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The CDC reports that between 1980 and 1994, the prevalence of asthma increased 75%.

“We’re definitely seeing more adults diagnosed with asthma, including an increase in the number of menopausal women,” Janson said. “We’re not clear if this is due to environmental factors, but women have more severe disease and a higher mortality rate.”

Researchers also note that asthma prevalence varies considerably by race and ethnicity, with Hispanics and African Americans having a much higher incidence rate than other ethnic groups.

In May, the Commonwealth Fund International Working Group on Quality Indicators released a study, “How Does the Quality of Care Compare in Five Countries?” that found the United States had a higher asthma mortality rate than Australia, Canada, New Zealand, and England among those aged 5 to 39. The study stated the U.S. mortality rate for asthma is higher now than it was 10 years ago, while it has been decreasing in the other countries.

“You wouldn’t think patients would be dying from a treatable disease such as asthma,” Janson said. “Yet there are many disparities in our health care system. Not everyone has access to quality care.”

Janson uses one of San Francisco’s impoverished neighborhoods as an example. “Many patients take three buses to reach our medical center,” Janson said.

Insurance coverage also can be a problem. For example, MediCal doesn’t cover the cost of spacers, a device that is attached to the metered dose inhaler used by asthma patients.

Because asthma is a complex condition with a wide array of symptoms, Janson notes it is often difficult for health care practitioners without extensive experience in the field to accurately diagnose and treat the disease.

“Often, patients will also have allergic rhinitis or gastric esophygeal reflux, and if these conditions aren’t treated, they can exacerbate asthma,” Janson said. “Older patients are often misdiagnosed with chronic obstructive pulmonary disease when, in fact, they have asthma.”

Janson recommends that all nurses who work in primary and acute care take a CEU class on asthma management.

“Because so many people are being diagnosed with asthma, it benefits all nurses to learn about devices such as peak flow meters, and how to recognize the signs of an asthma attack, which can mimic the signs of a heart attack,” Janson said.

The hygiene hypothesis

Some nurses, including Gayle Traver, RN, MSN, a pulmonary clinical nurse specialist at the Arizona Respiratory Center and University Medical Center in Tucson, Ariz., cite the hygiene hypothesis as a possible explanation of why asthma is on the rise.

The hypothesis revolves around a theory originally developed by David Stratham, MD; the theory was further studied by health researcher Erika von Mutius, MD. She compared the rates of allergies and asthma in East and West Germany in the late 1990s. Her hypothesis was that children growing up in the poor, dirty, and generally less healthful cities of East Germany would suffer from more allergy and asthma symptoms than youngsters in West Germany, where it is typically cleaner and the environment is more modern.

When the two regions were unified in 1999, von Mutius compared the disease rates and found exactly the opposite. Children in the polluted areas of East Germany had lower allergic reactions and fewer cases of asthma than children in the West.