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Health > More Health StoriesWinter 2011 IS Magazine1/26/11 IS Online

Asthma 101

An asthma attack feels like you can’t breathe. Learn the basics to manage your condition.

By Lucy Jokiel

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 lives.


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 the weather.

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 symptoms.


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.

Island Scene Online is not intended to replace the advice of health care professionals. Please consult your physician for your personal needs and before making any changes in your lifestyle.
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