1621-1675: Thomas Willis narrows the definition of asthma

The Ancient Greeks were the first to use and describe the term asthma.  Yet to them asthma was merely a symptom; it was synonymous with dyspnea, gasping, difficult breathing, and wheezing.  Our modern definition is more specific, and can be traced back to one man from the 17th century:  Dr. Thomas Willis.

Dr. Samuel Gee, our asthma expert from the turn of the 20th century, made a gallant effort to update the definition of asthma for physicians during his time.  It was he who gave Dr. Thomas Willis, who lived from 1621-75, credit as "innovator of the doctrines of the ancients."

Gee described in 1899 that prior to the 17th century asthma was considered "any kind of panting, gasping, pursy breathing such as follows on running on exertion." (1)

Thomas Willis (1621-1675)

Back then asthma was considered to be a disease caused by the spirits.  Yet in 1678 Thomas described asthma as "obstruction of bronchi by thick humors, swelling of their walls and obstruction from without." (2)

By these words Dr. Gee gave credit to Willis for the evolution of asthma as more than simply a disease of dyspnea and wheezing.

Other doctors may have helped to advance the definition, yet it was Dr. Willis who made asthma a unique illness in and of its own, such as Tuberculosis and Epilepsy are unique illnesses treated with unique remedies.

"Hence," Gee wrote, "Asthma and dyspnea were synonyms for most of the older physicians.  A few, such as Celsus, signified by asthma the highest degree of dyspnea, but this was all; asthma was never regarded as a special sort of dyspnea." (3)

For Gee, ancient definitions of asthma from Hippocrates to Galen to van Helmont are inaccurate until we get to Thomas Willis of the 17th century.  In his book  "Rational Pharmaceutic," which was published the same year as his death in 1675,  Willis explained that all ancient and modern physicians up to his time acknowledged only one kind of asthma, and this was pneumatic asthma.

Gee explained that pneumatic asthma was described by Willis as when the lungs are "obstructed or not open enough."  Gee wrote that the ancients regarded all asthma as "pneumatic and dependent on bronchial obstruction." (4)

Gee explained that this ancient definition of asthma is of little value in modern times (for Gee modern times would be 1899).  Yet, "It is interesting to note that those most conservative of people, the illiterate, continue to use the word in the sense of Hippocrates and Galen." (5)

However, we must note that it was illegal for the Ancient Greeks and Romans to dissect human bodies, and even in the 17th century it was very risky to publish ideas that opposed the beliefs of the church or ruling parties.  Plus people and societies tend to be stubborn to accept new ideas and to change.

We see this often as we follow the history of science, medicine, and asthma.  It's perhaps this stuborness of mankind that we can give credit for the slowness to which the term was defined, and why it took until 1901 for good asthma medicine to be discovered.

So Willis described three forms of asthma:

1. Pneumatic Asthma:  Dyspnea is a result of air passages in the lungs being obstructed or not open enough
2. Convulsive Asthma:  The primary fault of dyspnea comes from the lungs themselves, "in the moving fibres or muscular coats of the air vessels or in the diaphragm and muscles of the chest or in the nerves of the lungs and chest or of the origin of those nerves in the brain."
3. Mixed Asthma:  Both pneumatic and convulsive.

Gee explained that in defining convulsive asthma, Willis pondered all the theories before his time and incorporated them into his newly defined convulsive asthma, which "was soon laid hold of.  The term 'asthma' came to be reserved for the exclusive denomination of that form of the disease which was believed to be spasmotic; and this is the sense in which the word is still used by most parsons even in our own day."  (6)

Brenner, who wrote a brief history of asthma in "Emergency Medicine," explained that Willis also made an "association between food, emotion, heredity, and asthma."    In fact, it was in 1672 that Willis described emotion as bringing about an asthma attack.  (7)

While many before him described asthma as nervous, including many ancient societies, Willis is given credit for bringing the idea to the attention of the medical community.  He is given credit for the nervous theory of asthma.

Way back in the 12th century Maimonides described asthma as a nocturnal disease when studying the disease in Saladin's son.   In the 17th century there were many references to asthma as a nocturnal disease, and this was once again mentioned by Willis who, according to T.J.H. Clark, "Diurnal Rhythm of Asthma," "blamed the heat of the bed as the cause of nocturnal asthma and he advised leaving the bed and sleeping in a chair.  By contrast, Maimonides recommended celibacy." (8)

His theory that asthma was caused by emotion spun asthma experts on a lost journey even up to the 1950s when it was disproven.  Yet his fine tuning the definition of asthma as a condition of airway spasms would ultimately lead to great medicines like epinephrine, albuterol and xopenex.

Click here for more asthma history.

References:

1. 1.  Gee, Samuel, "Bronchitis, Pulmonary Emphysema, and Asthma,", Lancet, March 25, 1899, page 817
2.   Salvi, Sundeep S., "Is Asthma Really Due to a Polarized T Cell Response Toward a helper T-Cell Type 2 Phenotype," American Journal of Respiratory and Critical Care Medicine, Oct. 15, 2001, vol. 164, no. 8, pages 1343-6
3. Gee. op cit
4. Gee, op cit
5. Gee, op cit
6. Gee, op cit
7. Brenner, Barry, "Emergency Medicine," 1999, New York, page 6 (Brenner wrote 
8. Clark, T.J.H., "Diurnal Rhythm of Asthma," (American College of Chest Physicians), 1987,  page 1375

Why is sputum produced during asthma attack?

Your question:  Why is sputum produced during an asthma attack?

My humble answer:  An asthma attack occurs because you inhale something that your immune system responds to, such as dust mites, mold, cockroach urine, chemicals, etc.  One part of this response is to cause your goblet cells to secrete mucus in order to trap the invading microbes.  As the disease progresses you may even develop an abnormally large amount of goblet cells.  So when you have an asthma attack mucus may be excessive.  

One of the interesting things about asthma sputum is it is usually sterile and white, as I explain here. 

1579- 1644: Jean Baptiste van helmont

From about the time of Jesus to the Renaissance there were few advances in medicine. The Greek terms asthma and dyspnea had made their way into the vocabularies of doctors, yet little was considered about their causes.  Then along came the scientific revolution and Jean Baptiste van Helmont.

Up until this time the works of Galen were considered the gold standard in medicine.  Science wasn't needed, because every thing any physician could possibly need to know about any disease, asthma included, was in one of Galen's books

This started to change when the dark ages ended with the fall of Constantinople -- the final remnant of the Ancient Roman Empire -- in 1453.  This is believed by many historians to have ended the dark ages and sparked a Renaissance where lost Greek and Roman wisdom was recaptured.

It was in 1514 that Galen's reign as supreme master and god of medical superstitions took a major hit.  This was the year Nicolaus Copernicus was questioning the belief that the Earth was the center of the Universe and started writing his theories about the earth rotating the sun.  Out of fear of being rejected and perhaps even killed by the church, his works weren't published until eight years after his death in 1543.  

Jean Baptista van Helmont

This one event got many people to thinking, and became known as the age of reason, or the Renaissance.  This was a time people started questioning the views that were etched in stone by the Ancient Greeks and followed through the Middle Ages. 
This was a time when fresh ideas that were based on science as opposed to superstitions and false logic were formed in physics, astronomy, biology, chemistry, and medicine.  Copernicus was the first to use scientific research as opposed to superstitions in science, and it was Galileo Galilei who risked everything to use scientific reason and publish his works during his lifetime.

Galilei became famous, and because of this he is now called the father of modern science.  He set the way for others to question old scientific and medical superstitions that were regarded as facts, and one such physician was Jean Baptiste Van Helmont, who, in 1579, was born into the dawn of the Scientific Revolution.


Van Helmont was born into a noble family and worked to obtain a degree at Leuven. According to Wikepedia he studied various sciences, but what ended up gaining his interest was medicine.  He interrupted his studies for three years while he traveled to Switzerland, Italy, France and England, and became a physician in 1599, and in 1609 he received his doctoral degree in medicine.

That same year, 1609, he married Margaret van Ranst, who came from a wealthy family.  He and his new wife lived in Vilvoorde near Brussels, and had six or seven children.  The inheritance of his wife allowed van Helmont to retire from medicine early.  

According to bookrags.com he gained fame from his travels and experiences, and was ultimately offered many "attractive jobs", yet in 1609 he turned down all these jobs and "devoted himself to pure research on the principles of nature."

bookrags.com notes that in many ways he followed the teachings of Swiss physician Paracelsus who lived from 1493 to 1541.  Yet unlike Paracelsus, van Helmont did not believe in the Ancient Greek theory that all that ails the human body was due to an imbalance of the four humours:  black bile, yellow bile, blood and phlegm.  

He believed the basic element on the earth was water and he performed experiments to try to prove this.  He grew a tree in a tub for five years and gave it nothing but pure water.  He weighed the tree and soil before the experiments, and in the end the soil weighed the same and the tree had gained 160 pounds.  He attributed the weight gain of the tree as being due to water.

Bookrags notes that he may have come to the wrong conclusion in the end, yet due to his experiment he is sometimes referred to as the father of biochemistry. 

The physician is mentioned in many respiratory therapy books because of his experiments with gases, and it's due to these experiments that he is often referred to as the father of pneumatic (air) science as well.  He was the first to propose that air was one of many substances, and he coined the term "gases" to describe other substances besides air.  The word "gas" comes from the Greek word for chaos.

One of his most famous experiments was when he burned charcoal and produced the substance carbon dioxide.  He explained this was the same product produced from fermenting musk, which rendered the air inside caves as unbreathable.  Yet at that time he did not use the word carbon dioxide, he used instead the word gas sylvestre.

He also described other gases, such as carbon monoxide, chlorine gas (later used as an asthma medicine), digestive gases, sulfer dioxide, and a "vital" gas in the blood that we now refer to as oxygen.  

It's also interesting to note that van Helmont was also an asthmatic, and it may have been for this reason he found his interest in medicine and scientific research.  Later in his life he studied the lungs, and he became the first to dismiss the idea that asthma was a disease caused by an imbalance of the humors and instead was a disease caused by a narrowing of the pipes in the lungs.  


However, while he described bronchospasm accurately, he also concluded in his research that asthma was much like Hippocrates described in that it was "epilepsy of the lungs."  Yet van Helmont went further and concluded that epilepsy of the lungs was caused by the mind the same as epilepsy was caused by the  mind.  In this way, he was also the first to view asthma as a psychosomatic disorder.

His pshychosomatic theory of medicine was later given credence by 19th century physicians and sent doctors and researchers and scientists on a major sidetrack that may have been been a major reason why no adequate advances were made in asthma treatment until the discovery of adrenaline in 1901. 

Yet he generally believed that while asthma was a physical disease of the lungs, it was caused by factors outside the lungs, particularly the mind. 

Likewise, he describes asthma as more than just a disease of the lungs, and he concludes this mainly by observing changes in the rest of the asthmatic body:  barrel chest, catarrh (nasal inflammation), etc.  Yet still the physical ailment is in the lungs, "where the poison attacks directly, where they are produced as at a specific seat," writes Walter Pagel in describing van Helmont in his book, "Joan Baptista van Helmont:  Reformer of Science and Medicine." (page 176)


He adds, "To that extent asthma (as indeed every other disease) is a local and localized affair.  Its poison irritates in the same way cantharides do, and is essentially identical with the poison of epilepsy, but not strong enough to produce the latter."

Van Helmont also became the first to observe based on scientific research that the lungs responded poorly to dust and even fish.  He discovered these triggers caused the lungs in some individuals to contract and, thus, dust and fish were proven to bring on an asthma attack.  

Yet it was due to his studies on the lungs that he ended up clashing with the church.  According to Emergency Medicine*, he described a monk who fell down after eating fish because he was deprived of breathing "so that he was scarce distinguished from a strangled man."  This concept was contrary to the beliefs of the church that an imbalance of humors was the cause of disease.  He was condemned to death until he recanted.

He was basically kept under house arrest for several years, and because many of his beliefs differed from the officials at the schools he worked for, and from the church, that he did not publish any of his works. Instead, on his deathbed, he gave his works to his son to edit and publish.  Only then did we learn what else was up in his elustrious mind.

Yet due to the fact that many of his time refused to believe facts as proven by science and preferred to believe superstitions that were imposed on society 1500 years earlier in by the Ancient Greeks, much of what was in his mind we we will never know. 

So who knows what else the man might have discovered, or written about, had it not been for the paradigm that Galen was the all knowing master of all medical theories, or that Aristotle knew all about astronomy and the earth and it's elements.  

In modern times we now know that van Helmont was correct in his observation that asthma was a disease more so than a humoral process caused by some external poison, and he was correct in distinguishing asthma from other causes of dyspnea.  

Yet his belief that asthma was associated with "epilepsy" of the muscles of respiration, including the diaphragm, and his belief that asthma was caused by the mind, were ideas that would send the quest to understand and find adequate remedies for this disease on a major wild good chase.

van helmont good post

van helmont #2

http://www.google.com/#sclient=psy&hl=en&source=hp&q=van+Helmont%2C+nervous+asthma&aq=f&aqi=q-n1&aql=&oq=&pbx=1&bav=on.2,or.r_gc.r_pw.&fp=67c701de367b5b26

on asthma

Can you use dulera and symbicort together?

Your humble question:  Can you use dulera and symbicort together?

My humble answer:  Both of these medicines are basically the same; they both have the long acting beta adrenergic foracort in them.  You do not want to put too much of this medicine in your system, and therefore you do not want to use them together.  Doing so can have dire consequences.

Your question:  What is better, dulera or symbicort?

My humble answer:  The only difference between these two medicines is the inhaled corticosteroid.  Symbicort has Pulmicort and Dulera has Flovent.  Which one works best is a matter of personal choice.

Your question:  Will I gain weight if I use symbicort or dulera?

My humble answer:  There is no documented evidence either of these medicines will cause you to gain weight.  However, many of us asthmatics may disagree with this.

Your question:  Should you use a spacer with symbicort and dulera?

My humble answer:  Since they are both inhalers I would recommend you use a spacer.  It's proven to make the medicine work 75 percent better.  

Seneca's view of life helped him cope with asthma

I am in love with Seneca the Younger.  He was an asthmatic with allergies just like me, only he suffered with the disease over 2,000 years ago.  His descriptions of the disease were simply amazing, yet more impressive was the way he learned to cope, and the way he wrote about how asthma made him a better person simply for having experienced it.   

And even more  amazing is the methods that he developed to conquer his asthma.  He wrote that you cannot dwell on the past and say things like, "Oh why me?"  You cannot say things like, "No one had ever been in such a bad state."  You cannot say things like, "The torments and hardships I endured."  These thoughts should be banned, he wrote, because they are of little use.  Dewlling on what ailed you in the past does you no good.

Seneca

Likewise, he wrote that you cannot worry about an asthma attack that will strike you in the future either, because that will do you no good.  What you need to do is try to make the best of your life right now.  You need to clear your mind of such evil thoughts.

In his 78th letter to his friend Lucius he wrote that those who suffer through the battle of an asthma attack are like the boxer who suffers even during the trials of training.  He wrote that a boxer does this for wealth and fame.  He wrote, "Let us too overcome all things, with our reward consisting not in any wealth or garland, not in trumpet calls for silence for the ceremonial proclamaiton of our name, but in moral worth, in strength of spirit, in a peace that is won for every once in any contest fortune has been utterly defeated."

He wrote this over 2,000 years before I wrote my post The Seven Benefits of having Asthma and Seven Ways Asthma has Benefited my Life.  I wrote pretty much what Seneca wrote to his friend Lucius, only I wrote it before I ever even discovered who Seneca was. 

To manage his asthma he didn't rely on witchcraft, or magic, or prayer, nor did he rely on remedies based on some poppycock superstitions or false logic.  The way he learned to cope with his disease was by eating well, staying in shape, and by having many friends, diverting your mind so you don't think about the pains in your life.  He generally writes about the importance of relaxing and soothing your mind to remedy pain or dyspnea or any physical ailment. Today we refer to this as relaxation exercises.

He wrote that to think about the misery you put up with in the past, or to fear the future is senseless and will only increase your anxiety and make your disease and your life even worse; that fear and anxiety will only bring on an attack of "gasping for breath" or catahhr (which is the ancient word for the symptoms we now describe as allergies or nasal inflammation).

He writes, "'I am suffering from pain,' you may say.  'Well, does it stop you suffering it if you endure it in a womanish fashion"

He continued, "Plus there are men who have suffered greater sufferings than you have and survived.  In this way you should consider yourself fortunate.  You could have something worse, like "having your arms stretched on a rack or burnt alive... There have been men who have undergone these experiences and never uttered a groan... Surely pain is something you will want to smile at after this."

"But my illness has taken me away from my duties and won't allow me to achieve anything," he wrote as another example of a common complaint of the suffering. 

He wrote:

"It is your body, not your mind as well, that is in the grip of ill health.  Hence it may slow the feet of a runner and make the hands of a smith or cobbler less efficient, but if your mind is by habit of an active turn you may still give instruction and advice, listen and learn, inquire and remember, Besides, if you meet sickness in a sensible manner, do you really think you are achieving nothing?  You will be demonstrating that even when one cannot always beat it one can always bear an illness.  There is room for heroism, I assure you, in bed as anywhere else.  War and the battle-front are not the only spheres in which proof is to be had of a spirited and fearless character:  a person's bravery is no less evident under the bed-clothes. There is something it lies open to you to achieve, and that is making the fight with illness a good one.  If its threats or importunities leave you quite unmoved, you are sending others a signal example.  How much scope there would be for renown if whenever we were sick we had an audience of spectators!  Be your own spectator anyway, your own applauding audience."

In essence, he is saying that you are alive and therefore you have a gift to offer to the world if you see it and if you use it.  Your job is to bring yourself up, rise up, and make something of what you have left in life.  Use what is not ailing you: your brain, your ability to speak or listen, your ability to read and write and to communicate ideas. 

The benefits I wrote about are perspective on life and an appreciation for every breath, a sense of vulnerability in that you know that you will not live forever and that you must get what you can out of life, and give what you can give while you are here.  You know that you might die tomorrow, so you live for today.  you touch as many people as you can.  You read instead of doing things that might trigger your asthma. You write and communicate what you learn.  And, in this way, you are in effect making a difference in the world with the faculties you have left.

"Moreover," he writes, "even if death is on the way with a summons for him, though it comes all too early, though it cut him off in the prime of his life, he has experienced every reward that the very longest life can offer, having gained extensive knowledge of the world we live in, having learnt that time adds nothing to the finer things in life.  Whereas any life must needs seem short to people who measure it in terms of pleasure which through their empty nature are incapable of completeness."

We must never let the things that ail us set us back.  We must continue on and give what we can in this life.

Click here for more asthma history.

Source for above quotes:  Campbell, Robin, Lucius Annaeus Seneca, "Letters from a Stoic: Epistulae morales ad Lucilium, " Penguin, 1969, letter LXXVII.

The asthmatic said: "Who else is gonna do it?"

Several years ago my 75-year-old Uncle Mickey was admitted to the hospital because he fell off a roof.  Once he was feeling better I asked him, "So why did you do it?"

He said, "Who else was gonna do it?"

My first instinct was that anyone could have fixed his roof.  Now in retrospect I understand his answer better, because it -- whatever needed to be fixed -- was something he did himself his entire adult life.  It was just nature for him to take up the task himself.

To ask for help would be admitting he was old, and he wasn't ready for that yet.  

Today as I was cleaning the garage, a week after having my worst asthma attack in ten years during hunting camp last week, I said to my wife, "You know, I really shouldn't be doing this.  But who else is gonna do it?"

She said -- and with a smile, mind you -- "If you never did things because of allergies you'd never do anything.  You'd just sit on a couch getting fat."  

She was right.  We humans -- at least those among us who aren't lazy -- have a natural tendency to want things done, and there are certain things we do ourselves.  A perfect example is cleaning the basement or cleaning the garage.  Who else is gonna do it?

So, despite a chronic condition, or despite aging on my Uncle's part, we just do it regardless of the risk.  We may be a little slower, and we may have to pace ourselves -- in my case I had to quit before I was done -- yet who else is gonna come in and clean up my junk and my kid's junk.

That's right!  No one.  It's a job even an extrinsic asthmatic has to do.  And then we must consider the consequences of our actions.  

While my uncle was a goofus because he didn't want to admit he was aging, there are times I don't want to admit I have asthma.  While asthmatics like me want to be normal, we really aren't.  We will always have limitations due to our asthma.  

The trick is to make the best of it. The trick is to get the most out of life given our limitations.  Yet a truly gallant asthmatic will admit his limitations and find someone else to clean the basement and garage.

So I guess the purpose of this post is to admit that your humble asthmatic RT here is not a true gallant asthmatic.  I'm also not normal, if you know what I mean:  I have extrinsic asthma.

Why did Hippocrates believe evil spirits didn't cause asthma?

Your asthma question:  Why did Hippocrates believe evil spirits didn't cause asthma?

My humble answer:  I believe Hippocrates came from a medical family that believed there was a physiological cause to disease.  His school of medicine was actually one of the first in history not to believe that diseases were caused by evil spirits.  Likewise, he was among the first to try to find real remedies to diseases rather than simply chanting and praying.  He believed diseases were the result of an imbalance of the four humors in the body:  phlegm, yellow bile, black bile and blood.  If he believed a disease condition was caused by too much blood, his cure was to bleed the victim.  While his theory of diseases was incorrect, it was pretty much taught for the next 2,000 years.  

My advanced directives

Of course I'm only in my early 40s, but I was thinking about filling out an advanced directive.  The main reason is because I have a chronic lung disease and I don't want to suffocate at the end of my life.  So if my disease gets the better of me I want to have it in ink how I want to end my life.

So long as the reason is to help me overcome an acute illness, I have no problem with being a full code and being placed on a ventilator short term.  Yet if I'm in a coma, or if I'm in such a condition that there's no chance of a normal life, I want to be taken off a ventilator and let nature take its course.  I don't want to be kept alive if I've taken such an anoxic hit there's no hope of me being me. 

I also see a lot of doctors not wanting to oxygenate people with certain diseases.  Recently we had a patient with an oxygen level unsustainable with life.  The patient was very uncomfortable as a result.  Yet based on some stupid philosophy, the doctor decided not to oxygenate that patient.  God forbid that happen to me.

So I'd like to place in my advanced directives that my PO2 always be greater than 60.  In other words, I don't want to suffocate.  I want to be oxygenated. 

I also want in my advanced directive that no matter what condition I'm in that I be allowed to have as many bronchodilator therapies as I want in a day.  I don't want some doctor telling a nurse that I can only have one treatment every four hours when I need one every hour. 

If you're reading this blog chances are you have a lung disease too.  And even if you don't, it's never too early to fill out an advanced directive.  You can do so by following this link. 

Invincible asthmatic no more

Since I've started writing about asthma three years ago my asthma has been perfect.  This has meant that much of what I write on this asthma blog  has been based on asthma memories.  Yet that all came to an end last weekend at hunting camp.

It had been so long since I had a really severe asthma attack I started to feel like an Invincible Asthmatic, or one who feels he's never going to have that really bad asthma attack again.  It's simply not going to happen.  He's sees his asthma doctor regularly, takes all the best asthma medicines correctly, and has very good control of his asthma.

So then his asthma becomes under such great control that he decides he can live a completely normal life.  In my family, normal for a guy is going to hunting camp with the guys and having some fun.  Normal is not packing your own sheets and pillows and using whatever is in the cabin. Then when you're done having fun you sleep in the dusty and musty cabin, the same place where the guys smoke their cigars.

Yes, that's what I did.  I drank a few beers -- not toooo many, yet just enough so I didn't want to risk driving -- and observed as a huge stack of wood was burned. Every guy at camp stood around the fire, and the fire burned so bright that you could see the faces of everyone, and you could see as far back as the cabin as well as you might at noon.

I stood by the fire until there was nothing left but red and blue flames amid hot coals.  It was a great fire, and as the crowd of guys filtered away toward the cabin, me and three of my brothers hung around the pile of smoking ash for quite some time.

Around midnight I decided I had enough and entered the cabin.  As soon as I entered the door cigar smoke hit me and in my surprise I inhaled deep. My throat instantly burned.  I looked down and my little brother Tony was sitting in a chair by the door smoking his cigar with a big, cool grin.  He was being normal.  He was having fun.  Yet he was disregarding my dad's rule:  no smoking in the cabin when Rick is around.

I don't enforce that rule:  my dad does.  I think if the guys go to camp they should be able to be guys, and part of being guys is doing things you can't do at home, like drink or smoke cigars and use ribald words.  Yet my dad remembers the days he spend with me when I was a kid in the hospital and enforces the rule.

As I was closing my bedroom door I heard dad telling Tony to put out his cigar in the cabin.  Then I lied down on the musty smelling pillow and covered myself with the dusty blanket.  "One night and I'll be fine," I thought.  "All I have to do is make it one night.  My asthma's been fine, so I'll be fine.

Then a coughing fit hit me.  My throat and chest started to burn.  My breath came in short gasps.  I couldn't take in a deep breath.  I tried over and over and no breath would go in. 

I took 2 quick puffs on my albuterol inhaler:  no relief.  I took 2 more:  no relief came.  I took several more:  no relief.   I sat up and heard snoring.  Uncle Timmy had already fallen asleep in the bed next to mine.  At first I was afraid my gasping would wake him, then I didn't care.  I was in full panic mode.

This is the kind of crap that happens when you are a goofus asthmatic, even if you're a goofus asthmatic for one day.  I listened as the other guys said their good-nights and listened as the floor creaked as the guys walked to their respective rooms, and heard footsteps up the steps.  I heard doors slam one after another.  And then there was silence.

Now you might be thinking:  why didn't he just tell his dad or brothers he was having an asthma attack.  The answer to that was simple:  what are they going to do?  I had been drinking, and so had all of them.  You see, we didn't come to the cabin to gossip and talk about tooth ferries, we all came to the cabin to do things we aren't allowed to do when we are home.  So I didn't want to bother any of them.  And even if I did bother them, not one could drive me anywhere anyway.

This reminded me of when I was a kid and was having an asthma attack yet didn't want to bother my parents.  I didn't want to ruin their sleep. So I decided to tough it out, just like when I was a kid.  I tried to sleep, yet sleep never came.  So I went into the kitchen and sat in a chair.  "If I could only fall asleep everything would be all right.  

Yet I did fall asleep.  And I had dreams I was trapped.  One dream I was trapped in a room and finally escaped, only then I couldn't move my arms or legs.  My dreams were only fitting, because in real life I had air trapped in my lungs, and I was trapped in the cabin, and I was all alone suffering from the worse asthma attack in years.

By morning I didn't feel much better, and left before my dad even made breakfast.  Breathing was easier back home, yet it took a few days of taking it easy before my breathing was back to normal.

The only reason I'm writing this here is to make the point that even the best asthma expert can be a goofus asthmatic.  Yes, and it's only the goofus asthmatic who thinks he's also an invincible asthmatic.

4 B.C. to 65 A.D.: Seneca learns to cope with asthma

"My own advice to you -- and not only in the present illness but in your life as well -- is this: refuse to let the thought of death bother you: nothing is grim when we have escaped that fear."  Seneca

Seneca the Younger was another fellow asthmatic who walked the Earth while Jesus did.  Seneca is by far my favorite historical asthmatic, mainly due to his vivid descriptions of what it was like living with this disease 2,000 years ago when treatment for it was basically a crapshoot.

He was born in Greece but was a Roman at heart.  He lived from 4. B.C. to 65 A.C. and, like Pliney the Elder, he chose to use "difficulty of breathing" rather than the Greek term asthma.  He was a vivid -- very vivid -- writer through much of his life, and he wrote about his asthma because his asthma pretty much set the course of his life -- much like myself.

Seneca (4 B.C. to 65 A.D.)

Robin Campbell, in his 1969 book, "Letters from a Stoic: Epistulae morales ad Lucilium," wrote that Seneca was born in Cordoba and lived while Jesus walked the Earth.  He suffered from "severely ill health, particularly asthma," throughout his life."

 Mark Jackson, in his book, "Asthma:  The Biography," explained that Seneca spent several years in the drier climate of Egypt during his childhood.  He also suffered from chronic catarrh, which is a description in many older books to describe the symptoms inflammation of tissues lining the respiratory tract (mainly the nose) resulting in increased secretions.  We now call it hay fever, nasal allergies, or rhinitis.

He paid careful attention to his diet, and was a teetotaler. He was likewise a Stoic, in that he believed there was no life after death, and his time in this life was all that he had.  He studied law, and later became a Senator.

Campbell further explained that in 37 A.D when Caligula succeeded Tiberius as Roman Emperor, Seneca had worked his way to leading speaker of the Senate, and the emperor was so jealous of him that he called for Seneca to be executed.  Yet Seneca was rescued by a woman close to the throne who said Seneca was "suffering from tuberculosis and it would not be long before he died."

It's difficult to know whether Seneca had tuberculosis or asthma, although many historians believe he had neither:  they think he had cardiac asthma, which is heart failure. 

Seneca was expelled from Rome for eight years for committing adultery. 

Later, in 49 A.D. Seneca was recalled to Rome and became tutor to a boy named Lucius Domitius Ahenobarbus, who later became the emperor Nero.  This was about the same time Alexander the Great was being tutored by Aristotle.  Claudius died in 54 A.D. and some suspected Seneca as the killer, although there was never any proof of this found.

Ironically (I will write about this later in my history of allergies), Nero had a stepbrother named Brittanicus who was his elder.  Yet Brittanicus had an allergy to horses, and was therefore unable to participate in many activities.  Since Brittanicus was viewed as inferior, Nero succeeded Claudius to the throne. 

One would think that with an instructor with allergies and asthma that Nero would have had empathy for his brother.  Yet this was not the case, as it's believed Nero had Brittanicus poisoned to death.  Yet I digress.

Seneca is mentioned in the writings of Pliney the Elder, and it wasn't until the last three years of his life that Seneca dedicated to philosophy and writing full time.  In 65 A.D. a plot to kill the emperor Nero was uncovered and this resulted in the deaths of many close to the king. 

Seneca was asked to commit suicide, and he did.  It ended up for Seneca being a long and painful death by suffocation from fumes and bleeding.

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