It comes as no surprise to local physicians that St. Louis has the distinction of being the worst place to live for people with asthma. The ranking as the nation’s ‘Asthma Capital’ was meted out by the Asthma and Allergy Foundation of America last month, citing high pollen counts, insufficient public smoke-free laws and an above-average death rate from asthma throughout the St. Louis region.

     “Any physician who treats asthmatic patients and has lived in this area for any length of time would not have been shocked by the news,” says SLUCare allergist Dr. Raymond Slavin.

    Slavin explains that St. Louis provides a non-stop dose of seasonal and non-seasonal allergens that can trigger asthma. “We have an abundance of all four seasonal allergens grass, trees, weed and mold,” he says. “The climate is perfect for the growth of trees, grass and ragweed. In fact, we get ragweed counts in one day comparable to what many cities in the East get in an entire season!”

    But Slavin says the thing that most sets St. Louis apart from other sections of the country is mold. “Mold spores come from grain fields. When the wind is coming from the West, it brings in the mold from Kansas and Nebraska. From the East, we have the cornfields of Illinois,” he says. “Because we’re in the river valley, when things come in, they tend to stay here.”

    As far as non-seasonal or ‘perennial’ triggers, Slavin says there are plenty of house dust mites and pet allergens to go around. He adds there are also non-specific causes, such as air pollution. “It has definitely improved, I remember the days when we used high sulfur coal, but there are still many areas in St. Louis where smoking is allowed,” he notes. “Passive smoke definitely makes asthma worse.”

    There are common-sense ways to curb indoor and outdoor irritants, according to Dr. H. James Wedner, professor of medicine and chief of allergy/immunology at Washington University School of Medicine. “Environmental control is very important, nobody’s allergic to something that isn’t there,” he says. “If you know you’re allergic to things outdoors, stay indoors.”

    When indoors, air-conditioning is a must in humid weather. “Pollen and mold spores are relatively easy to filter, so make sure you have a good filter,” Wedner says. It’s also a good idea to keep the fan on instead of leaving it on the ‘auto’ setting, he adds. “Let the air circulate throughout the house. Turning the fan on doesn’t cost very much to run and it cleans the air quite efficiently, combined with the filter.” His other advice includes keeping the house dry and cool (68 degrees or lower) and keeping pets out of the bedroom. If you choose to spend time outdoors, he notes that ragweed pollinates early in the morning. “So if you walk or jog, do it in the evening.”

    Moving to another city won’t help, Wedner says. “There aren’t too many places where one can be completely free of allergies,” he explains. “Whether you move east or west, you may get a respite of 18 months or so, but you’ll soon develop allergies to what’s around there.”

    It’s important to realize that asthma is a chronic and relapsing disease, says allergist and clinical immunologist Dr. Hamsa Subramanian of Allergy and Asthma Docs. That’s why using over-the-counter products, such as ‘mists,’ is not a solution, she says. “The very fact that people look for a quick fix is not the right concept,” Subramanian notes. “There are some acceptable ‘rescue’ medications, but even better are the maintenance drugs available that can be taken year-round. With asthma, it’s true that an ounce of prevention is worth a pound of cure.” 

    Subramanian also discourages the use of so-called ‘natural’ medication to treat the symptoms of asthma. “There’s a lot of hype about natural remedies, but the biggest fear I have is that they will interact with other medications the patient is already taking,” she says. “None of these natural medications will help in an acute attack, and they could interfere and cause side effects. I always caution patients because not enough research has been done on this subject.”

    Instead, Subramanian suggests talking with your physician to determine treatment. “In addition to safer medications, the asthma guidelines have been improved and now are tailor-made for specific age groups and populations,” she says. “People are so afraid of diabetes, heart attack and stroke, they don’t realize that asthma can be just as severe and therefore should be taken seriously.”