Monday, June 20, 2011

x1899: Is asthma simply a "Nerve Storms"


Nerve Storm: Seizure, as in seizure of the entire body (epilepsy), seizure of the muscles of a certain joint (gout) or seizure of the respiratory bronchi (asthma). The seizure is caused by some imbalance either internal (emotion) or external that triggers the abnormal response of the brain.

I've read about asthma being described this way in many older journals, yet Dr. Joe Shoemaker, in his 1899 book, "The Monthly Encyclopedia of Practical Medicine" (Philadelphia, Vol. XIII), uses this term with force.

He further describes asthma as:
  • A disease essentially due to some nervous change (this was the accepted dogma of the time)
  • Partial hereditary (so we still think this)
  • It's occurrence is largely in "neurotic" subjects
  • It's occurrence in families subject to migraine (hmmm, where does this come from?)
  • Attacks are characteristic of asthma (dyspnea due to bronchospasm)
  • Pt inclined to hold to a chair or bed railing firmly to help expiratory muscles of expiration
  • And all this is caused by a "nervous storm"
  • Triggered by some unknown cause
  • The cause of who has such a "nervous change" also remains a mystery
  • It's seen in children and some adults
  • It's rare
  • Sudden in onset
  • Occurs between 2-4 a.m. (remember, this is based on his observations)
  • Accessory and natural muscles of respiration are contracting vigorously
  • Dusky face shows embarrassment to circulation and deficient oxygen in the blood
  • Sweating skin shows muscular exertion
  • Lungs enlarged during paroxysm
  • Yet auscultation shows little to no air entering them
  • No normal respiratory murmur, instead expiratory whistle is heard upon austultation
  • Sonorous rhonchi often heard (which is what we now call a wheeze)
  • Duration of attack is variable, yet is often over by morning
  • Duration may last 24 hours or longer
  • Attack ends with expulsion of mucus
  • No continued cough or expectoration
This is all part of the nervous storm we call asthma. What do you think?

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