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November 16, 2004

Host: Cary Pfeffer substituing for Michael Grant
Topics:
· Medical Breakthroughs "Asthma;"
· Proposition 400 and plans to expand Valley freeways
In-Studio Guests:
· Dr. Gerald Schwartzberg, pulmonary disease specialist;
· Dr. Charles Finch, emergency room physician and for the Arizona Lung Association's Camp Not-A-Wheeze
Important Links & Resources:
University of Arizona Allergy and Asthma Information
American Lung Association Asthma & Allergy
Web MD Asthma Health Center
Center for Disease Control Asthma & Allergies
National Institutes of Health
Mayo Clinic Research: "Esinophils in Asthma"

Cary Pfeffer:
Tonight on "HORIZON", asthma is the fastest growing chronic disease in America. It's worse here in Arizona. Asthma causes thousands of kids to miss school and is a major reason people visit emergency rooms. Now, new research here in Arizona has pinpointed a blood cell component needed to trigger asthma.

>> Bill J. Pfeifer:
It's so important that we do recognize it, that the research and cure and better treatment of asthma comes from anywhere in the world. You've got to be able to support cutting edge research. The better way to treat asthma and one day how do we cure asthma.

Cary Pfeffer:
Plus, a look at how valley freeways will be expanded now that voters have passed proposition 400.

Announcer:
"HORIZON" is made possible by the friends of Channel 8, members who provide financial support to this Arizona PBS station. Thank you.

>> Cary Pfeffer:
Good evening, welcome to "HORIZON". I'm Cary Pfeffer in for Michael Grant. People with breathing problems once came to Arizona to recover. Not anymore. Allergies, air pollution and other triggers are one reason that the state has a higher percentage of asthmatics than most other states. There are an estimated 20 million people with asthma in America. More than 300,000 Arizonans have asthma, in including 80,000 children. It's the leading cause of missed school and outside of accidents, the top reason for emergency room visits. Asthma is associated with about 5,000 deaths each year. The chronic disease is treatable, medications allow many sufferers to resume normal activity. And new research could lead to better medicines and treatment. As we continue our medical breakthroughs series, we meet a researcher at Scottsdale's Mayo Clinic who has given asthma sufferers hope. He's identified a component of a white blood cell necessary for asthma to be triggered. Paul Atkinson reports.

>> Paul Atkinson:
Jaime Lee has asthma and his wife and one of his four children. He is wheezing today but is still able to work.

>> Jaime Lee:
Since I was a kid, the asthma has gotten worse and worse to where I'm a steroid dependent asthmatic. For the most part, that works and it's okay but during different parts of the season, of the year, when the seasonal allergies get above the medication, I start getting a little wheezy. I have to increase dosage of medications.

>> Paul Atkinson:
Asthma causes a person's airways to inflame. Here is a bronchial tube. Here's one with inflammation.

>>Dr. Thomas Van Osdol:
the most common triggers for asthma in the early age group tends to be more viruses and colds. Children get older, pollens, molds, animals, those tend to be more factors in they are allergens.

>> Paul Atkinson: T
he National Institutes of Health report that 20 million have asthma, more than 12 million have had an asthma attack in the last year. It's responsible for half a million visits to the hospital annually. The cost on the economy is great. An estimated $12.7 billion in 1998.

>> Bill J. Pfeifer:
When a child does have an asthma attack and they have to stay home from school, if they have the asthma attack they are going to the emergency room. That's increased burden on the emergency room in the hospital alone, but also to our health care system. That's added cost that didn't have to happen. Now you have a parent who has stayed home and they have a lost day of work, possibly a lost day of wages. Then the employer is impacted. It's a trickle down effect.

>> Paul Atkinson:
Medication plays a major role in preventing attacks.

>> Dr. Thomas Von Osdol:
There's two types of medication, controllers, control inflammation and swelling and prevent asthma symptoms from developing. Those are typically daily symptoms. If you have symptoms more than twice a week you should probably be on a daily preventive medication for asthma. The quick reliever medicines help open up the airways, relaxes the muscles around airways so individuals can breathe better fairly quickly.

>> Paul Atkinson:
Medicine has made the world of difference in Jaime's life.

>> Jaime Lee:
I would be a fairly sick adolescent, I'm a fairly healthy adult. By staying on medication and staying on doctor's advice, I live a fairly normal life.

>> Paul Atkinson:
Jaime is hoping for more dramatic results. He is a researcher in Scottsdale. He switched his area of research while in grad school while at Cal Tech.

>> Jaime Lee:
My asthma got so bad, I ended up in the hospital. From my hospital bed I said I'm going to work on asthma because I'm going to die before I go anywhere.

>> Paul Atkinson:
In September, Science Magazine published his research. The research took place in his lab, mice were exposed to same things that trigger asthma attacks in humans.

>> Jaime Lee:
You can see his, mouse 2, you can see the breathing patterns. We will graph it and we can calculate exactly what mice are we reacting to what. We kind of figure out why they are.

>> Jaime Lee:
We engineered a mouse it has all the cells a human does but it's missing eosinophils. They all disappeared. Everything from just the inability to breathe as well as the mucous that would start to accumulate in lungs, all of that disappeared and the only difference between that mouse and a normal mouse is a presence or absence of eosinophils.

>> Paul Atkinson:
The doctor says the key is finding out exactly what role it plays in triggering the chronic disease.

>> Jaime Lee:
It's a long road from where I'm at. I'm not at the bed side. I'm trying to figure out at a real fundamental level what's going on, but I've been surprised in the past how such of an impact this kind of research has on patient care. And in this case, because we're identifying a clear agent, it's not going to be too far from potential therapies that are directed against that causative agent.

>> Cary Pfeffer:
Joining me are two doctors familiar with asthma. Dr. Gerald Schwartzberg is a pulmonary disease specialist who treats people with lung problems in both hospital and clinical settings. Also here is Dr. Charles Finch, an emergency room physician. Dr. Finch volunteers for the Arizona Lung Association's Camp Not-A-Wheeze for children with moderate or severe asthma. Thank you both for being here.

>> Dr. Charles Finch:
Thank you.

>> Cary Pfeffer:
Let's take a step back. That was a great story by Paul laying the groundwork. Let's make sure everybody understands what we're talking about when we talk about asthma. Define it, when somebody asks you what you do and the work that you focus on.

>> Dr. Gerald Schwartzberg:
Asthma is not what it used to be. Years ago we used to think that asthma was a series of events. They would have an attack, sick, then get better. Now we realize that's not the case at all. Asthma is a chronic disease of inflammation of the lining of the bronchial tubes, similar to if you had arthritis and inflammation of a joint or an inflammatory thing on your skin. The same thing occurs in the bronchial tubes. This is a chronic problem, it doesn't go away at the end of an attack, it's there all the time or at least the tendency for it to be there stays all the time. Many people who feel they just have attacks still are living with that abnormality inside of them. It's a kind of defect. The eosinophil has mediators which let loose which cause that inflammatory reaction.

Cary Pfeffer:
We have reason for hope based on that research and other things being learned?

>> Dr. Gerald Schwartzberg:
There's a tremendous amount of hope. I have been in the valley 35 years. I remember, people were coming in the emergency room critically ill. Dr. Finch will talk about that in a little bit. Now with the treatment we have, only because of research that has allowed us to understand the disease better we can control almost everybody with asthma. The trick is, it's a control to get them in a situation to give them medicines that will help them control the symptoms.

Cary Pfeffer:
One more quick question before we move to Dr. Finch. Part of the challenge seems like the fact someone can feel, quote unquote, normal and still be under the effect of asthma.

>> Dr. Gerald Schwartzberg:
We see this all the time. Many people have the mistaken idea once they are better from the attack then they can stop the medicine and they do. If they're lucky, that will work. More often than not it doesn't. One of two things will happen, they will have another attack later when something else happens like a cold or atmospheric pressure changes or a whiff of pool chemicals or bleach. Or the airways narrow, they don't realize unless they're athletes, heavy exertion. We have seen people who aren't wheezing who come in because of shortness of breath and we have found lung function to be 30 and 40% of normal when they don't realize they are in trouble.

Cary Pfeffer:
Dr. Finch, talk about your experience in the emergency room. Again, the possibility of somebody coming in there at the point they're at the emergency room it is a serious situation.

>> Dr. Charles Finch:
That's what it gets down to. By the time I see them in the emergency department, they can't breathe. I look at them as breathing through a straw. Air is important, the oxygen we need in our lungs is important. When you can't breathe and have that much inflammation, it's a major issue. I see it daily. And as we get into fall and winter seasons, we're going to see more of that with viruses and upper respiratory conditions. Asthma can kill. We have to educate. We have to understand not only what triggers are that can spur on an asthma attack but also what medicines we can take, how to take them and how to maintain and improve our overall condition.

Cary Pfeffer:
Are the options that you have in the emergency room now, do you have more options now than 10 years ago?

>> Dr. Charles Finch:
With the research that's gone on over the last 10 years and ongoing research continuing, certainly our medicines that we have now are far and away improved over the last 10 to 20 years. Asthma still is prevalent out there so I don't want to make it known that asthma is decreasing. That's not the case. Our medicines are getting better but we have to work as a team to overcome this particular entity.

Cary Pfeffer:
Doctor, your point is people should not have to make it to the emergency room, maintaining that process will mean they wouldn't have to make that trip?

>> Dr. Gerald Schwartzberg:
I don't want to put Dr. Finch out of business, but that's our goal. We don't want our patients to go to the emergency room with asthma. If they follow instructions generally, they won't. Education is so critical. People have to learn how to take care of their disease. Part is teaching them what to do when they have attacks that will allow them to keep themselves out of the emergency room and not die.

Cary Pfeffer:
That's an important point to make. Dr. Finch mentioned that. We think of asthma as something that's controllable or for people uneducated about the process, that comes and goes, but it can be fatal?

>> Dr. Charles Finch:
I see in the emergency department, I wouldn't say on a regular basis but I do see patients, children and adults who come in and certainly the severe asthmatics that come in sometimes too late. By the time I see them, despite the medication and therapies that we do have, patients do die. I think it's an educational piece that families need to understand. When I say family, I'm referring to especially the adults who have children that have asthma. I think it's important to realize this is a controllable disease, but we have to work together to make it that way.

Cary Pfeffer:
The history here, you made some mention of it, it's ironic that we're in the situation now. Years ago, people packed up and left all kind of places in the country to come to Arizona.

>> Dr. Gerald Schwartzberg:
Doctors didn't know what to do. They had the idea if they came to a warm climate, desert, that they would do better. There was an advertisement in the '60s, send your sinuses to Arizona. People would come to Arizona and supposedly get better. They did. They came to Arizona and other people came to Arizona and their children met each other and since it is a genetic condition, we have a huge population of people here with allergies and asthma. Not only that, they planted grass. And planted trees. And so we end up down here now with allergy season just as bad and just as difficult as in any other of the more tem pretty climates.

Cary Pfeffer:
Over a higher population of people who are affected by it.

>> Dr. Gerald Schwartzberg:
A higher prevalence of people in this part of country have asthma than other parts of the country, I think that's true.

Cary Pfeffer:
Getting back to the emergency room side of it, the thing that comes to mind is adults dealing with this is one thing. An adult is expected to be able to make those kinds of judgments and follow advice of doctors. The tough thing I have to believe is kids coming in and dealing with that.

>> Dr. Charles Finch:
It's a scary thing for the healthcare workers, as well, but parents. Parents with children who have asthma. It's an issue that's a problem for them. Understanding how to control their child's own disease is important. Certainly children with asthma is really the leading cause of school absenteeism. That leads into the adults not going to work as well. So it is a major issue. We, as a health care team, need to work with these families to allow them to better understand what the triggers are, how to manage those triggers, what appropriate medicines their children can be on. That will improve the self-esteem.

Cary Pfeffer:
Understanding what's happening to them in an attack situation.

>> Dr. Charles Finch:
The children feel like they're different than others, that may not have asthma, for example, they are looked as being different. That is not necessarily always the truth. There's a lot of things these children can do but sometimes aren't allowed to because they have asthma.

Cary Pfeffer:
How early are you able to tell? It seems that would play a part in sort of battling what you have to face. How early in a patient that you can tell that someone is going to have to deal with that?

>> Dr. Gerald Schwartzberg:
I deal with adults mostly. I said I would pass, I will.

>> Dr. Charles Finch:
Certainly children, once -- typically you start seeing asthma being a recurrent inflammatory constrictive disease, sometimes as early as two to three years old but generally it's five, six, seven-year-olds that you see this as a recurrent problem.

>> Dr. Gerald Schwartzberg:
We see an interesting phenomenon. We see adults that had asthma as children and grew out of it, that's how they describe it. Suddenly they catch a coal, age 28 -- catch a cold, age 28, it's back. It's always been there, this growing out business doesn't really happen.

Cary Pfeffer:
Talk finally about some of the advances that you have seen over the time that you have been able to work with patients.

>> Dr. Gerald Schwartzberg:
Well the advances have been spectacular. We are fortunate to have all the medicines available that we have now to take care of asthma. The steroids which don't cause any -- the steroids that you get by mouth cause because it's deposited in the lungs. These have changed the lives of many people. People who have been sick, sick, sick, who can't do anything. Like Jaime Lee was talking about. Once they start on the inhaled steroids, life is different. They worry about something else. They're not worried about their asthma. It's spectacular to see how that's changed. We have the dual controller drugs now that can keep people from wheezing and most patients when treated properly with the correct medicines don't even know they have it.

>> Dr. Charles Finch:
I would also include overall, the last several years at least, I've seen less asthmatics coming through the ER and I think that's a key role at the primary care level. Getting the word out and together, us working together in the emergency department and primary care level and we work together to better him.

Cary Pfeffer:
Dr. Finch, thank you very much. Doctor, thanks very much for the information.

>> Thank you.

Cary Pfeffer:
The valley's freeways will soon undergo upgrades now that proposition 400 has passed. 58% of Maricopa County voters approved the ballot measure two weeks ago. Let's take a look at a map of the current freeway system and the additions that will be made over the next five years. Up in the northwest, loop 303 will be built between Happy Valley Road and I-17. Interstate 17 will get new lanes from the 101 north to the Carefree Highway. The 51 will get HOV lanes from Shea Boulevard north to the 101. The 101 will also get HOV lanes from Princess Drive south all the way to the Santan freeway. U.S. 60, the superstition freeway, will get HOV lanes from Val Vista Drive east to Power Road. I talk to Arizona Department of Transportation director Victor Mendez about the upcoming freeway expansion projects.

>>> Cary Pfeffer:
You have administrative responsibilities, not really political responsibilities but at the same time you're probably breathing a sigh of relief with the passing of proposition 400?

>> Victor Mendez:
Yes, Cary. And thank you for inviting me. We're prepared. We are happy that prop 400 passed. There was a little anxiety, but we're prepared to move on. We have a good track record in the past decade of providing a new freeway system. We're ready to move forward.

Cary Pfeffer:
Speaking of moving forward, how filled are the current freeway systems? In other words you probably have a way of measuring our traffic flow and that sort of thing. Give us a sense of that for people who sit in bumper to bumper traffic from time to time.

>> Victor Mendez:
That is a very good question. Most of us drive on a freeway system, there is a definite rush hour. Basically what I tell people, when you have about two million people at about the same time decide to go to work or go home from work, you're going to have congestion. I think we have definitive rush hours, early morning, late afternoon I believe it's about a three hour rush hour. Prop 400 will help us manage the congestion as we grow through the valley.

Cary Pfeffer:
As far as the projects those start kicking in in 2006 as far as construction and moving forward.

>> Victor Mendez:
We're in the process of actually establishing the priorities. They will kick in in the time frame 2006 to 2010. We do not have any specific priorities, that will be done through the Maricopa association of governments, the planning process and all the mayors and everybody involve will have say so into the priorities.

Cary Pfeffer:
In the northwest valley there is some activity going to happen on the Estrella, making that a more complete process?

>> Victor Mendez:
The Estrella Parkway, that is correct. We will build it as a four-lane highway, to be improved in the later phases. It will be a divided highway and help relieve some of the congestion that occurs in the northwest valley.

Cary Pfeffer:
The 101, people who have lived here awhile think of that as new freeway space but it is in need of updating.

>> Victor Mendez:
That is correct. We will add lanes and HOV lanes.

Cary Mendez:
In the east valley, more attention focused on the 60.

>> Victor Mendez:
That is correct. That is a really exciting project, from Val Vista to Power road. We will add the car pool lanes, additional lanes. We try and finish that when we finish the intersection that brings together the Red Mountain, Santan and 60. We hope to accomplish that and open everything at once. We're working on that.

Cary Pfeffer:
Just to finish up, people are happy about the idea that there are going to be improvements but they are going to have to have patience with the construction process.

>> Victor Mendez:
Very true. Building these kinds of facilities does get in the way and we ask patience from the traveling public. Bear with us. We're doing a good job, I believe, and we will continue to keep our track record intact.

Cary Pfeffer:
Victor Mendez, appreciate your being here.

>> Victor Mendez:
Thank you very much. Appreciate it.

Cary Pfeffer:
"HORIZON" has more information on tonight's main topic -- asthma -- on our website at www.az.pbs.org. Just click on "HORIZON" and look for "HORIZON" links. You'll find information on asthma, asthma medication and research at the Mayo Clinic in Scottsdale.

>> This Arizona man like more than 20 million adult Americans has osteoarthritis. It's the common form of the disease and leading cause of disability in the U.S. But a medical breakthrough is helping this patient get back on his feet. That, plus more new treatments for other forms of arthritis, Wednesday at 7 on "HORIZON". Cary Pfeffer: Thursday on "HORIZON", Maricopa County voters approved a new football stadium four years ago. We'll update you on the progress of its construction in Glendale. Then Friday, a panel of reporters join Michael Grant for the journalists' I'm Cary Pfeffer. Thanks very much for watching. Michael Grant will be back in this chair tomorrow night. I hope you have a great night.

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