"This can't be happening," thought Jackie Joyner-Kersee as she gasped for breath. As desperately as she tried, the Olympic track-and-field champion couldn't get enough oxygen into her lungs. Panicking, Joyner-Kersee concentrated on not losing consciousness while friends rushed her to the emergency room.

"I felt like walls were closing in on me," says 39-year-old Joyner-Kersee of the 1993 episode when she came close to dying from a serious asthma attack. "The doctors were giving me the breathing test, and I could see something was wrong. I knew I was in big trouble," she says. "I prayed, 'I'll do everything right next time. Just let me get through this.'"

Diagnosed in 1981, Joyner-Kersee had denied her asthma for years. "I thought that if it were true, I would have to give up running and competing," she says. As a result, she frequently stopped taking her medication. That left her vulnerable to severe asthma attacks, a number of which landed her in the emergency room. "What finally made me accept my diagnosis was seeing the fear on my family's faces," says Joyner-Kersee. "It made me think about my life, and that meant thinking about asthma."

Out of Control

Today, more women are having to think about this serious, sometimes fatal, respiratory ailment. According to the Centers for Disease Control and.Prevention, roughly 15 million Americans have asthma, with the disorder nearly twice as prevalent in women as in men. What's more, studies have shown that asthma death rates are 25 percent greater in women than in men, and women who have an asthma attack that lands them in the emergency room are twice as likely to be hospitalized as men with the same or worse degree of the disease.

Unfortunately, recent information suggests that many women are not taking their asthma seriously enough or controlling it properly. A survey of 500 women with asthma, funded by GlaxoSmithKline and backed by the American College of Allergy, Asthma & Immunology (ACAAI), revealed that more than half have had an asthma attack that sent them to an emergency room or urgent care center, and nearly half said the attack was so bad they felt their lives were in danger.

The survey, conducted in October 2001, also revealed how uninformed many women are about how to properly manage the disease. A third believed it was only possible to treat the symptoms, not the causes, and less than 10 percent could name either of the two main causes of asthma symptoms.

Although asthma is not curable, the symptoms of the disease -- wheezing, chest tightness, shortness of breath, persistent coughing, low exercise tolerance and frequent bouts of bronchitis or pneumonia -- are eminently manageable, and most patients can live normal, full lives, says Kathleen A. Sheerin, M.D. of the Atlanta Allergy and Asthma Clinic.

Just ask Jackie Joyner-Kersee. Once she started taking better care of herself, there were no more trips to the ER and she was back in fighting form. "I am proof that if you manage your asthma, you can still live life to the fullest," she says.

Keys to Treatment

Managing persistent asthma requires a three-way approach:

Medication. Asthma symptoms have two main causes: swelling and irritation in the airways (inflammation), and tightening of the muscles surrounding the airways (bronchoconstriction). So the proper management of asthma requires two types of medications:

Long-term control (preventive) medications -- such as inhaled corticosteroids -- primarily treat inflammation and must be taken every day, even when you are feeling well, in order to keep asthma symptoms from developing. The newest class of preventive medications are oral drugs called leukotriene modifiers, but they may not be as effective for moderate to severe asthma.

Quick-relief (rescue) medications -- such as bronchodilators -- give relief when symptoms worsen, mainly by relaxing airway muscles. However, they don't provide long-term control of asthma and should not be used more than once or twice a week. If you need to use a rescue inhaler more frequently, you should talk to your doctor about a new asthma management plan. The newest medication, Advair Diskus, is the first to treat both inflammation and bronchoconstriction with one inhaler.

Since everyone's asthma is a little different, you'll need to work with your doctor to find the best medication plan for you. "I stay in close touch with my doctor, because I find there is always some new medication to work with," says Laura Forbis, 39, a music director in Jefferson City, Missouri. "A while back, I had a bad episode, and I immediately went to my doctor who switched my medications. Now I'm fine and singing is no problem."

Environmental. If your asthma is triggered by allergens -- including pollen, dust mites, mold, pet dander or cold air -- it's important to reduce your exposure to them as much possible.

Behavioral. Reduce your stress levels, if that is one of your triggers. "I have patients who have asthma attacks every time they visit their parents," says Daniel Ein, M.D., clinical professor of medicine, George Washington University Medical Center. If you are reacting stressfully to an environment, you need to get out of it, he says

If you have exercise-induced asthma, you don't have to stop working out. Just exercise smarter. Warm up, cool down and avoid exercising in extremely cool environments. Most importantly, listen to your body and find the exercise that feels right for you. "When I tried to do cardio workouts, I always got a headache," says Lisa Kent, 35, a stay-at-home mom in Alpharetta, Georgia, who was diagnosed with asthma five years ago. "So now I lift weights," she says. "It works best for me."

Gender Matters

A woman with asthma faces some specific concerns:

Pregnancy. During pregnancy, one-third of asthmatic women will get worse, one-third will improve and one-third will stay the same, experts say. Many women, rightfully concerned about taking any kind of medication when pregnant, may decide to stop taking their asthma medicines. But doctors say that's a decision that can backfire. "During an asthma attack the mother is not getting enough oxygen, which can have a dramatic effect on the developing baby," explains Andrew G. Villanueva, M.D., director of the Lahey Clinic's Asthma Center in Boston. "Out-of-control asthma is far more risky to mother and baby than any asthma medications."

Osteoporosis. Studies have shown that postmenopausal women who have taken inhaled or oral corticosteroids for a long time are more prone to developing osteoporosis, a thinning of the bones. Although this is a concern, it's not a reason to go off asthma medication, says Angela Davis, M.D., assistant professor of medicine, rheumatology, allergy and immunology at Duke Medical Center in Durham, North Carolina. "I would manage it by supplementing with calcium and vitamin D, adding other bone-sparing medications, and advising a good exercise routine," says Dr. Davis. wd

[sidebar 1:]

The Female Factor

Health experts aren't entirely sure why there is such a gender difference with asthma. One theory is that women tend to go to doctors more readily than men and so they're diagnosed more often. Another is that since women have smaller airways than men, they're more likely to feel obstructions. Other factors that may explain the difference:

Hormones. Until puberty hits, asthma is more prevalent among boys than girls. Afterward, the numbers switch, suggesting that a hormonal surge may be at fault. Many women report an increase in asthma symptoms right around their periods.

Smoking. Cigarette smoking and exposure to secondhand smoke are major triggers of asthma symptoms. Although the rate of both male and female smokers has been dropping since the 1960s, the decline in women hasn't been as great. Currently, about 22 percent of adult women smoke, according to the American Lung Association. "Heavy smoking can cause an asthma-like disease called chronic obstructive pulmonary disease," notes the Atlanta Allergy and Asthma Clinic's Kathleen A. Sheerin, M.D.

Obesity. Being overweight is a much stronger risk factor for women with asthma than for men with the disease. "Obesity won't increase the likelihood of a woman developing asthma, but it will make present asthma much worse," says Reynold Panettieri, Jr., M.D., director of the Asthma Program at the University of Pennsylvania Health System in Philadelphia. "Obese women also have a greater chance of dying from the disease."

Poverty. The poor are more prone to asthma for two reasons: They are more likely to live in an environment with bad air quality, and they don't have access to good medical care. Instead of treating the underlying causes of the disease, they are forced to rely on over-the-counter emergency rescue medications as symptoms crop up. According to the United States Census Bureau, more adult women than men live below the poverty line.

[Sidebar 2:]

Are You at Risk?

Your risk for developing asthma as an adult increases if you:

* had asthma as a child.

* have allergies.

* have a family history of allergies and asthma.

* smoke or live with someone who does.

* live in a city or home with poor air quality.

* suffer from viral respiratory synctial virus (RSV).

* have persistent eczema.

* are African-American or Latina.

* live in an inner-city neighborhood or below the poverty line.
 

DID YOU KNOW?

From 1982 to 1996, the prevalence of asthma among women increased by 97 percent, compared with just 22 percent among men.

Want to know more?

Contact the following organizations:

American Academy of Allergy, Asthma & Immunology

e-help: www.aaaai.org

American College of Allergy, Asthma & Immunology

e-help: allergy.mcg.edu

American Lung Association 1-800-LUNG-USA

e-help: www.lungusa.org

National heart, Lung and Blood Institute, 301-592-8573

e-help: www.nhlbi.nih.gov

 

[Sidebar 3:]

Is Your Asthma Under Control?

Under treatment guidelines established by the government in 1997, a person whose asthma is being properly controlled should be able to:

* prevent chronic asthma symptoms and attacks during the day and night, including:

-- no sleep disruption due to asthma,

-- no missed school or work due to asthma,

-- and no or minimal need for ER visits or hospitalizations.

* maintain normal activity levels.

* have normal or near-normal lung function.

* be satisfied with asthma care received.

* have no or minimal medication side effects.

 

[footnote for box 3:]

Source: National Heart, Lung and Blood Institute

Woman's Day May 14, 2002