Dust, secondhand smoke, cleaning chemicals in the housekeeping closet at the family-owned tourist cabins. The stress of running more than one business. Keeping up her own housework. Any or all of these irritants introduced Dolly Mowrer of Strasburg to asthma.

She was 42 years old then. “When I went to bed at night I would lay down and not be able to breathe. I had to sit up to sleep,” she said.

She never had allergies, so she blamed it on “age.”

Everybody else blamed it on stress, she said, until she used the word “wheezing.” Then the pulmonary physician at Lancaster General Hospital figured it out. Mowrer went on medications.

Nearly 30 years later, Mowrer is retired. She uses an inhaler every day. The variety of irritants has been minimized, but she knows she will not be cured of asthma.

Mowrer is one of 20 million people in the United States who have asthma; nearly 9 million of them are children, according to the National Heart, Lung, and Blood Institute. Managing her asthma has become routine for Mowrer.

For younger people with asthma, the options for treatment may be different. At the Hospital of the University of Pennsylvania in Philadelphia, pulmonary researchers are looking for volunteer patients, who meet specific criteria for eligibility, to participate in clinical research trials that treat asthma symptoms in a way that is not dependent on medication.

This could help the next generation of Americans, which has a growing number of people who have asthma. The number of children with asthma has increased over the past 20 years, said Dr. Lois Fisher, a physician with the Allergy & Asthma Center on Marietta Avenue.

Several theories have been advanced for this dramatic increase, including the “too-clean theory,” said Fisher. “Too-clean” (the hygiene hypothesis) suggests that Third World children are exposed to infections, dirt and microbes and, therefore, build up resistances and stronger immune systems than American children. Third World children are much less likely to go down the allergy path.

“Asthma is like a squeezing down on your lungs,” Fisher said. “For some people, that is caused by allergy; for some, it is strong irritants like tobacco smoke, pollution, even temperature changes may trigger asthma.

“The best control is to be smart about triggers,” she said.

An allergy attack feels like hands grabbing your lungs, said Angela Keith, 16, of Ephrata. She knows what to do when she suffers one. However, when she was younger she went to the hospital at least once a month, a total of 24 hospital visits over her young life.

Angela gestures, making open and closed fists toward her chest, while she explains what an asthma attack feels like. “It’s like someone is sitting on your chest.” she said and looked at her 13-year-old sister, Kathryn, for affirmation.

Asthma runs in their family, as it does with many people who have it.

“When I was young,” said Angela, “Mom and Dad managed my medications. They would tell me what to do.

“Now I can tell when I forget to take my medicine.” She looked at Kathryn: “Is that the same with you?”

Kathryn nodded. “Sometimes you feel like you are breathing through a straw,” Kathryn said. “You can’t get enough breath.”

Kathryn is allergic to grass. They are both allergic to cats and dogs.

They have learned how to live normal lives. Kathryn plays soccer and volleyball and is a member of the Red Rose Figure Skating Club.

Angela has been a dancer — tap, ballet and jazz — since age 3. “If I am taking medications, I don’t have to worry. I can do the slow stuff. But if I have a cold,” she said, “I have to sit out the dance lessons that include a lot of skipping and jumping.

“If there was some way to make (asthma symptoms) better, I would try it,” Angela said.

In Philadelphia — and in 40 other locations worldwide, — interventional pulmonologists such as Dr. Ali Musani, assistant professor of medicine at the University of Pennsylvania, are investigating a new, therapeutic approach.

Until now, he said, medication has been the only treatment available.

In this study, Musani uses a trial medical device to apply thermal energy to the smooth muscles in the airways of paid volunteers.

First, he explained what happens in the body during an asthma attack:

In response to an irritant — be it grass, cats, dust, stress, chemicals or pollens — a large smooth muscle in the back of the throat constricts, tightens and narrows the airway considerably, said Musani.

Although the muscle serves no identifiable purpose, he said, “when something goes wrong and it goes into spasm, it can cause real health consequences for asthmatics.”

He admits this is a controversial philosophy; some scientists believe this muscle is like an appendix and some do not.

Musani and other research pulmonologists participating in the trial go into the airways with a bronchoscope.

Then, a little wire basket, with four arms that can fit snugly against the airway wall, is passed into one of a person’s four airways through a catheter. Through this device, thermal energy is generated and applied to the smooth muscle.

The expanded basket delivers controlled radio frequency energy for about 10 seconds and the basket is then removed.

“These smooth muscles are inherently sensitive to thermal energy and to some extent are destroyed for a long period of time, or perhaps permanently. Then, when there is exposure to allergens or chemicals, the patient’s asthma flares up but the airways do not constrict so narrowly,” he explained.

The procedure is conducted under conscious sedation, not anesthesia, and takes about 45 minutes, Musani said. One-third of the lung is treated in each of three, separate procedures on separate days. The patient goes home the same day.

“There is no expectation that this new procedure will cure asthma but we are hopeful it will be useful in reducing the severity and frequency of asthma symptoms,” he said.


Asthma Resources

The Pennsylvania Medical Society’s Family Health and Wellness Web site offers resources that address air quality issues in the state, as well as advice for asthma sufferers to help them cope with the disease. Personal action plans are available to download free. Visit www.myfamilywellness.org.