immune responses such as asthma. A British scholar named Andrew Wakefield came up with a parallel theory that focused on childhood vaccinations. In the absence of immune-priming diseases like whooping cough, he theorized, the immune system went bonkers and turned on the body.

Few well-known asthma researchers concur with the theories of Profet and Wakefield. But some of them speak of "the Golden Arches'' effect, namely that asthma affects lungs weakened by the more sedentary lifestyle associated with American couch potatoes and fast-food culture. Asthma is less prevalent in rural, less-developed areas of the world, where people ride bicycles and walk, eat fewer foods containing saturated fats, some of the byproducts of which are believed to feed into the chemical pathways of allergic reaction.

In hopes of finding a cure, geneticists are furiously studying asthma and have actually cloned several genes that seem to be linked to the disease. But whatever has caused the asthma upswing, it's unlikely genetics alone are going to reverse the trend. "The environment plays such a big role in this disease," says Malveaux, the Howard University dean. "It's not one of those diseases where if you have the genes you'll get the disease -- though genes may affect the ultimate severity. There's nothing we can do about the genetics right now anyway. There's a lot we can do about reducing triggers to the disease and structuring the environment -- but it means having access to health-care systems. The poor generally don't."

Without guidance, Thornton says, many children neglect their medicine altogether until they end up in the emergency room. With the right drugs and equipment, though, they can master asthma. Access to health care can help children figure out how to control their condition. It also helps to have a doctor and nurse tell your mother to stop smoking, or to vacuum the place more often, or get rid of the rug and the old couch, so there are fewer places for dust mites to live.

For Thornton, childhood asthma is one of the insidious, endemic afflictions of the black community, but getting a handle on it may also be a way to start tackling some other problems. "You wonder why their attention spans are so short," she says after the asthmatic children at Payne Elementary have filed back to their classrooms. "It's because they're sitting there not breathing."
SALON | Aug. 31, 1998

Arthur Allen is a Washington-area writer whose work appears in the Washington Post magazine and the New Republic.