Lung Hsin-kai is not an isolated exception. On this afternoon, many children came in and out of the ward to get routine treatment. Switching locales, but the scene remaining the same, the children's asthma department at National Taiwan University Hospital sees 200 little patients on a typical afternoon, and every Thursday the number increases by 40 to 50 cases.

According to statistics, the incidence of asthma among Chinese exceeds five percent. More than a million people in Taiwan suffer from asthma. Among them, three times as many children as adults have asthma. It is the second most commonly seen chronic illness among children, trailing only allergic nasal catarrh.

Asthma, along with its brothers in arms--nasal catarrh, atopic exzema, and urticaria--have always been seen as indicators of civilization: There is a direct correlation between deterioration in air quality and the number of sufferers.

Hsieh Kue-hsiung, a doctor in the Department of Pediatric Allergies at NTUH, undertook two studies of 150,000 children in Taipei City between the ages of 7 and 15. The studies, conducted in 1974 and 1985, discovered that the rate of illness has increased from 1.3% to 5.07%, almost four times over. In 1985 the rate in Kaohsiung was 5%, but only 2.5% in Taichung and only around 2% in Pingtung. Hsiehunder took another study this year. Although the results are not yet available, he estimates the rate will increase to 6%.

"This is identical to the trend of ten years ago in England, the US, Japan, and other advanced industrial nations," says Dr. Hsieh. "This clearly tells us that there is an unbreakable relationship between industrialization and urbanization and the increase in asthma."

Although it is true that pollution is a factor, doctors all stress that asthma is a multiple causation illness. Air pollution can only be considered an indirect cause. One cannot overlook the changes in living style brought about by modernization.

Doctor Chen Chi-chang of the Pediatrics Department of the Hospital for Women and Children points out that asthma is generally divided into allergic and nonallergic types. Allergic asthma is in those who have natural inborn allergic physical condition. Given some triggering factor, such a house-hold dust, flour, or pollen, they have an allergic reaction which causes the amount of sputum to increase, and the air passage to narrow, resulting in asthma attacks.

Wang Soo-ray, section chief for the Allergy, Immunology and Rheumatology Section at Veterans' General Hospital, reminds people to be careful of yet another kind of air pollution. "The air inside our houses is sometimes even dirtier, because the air conditioning system continually circulates second hand smoke and other toxic particles through a closed space."

Since 1987, the Women's and Children's Hospital--with the Assistance of the Department of Health and the Taipei City Department of Health--has undertaken a program of "Children Asthma Hygiene Education." Because in theory one need only avoid allergic triggers in the environment in order to prevent attacks (for example by changing over to wooden chairs and tables, changing to silk blankets or space blankets, and by completely avoiding mattresses and tatamis), in the past year their tracking studies of children with the illness have shown that if family members are able to correctly accommodate the needs of the patients, the number of attacks and expenses for treatment will clearly decrease.

As for nonallergic asthma, acquiring a highly sensitive physical condition genetically from one's parents is still a decisive condition for getting the illness. If one is then exposed to colds, intense physical activity, air pollution, stimulating smells (like incense, perfume, or oil paints) or the humidity is too high or changes too suddenly, this can cause an increase in the glandular secretions in the air passage, leading to asthma. Thus doctors recommend that it is best for households with asthmatics to install dehumidifiers or air purifiers to control the factors leading to attacks.

Hsieh Kue-hsiung goes a step further, and explains that the eating habits of modern people can also contribute to the illness. This is because eating a great deal of high protein, high calorie, and high fat products can lead to a deterioration in resistance, so that milk, eggs, and seafood are all on the triggering factor blacklist.

Psychological pressures also have to be dealt with, because asthmatics commonly have sharp sensitivity, it is extremely important to maintain calm emotions. The Friends of Asthmatics Association, besides holding periodic medical conferences and publishing a monthly report, also hopes to get asthmatics to exchange what they have learned through the organization and reinforce each other's morale. They use a blue whale as their trademark.

Asthma is a long term disease. About 50% of sufferers will never fully escape the disease at any time in their lives. Like the blue whale aspiring to breathe on the surface of the water, a clean environment is the dream that all asthmatics hope to realize. Yet isn't this something that even the lucky among us, like you and me, are entitled to anyway?

[Picture Caption]

The dramatic increase in asthma among children in recent years is just one aspect ot a rise in all pulmonary diseases. (photo by Pu Hua-chih)