More than 106,000 Hawai‘i residents (about 8 percent of the population) are
affected by asthma. About 30,000 of them are under age 18 – the second highest
percentage in the country, according to the American Lung Association in Hawaii.
Every year, about 5,000 people, most of them under 4 years of age, are rushed to
local emergency rooms because of distressing episodes of wheezing, breathlessness,
chest tightness, and uncontrollable coughing.
Asthma is a chronic inflammatory disorder of the airways. It occurs when the bronchial
tubes in the lungs become swollen and constricted, blocking airways with excessive
mucus. Asthma cannot be cured, but individual attacks can often be prevented. With
proper self-management and medical treatment, most people with asthma can lead normal
When Debbie Ito was 6 years old, she began experiencing periodic bouts of coughing,
chest tightness, wheezing after play, and shortness of breath at bedtime. Her primary
triggers were running, exuberant laughing, and secondhand smoke (her dad was a smoker).
Ito’s pediatrician diagnosed her with asthma. “After high school, my
asthma became dormant,” recalls Ito, now in her mid-40s. “When I was
25, I went to Las Vegas and caught a cold; after sitting in smoke-filled casinos,
I developed phlegm and a cough that lingered for weeks.”
A pulmonary specialist in Honolulu told Ito that her asthma had returned and instructed
her to treat her airway constriction and inflammation with medication, using a hand-held
inhaler every morning.
Since then, Ito has only had a few asthma attacks, the last one in 2009. For several
nights, she was forced to sleep while sitting upright to breathe more comfortably.
After her physician ordered corticosteroids, Ito’s symptoms gradually disappeared.
“I’ve learned that my biggest asthma trigger as an adult is catching
a cold, which causes my chest to tighten and constant coughing,” she says.
Other asthma triggers for Ito are cold weather and stress. “If I have to give
a speech, my chest always tightens up.”
An asthma episode can be triggered by exposure to allergens and irritants such as
dust mites, indoor or outdoor mold, pollen, cockroaches, fireworks, pet dander,
and secondhand smoke, as well as cold or flu viruses, heartburn, and changes in
No conclusive answers are available as to why more local children are developing
asthma. But some experts suggest that children are spending too much time indoors,
where they are exposed to secondhand smoke and allergens. Cold air, viral infections
and obesity are also possible triggers for asthma.
Some people believe their asthma is worsened by episodes of vog from Kilauea Volcano
on the Big Island. But Elizabeth Tam, M.D., a Honolulu pulmonologist and HMSA participating
provider, says it’s too soon to make that judgment.
In 2006, Tam, a leading researcher on local respiratory ailments, completed a three-year
study of environmental exposures, symptoms and lung function in 2,000 children in
30 schools on the Big Island. She was surprised to find no evidence that vog from
Kilauea Volcano led to increased asthma rates in that population. “There’s
a stronger correlation between asthma and environmental tobacco smoke than with
recent levels of volcanic air pollution,” says Tam. But the study ended in
2006, when volcanic emissions were much less. It will be extended until the children
are 18 years old.
Asthma rates are higher in communities where children are exposed to smoking in
their homes, according to Tam, who is studying the role of molds, pollens, pets,
nutrition, and activity as possible triggers of respiratory disease. Exposure to
secondhand smoke can cause asthma in children who have never previously shown any
To control their condition, most people with asthma should avoid the substances
that trigger their symptoms and cause airway inflammation. By working with your
physician to develop and carry out a plan to eliminate those triggers and monitor
your symptoms, you can live a healthy, active life.
You may need to take short-term “rescue” medications to control symptoms
once they start. The most common asthma devices are inhalers that send medicine
to your airways, nebulizers that make a mist of medicine that you breathe into your
airways, and peak flow meters that check your lung power by measuring how well air
moves out of your lungs.
To help prevent flare-ups, you may also need to regularly take long-term control
medications, such as inhaled corticosteroids, that reduce swelling in your airways
and help prevent symptoms. Long-acting beta-2 agonists are considered add-on therapy
and should not be taken alone, for safety reasons.