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Shadid's death highlights dangers of asthma

This May 25, 2004 photo provided by The Washington Post shows then-Post reporter Anthony Shadid, in Washington. Shadid died Thursday, Feb. 16, 2012, apparently of an asthma attack, while on assignment for the New York Times in Syria, the paper said. He was 43.

Journalist Anthony Shadid’s sudden death has many wondering how an apparently healthy 43-year-old man could be struck dead by an asthma attack.

No one knows the exact circumstances surrounding Shadid’s collapse, but the New York Times has reported that Shadid, who was on assignment for the paper in Syria, began to show asthma symptoms as he was preparing to leave the country on Thursday and that those symptoms intensified and culminated in a fatal attack.

Times photographer Tyler Hicks, who was with Shadid when the reporter started to have trouble breathing, described the suddenness of the attack.

"I stood next to him and asked if he was OK, and then he collapsed," Hicks told the Times. "He was not conscious and his breathing was very faint and shallow."

Within minutes Shadid had stopped breathing.

Tragic asthma deaths like Shadid’s are more common than they should be, said Dr. James Sublett, a spokesperson for the American College of Allergy, Asthma and Immunology and a managing partner for Family Allergy and Asthma in Louisville, Ky. “The latest numbers are four to five thousand deaths per year,” Sublett said.

In life-threatening situations, something -- often an intense allergic response -- kicks off a severe attack in which the muscles that wrap around airways begin to spasm.

"When that occurs, they can tighten down and stop air from moving in and out," Sublett said.

The scary thing is that it can all happen very quickly, especially if a person’s asthma is not well-controlled. If there is already inflammation in the airways, add triggers like heavy exposure to allergens, stress and physical exertion, and a severe attack can happen.

Hicks speculated that an initial bout of asthma a week earlier was set off by Shadid’s allergy to their guides’ horses. And that apparently was exacerbated as the two walked behind the horses towards the Syrian border the day Shadid died.

It’s possible, Sublett said, that Shadid was exposed to a fatal cocktail of allergens. The journalist might have been allergic to more than just horses. Many people are allergic to mold, and while one doesn’t think of mold as being an outdoor problem, there is a particular type of mold that thrives in the desert. Dust kicked up by the horses might have made things even worse. Reports of soldiers’ having asthma attacks triggered by dust are starting to come out of Afghanistan, Sublett said.

If anything positive could come out of Shadid’s tragic death, it might be heightened awareness of the dangers of asthma, Sublett said.

People often don’t realize that even mild asthma can turn deadly, Sublett said. And because of that, many patients don’t take their condition seriously enough.  They don’t understand that uncontrolled asthma is a ticking time bomb, he said. Severe attacks are far less likely when asthma is controlled.

In the 32 years he’s been practicing, Sublett has seen 3 deaths that he considers to have been entirely preventable. The patients weren’t good about taking their medications on a regular basis and their asthma never got well controlled.

Even when asthma is under control, there’s always the possibility of a flare-up and a severe attack. That’s why Sublett tells his patients that they need to be prepared for the worst -- especially if they are going to be away from medical care.

"Students who are traveling abroad, for example, need to talk to their doctor before leaving and have a plan," he said. "If they’re going to have limited access to medical care they need to take extra medication with them. They need to have steroids and extra inhalers. And they should have an EpiPen and a backup EpiPen."

The EpiPen, a shot that sends a jolt of epinephrine into the body, can abort an attack, Sublett said. But meds aren’t enough.  "They need to make sure their friends know about their asthma and are ready to use the EpiPen," Sublett said.