Friday, January 15, 2010

Introduction to Hardluck Asthma

Dear readers:

If you read books about asthma that were written prior to the late 1990s, you will not see asthma defined the same way it is today. In fact, asthma, as defined prior to the 1930s, may not even be asthma at all.

Now I'm sure Teddy Roosevelt had the disease, the same as you and I do, yet even physician's like J.B. Berkart, who wrote his version of "
On Asthma: It's pathology and treatment" in 1878 noted the following:

"ALL early historical traces of the affection at present called asthma are lost. Although the disease is said to be mentioned in the Bible, and described by Hippocrates, Areteaus, Galen, and Celsus, there is not the least evidence that those remarks apply to the asthma of to-day. For in the former systems of medicine, all cases presenting the same conspicuous symptoms were, regardless of their anatomical differences, considered as of a kindred nature, and grouped into classes according to imaginary types."

In this regard, any disease that caused shortness of breath, or dyspnea (being winded) were all called asthma. Chronic bronchitis, emphysema, COPD, cystic fibrosis, pneumonia and heart failure all result, at times, in symptoms similar to asthma, and, thus, were all grouped in the class of asthma.

(Naive doctors still often confuse these diseases, and often treat all that wheezes and all that causes shortness-of-breath as asthma, as I often make fun of in my sister blog, respiratory therapy cave. Examples of this are here and, better yet, here.)

The funny thing is, that even while Berkart noticed this, he himself believed asthma was caused by Rickets, and he also believed asthma was psychosomatic. Likewise, he himself said that he had never performed an autopsy on an asthmatic and not seen emphysema. Emphysema, as you and I know today, causes permanent air trapping in the lungs, while asthma causes air trapping only during an exacerbation (with a few exeptions). Yet that wisdom is relatively new.

During most of the 19th century asthma was thought to be a psychosomatic disease, in that asthma experts believed asthma was all in the head of the asthmatic. With good psychiatric care, and good medicines like opiates and caffeine, one asthmatic was expected to relax and the asthma attack will go away, and asthma itself will go away with age (a fallacy that still exists as you can read about here). I wrote about old and wacky asthma remedies

In fact, there are and were (are) so many asthma myths that I can hardly scratch the surface, although I try in
this post.

When I was a kid growing up in the 1980s it was known that corticosteroids worked to end an asthma attack by reducing inflammation, yet it was believed this inflammation was only present during an acute attack. Therefore, as soon as my asthma was doing better, I was told to quit taking my Vanceril or Azmacort (as you can see by my medical records

And, when I was 10, my doctors introduced me to the rescue inhaler, which has since become my best friend (I wrote about this here).

Ah, even since I was a kid asthma wisdom has grown. I was correctly taught in 1985 that asthma was a reversible obstructive airway disease, and that during an exacerbation bronchospasm and swelling (inflammation) of the air passages in my lungs occurred.

Yet, it was in 1985 that the first studies were completed showing that asthma wasn't just a disease the resulted in inflammation during an asthma attack, but that this inflammation was always present -- chronic. And that the repair process from that first acute asthma attack, and subsequent ones, often results in airway changes that may lead to permanant airflow obstruction and, perhaps, hardluck asthma. Yet, sometimes hardluck asthma is simple pure asthma that's difficult to manage.

I had the pure asthma part of hardluck asthma as a kid, although with modern medicine and good compliance, I am no longer a hardluck asthma. Other than the fact I take meds twice a day, or the occasional flare up, or by writing about it as I'm doing here on this blog, I often forget I even have the disease these days.

Thus, today, most asthmatics who are compliant, who are
gallant asthmatics, rarely have to experience asthma. In fact, I bet most asthmatics don't even know they have the disease.

Yet, as we all know, there are some asthmatics, both gallant and
goofus, who continue to have problems with their asthma regardless how well their asthma is managed. These are your hardluck asthmatics, and thus is what I chose to name this blog.

I was a hardluck asthmatic until a few years ago. Technically speaking, I'm probably still a hardluck asthmatic considering in order to keep my asthma tamed my wife has to fork out $80 a month for asthma medicines. Actually, my co-pay just increased, so starting next month I'll have to pay over $100 a month. The fact I have to fork out so much money is "hardluck" in and of itself.

Asthma is hardluck in more ways than one. It's hardluck in that it remains a conundrum for scientists, asthma experts, and thus doctors, and has remained so for over 5,000 years. Asthma is an inexplicable disease in that scientists remain baffled as to what it is and what causes it. They are also perplexed as to why it has a tendency to seem to disappear for days, months and even years, and then come back with a vengeance.

Scientists have recently discovered a gene they think is linked with asthma, emphysema, COPD, and certain diseases of atopy like psoriasis and eczema. In that sense, will in the future scientists link these disease processes? Is it possible that COPD only occurs when the patient has the asthma gene -- I think so.

Some doctors think of asthma more as a syndrome (as I write here) more than just a disease, as it is linked to the immune system (allergies and atopic dermititis), acid reflux that causes airway changes and leads to asthma (GERD), the upper respiratory tract (polyps, sinusitis, crooked nasal passages) and mouth breathing, anxiety, and perhaps more yet to be discovered pathologies.

What is asthma really? While I think we are closer now than ever to knowing all the secrets of the asthma conundrum, so too did Henry Hyde Salter think he had all the answers when he described asthma as a psychosomatic disease in his book "
On Asthma: It's pathology and treatment" in 1860, and so too did Berkart when he linked asthma with Rickets and emphysema.

Hippocrates -- of Hippocratic oath fame -- actually was closer to the true definition of asthma when he said it was caused by "broncho spasms" way back in ancient Greece than Salter was in 1860. Although Salter did accurately predict asthma to be a disease passed on by the parents (although he didn't know about genes). Salter also suspected certain "things" brought upon an attack, although he didn't understand about dust mites and cockroach urine.

Likewise, Salter and most doctors who followed him even up until the 1950s when the "atomizer" (inhaler) was invented often prescribed asthma cigarettes and even marijuana as asthma cures. While these remedies showed bronchodilating properties, they also made asthma worse, and maybe even caused COPD in many of these asthmatics, or at least made asthma worse. Yet, how were they to know.

I will delve into these topics and more on this blog and my myasthmacentral blog.

So I tackle asthma in my weekly
sharepost at, and I have tackled it on my RespiratoryTherapyCave blog. I will continue to write a weekly sharepost at MyAsthmaCentral, and I will continue the RT Cave, although I will reserve asthma wisdom to this blog starting in July, 2010.

This blog is our opportunity to delve into this disease further, and to fully understand it. As you can see I have a Passion for history, and what we experience now is in every way linked to the past.

I will learn along with my readers, share the latest (and oldest) asthma wisdom, and share asthma experiences. I will share facts blended in with my opinion, and an occasional splatter of asthma wit.

What I will not do on this blog is reiterate what is in the news. For that I will reserve you to my
Twitter account or to other online resources. We'll see where this goes. Perhaps it'll end in the trash heap of blogs for all I know.


Rick Frea.

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