For the fourth year in a row, Atlanta has climbed the charts to number one, leaving other big cities in its wake. As 2007 began, it saw this sprawling city of more than 470,000 residents claim the top position as Asthma Capital in the United States, according to the Asthma and Allergy Foundation of America (AAFA).

Asthma Capitals, which began in 2004, is an annual research project funded by Astra Zeneca. The research compiles data and then ranks cities based on factors, such as prevalence, risk and medical factors. Atlanta beat out Philadelphia, Raleigh, Knoxville and Harrisburg, all in the top five.

In surveyed cities, poverty and lack of health insurance were factored in as barriers to adequate asthma care, contributing to Atlanta's rise to No. 1.

"The idea that Atlanta is in the top tier of cities that has asthma helps, because residents hear about it and that empowers them to go back to their doctors and say…'tell me about asthma,'" said Dr. Mark Moncino, general pediatrician and director of Breathe Georgia, an asthma education organization working to regain its financial footing. "The greater the awareness of the problem, the better. It makes it a little easier to have a conversation with parents."

Asthma is a chronic respiratory disease, often triggered by allergens and characterized by labored breathing and coughing due to the constriction of airways in the lungs. Asthma affects almost 20 million Americans and includes allergic and non-allergic asthma, or asthma attacks that are caused by allergens and attacks related to anxiety, stress or smoke.

"I think asthma is a serious problem, an incredibly under-diagnosed problem, and it continues to be, on a day-in day-out basis," Moncino said. "The problems we face in asthma are the same with other chronic diseases."

Although it's not rare for parents to come in and ask about asthma, Moncino said, patients start taking medication when they feel bad and stop taking it when they feel better, which can prove to be dangerous.

Asthmatic attacks are responsible for 1.8 million emergency rooms visits a year, 14 million missed school days, 14.5 million missed work days and more than 4,000 asthma-related deaths, according to the American Lung Association (ALA).

"Deaths from asthma are improving now, we believe, because physicians are more aggressive about medicating people," said Dr. Norman Edelman, pulmonologist and chief medical officer of the ALA. "We think better education of doctors and patients are bringing down asthma deaths."

However, the rates worsen for ethnic minorities and women. African Americans are three times more likely to be hospitalized and die from asthma. And although women make up about 65 percent of asthma deaths overall, it's African-American women who make up the largest group of asthma sufferers.

Although the rate of asthma-related deaths is evidence of a disconnect, Edelman attributes that to undertreatment of patients. Clean air, which the ALA heavily promotes during the month of May, is vital to asthma sufferers, Edelman said.

"There are two pollutants that are bad for asthma," Edelman said, "one is ozone— and that's what you get in smog— and then there's particle pollution and that comes from diesel engines and coal-burning factories."

That is why the average rate of asthmatic children quadruples in cities like Harlem, Edelman said, adding that the ALA is seeking better regulation by the Federal government to help clean up the air.

Instead of opting to move, the AAFA promotes seeing a healthcare professional and working in local communities to promote better air quality and increase smoking bans and health insurance coverage.

"Make sure you work with an allergist on how to control your asthma no matter where you live," said Mike Tringale, director of External Relations of AAFA, adding that it's important to change household filter at least once a year.

Working with environmental groups to promote clean air, and smoke-free areas will combat potential problems outside the house, he said.

"All of these cities are a problem—they all have their own mix of problems—it's a problem everywhere. That's why we say we don't care if you're No. 100 on the list--you're not getting off scott free whether you're No. 100 or No. 1."

The importance of controlling asthma, Tringale said, is often overlooked because of advances that have been made in medication.

"People don't take it seriously—even people who have asthma, he said. "We take it for granted."

He compares medication to the need for food.

"Asthma is only controllable if you have it under control. It takes daily control," he said. "You can have a life without limits, as long as you take care of it."

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Fia Curley is a writer for the OMHRC. Comments? Email: fcurley@omhrc.gov

Links

Asthma 101
http://www.omhrc.gov/templates/browse.aspx?lvl=3&lvlID=149

Asthma Control
http://www.omhrc.gov/assets/pdf/checked/factscontrolling%20asthma.pdf

Asthma in Adults
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22596

Asthma and Children
http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=22691

State of the Air
http://www.stateoftheair.org/

Asthma Facts and Figures
http://www.aafa.org/display.cfm?id=8&sub=42

May is National Asthma and Allergy Awareness Month
http://www.aafa.org/display.cfm?id=7&sub=92&cont=569