By Dr. Paul Ehrlich
The verdict is in, and asthma did it, according to the pathologist in the case of Naishei Kelly, 14, whom I wrote about last week when there was talk of a nut allergy as well. The girl’s godmother, Amanda Kelly, told reporters: “On the day she died, she seemed so full of life and energy…Yet it appears that her asthma was far worse than any of us thought.”
“….far worse than any of us thought.” That’s so often the case. Absence of symptoms doesn’t mean the absence of inflammation that can flare up any time. Patients are casual about compliance, and they shouldn’t be. The UK has an asthma mortality rate much higher than in the United States. Approximately 1500 people die from asthma in the UK every year, compared to 3500 in the US, but with a population only 20% of ours.
The costs of controlling asthma, in medicine and time, are high. The costs of not controlling it, in time lost at school and work, as well as medical emergencies and hospitalizations, are much higher. In the case of a 14-year-old girl “full of life and energy” they are incalculable.
This tragedy also points out the pitfalls of relying on subjective criteria in gauging whether asthma is under control. What does it mean for a teenager to be full of life and energy? It’s hard enough to read their moods. No “normal” teenager wants to be sick. I can’t count the times over decades of practice in which I have asked a vital young person how he was feeling, and he answered “fine” but a peak flow measurement showed pulmonary flow capacity of 70 to 75 % of normal, a level that would indicate a step up in medication.
Closer questioning might tell a very different story. Are you dozing off in school? Do you have trouble staying awake watching television or at the movies? Do you climb stairs with no shortness of breath?
Who can tell when a mood swing is the result of hormones or of diminished breathing? It might be a lack of sleep. But as Larry points out in his new blog, the lack of sleep might be the result of allergies and asthma. It’s a vicious cycle.
Then, too, being an active child doesn’t necessarily mean what it used to. Kids used to spend much more time out of doors. When an asthmatic child is moved from halfback on the soccer team to goalie, it may be a sign of worsening asthma. A lack of energy would show up more readily at the playground than it does when your principal recreation is exchanging text messages. It is vital that children with a history of asthma, or adults for that matter, play closer attention to objective measures of control.