Kids of America

Dr. Tim Buckley talked about asthma and the environment: How we can prevent asthma or live with it

Tuesday, March 15, 2005 By Kids of America

KOA: Hello, Mr. Buckley. We are from St. Veronica’s After-School Program, and we are from Cherry Hill. We are here to interview you about asthma and other stuff. What is asthma? TB: Asthma is a lung disease. Do any of you have asthma? KOA: I have asthma. TB: Asthma is a disease of the lung airways that is caused by inflammation,n so that it makes it difficult to breathe air into and expel air from your lungs and it’s not entirely clear what causes asthma. But there is some data to show that it is related to air pollution and to allergens. And it’s pretty clear, too, that there’s a genetic component to asthma, so that it runs in families. So, those of you who have asthma, it might be that your parents, or brother and sister, grandparents might have asthma. Is that true? KOA: My mom and my dad. KOA: My mother. TB: It’s one of those diseases that there’s pretty clearly a genetic component to it as well as an environmental component and the two interact together in a way that causes and exacerbates the disease. We’re quite certain that air pollution and allergens make the disease worse, or exacerbate it, but what causes the disease in the first place is much more difficult question to answer. KOA: What age do children usually get asthma? TB: That’s a difficult question, too. Asthma is a difficult disease to diagnose. So, it may be diagnosed in a very young child, let’s say a 1 or 2-year old, as something other than asthma like bronchiolitis. From 2-4 it becomes much easier to diagnose because the way that you diagnose it is in part through a test that’s called pulmonary function. It’s a method of measuring how quickly you can expel air from your lungs. It’s very difficult to administer those tests to a 2-year-old, so you really don’t know whether or not the child may have asthma. Asthma is one of those diseases—it’s not like you can take a blood test and determine if someone has asthma or not. It’s a set of symptoms that kind of paint a picture for the disease and one doctor may diagnose it as asthma and another doctor may not. KOA: If you can diagnose it or catch it at a young age, how come nobody’s found a cure yet? TB: First of all, not only is there a genetic component, but there’s an environmental component. That means is it’s possible for somebody to acquire asthma even though there’s no family history. It can be a disease that is exclusively determined based on environmental factors. And it’s also possible that, for instance, if you have a family history of asthma, and you carry those genes that make you susceptible, but because you are able to avoid certain environmental agents, you don’t acquire the disease. So it can work both ways. You can carry the genetic susceptibility and not acquire the disease and it’s also possible that you don’t have the genetic susceptibility and you still can acquire the disease. So it’s one of those diseases that’s very difficult to understand the environmental and genetic determinants. It’s very much an active area of research across the country and, in particularly at Hopkins there’s a great deal of research going on with respect to asthma. They’re questions for which science is still trying to find the answer. There are some fairly effective treatments for asthma, but you’re right, there is no cure. But there are some fairly effective treatments which, if the airways do become restricted, the medication will relax the airways so that they open and reduce the swelling. KOA: How can you tell the symptoms of asthma? As your airways become restricted, you have some difficulty bringing air into and expelling air from your lungs, and it might be that it makes a little bit of noise, kind of a whistling noise within your lungs as they become restricted, and that’s what’s called “Wheeze.” In severe cases, your airways can become so constricted so that you can’t get air in or out and that’s a very, very serious and dangerous situation where you need to get medical treatment right away. There’s a range of severity of symptoms associated with the disease. So wheeze would be one way. The other thing that your doctor might do in the clinic is to listen to your lungs for the wheeze or the constriction, or to give you a pulmonary function test where you would blow into a device and you would measure how quickly you can expel air from your lungs. KOA: How many people a year get cancer or asthma from air pollution? TB: I don’t think we know the answer to that question. There are some estimates of the role of air pollution. The EPA—Environmental Protection Agency—does make some estimate of the cancer prevalence or the asthma prevalence associated with air pollution, but I’m not exactly sure what those numbers are, but the numbers are substantial. And they’re growing. There’s what’s called an epidemic related to asthma. For some reason, the rates of asthma in this country and other developed countries of the world is increasing dramatically. If asthma were only genetic, could you get an epidemic increase in asthma? There’s very little genetic variability from one generation to the next. So, for there to be significant changes in the genetic pool, it takes many, many, many years. That’s evolution. One piece of evidence that suggests that environment is playing an important role is the fact that in the last 20 years, we’ve seen a dramatic increase in the incidence of asthma. Now you asked about cancer also. KOA: How many people a year get cancer or asthma from air pollution? TB: If you consider cigarette smoking to be part of the environment, there is a significant number of lung cancers that are related to the environment. But if you don’t consider cigarette smoking to be part of the environment, and you consider just the air pollution, then it’s probably a much smaller number, probably on the order of 3 or 4%. KOA: When did asthma first start to spread in Cherry Hill? TB: Asthma’s probably been in Cherry Hill as long as Cherry Hill’s been here. Asthma’s a very old disease, but what’s changed is the prevalence. Do you know what prevalence is? It’s the number of people who have the disease compared to the population. If there were 100 people who lived in Cherry Hill 20 years ago, maybe 5 of them would have asthma. But these days, it could be as many as 20 of those 100 people would have asthma. That’s what the prevalence is. The 20/100. I don’t know the exact numbers for Cherry Hill, but we do know that there is a higher prevalence in urban environments and a higher prevalence among African Americans, so and I think Cherry Hill would obviously be considered urban, so the asthma prevalence rates are probably on the order of 15-20% in Cherry Hill. Right, there’s how many of you--and how many of you have asthma? 3 of you? KOA: What made you think it was pollution that caused the asthma and cancer? TB: There have been studies that provide evidence of air pollution and both of those diseases—asthma and cancer. And the evidence is of a couple of different types. One is you can go into the laboratories and you can use experimental animals and you can administer air pollution to these animals and you see an increase in both asthma and cancer. The other way is you can study communities and you can look at the asthma prevalence rates in a community like this compared to, let’s say, a community that has a very similar population but without the air pollution. And then you can start to tease out what might be causing the cancer and the asthma. There is a very important study that just came out in the New England Journal of Medicine that came out of California where they followed children for a period of time, like 10 years, and they measured the air pollution over 10 years and they measured the pulmonary function of those kids. And what they observed was that the kids who were exposed to the air pollution, their lungs were smaller and less developed relative to the kids who were exposed to lesser amounts of air pollution. That’s the kind of evidence that begins to establish an association of causality between air pollution and disease. KOA: How can people protect themselves from cancer or asthma? TB: There are some things you can do. There are some things that trigger asthma, so you can try to avoid those things that trigger asthma. It might be exercise. It might be cat dander. It might be a dusty environment. So it’s a matter of avoiding those triggers. There are lots of different kinds of cancers and we’re learning more and more about what causes cancers. But now for lung cancer, the best thing you can do is to not smoke, right, and if there’s somebody in your home that smokes, it would be good to have that person smoke outdoors. You don’t want to be near that cigarette smoke. KOA: My mother’s got asthma and she smokes. TB: She smoke in the house? That’s a concern both in terms of causing asthma and because it’s associated with lung cancer. Now the other important factor related to cancer is diet. Do you know what protects you from cancer in terms of diet? KOA: Salad. TB: Salad. Fruits and vegetables. Meat is actually a risk factor for some cancers, and especially high fat meats. It depends on how much fat, but in general the meats are a concern because, one, the fat content. And number two is when you cook pork chops or steaks, you actually form carcinogens in the meat by virtue of the cooking process. That’s especially true with cancers related to the gastro-intestinal tract, like colon cancer, for instance. KOA: If you had asthma, would you protest against pollution? How? TB: I think I would be very concerned about the neighborhood that I live in and the sources of air pollution, and I would probably also be interested in advocating for clean air, better air quality, reduced emissions. KOA: Do you think there will be a cure for asthma in the future? TB: I do. I think in part because of the advances in gene therapy. I think there is really good hope that there will be very effective treatments for asthma. KOA: If you were to stop building more factories, do you think that less kids would get asthma? TB: You know, it’s not only factories. Especially these days, there are so many automobiles that they play a very significant role in terms of the air quality within our communities. Things like the airport, which isn’t too far from here, there’s very significant air pollution. Construction vehicles--these also generate a lot of air pollution. It’s a whole wide range of sources that produce air pollution. When we heat our homes, right, we are generating some of the same pollutants that come out of factories. KOA: If there is any solution to asthma in Cherry Hill, what do you think it would be and would you try to do it? I think [in] Cherry Hill, like most urban environments, one of the most important sources of air pollution is going to be mobile sources, or the automobiles and trucks. So, if we could somehow separate automobiles from our communities or better separate automobiles. There are some very busy streets which people live very close to, so I think there’s got to be better separation between these roadways and where people live and go to school. And I think the same argument could be made for the factories. Wagner’s Point used to be kind of a primary example of a failure to zone industry separate from communities so that the impact of the industry upon the community is minimized. [Draws map] Wagner’s Point is out here. Brookyn and Curtis Bay and this the Patapsco River. Cherry Hill is up here. And Brooklyn is here. All along there’s probably a dozen very large industries in Wagner’s Point here as well as a municipal waste water treatment plant. If we were to go down to Wagner’s Point, you would see these large tank farms filled with gasoline and other petroleum products. There’s a chemical manufacturing plant—there’s several chemical manufacturing plants. There’s a medical waste incinerator. So all of that air pollution can potentially, if the meteorological conditions are favorable, can be transported into the community of Brooklyn and Curtis Bay and Cherry Point(sic) where large numbers of individuals can breathe the emissions and there can be adverse effects on especially those of you with asthma. KOA: Thank you again for letting us interview you and we had a great time. TB: I really appreciate your thoughtful questions. It’s been a total joy for me to be here.