Imagine headlines blaring the news that children all over the country were falling mysteriously ill at unprecedented rates, and no one was quite sure why. That during flare-ups children had to be rushed to emergency rooms, and that in extreme cases, they were dying from this incurable disease. Imagine that not just hundreds of children, or thousands, but millions had contracted this illness. There surely would be an outcry: government scientists rushing to investigate, Congress forming task forces, terrified parents forbidding children to attend school or even go outside.

Right?

Wrong. While we do have millions of children suffering from a mysterious epidemic -- asthma -- our reaction to this public health crisis has been more like that of actors in a slow motion, silent movie.

The statistics are staggering:

Even more troubling is the increase in childhood asthma rates in recent years. The number of children who have asthma increased by 58 percent between 1980 and 1992. The number of deaths attributed to asthma among 5- to 14-year-old children nearly doubled between 1980 and 1993. And while the CDC tentatively reports that the rate of increase appears to have slowed in the last few years, the overall incidence of asthma remains disturbingly high.

That the public reaction to this crisis has been strangely muted may be partly due to the confusing nature of asthma itself. It is a quiet disease: Its ravages are subtle, its victims the smallest and most vulnerable among us. But that doesn't make asthma any less devastating in its effects than better-understood maladies. Parents of asthmatic children will tell you that their child's asthma attacks rank among their most terrifying moments.

"It's scary because it is completely out of your control," says Mary Vyas, whose 3-year-old daughter, Devin, was diagnosed with asthma as an infant. "Devin is such a happy, active child, but when she gets sick she draws into herself, struggling to breathe, and there is nothing I can do to help her." Devin was admitted to the hospital for the first time when she was three months old. "She was so little -- it seemed too much for a little person to go through. We've been to the ER four or five times since then."

Statistics show that, like the Vyases, more and more families have become familiar with the emergency room of their local hospital, with the perils of cat dander and dust mites, and with the soupy, yellowish sky that signals high levels of smog. Asthma is the most common, chronic disease of childhood in the United States today.

And no one is exactly sure why.


One reason that asthma remains a mystery is that it is an extremely complicated condition medically: Untangling its specific causes has proved impossible to date. Experts believe that genes play an important role in who gets asthma, yet not all those with a genetic link will actually contract asthma. "A genetic predisposition, while necessary for asthma, is not sufficient," according to a 2002 report by the Center for Children's Health and the Environment at the Mount Sinai School of Medicine. "Asthma attacks typically occur when a genetically predisposed child encounters one or more environmental triggers."

But genetic factors and household environmental triggers like dust and perfume do not alone explain the tremendous increase in asthma rates in recent years. Many of those who study asthma believe the answer is all around us -- in the contents of the air we breathe. Others think it is closer to home, in a cultural tendency toward overcleanliness.

Recent research findings demonstrate the strong link between asthma and air pollution.

These findings and others point to a causal link between air pollution and the epidemic of childhood asthma in the United States today. Pediatrician Philip Landrigan has watched the number of asthma patients in his practice increase in recent years. And as the director of the Center for Children's Health and the Environment, he has also been a close observer of the rise in the childhood asthma rate nationwide. Landrigan believes that our contemporary living conditions are a factor in increased asthma rates: "Our homes are a lot tighter today than they used to be, and we breath a lot of recirculated air," he said in a recent interview. "And outdoor air pollution is also a major factor. We drive a lot more miles than we did 25 years ago. We've cleaned up the big black smog particles that you can see. But the fine particulates in the air have increased, and they get deep into the lungs and cause damage."

Our dependence on the automobile is at least partly responsible for the deterioration in the air we breathe; other polluters include diesel trucks and buses, power plants, industrial emissions, and waste incinerators -- that is, many of the features of modern life upon which we all depend. There is reason to believe that one side effect of modern industrial civilization is the poisoning of our children.


A number of biological factors put children at particular risk to the adverse effects of air pollution. Children's air passages are narrow, and their lungs immature, which makes them more vulnerable; they also breathe more rapidly and absorb more pollutants per pound of body weight than do adults. Children are more likely to be exposed to outdoor air pollutants than adults, since they spend more time in active outdoor play and their small stature puts them in the direct line of fire from the exhaust of passing vehicles.

Still, some children are more at risk than others. Asthma can be found in all population groups, yet the disease targets poor children above all others. This may be because children in lower socioeconomic groups receive a double -- even triple -- whammy. Low-income housing is usually concentrated in areas of high traffic, heavy industry and toxic waste. Housing that the poor can afford is often riddled with such asthma triggers as mold, vermin and cockroaches. Finally, a child with little access to health care probably won't receive the regular medical attention and medication necessary to contain the disease. Accordingly, the rates of asthma in non-white communities are particularly high: Black youths under the age of 24 are three times more likely to be hospitalized for asthma than Whites in the same age group according to the CDC.

The spike in childhood asthma rates are only one sign that environmental pollution is a threat to human health. There is evidence that air pollution effects us all. According to the National Resources Defense Council, for example, about 64,000 people in the United States die prematurely each year from heart and lung disease caused by particulate air pollution. In another disturbing study, the results of autopsies of young accident victims who were residents of highly polluted areas in Southern California showed a significantly elevated rate of lung disease. One of the study's researchers observed that the youths "had lungs of older people."


One reason that the childhood asthma epidemic has received so little attention may be that the solutions seem so daunting. If in the near future the connection between air pollution and asthma is definitively established by scientists, what exactly will that mean? It seems unlikely that we will suddenly give up our love affair with cars or with the other conveniences of modern life. Knowing this, experts say that there are smaller steps that could be taken even now to minimize harmful air pollution.

There is little consensus around regulatory reforms and legislation. Environmentalists charge that "Clear Skies" legislation introduced by EPA Administrator Christine Todd Whitman will undermine the Clean Air Act and delay reductions in power plant pollution, resulting in higher sulfur, nitrogen oxide and toxic mercury emissions. Whitman claims the legislation will dramatically improve air quality to protect public health and the environment.

While we debate the pros and cons, children continue to fall ill in record numbers, say those who believe air quality and asthma are linked.

Readers seeking more information and ideas on how to get involved, can visit our resources section.

• The Hygiene Hypothesis: Are We Too Clean for Our Own Good?
• Cleaning Up Our Air

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