NEW YORK – Josh Watkins takes the ball from the left wing. He hops up, fakes out his defender and barrels past him. He moves between the traffic in the paint, spins and passes to Phillip Seymour, who easily puts it in for a Wadleigh Secondary School basket.

The crowd of players sprint down the court. Watkins trails behind, his head moving up and down quickly. He breathes heavily, his chest shuddering as he fights to fill his lungs.

“It’s not so bad,” the junior guard says after the game. “I know when it gets bad, I know when it’s coming.”

When the attacks of asthma come, Watkins says the battle to open up his airways is like a street fight. It feels like someone has him in a chokehold and is sitting on his chest. He can’t get air into his lungs. His chest feels like it’s being crushed. The rest of his body starts to feel heavy, his muscles tingle.

“I go right to the hospital then,” Watkins says in a raspy voice. “Wherever I am, I either walk right into the emergency room or take a cab and get there quick. You don’t want to let it get much worse than that. I have to go and get on the machine right away. Everybody there knows me.”

Watkins is a regular at Harlem Hospital’s emergency room, one of the nation’s leaders in dealing with childhood asthma. Like so many of his peers in Harlem, the 17-year-old Watkins was diagnosed as an infant and has been through so many attacks that he is a familiar face at the hospital. With a rate of asthma almost three times higher than the national rate, the kids of Harlem and the South Bronx are living and succeeding with asthma.

Asthma is a disease of the bronchial tubes, the main airway to the lungs, which when afflicted become inflamed, constricted and choked with mucus, making breathing difficult. It affects an estimated 15 million Americans and nearly 9 percent of children nationwide, according to the Centers for Disease Control and Prevention.

Scientists do not know exactly what causes the disease, but it tends to be genetic, and exposure to certain triggers early in childhood increases the likelihood of its development. Allergens and irritants, including pollution, cigarette smoke, the feces of dust mites and cockroaches, pollen, mold, stress and infections seem to bring on the symptoms, according to the National Heart Lung and Blood Institute.

In 2001, the Harlem Children’s Zone teamed up with Harlem Hospital in an attempt to get a grasp on the magnitude of the problem. Interviewing every child under the age of 13 in a 60-block radius that makes up Central Harlem, the ongoing study has found that more than one in every four children has the disease.

A study released by the New York City Department of Health indicated that poorer communities have higher rates of asthma because of older housing (mold), pests and the increased likelihood of having a smoker in the house.

Political activists and environmentalists also charge that the children of Harlem are more frequently subjected to the particles of diesel fuel exhaust, a known asthma irritant. The Metropolitan Transportation Authority has two large diesel-fuel bus depots in Harlem, and trucks not allowed on the parkways are routed through Harlem on the way in and out of Manhattan. Experts say the presence of crime and stress can lead to higher rates of asthma in poorer neighborhoods, too.

“We know there are higher rates in urban areas, among African-Americans and Latinos, Harlem and the South Bronx,” says Dr. Josh Needleman, Directory of Pediatric Pulmonology at Montefiore Children’s Hospital. “There are many factors, demographic, societal, sociological. A lot of places where their morbidity rate is worse is where kids have less access to health care and have less expectation of good control of their asthma.”

At Wadleigh, coach Mike Crump keeps an eye on more players than just Watkins. Three on his team suffer from severe asthma and five others have some form of breathing problem.

Further uptown at Thurgood Marshall Academy, coach Abdu-Allah Torrence has to keep close watch on junior forward Justin Peaker. Like Watkins, many children show signs of the disease as infants, but Peaker didn’t know he had asthma until he was 13. He was playing basketball when he felt his chest tighten. Something seemed to clog his airways. He tried drinking water. When he still had trouble breathing he went home, where he nearly passed out. He was rushed to the hospital, where he was diagnosed with asthma.

“It was the worst feeling I ever had,” Peaker says. “It was scary. I felt like I would never get a full breath again.”

After his release from the hospital, Peaker was hesitant to get back on the basketball court.

“I didn’t want to feel that way ever again,” he says. “I thought about not playing again, but I couldn’t do it. I have played my whole life, I couldn’t give it up.”

In fact, his doctors didn’t want him to give up basketball. Exercise and fitness help manage the disease.

“When most people run and get out of breath, they know it’s from conditioning, you need to run more so your body gets used to it,” Needleman says. “With kids with asthma, when they get winded, people worry and think of the medical condition and immediately think they need to stop exercising. Exercise helps manage the disease. It’s important. It shouldn’t be limiting kids’ abilities.

“I tell kids that asthma will probably always be there, but it can be controlled and it should not interfere with their lives whether they want to be an athlete, a musician or aerospace engineer.”

Athletes diagnosed with asthma are required to take an additional medical exam to play sports in the Public Schools Athletic League and their coaches are notified of their condition.

Peaker’s coach, Torrence, finds himself monitoring his junior forward a little more closely than the others. He’s looking for signs that Peaker is winded, whether he’s leaning over on the court, hands on his knees, or displaying any other indications of an oncoming attack. An inhaler is always on the bench just in case.

“It’s a hard thing, because I worry, I want to protect him, but I don’t want to be over-protective,” Torrence says. “I don’t want to single him out. I have to let him push himself and know he will know what is too much or when he needs a break.”

It is the tricky balancing act for athletes like Watkins, Peaker and Devin Austin – they must push their bodies to stay in good shape while knowing when they’re going too far.

“I didn’t want to be the big kid that could not do anything,” Harlem Hellfighter defensive end Austin says. “I didn’t want to be embarrassed because I couldn’t do what the other players could.”

At 6-5 and 348 pounds, Austin did not join the football team on a whim. It was a decision he made with his mother and doctor. He needed exercise, the doctor said. Football was the only exercise Austin was interested in. His mother, Peggy Morales, agreed only after extensive tests on her son’s heart and lungs.

As she watched her son struggle through those first few weeks of practice, Morales got through the anxiety by being prepared and cautious.

“I was behind him all the way. We wanted to do this as a family,” Morales says. “That doesn’t mean I didn’t have an extra inhaler and a cell phone ready to call 911.”

Austin got through the preseason. He lost nearly 50 pounds and the constant worry of an asthmatic attack. As he shed the weight and shaped up, he found he had fewer and less severe attacks.

Austin also became a starter – and he quickly gained some attention as a defensive end. Next month, the junior will join the nation’s top players at a combine coinciding with the Army All-American game. He is hoping to impress the college coaches gathered there enough to get a college scholarship.

He smiles when asked about what is next for him.

“This could be a way out,” Austin says. “I have always said I want to be a lawyer, but after playing one year, I would really like to try for the NFL. That would be a dream. But, most importantly, this is my chance at college.”

Watkins, too, is hoping to overcome asthma and earn a basketball scholarship. He has struggled with the disease and the side effects. He has bursts of speed and explosion during games, but has trouble with endurance in practice. He battles bulking up because he can’t complete long sessions of cardio activity, like running.

“He’s well-developed in his upper body, because even when he feels like he can’t run, he works on his body with weights or a medicine ball,” says coach Crump. “People say he isn’t in shape, because he’s bulky and they see him panting on the court. They don’t realize what he goes through to play.”

That is the fight Watkins will never give up. He’s had a basketball in his hand since he was 4. He loves the game and he is good at it. One of the city’s best combo guards, he is averaging 24.2 points and 6.3 assists a game.

But the battle to keep playing is obvious. On the court, as he stands waiting for a teammate to hit a free throw, Watkins fights for a deep breath. His chest shudders, he lifts his chin repeatedly, as if to clear his airway. Then, the ball bounces off the rim and Watkins is a blur. He swoops in quickly, cuts through a crowd of bigger teammates and is fighting for the rebound. After scoring, in the few seconds it takes the other team to get the ball in bounds, he stands still again. And again, his chest shudders and he lifts his chin.

“It’s all I do, school work and basketball,” Watkins says. “I’ll never stop. I’ll do this until the day I die.”

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