Horizon, Host: Ted Simons

July 23, 2007


Host: Richard Ruelas

Health Epidemics? Asthma


  • The first in our four-part series on increasingly prevalent health issues examines a condition that afflicts more than 600,000 Arizonans — asthma. Our guest is M. Magda Ciocazan, program manager for Steps to a Healthier Arizona Initiative, Arizona Department of Health Services asthma liaison and member of the Bureau of Chronic Disease Prevention and Nutrition Services.
Guests:
  • Magda Ciocazan. - Asthma Liaison, Arizona Department of Health Services
  • Jaime Molera - Former Arizona Superintendent of Public Instruction and a partner at Molera Alvarez Group
Category: Medical/Health

View Transcript
>>Richard Ruelas:
Tonight on Horizon, we begin a four-part series looking at health conditions that seem to have become more prevalent. Tonight we look at asthma. And two political types go head-to-head on issues that affect Arizona in our regular Monday feature, one-on-one, next on Horizon.

>>Announcer:
Horizon is made possible by contributions from the Friends of Eight, members of your Arizona PBS station. Thank you.

>>Richard Ruelas:
Good evening and thanks for joining us tonight on Horizon. I'm Richard Ruelas. Does it seem like you're hearing a lot more about certain medical conditions and diseases? Tonight on Horizon, we begin a four-part series on possible health epidemics, looking at conditions that appear to be increasing. Later in the week we'll examine the increase in obesity and medical problems that lead to autism and sleep disorders. Tonight, we take a closer look at asthma. Long-time Arizona residents probably remember a time when it was rare to see a kid with an inhaler. These days it's not rare at all. Arizona once had a reputation for being a place where those with respiratory problems could live comfortably. That's certainly not true anymore in the Valley, where pollution concerns bring threats of lost federal dollars and legislative action. Larry Lemmons introduces us to one little girl who is fighting a battle to breathe.

>>Larry Lemmons:
On a blistering summer day in Phoenix, Catrina Walters and her mom are visiting Catrina's doctor, Allan Wachter. Eight-year-old Catrina suffers from asthma.

>>Catrina Walters:
It's hard ‘coz I can't run and it hurts when I cough. So a lot of times I just stay indoors, which is hard because I like the outdoors.

>> Larry Lemmons:
Catrina is part of a growing trend in Arizona, where the prevalence of asthma is increasing more than in the nation as a whole. About 100,000 of the over 600,000 asthma sufferers in Arizona are children. It's ironic, perhaps, that Arizona was once known as a destination for those suffering from respiratory diseases. Asthma is becoming more common.

>>Colleen Walters:
When I first started substitute teaching maybe 20 years ago, I would be doing P. E. and I'd get one inhaler from a child to hold during the P.E. class. Now, a couple of years ago, you'd get maybe like 10 inhalers to hold for the children. Now we just keep them at the school's office.

>>Allan Wachter
Catrina, would you like to come with me? It's good to see you.

>>Colleen Walters:
Hi, Dr. Wachter. It's nice to see you again.

>>Allan Wachter:
Asthma is a chronic illness that usually presents with acute exacerbations, which means you get ill quickly. And usually patients will present with cough, wheezing and shortness of breath.

>>Allan Wachter (talking to Catrina):
We're going to do a breathing test. This is a pulmonary function test. You've done this before, okay?

>>Catrina Walters:
It sometimes feels normal. But when I cough and stuff or when I'm like recovering from an asthma attack, it's really hard.

>>Allan Wachter:
Okay. So let's put in some of the numbers. That is a standardized test that looks at your lung volumes. And as you breathe out quickly you're supposed to expel a certain amount of air from your lung. And the computer will generate a graph. And it's based on a population of your peers. And if your capacity is equal to your peers, based on your age or sex or height, you'll have a normal breathing test. But if it's abnormal, then we can start to say, "Why is this airway restricted?"

>> Larry Lemmons:
To control her asthma, Catrina receives various treatments.

>>Catrina Walters:
I take two pills. One is because I itch, and the other I've got no clue what it does.

>>Colleen Walters:
On a daily basis, in the morning she does, she has a puff that she takes. Then right now we're also on a different medication where she takes two puffs of that every morning. Then in the afternoon we'll take two puffs of that and then in the evening she'll take another two puffs of that. Then she has another puff and then she's on two different medications.

>>Allan Wachter:
You've been having a good day?

>>Catrina Walters:
Yup.

>>Allan Wachter:
Great. Let's take a listen to you.

>> Larry Lemmons:
There is currently rethinking about treatment that will be addressed by the new guidelines due this year from the National Institutes of Health. Rather than focusing on relieving attacks, doctors will focus on control.

>>Allan Wachter:
We don't think we can cure it, but we know we can control it. And we want to control the number of attacks a patient has. So the first thing is to know the difference between a reliever, which is a drug called Albuterol, as opposed to a drug such as an inhaled steroid or a drug called Montelucast or Singulair, which is a controller medication. So patients should not rely on their Albuterol. We think that's a very important concept to get across to patients. Many patients don't have that concept. And I think that's probably the cornerstone of asthma treatment, is knowing the difference between reliever and controller.

>> Larry Lemmons:
Not only is there no known cure for asthma, nobody really knows why people suffer from it. But researchers do suspect that the cause is a combination of genetics and environment.

>>Allan Wachter:
This research I'm looking at different genes that have been involved. But there's no one gene that will cause asthma and that's probably the difficulty with the disease.

>> Larry Lemmons:
In fact, Catrina's grandmother has asthma. She's also one of Dr. Wachter's patients. While there is no direct link showing air pollution causes asthma, certainly bad air can trigger asthma attacks on those susceptible. And the Phoenix metropolitan area's air quality is becoming problematic.

>>Allan Wachter:
I think the reason that Arizona is turning out to be a difficult state is multifactorial. I would say number one the air quality is getting, each year it's getting worse here. The population, the economic boom that's happening here, the development of the land, the air quality has definitely gone down.

>> Larry Lemmons :
Since she began her treatments with Dr. Wachter, Catrina says the asthma hasn't kept her inside as much. She says she's able to enjoy the things she loves, just like other kids.

>>Catrina Walters:
I like to climb trees, run, play soccer. I'm very athletic.

>>Richard Ruelas:
Joining me now to talk about the programs available to help those suffering from asthma, the Arizona Department of Health Services asthma liaison, Magda Ciocazan. Thanks for joining us this evening.

>>Magda Ciocazan:
Thank you, Richard.


>>Richard Ruelas:
So why do you think we're seeing more cases of asthma in Arizona?

>>Magda Ciocazan:
Certainly as we have seen, growth in the population as well as the air pollution that has gotten a little worse. In fact, the Arizona Department of Health Services and the Arizona Department of Environmental Quality are looking at, they're collaborating together on a project, Information Technology grant, looking at air quality and hospitalization to see how those correlate.

>>Richard Ruelas:
Oh, to see when we have higher pollution days, if that results in more cases of asthma in emergency rooms?

>>Magda Ciocazan:
Yes. And also to be able to get the news out there to folks earlier, ahead of time, so that they can be aware of that, of those triggers, and be able to manage their asthma better.

>> Richard Ruelas:
It would seem like a no-brainer that when we have high pollution days, there would be more instances of people with asthma in general. Is that linked solid or there might be other factors?

>>Magda Ciocazan:
That's why we actually need to look at the data. So we're trying to do that. It does sound like a no-brainer, but a lot of times, we don't want to go on just hearsay. We want to look at what the data says.

>>Richard Ruelas:
What else might be the cause besides our dirty air for more cases of asthma, more people having asthma in Arizona?

>>Magda Ciocazan:
I think maybe some people aren't being more aware that they need to seek care. So they're going to their doctor, but instead of, they're going to seek care, rather, instead of managing their asthma and working with their physician, they're going to urgent care and E. R. and so we see more hospitalization data, which is the data you're probably looking at.

>>Richard Ruelas:
Okay. There's some resources for asthma sufferers. Tell us briefly about the Arizona Asthma Coalition and their Web site.

>>Magda Ciocazan:
Yes. The Arizona Asthma Coalition Web site is azasthma.org. And the asthma coalition has really served as an asthma program, if you will, for Arizona. You may or may not know that Arizona is an unfunded asthma state, meaning we don't have a program. We don't really have a centralized funding program that can take care of all of these advocating for different programs and different services. So the Arizona Asthma Coalition has served as our advocate for the services as well as a good quality of life for the people in Arizona with asthma.

>>Richard Ruelas:
So you sort of do what you can by culling from other resources, one of those being, tell us about the breath mobile that's going to start visiting Head Start programs.

>> Magda Ciocazan:
Yes. The Maricopa Asthma Coalition is working with Head Start programs to look at getting the breath mobile out there, working with the school-aged children, working with the school personnel, and seeing, doing some pre-testing, some pre-screening for asthma, and working with them on managing their asthma rather than waiting until it exacerbates.

>> Richard Ruelas:
So obviously like with most diseases, early detection helps a lot as far as managing symptoms?

>> Magda Ciocazan:
Definitely. Looking at the triggers that bring out the asthma.

>>Richard Ruelas:
Something interesting about the air quality, the School Flag Program, is this going to actually take place? This is already going on?



>> Magda Ciocazan:
Yes, this has been going on, actually. The Maricopa coalition has been working with the schools in Maricopa County and actually looking at expanding that throughout the state, we'll see how that goes. But putting up different color flags, green, yellow, red, depending on the air pollution that day, to educate both the patients, meaning the children, as well as the school personnel, on how to help the children manage their asthma.

>>Richard Ruelas:
Part of that has to be a little bit so the students can go home and tell their parents, we have another red flag day today, and make that awareness happen?

>> Magda Ciocazan:
Yes, definitely. And I think the children can be more aware at school about that. The school can be more aware about indoor air quality as well as outdoor air quality. And the parents can be aware as they allow their children to maybe play outside, more or less, depending on the air quality.

>>Richard Ruelas:
The state legislature just got through with some clean air legislation. Do you see that helping as far as controlling dust in Maricopa County and other urban areas?

>> Magda Ciocazan:
Yes, definitely I think it can help. Maricopa County has been identified as one county in the nation that really needs that, definitely. Pinal County is up and coming in their growth, so we really need to look at that as well.

>>Richard Ruelas:
As we wrap up, some brief tips on what viewers with asthma can do to sort of minimize the symptoms.

>> Magda Ciocazan:
Yes. Definitely look at not smoking, not being exposed to second-hand smoke. Even increasing your diet to healthy living.

>>Richard Ruelas:
Sort of minimizing dust around the house?

>> Magda Ciocazan:
Exactly.

>>Richard Ruelas:
Thank you for joining us this evening. Thank you very much.

>> Magda Ciocazan:
Thank you very much.

>>Richard Ruelas:
Every Monday evening we feature two political experts going one-on-one on issues that affect the state. Tonight we examine the presidential aspirations of Senator John McCain and other candidates, and the political fallout from the war and other issues. Going head-to-head tonight is the former Arizona Superintendent of Public Instruction and a partner at Molera Alvarez Group, Jaime Molera. Also an editor of Democracy, A Journal of Ideas at democracyjournal.org and a former speech writer for Al Gore, Andrei Cherny.

>>Jaime Molera:
Well the first topic we'll start off with is presidential politics. In Arizona it's easy to do that because we have our own John McCain involved in the race. It's interesting, because of all of the last couple weeks, the stories have been about McCain, how he's basically about to be forced out of the race and he's going to be forced out of this process. But one of the things that strikes me is that I think we're getting back to the situation that McCain feels most comfortable in. His back's against the wall and he's really starting to embrace his old mantra of reform, whereas being a frontrunner I never thought was McCain's style. And I think one of the tactical mistakes he made was allowing his handlers to really create a strategy around that. One of the things I think we're seeing is that McCain, who's still strong in some of the early key primary states, South Carolina, for instance, he's one of the top two right now, and about 5 percent behind Giuliani. I think he has a real chance if he's able to get some of the core resources that he needs. We all know money is going to play a big part of this. But if he also is able to get a message out and the vision of what he did in 2000.


>>Andrei Cherny:
I think that's right. I worked for John Kerry back in 2003 and he was completely written off. You have to remember that a month before the Iowa caucuses he was at 5 percent in the polls. Al Sharpton was beating him in New Hampshire. He had no money, he'd had to take out a new mortgage on his house. Howard Dean was getting all the endorsements from the big labor unions, and Al Gore and everybody else, and people thought the primaries were over. But it turned out that the people who were starting to look at the race in places like Iowa and New Hampshire and around the country had a very different set of ideas and a very different set of thoughts about where we should be going in terms of that election. I think you're going to see the same thing happen with the Republican primary. There's a core group of people that still admire John McCain greatly for a whole set of reasons like the ones you were talking about. His best attributes, his best features, his brand, if you will, in politics has been having that maverick personality. And people I think are going to get back to looking at that. All of the trappings of turning him into an establishment figure meant that all the people who didn't like him were still not going to like him. But the people who did like him were going to move away from him.

>>Jaime Molera:
And that's a good point. I think if you look at the Republican field you have Giuliani who's never really been embraced by the core constituency of the party. Mitt Romney as well. Mitt Romney, who is actually on the very far left of the party until recently is now --

>>Andrei Cherny:
On the very far right.

>>Jaime Molera:
He's had a metamorphosis and is now on the very far right. Fred Thompson who's still the unknown, continues to be, I'm not sure if I'm going to run or not, trying to keep the media scrutiny from hitting him. But I think once he jumps in there'll be a lot of scrutiny on his past and his records and some of the things I think he stands for and doesn't stand for. McCain I still believe has a very good opportunity. But it's getting that vision, restructuring that organization in a way that really fits the McCain style.


>>Andrei Cherny:
It's funny if you think about it. The Republican primary this time around looks a lot more like Democratic primaries used to look, where you had a lot of different people running around and no clear frontrunner and anything could happen. Whereas on the Democratic side, it looks like your traditional Republican primary where there's one person who is way out ahead, whether it was Bob Dole or George Bush or going back to Ronald Reagan, and then other people trying to scrap for that other place. Right now, there's a new poll that came out today from The Washington Post, had Hillary Clinton at about 35 percent, or maybe even higher, Barack Obama at about 25 percent, John Edwards around 12 percent and nobody else over three.

>>Jaime Molera:
Right.

>>Andrei Cherny:
So it really right now is a two-person race between Barack Obama and Hillary Clinton. We're going to have a Youtube primary debate tonight along with CNN. So I think this will be the first officially sanctioned debate by the Democratic National Committee. This is the time that you're going to see those kinds of things come to fore. Obviously one of the things people will be talking about tonight and one of the big topics is of course going to be the war in Iraq. And again I think here you see both parties really being split by the war. George Bush's approval ratings, a new poll that came out today, down to 25 percent. Historic low numbers beyond where Richard Nixon was at the very height of Watergate. And so there's a real sense in the country that the war in Iraq is being written off. And I think people are now looking for a question about what happens next. The steady drip of bad news coming out of Iraq, the steady sense that there wasn't much of a plan for what we should be doing is being given to frustration now. I think people are going to be starting in both the Republican primaries as well as the Democratic primaries to be asking, where do we go in Iraq.

>>Jaime Molera:
And that's the central issue. I think the Democrats have had a hard time, in my opinion, developing what is the vision? What is the next step? I think there's about 99 percent consensus that we've mishandled the war and what we're doing. The other 1 percent I think is the administration. Everybody else, Republican Senators and Congressmen have a really, really hard time saying that we're willing to go forward as planned the way it's been going now. I think they want a change of course. But the issue is, how do we both extricate ourselves and continue our presence in the Middle East that we need to have for security reasons and for our allies? Israel is a perfect example. Israel has a hard time saying, Olmert has been talking about this, Benjamin Netenyahu was in the United States recently, he was talking about this at length. They have a hard time saying if the United States were to pull out, don't you think there will be problems in our country? Don't you think that a lot of these same kinds of radicals are going to want to take that strategy and employ them in Israel and Palestine? And that's some of the things I think the Democrats have to realize. A lot of them do. I think leadership understands that for political reasons it's good to have this all-nighter, that we're going to force the administration's hand. But for practical reasons, if they're going to come up with a long-term strategy in the Middle East, that we can't just say we're going to pull our troops out and then that's it. There has to be a more comprehensive approach to this. That's one of the problems I think all the candidates have faced. I know Hillary Clinton, who is the target right now, and a lot of the Democrats tonight are going to be shooting at her saying you're not really against pulling out our troops. She's going to have to walk a fine line. She realizes that certainly you have to get past the primary. But then you have this difficult thing called the general election.

>>Andrei Cherny:
I think it's hard on both parties. The fact of the matter is, there are no really good silver bullet answers on Iraq. Both parties are seeing that. On the Republican side, other than John McCain, all the other candidates hardly mention Iraq. Rudy Giuliani, Mitt Romney, they talk about the war on terror, they talk other things facing the country, but Iraq is dealt with in a sentence. There's not really a set of good answers about what to do. Clearly the course we're on in Iraq is not working. It's failing. But of course, you're right, that just pulling troops out immediately will most likely lead to genocide, lead to a horrible situation where we have a failed state that becomes in Iraq what George Bush said it was but wasn't, a home base for Al Qaida.


>>Jaime Molera:
Well, and the Republicans I think are having a hard time talking about Iraq because of the political fallout that we've seen, to the likes of John McCain. Let's talk about how this has political fallout. Not just on the federal election side but even how it translates into statewide elections. One of the things that is very, very clear is that the Iraq war and the 25 percent approval rating that the Bush administration translates into a hard time for Republicans to get out the base and get out their supporters to counter what the Democrats have done. Here in Arizona that's compounded with the fact that the state Republican party I think is in a state of a little bit of chaos.

>>Andrei Cherny:
Disrepair, maybe.

>>Jaime Molera:
I would call it chaos. I think Randy Pullen has alienated a lot of folks. The biggest problem is getting the money. Because the two functions the party serves, as you know, is to get money for candidates and organize grassroots. And that's been a very, very difficult time. I believe that the Republicans want to fend off -- well, it's two-fold -- they want to fend off the Democrats from making more gains, whether in Congressional races or in the state elections like they did last time in the state legislature. They're going to have to have some of the other types of leaders step up to the plate - Tim Bee, President of the State Senate, Jim Weiers, Speaker of the House. I think the John Shadeggs of the world have to come in and say, we're going to have to take this over, have a core group, help raise the money, help raise the organization that we're going to need. Because I think otherwise it's going to be another good Democratic year.

>>Andrei Cherny:
I think that's part of the problem. But you can't just put the problems of the Arizona Republican party at the base of Iraq or saying it has to do with the national trends going against the Republicans. I think what we've seen in the Arizona Republican party, going back to its losses in legislative seats in 2006, is a sense that the Republican party in Arizona has taken a right turn, that it stopped being about the kind of problem-solving that it was at the best when you were working in the governor's administration and other times. It's become about petty partisan sniping. And people look at, they see a real difference between somebody like Tim Bee, who I think has been able to work, able to try to solve problems, versus somebody like Jim Weiers. Those are two very different strategies for the Republican Party. And they need to figure out how they're going to deal with it. Because there's a series of big issues going on, economic issues, education issues, immigration. The big decision on the Employer Sanctions Bill still reverberates. There's been calls for a special session by the governor, some of the business interests are looking at how to reform it from their standpoint. And I think there's going to be a question for what kind of Republican Party are we going to have? Are we going to have one that actually tries to solve problems or one that plays politics. I think immigration is probably one of the best examples.

>>Jaime Molera:
But I think one of the things that has to happen for the Republican Party is that they have to get back to what their core message is. And I'm not sure that we've seen that. In that we believe in an efficient government, limited government, and we're going to push forward the kinds of tax cuts that make sense to folks in the state. We really didn't have that debate. Big part of the reason is I think Governor Napolitano has been able to co-opt them in a lot of issues and has done an effective job with that. But I think with the experience that Tim Bee has, Jim Weiers and Tom Boone who most people would regard as a very strong, effective majority leader, I think they can build a coalition. I think it will be interesting to see. I think next year they'll be able to put forth policies that are not just ‘we're Napolitano but lighter,' but ‘we're Republicans and we're going to fight for these kind of ideals that may not be what Governor Napolitano believes in but what we believe in.'

>>Andei Cherny:
That becomes a trap. You saw that happen in the 1990s with the Republicans in the United States Congress dealing with President Clinton. And they went off and they said, we're going to try to draw a bright line of distinction. So they adopted a series of policies that were so far outside the mainstream. They said they wanted to have something very different.



>>Jaime Molera:
But it worked in '94, where they were able to get back the Congress. That's the kind of distinction I think will be helpful for us at the end of the day, if we're actually able to say that ‘we're not just light but a party that stands for something.'

>>Andrei Cherny:
You can always win back some seats based on attacks. But to actually govern and to actually be able to have the kind of control over the state that Governor Napolitano has in terms of shaping the debate, shaping the priorities for the state, you have to figure out what the right answer is. That's something we'll have to figure out on a future segment. It's been great talking with you.

>>Jaime Molera:
Likewise.

>>Andrei Cherny:
Take care.

>>Announcer:
What is normal healthy sleep and what is considered a sleep disorder? We look at symptoms, causes, diagnosis and treatment of sleep disorders as we continue our series on increasingly prevalent health issues. Plus see Arizona's gold mining history at Wickenburg's Desert Caballeros Museum, Tuesday at 7:00 p.m. on Horizon.

>>Richard Ruelas:
Wednesday we continue our look at health epidemics with an examination of autism. Thursday we focus on obesity. Friday join us for the Journalists' Roundtable where maybe we'll discuss hyper-tension. For all of us here at Horizon, I'm Richard Ruelas. Have a good night.

One on One


  • Molera Alvarez Group’s Jaime Molera and Andrei Cherny of Democracy Journal go head to head on issues that affect Arizonans.
Guests:
  • Magda Ciocazan. - Asthma Liaison, Arizona Department of Health Services
  • Jaime Molera - Former Arizona Superintendent of Public Instruction and a partner at Molera Alvarez Group


View Transcript
>>Richard Ruelas:
Tonight on Horizon, we begin a four-part series looking at health conditions that seem to have become more prevalent. Tonight we look at asthma. And two political types go head-to-head on issues that affect Arizona in our regular Monday feature, one-on-one, next on Horizon.

>>Announcer:
Horizon is made possible by contributions from the Friends of Eight, members of your Arizona PBS station. Thank you.

>>Richard Ruelas:
Good evening and thanks for joining us tonight on Horizon. I'm Richard Ruelas. Does it seem like you're hearing a lot more about certain medical conditions and diseases? Tonight on Horizon, we begin a four-part series on possible health epidemics, looking at conditions that appear to be increasing. Later in the week we'll examine the increase in obesity and medical problems that lead to autism and sleep disorders. Tonight, we take a closer look at asthma. Long-time Arizona residents probably remember a time when it was rare to see a kid with an inhaler. These days it's not rare at all. Arizona once had a reputation for being a place where those with respiratory problems could live comfortably. That's certainly not true anymore in the Valley, where pollution concerns bring threats of lost federal dollars and legislative action. Larry Lemmons introduces us to one little girl who is fighting a battle to breathe.

>>Larry Lemmons:
On a blistering summer day in Phoenix, Catrina Walters and her mom are visiting Catrina's doctor, Allan Wachter. Eight-year-old Catrina suffers from asthma.

>>Catrina Walters:
It's hard ‘coz I can't run and it hurts when I cough. So a lot of times I just stay indoors, which is hard because I like the outdoors.

>> Larry Lemmons:
Catrina is part of a growing trend in Arizona, where the prevalence of asthma is increasing more than in the nation as a whole. About 100,000 of the over 600,000 asthma sufferers in Arizona are children. It's ironic, perhaps, that Arizona was once known as a destination for those suffering from respiratory diseases. Asthma is becoming more common.

>>Colleen Walters:
When I first started substitute teaching maybe 20 years ago, I would be doing P. E. and I'd get one inhaler from a child to hold during the P.E. class. Now, a couple of years ago, you'd get maybe like 10 inhalers to hold for the children. Now we just keep them at the school's office.

>>Allan Wachter
Catrina, would you like to come with me? It's good to see you.

>>Colleen Walters:
Hi, Dr. Wachter. It's nice to see you again.

>>Allan Wachter:
Asthma is a chronic illness that usually presents with acute exacerbations, which means you get ill quickly. And usually patients will present with cough, wheezing and shortness of breath.

>>Allan Wachter (talking to Catrina):
We're going to do a breathing test. This is a pulmonary function test. You've done this before, okay?

>>Catrina Walters:
It sometimes feels normal. But when I cough and stuff or when I'm like recovering from an asthma attack, it's really hard.

>>Allan Wachter:
Okay. So let's put in some of the numbers. That is a standardized test that looks at your lung volumes. And as you breathe out quickly you're supposed to expel a certain amount of air from your lung. And the computer will generate a graph. And it's based on a population of your peers. And if your capacity is equal to your peers, based on your age or sex or height, you'll have a normal breathing test. But if it's abnormal, then we can start to say, "Why is this airway restricted?"

>> Larry Lemmons:
To control her asthma, Catrina receives various treatments.

>>Catrina Walters:
I take two pills. One is because I itch, and the other I've got no clue what it does.

>>Colleen Walters:
On a daily basis, in the morning she does, she has a puff that she takes. Then right now we're also on a different medication where she takes two puffs of that every morning. Then in the afternoon we'll take two puffs of that and then in the evening she'll take another two puffs of that. Then she has another puff and then she's on two different medications.

>>Allan Wachter:
You've been having a good day?

>>Catrina Walters:
Yup.

>>Allan Wachter:
Great. Let's take a listen to you.

>> Larry Lemmons:
There is currently rethinking about treatment that will be addressed by the new guidelines due this year from the National Institutes of Health. Rather than focusing on relieving attacks, doctors will focus on control.

>>Allan Wachter:
We don't think we can cure it, but we know we can control it. And we want to control the number of attacks a patient has. So the first thing is to know the difference between a reliever, which is a drug called Albuterol, as opposed to a drug such as an inhaled steroid or a drug called Montelucast or Singulair, which is a controller medication. So patients should not rely on their Albuterol. We think that's a very important concept to get across to patients. Many patients don't have that concept. And I think that's probably the cornerstone of asthma treatment, is knowing the difference between reliever and controller.

>> Larry Lemmons:
Not only is there no known cure for asthma, nobody really knows why people suffer from it. But researchers do suspect that the cause is a combination of genetics and environment.

>>Allan Wachter:
This research I'm looking at different genes that have been involved. But there's no one gene that will cause asthma and that's probably the difficulty with the disease.

>> Larry Lemmons:
In fact, Catrina's grandmother has asthma. She's also one of Dr. Wachter's patients. While there is no direct link showing air pollution causes asthma, certainly bad air can trigger asthma attacks on those susceptible. And the Phoenix metropolitan area's air quality is becoming problematic.

>>Allan Wachter:
I think the reason that Arizona is turning out to be a difficult state is multifactorial. I would say number one the air quality is getting, each year it's getting worse here. The population, the economic boom that's happening here, the development of the land, the air quality has definitely gone down.

>> Larry Lemmons :
Since she began her treatments with Dr. Wachter, Catrina says the asthma hasn't kept her inside as much. She says she's able to enjoy the things she loves, just like other kids.

>>Catrina Walters:
I like to climb trees, run, play soccer. I'm very athletic.

>>Richard Ruelas:
Joining me now to talk about the programs available to help those suffering from asthma, the Arizona Department of Health Services asthma liaison, Magda Ciocazan. Thanks for joining us this evening.

>>Magda Ciocazan:
Thank you, Richard.


>>Richard Ruelas:
So why do you think we're seeing more cases of asthma in Arizona?

>>Magda Ciocazan:
Certainly as we have seen, growth in the population as well as the air pollution that has gotten a little worse. In fact, the Arizona Department of Health Services and the Arizona Department of Environmental Quality are looking at, they're collaborating together on a project, Information Technology grant, looking at air quality and hospitalization to see how those correlate.

>>Richard Ruelas:
Oh, to see when we have higher pollution days, if that results in more cases of asthma in emergency rooms?

>>Magda Ciocazan:
Yes. And also to be able to get the news out there to folks earlier, ahead of time, so that they can be aware of that, of those triggers, and be able to manage their asthma better.

>> Richard Ruelas:
It would seem like a no-brainer that when we have high pollution days, there would be more instances of people with asthma in general. Is that linked solid or there might be other factors?

>>Magda Ciocazan:
That's why we actually need to look at the data. So we're trying to do that. It does sound like a no-brainer, but a lot of times, we don't want to go on just hearsay. We want to look at what the data says.

>>Richard Ruelas:
What else might be the cause besides our dirty air for more cases of asthma, more people having asthma in Arizona?

>>Magda Ciocazan:
I think maybe some people aren't being more aware that they need to seek care. So they're going to their doctor, but instead of, they're going to seek care, rather, instead of managing their asthma and working with their physician, they're going to urgent care and E. R. and so we see more hospitalization data, which is the data you're probably looking at.

>>Richard Ruelas:
Okay. There's some resources for asthma sufferers. Tell us briefly about the Arizona Asthma Coalition and their Web site.

>>Magda Ciocazan:
Yes. The Arizona Asthma Coalition Web site is azasthma.org. And the asthma coalition has really served as an asthma program, if you will, for Arizona. You may or may not know that Arizona is an unfunded asthma state, meaning we don't have a program. We don't really have a centralized funding program that can take care of all of these advocating for different programs and different services. So the Arizona Asthma Coalition has served as our advocate for the services as well as a good quality of life for the people in Arizona with asthma.

>>Richard Ruelas:
So you sort of do what you can by culling from other resources, one of those being, tell us about the breath mobile that's going to start visiting Head Start programs.

>> Magda Ciocazan:
Yes. The Maricopa Asthma Coalition is working with Head Start programs to look at getting the breath mobile out there, working with the school-aged children, working with the school personnel, and seeing, doing some pre-testing, some pre-screening for asthma, and working with them on managing their asthma rather than waiting until it exacerbates.

>> Richard Ruelas:
So obviously like with most diseases, early detection helps a lot as far as managing symptoms?

>> Magda Ciocazan:
Definitely. Looking at the triggers that bring out the asthma.

>>Richard Ruelas:
Something interesting about the air quality, the School Flag Program, is this going to actually take place? This is already going on?



>> Magda Ciocazan:
Yes, this has been going on, actually. The Maricopa coalition has been working with the schools in Maricopa County and actually looking at expanding that throughout the state, we'll see how that goes. But putting up different color flags, green, yellow, red, depending on the air pollution that day, to educate both the patients, meaning the children, as well as the school personnel, on how to help the children manage their asthma.

>>Richard Ruelas:
Part of that has to be a little bit so the students can go home and tell their parents, we have another red flag day today, and make that awareness happen?

>> Magda Ciocazan:
Yes, definitely. And I think the children can be more aware at school about that. The school can be more aware about indoor air quality as well as outdoor air quality. And the parents can be aware as they allow their children to maybe play outside, more or less, depending on the air quality.

>>Richard Ruelas:
The state legislature just got through with some clean air legislation. Do you see that helping as far as controlling dust in Maricopa County and other urban areas?

>> Magda Ciocazan:
Yes, definitely I think it can help. Maricopa County has been identified as one county in the nation that really needs that, definitely. Pinal County is up and coming in their growth, so we really need to look at that as well.

>>Richard Ruelas:
As we wrap up, some brief tips on what viewers with asthma can do to sort of minimize the symptoms.

>> Magda Ciocazan:
Yes. Definitely look at not smoking, not being exposed to second-hand smoke. Even increasing your diet to healthy living.

>>Richard Ruelas:
Sort of minimizing dust around the house?

>> Magda Ciocazan:
Exactly.

>>Richard Ruelas:
Thank you for joining us this evening. Thank you very much.

>> Magda Ciocazan:
Thank you very much.

>>Richard Ruelas:
Every Monday evening we feature two political experts going one-on-one on issues that affect the state. Tonight we examine the presidential aspirations of Senator John McCain and other candidates, and the political fallout from the war and other issues. Going head-to-head tonight is the former Arizona Superintendent of Public Instruction and a partner at Molera Alvarez Group, Jaime Molera. Also an editor of Democracy, A Journal of Ideas at democracyjournal.org and a former speech writer for Al Gore, Andrei Cherny.

>>Jaime Molera:
Well the first topic we'll start off with is presidential politics. In Arizona it's easy to do that because we have our own John McCain involved in the race. It's interesting, because of all of the last couple weeks, the stories have been about McCain, how he's basically about to be forced out of the race and he's going to be forced out of this process. But one of the things that strikes me is that I think we're getting back to the situation that McCain feels most comfortable in. His back's against the wall and he's really starting to embrace his old mantra of reform, whereas being a frontrunner I never thought was McCain's style. And I think one of the tactical mistakes he made was allowing his handlers to really create a strategy around that. One of the things I think we're seeing is that McCain, who's still strong in some of the early key primary states, South Carolina, for instance, he's one of the top two right now, and about 5 percent behind Giuliani. I think he has a real chance if he's able to get some of the core resources that he needs. We all know money is going to play a big part of this. But if he also is able to get a message out and the vision of what he did in 2000.


>>Andrei Cherny:
I think that's right. I worked for John Kerry back in 2003 and he was completely written off. You have to remember that a month before the Iowa caucuses he was at 5 percent in the polls. Al Sharpton was beating him in New Hampshire. He had no money, he'd had to take out a new mortgage on his house. Howard Dean was getting all the endorsements from the big labor unions, and Al Gore and everybody else, and people thought the primaries were over. But it turned out that the people who were starting to look at the race in places like Iowa and New Hampshire and around the country had a very different set of ideas and a very different set of thoughts about where we should be going in terms of that election. I think you're going to see the same thing happen with the Republican primary. There's a core group of people that still admire John McCain greatly for a whole set of reasons like the ones you were talking about. His best attributes, his best features, his brand, if you will, in politics has been having that maverick personality. And people I think are going to get back to looking at that. All of the trappings of turning him into an establishment figure meant that all the people who didn't like him were still not going to like him. But the people who did like him were going to move away from him.

>>Jaime Molera:
And that's a good point. I think if you look at the Republican field you have Giuliani who's never really been embraced by the core constituency of the party. Mitt Romney as well. Mitt Romney, who is actually on the very far left of the party until recently is now --

>>Andrei Cherny:
On the very far right.

>>Jaime Molera:
He's had a metamorphosis and is now on the very far right. Fred Thompson who's still the unknown, continues to be, I'm not sure if I'm going to run or not, trying to keep the media scrutiny from hitting him. But I think once he jumps in there'll be a lot of scrutiny on his past and his records and some of the things I think he stands for and doesn't stand for. McCain I still believe has a very good opportunity. But it's getting that vision, restructuring that organization in a way that really fits the McCain style.


>>Andrei Cherny:
It's funny if you think about it. The Republican primary this time around looks a lot more like Democratic primaries used to look, where you had a lot of different people running around and no clear frontrunner and anything could happen. Whereas on the Democratic side, it looks like your traditional Republican primary where there's one person who is way out ahead, whether it was Bob Dole or George Bush or going back to Ronald Reagan, and then other people trying to scrap for that other place. Right now, there's a new poll that came out today from The Washington Post, had Hillary Clinton at about 35 percent, or maybe even higher, Barack Obama at about 25 percent, John Edwards around 12 percent and nobody else over three.

>>Jaime Molera:
Right.

>>Andrei Cherny:
So it really right now is a two-person race between Barack Obama and Hillary Clinton. We're going to have a Youtube primary debate tonight along with CNN. So I think this will be the first officially sanctioned debate by the Democratic National Committee. This is the time that you're going to see those kinds of things come to fore. Obviously one of the things people will be talking about tonight and one of the big topics is of course going to be the war in Iraq. And again I think here you see both parties really being split by the war. George Bush's approval ratings, a new poll that came out today, down to 25 percent. Historic low numbers beyond where Richard Nixon was at the very height of Watergate. And so there's a real sense in the country that the war in Iraq is being written off. And I think people are now looking for a question about what happens next. The steady drip of bad news coming out of Iraq, the steady sense that there wasn't much of a plan for what we should be doing is being given to frustration now. I think people are going to be starting in both the Republican primaries as well as the Democratic primaries to be asking, where do we go in Iraq.

>>Jaime Molera:
And that's the central issue. I think the Democrats have had a hard time, in my opinion, developing what is the vision? What is the next step? I think there's about 99 percent consensus that we've mishandled the war and what we're doing. The other 1 percent I think is the administration. Everybody else, Republican Senators and Congressmen have a really, really hard time saying that we're willing to go forward as planned the way it's been going now. I think they want a change of course. But the issue is, how do we both extricate ourselves and continue our presence in the Middle East that we need to have for security reasons and for our allies? Israel is a perfect example. Israel has a hard time saying, Olmert has been talking about this, Benjamin Netenyahu was in the United States recently, he was talking about this at length. They have a hard time saying if the United States were to pull out, don't you think there will be problems in our country? Don't you think that a lot of these same kinds of radicals are going to want to take that strategy and employ them in Israel and Palestine? And that's some of the things I think the Democrats have to realize. A lot of them do. I think leadership understands that for political reasons it's good to have this all-nighter, that we're going to force the administration's hand. But for practical reasons, if they're going to come up with a long-term strategy in the Middle East, that we can't just say we're going to pull our troops out and then that's it. There has to be a more comprehensive approach to this. That's one of the problems I think all the candidates have faced. I know Hillary Clinton, who is the target right now, and a lot of the Democrats tonight are going to be shooting at her saying you're not really against pulling out our troops. She's going to have to walk a fine line. She realizes that certainly you have to get past the primary. But then you have this difficult thing called the general election.

>>Andrei Cherny:
I think it's hard on both parties. The fact of the matter is, there are no really good silver bullet answers on Iraq. Both parties are seeing that. On the Republican side, other than John McCain, all the other candidates hardly mention Iraq. Rudy Giuliani, Mitt Romney, they talk about the war on terror, they talk other things facing the country, but Iraq is dealt with in a sentence. There's not really a set of good answers about what to do. Clearly the course we're on in Iraq is not working. It's failing. But of course, you're right, that just pulling troops out immediately will most likely lead to genocide, lead to a horrible situation where we have a failed state that becomes in Iraq what George Bush said it was but wasn't, a home base for Al Qaida.


>>Jaime Molera:
Well, and the Republicans I think are having a hard time talking about Iraq because of the political fallout that we've seen, to the likes of John McCain. Let's talk about how this has political fallout. Not just on the federal election side but even how it translates into statewide elections. One of the things that is very, very clear is that the Iraq war and the 25 percent approval rating that the Bush administration translates into a hard time for Republicans to get out the base and get out their supporters to counter what the Democrats have done. Here in Arizona that's compounded with the fact that the state Republican party I think is in a state of a little bit of chaos.

>>Andrei Cherny:
Disrepair, maybe.

>>Jaime Molera:
I would call it chaos. I think Randy Pullen has alienated a lot of folks. The biggest problem is getting the money. Because the two functions the party serves, as you know, is to get money for candidates and organize grassroots. And that's been a very, very difficult time. I believe that the Republicans want to fend off -- well, it's two-fold -- they want to fend off the Democrats from making more gains, whether in Congressional races or in the state elections like they did last time in the state legislature. They're going to have to have some of the other types of leaders step up to the plate - Tim Bee, President of the State Senate, Jim Weiers, Speaker of the House. I think the John Shadeggs of the world have to come in and say, we're going to have to take this over, have a core group, help raise the money, help raise the organization that we're going to need. Because I think otherwise it's going to be another good Democratic year.

>>Andrei Cherny:
I think that's part of the problem. But you can't just put the problems of the Arizona Republican party at the base of Iraq or saying it has to do with the national trends going against the Republicans. I think what we've seen in the Arizona Republican party, going back to its losses in legislative seats in 2006, is a sense that the Republican party in Arizona has taken a right turn, that it stopped being about the kind of problem-solving that it was at the best when you were working in the governor's administration and other times. It's become about petty partisan sniping. And people look at, they see a real difference between somebody like Tim Bee, who I think has been able to work, able to try to solve problems, versus somebody like Jim Weiers. Those are two very different strategies for the Republican Party. And they need to figure out how they're going to deal with it. Because there's a series of big issues going on, economic issues, education issues, immigration. The big decision on the Employer Sanctions Bill still reverberates. There's been calls for a special session by the governor, some of the business interests are looking at how to reform it from their standpoint. And I think there's going to be a question for what kind of Republican Party are we going to have? Are we going to have one that actually tries to solve problems or one that plays politics. I think immigration is probably one of the best examples.

>>Jaime Molera:
But I think one of the things that has to happen for the Republican Party is that they have to get back to what their core message is. And I'm not sure that we've seen that. In that we believe in an efficient government, limited government, and we're going to push forward the kinds of tax cuts that make sense to folks in the state. We really didn't have that debate. Big part of the reason is I think Governor Napolitano has been able to co-opt them in a lot of issues and has done an effective job with that. But I think with the experience that Tim Bee has, Jim Weiers and Tom Boone who most people would regard as a very strong, effective majority leader, I think they can build a coalition. I think it will be interesting to see. I think next year they'll be able to put forth policies that are not just ‘we're Napolitano but lighter,' but ‘we're Republicans and we're going to fight for these kind of ideals that may not be what Governor Napolitano believes in but what we believe in.'

>>Andei Cherny:
That becomes a trap. You saw that happen in the 1990s with the Republicans in the United States Congress dealing with President Clinton. And they went off and they said, we're going to try to draw a bright line of distinction. So they adopted a series of policies that were so far outside the mainstream. They said they wanted to have something very different.



>>Jaime Molera:
But it worked in '94, where they were able to get back the Congress. That's the kind of distinction I think will be helpful for us at the end of the day, if we're actually able to say that ‘we're not just light but a party that stands for something.'

>>Andrei Cherny:
You can always win back some seats based on attacks. But to actually govern and to actually be able to have the kind of control over the state that Governor Napolitano has in terms of shaping the debate, shaping the priorities for the state, you have to figure out what the right answer is. That's something we'll have to figure out on a future segment. It's been great talking with you.

>>Jaime Molera:
Likewise.

>>Andrei Cherny:
Take care.

>>Announcer:
What is normal healthy sleep and what is considered a sleep disorder? We look at symptoms, causes, diagnosis and treatment of sleep disorders as we continue our series on increasingly prevalent health issues. Plus see Arizona's gold mining history at Wickenburg's Desert Caballeros Museum, Tuesday at 7:00 p.m. on Horizon.

>>Richard Ruelas:
Wednesday we continue our look at health epidemics with an examination of autism. Thursday we focus on obesity. Friday join us for the Journalists' Roundtable where maybe we'll discuss hyper-tension. For all of us here at Horizon, I'm Richard Ruelas. Have a good night.

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