Asthma can occur in pregnancy and requires very close monitoring during that time. Asthma can even begin during pregnancy. Three to five percent of all pregnant women have asthma (11).

The Magnitude of the Problem

Asthma is responsible for:

• Restricted days - over 100 millions days annually)
• Huge costs - total annual costs of $6.2 billion
• Deaths - 5,000 asthma-related deaths in the U.S. each year

The National Asthma Education and Prevention Program (NAEPP) started in 1989 with the goal of raising awareness about the seriousness of asthma as a chronic disease, as well as improving recognition of symptoms of asthma by doctors and the public. The NAEPP is run by the National Heart, Lung, and Blood Institute. Statistics about asthma, including those above, can be obtained from the NAEPP.

Between 12 and 15 million people in the U.S. have asthma (7). One 1998 estimate from the Centers for Disease Control, was even higher at 17 million. In 1998, asthma cost the U.S. $11.3 billion (2).

Diagnosis (Symptoms): How Does a Woman Know She Has Asthma?

There are many hints that a woman has asthma, but she may not recognize it as asthma. Understanding the symptoms is easier after realizing what is actually happening during the attack.

A few major things happen during an asthma attack. First of all, the muscles lining the airways spasm, meaning tighten up, and this causes the tubes to become narrow. Secondly, to make matters worse, more mucus is produced than usual. The mucus can block the flow of air in the already narrow tubes. These changes are responsible for the symptoms of asthma, the hints that someone has asthma. The inflammation causes wheezing, breathlessness, chest tightness, and cough, which tend to be worse in the night and early morning. Asthmatics tend to be more sensitive to things that generally irritate the airways, like heavy scents and smoke. Sometimes people have disrupted sleep from asthma because they wake up with coughing or trouble breathing. Asthma can get better, stay the same, or get worse with time. It is pretty much impossible to predict what will happen years down the road in a given person.

Asthma attacks can be mild, moderate, or severe. Fortunately, they only rarely lead to death. Mild or moderate attacks may show up as coughing, chest tightness, or a wheezing (whistling type of noise) during breathing. Any one person can have any one or a combination of these symptoms.

Many people do not know that coughing by itself can be a symptom of asthma. In fact, asthma is one of the three top causes of chronic cough. Also, many people only experience symptoms of asthma with a viral respiratory infection, as during a bad cold. Alternatively, asthma may show up as a cough that occurs only during or after exercise.

In severe attacks, the woman feels short of breath, has trouble talking, and may notice retraction (sucking in) of the muscles surrounding the ribs. This is called intercostal retraction. Bluish nails or lips may signal lack of sufficient oxygen to the tissues due to severe asthma. The extreme respiratory difficulty can also cause the neck muscles to work harder. She may notice a very fast heartbeat.

The official diagnosis of asthma requires 3 things. First, episodes of symptoms suggesting blockage of air-flow (airflow obstruction) must be present. The obstruction must be at least partly reversible (it can respond to medication), and other explanations for the symptoms must be ruled out (2).

There is an asthma screening program occurring in convenient locations, such as malls and health fairs, that is carried out by the Nationwide Asthma Screening Program. More information on screening dates and locations is available (14).

Epidemiology: Who Gets Asthma? Is Asthma Different In Men and Women?

Among 5-24 year-olds, the risk of dying from asthma in 1993 was 1.5 times higher in men than women (2). Mortality from asthma in females in 1995 was 2.5 per 100,000, compared to 1.9 in males. 1998 American Lung Association estimates observed that asthma increased much faster in women than men, 42% vs. 81%, between 1982 and 1994.

In people aged 20-50, the ratio of women to men admitted to the hospital for asthma is 3:1 (2). In 1995, the rate of hospitalization for asthma in females was 22.4 per 10,000, vs. 16.5 in men (2). Women also had longer lengths of stay once admitted to the hospital, 4.1 vs. 3.2 days (2). It is thought that asthma may therefore be related to hormonal conditions. There is some research proof of this.

Asthma is more severe in women, especially in the childbearing years, than in men, and it may get worse during a woman's menstrual period, again suggesting a possible involvement of female hormones. Although asthma affects females more than males in general, during childhood the opposite is true (2).

In 1995, 52.6 women per 1000 population had asthma, compared to 52.6 in men (2). Females also have a greater use of emergency rooms for asthma, 82.3 vs. 57.8 per 10,000 in men vs. women in 1995 (2). These gender differences appear to be growing, not lessening.

Preliminary work suggests that woman may access outpatient care for asthma more frequently than do men, and that women in the emergency room for asthma may have a bigger chance of being admitted to the hospital compared to men. Also, of asthma patients admitted to the intensive care unit, females may have worse asthma (more severe disease) than do males. The reasons for these gender differences in asthma are not yet known. Since it has been reported that women use "rescue medications" (see treatment section below for description) more frequently than men do, the women may either have more severe asthma, may not be prescribed the daily maintenance medications as often as are men or may not be taking their controller medication.

Complications

Rarely, asthma can result in death. Asthma causes 5000 deaths per year (6). The asthma deaths occur mostly in blacks aged 15-24 years (2). It causes days of restricted activity and multiple hospitalizations each year.