History of Asthma Definitions

As we travel back in time we will learn the definition of asthma has grown through the years.

• 800 BC?  The first reference to asthma was made by Homer in his epic poem The Illiad.    "asthma" was derived from the Greek word aazein, which means to exhale with an open mouth or to pant.  Actually, asthma is derived from the Greek word Panos which means panting.  Homer used the term to reference any dyspnea, including shortness of breath after exertion from fighting in a battle.
• 400 B.C.:  Hippocrates introduced the term asthma into the medical community, using it to describe any medical condition that caused dyspnea.  
• 1859: American physician J.A. Swett acknowledged that bronchospasm was important, but regarded 'bronchial inflammation' as the 'principal exciting cause of the paraxysm'. (1, page 109, 110)
• 1859: Berkart rejected the idea that 'mysterious derangements of the nervous system' caused asthma, yet he saw little evidence that anti-spasmotics of that time benefited the disease. Based on this wisdom he believed asthma was a product of transient obstruction of the bronchi. (1, pp. 110)
• 1873: Charles Harrison Blackley argued that symptoms of hay asthma (hay fever) were due to inflammation of the 'submucous cellular tissue' of the bronchi rather than 'spasm of the circular muscles of the bronchial tubes'. (1, pp. 110)
• 1870s: Mucus plugs were discovered in the lungs of asthmatics(1, pp. 110)
• 1890s: Eosinophils in both the sputum and the blood of asthmatics were found, which confirmed that inflammatory exudates layed a pivotal role in bronchial asthma (1, pp. 110).
• 1892: In The Principles and Practice of Medicine, William Osler believed the theory of bronchospasm was not proven, and he suggested attacks of asthma were due to 'swelling of the bronchial mucus membrane' (later referred to as inflammation), otherwise referred to as inflammation of the smaller bronchi. He also believed asthma was caused by a reflex spasm of the diaphragm and other respiratory muscles. He acknowledged asthma as neurotic. He believed the relationship between hay fever and asthma deserved attention, because he believed if the changes in the mucosal membranes that occured with hay fever were to occur in the lungs, this would further explain a paroxysm of asthma (1, pp. 111, 112).
• 1894?: Edouard Brissaud condisered the symptoms of asthma to be the product of both bronchospasm and hypersecretion, which constituted a form of 'bronchial urticaria' (1, 111).
• 1895: Arthur Foxwell suggested attacks of asthma were characterized by a combination of bronchial oedema, bronchial constriction, and contraction of blood vessels in teh lungs (1, pp. 111).
• 1959: The Condition of subjects with widespread narrowing of the bronchial airways changes its severity over short periods of time either spontaneously or under treatment. (American Thoracic Society: Am Rev Respir Dis 85: 762-785, 1962)
• -- Asthma experts at this time were working hard to differentiate asthma from COPD. Although it was basically defined, in 1959, as a form of intermittent airway obstruction that could be reversed with bronchodilators. Chronic bronchitis was defined as productive cough, and emphysema was defined as dilation of the air-spaces distal to the terminal bronchi.**
• 1962: Asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (Ciba Foundation Guest Symposium: Thorax 14: 286-299, 1959)


• 1975: A chronic condition is characterized by recurrent bronchospasm resulting from a tendency to develop reversible narrowing of the airway lumens in response to stimuli of a level or intensity not inducing such narrowing in most individuals (World Health Organization: Bull World Health Organ 52; 251-260, 1975)


• 1985: Reversible Obstructive Airway Disease: The acronym R-O-A-D was what I was taught in 1984 during my time at National Jewish Hospital/ National Asthma Center.


• 1987: A clinical syndrome is characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli. Major symptoms are paroxysms of dyspnea, wheezing, and cough, which may vary from mild and almost undetectable to severe and unremitting (status asthmaticus). The primary physiological manifestation of this hyperesponsiveness is variable airways obstruction. This can take the form of fluctuations in the severity of obstruction, after the use of bronchodilators or corticosteroids, or increased obstruction caused by drugs or other stimuli. There is evidence of mucosal edema of the bronchi, infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially eosinophils; shedding of epithelium; obstruction of peripheral airways with mucus. (American Thoracic Society: Am Rev Respir Dis 136: 1285-1298, 1987)


• 1991: A lung disease has the following characteristics (1) airway obstruction that is reversible (but not completely so in some patients) either spontaneously or with treatment; (2) airway inflammation; and (3) increased airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: Guidelines for the diagnosis and management of asthma, NIH pub no 91-3642, Bethesda, MD, 1991.)


• #1992-1997: A chronic inflammatory disorder of the airways in which many cells play a role, particular mast cells, eosinophils, and T lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough in early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: International Consensus report on diagnosis and management of asthma, NIH pub no 92-3091, Bethesda, MD, 1992


• 2010: A lung disease that is associated with chronic inflammation of the air passages (bronchioles) of the lungs. The bronchioles are therefore sensitive to various stimuli (asthma triggers) that should be harmless. The degree of inflammation determines severity. When exposed to asthma triggers the inflammation worsens, thus causing acute spasming of the muscles of the air bronchioles (bronchospasm) which causes the bronchioles to become narrow, thus trapping air inside the lungs. This is called an asthma flare, and results in coughing, wheezing, chest tightness and shortness of breath. The episode is reversible sometimes on its own, and sometimes with therapy. Between episodes breathing is normal for most patients.

Stay tuned, because I have some definitions from the pre modern era that might take your breath away.
This is a living history. I will add to this list as I obtain more definitions of asthma, either modern or from the past. So come back here every once in a while.
References: 1. Asthma: "The biography," by Mark Jackson."