Imagine breathing through a straw — the skinny kind you get with a cocktail.
That's what breathing can be like during an asthma attack. Asthma patients say the sensation feels like they're drowning.
It sends them, or their parents, scrambling for a rescue inhaler, a puff of inhaled medication that quickly opens airways and restores more normal breathing. Or it sends them to a hospital emergency department for life-saving treatment.
Doctors often prescribe daily medication to prevent such attacks. And it works for most people, maybe a little too well. Because after weeks of following a treatment plan, when the coughing, wheezing and chest tightness subside, about half of all asthma patients stop taking their medication.
"It's a huge problem," says Dr. Richard Lockey, director of the Division of Allergy and Immunology at the USF College of Medicine. "Medication compliance is the biggest barrier to asthma control."
Almost 23 million Americans have asthma. The Centers for Disease Control and Prevention estimates that more than 9 percent of all children in this country have asthma. It takes the lives of almost 4,000 Americans each year.
Asthma attacks can be triggered by exposure to dust, pet hair, mold or tobacco smoke. During an attack, the branchlike network of breathing tubes in the lungs swells, narrowing the airways.
Thick mucus, naturally produced by the body, starts to collect and clogs the shrinking airways, making breathing even more difficult. Without prompt treatment, patients can suffocate and die.
Stewart Killgallon, 25, of Tampa, knows the feeling. Diagnosed with asthma while he was a high school football player, two years ago he woke up at his family's North Carolina mountain home gasping for breath.
His frantic mother got him to the car and started driving to the nearest hospital, a half-hour away. Killgallon wasn't sure he would survive the trip.
His mother managed to flag down paramedics in a passing ambulance. They administered emergency treatment and got her son to the hospital.
"Not being able to breathe is the scariest feeling," he says. "I'd rather have an alligator chase me than an asthma attack."
To that end, Killgallon says these days he rarely misses his daily medication and hasn't had an asthma emergency since that time in North Carolina. He keeps his medication near his toothbrush so he doesn't forget.
After a visit to the emergency room, most patients are better about taking their medication, at least for a while.
But Tara Slusher, of Tampa, says when your asthma is under control, you feel so good that it's easy to become complacent. "You start to think you don't need your medication, you can get by without it," says Slusher, 28.
She has been to the hospital emergency department three times since being diagnosed with asthma at age 3. Her infant daughter was recently diagnosed with the disease, which tends to run in families.
The cost of medication can also be a barrier to asthma control, says Slusher. "Even with health insurance, the copays and meeting deductibles can make (medication) very expensive. One nebulizer for my daughter cost more than $100."
The type of medication used to treat asthma is also a concern to some patients. Steroids, oral and inhaled, are often prescribed for long-term control and for quick relief of symptoms.
"I tell patients, these aren't the kind of steroids the athletes take to perform better," Lockey says. "These drugs are safe and effective. Much less dangerous than the disease itself."
Take your medicine
Michiko Otsuki is an assistant professor of psychology at the University of South Florida St. Petersburg. She will soon begin recruiting adolescents and teenagers for a study looking at the reasons patients don't take their medication as prescribed and what can be done to improve compliance.
Teenagers may not take their medication because they don't want to be different from their peers, Otsuki says. For younger children, parents must take the lead.
"Mom thinks, do I really want to give this chemical, this medication, when the kid looks just fine?" she says.
Some parents mistakenly fear that giving their child a medication every day will result in a dangerous drug addiction. And in some families, taking medication regularly can become an issue of defiance and control between parent and child.
Education is critical to good asthma control. Lockey says each patient should be given an asthma action plan that outlines exactly what to do depending on how they feel.
"Medications today are revolutionary,'' he says. "No one should be going to the hospital with asthma."
Irene Maher can be reached at firstname.lastname@example.org.