My daughter's asthma attack, and the arrogant doctor

My daughter, Mrs. L, all three years of her, was introduced to the asthma beast this past week.  She required a breathing treatment a few weeks ago and it worked like a charm.  Yet last weekend the asthma beast struck with a vengeance.

She woke up in the night coughing.  I gave her a breathing treatment and it seemed to work.  Yet the next night she was up crying.  I entered her room and she was sitting up in bed.  It didn't take much convincing for her to let me carry her to the living room.

The nebulizer -- the community nebulizer for my family -- was already set up next to the recliner I set in with her.  I grabbed an amp of Albuterol and squirted it in, and revved the machine to life.  You can always tell when a kid benefits from a bronchodilator because she sits through it. 

Yet the treatment did little to relieve her coughing.  I sat up with her for an hour watching some old cartoon I can't even recall what it was.  Quite frankly I don't think she did either.  In fact, we didn't even have the sound on.  The vision of a toon was all that was needed to placate my daughter.

I was emotionally into this, because I could remember vividly sitting up in bed all night long when I was a kid not being able to breathe, and my parents had no clue.  It's not like they didn't care, they just didn't know.  I didn't want my child to have that scar, so I doted her.

The next day, Sunday, my wife or I had to give her a breathing treatment every few hours.  She probably could have used one more frequently.  Yet it was enough for us to realize she needed more than bronchodilators:  she needed systemic steroids.

Her doctor was out of town, so that posed a problem.  If she was in town we would have called her and she would have written a script for prednisone.  She knows me and my wife.  She knows I'm an RT and a lifelong asthmatic.  She knows we have a pharmacy here and everything except steroids to keep an asthmatic full of fresh air.  Yet she was out of town.

Dr. B. is a new doctor and I've worked with her enough to be impressed with her.  Yet she said she wasn't familiar with Mrs. L enough to just prescribe something over the phone.  So she recommended we take her to the ER. 

This posed a dilemma. Surely we had no problem taking her to the ER, but my wife and I both know that a trip to the doctor's office usually results in an assessment and a quit treatment of the cause of the problem.  Then you go home and that's that.  You get better. 

Yet if you go to the ER they have to do a bunch of stuff just to cover the butt of the doctor.  Labs will be drawn, an x-ray will be given, and an IV will be put in.  We mentioned this to Dr. B. and she said she'd call the ER doctor with her recommendation.

Great!  Or so we though.  The ER doctor was pissed that Dr. B called her.  The ER doctor was condescending and arrogant to my wife.  She said something like, "It doesn't matter what your doctor said.  I'm here and I'm assessing your daughter.  I have to do what I think is needed.  Dr. B. is not here."

My wife said she wanted to walk out the door right there.  If her daughter didn't need the steroids right now that's what she would have done.  And this is the hospital I work at.  The nurses tried to take a pulse ox on my daughter's food, and my daughter said, "Go away!  Leave me alone!"

My wife said, "Why don't you guys leave and I'll get a pulse on on her finger."

Yet they insisted on getting a pulse ox on her foot.  Here my daughter, my shy daughter who is deathly afraid of people, has five nurses holding her down to get a pulse ox.  My daughter cried and fought vehemently. Good for her.  I wish she would have fought harder.

The doctor peeked her head in at this time and said, "Well, she's crying.  So she must be breathing fine."  My wife responded, "Wait for her to stop crying and you'll see she's retracting and her fingers are blue."

The doctor left.  The nurses left.  My wife got a pulse ox reading in about 2 seconds once they were out of the room.  My daughters oxygen saturation of 82%.  That's not good.  And this all happened in triage.  When she finally got to her room my wife had to fight off the impulse of the doctor to insist an IV and labs be drawn.  Yet my wife stubbornly resisted.  I am proud of her.  "All she needs is steroids," my wife insisted.

The doctor was pissed.  She listened to Mrs. L. with her stethoscope.  She said, "She's wheezing.  She has inspiratory and expiratory wheezes.  Inspiratory wheezes are the worse kind.  You should have come in sooner.  If you need to give treatments every two hours you need to come to the ER."

My wife rebutted her comment:  "We did come to the ER."  And she probably thought, "You dumbF#$@!"  I know my wife thought that because I know my wife.  Yet I bet that doctor would doubt me. 

The doctor prescribed a steroid drink, and my wife said Mrs. L. won't drink it.  The doctor said, "We'll mix it up in a pop and she won't even know the difference."  My wife said, "She's never had a pop in her life, so she probably won't even know what pop is.  She won't drink that."

So you can see this made for an interesting visit.  Finally my wife said, "She's not going to drink this stuff.  Let's just give her the shot and get it over with."  Five nurses held Mrs. L. down, and she didn't even fight.  Later that night she said to me at home, "Daddy, I got a shot and I didn't even cry."  She smiled.  She smiled because she knew the shot made her better. 

Yet. Steroids work on asthmatics in my family.  We don't need labs and xrays and IVs and all that unnecessary stuff.  Surely if the steroids didn't work you can look for something else. 

My wife said the nurses were great.  Later I talked to one of these nurses about that doctor, and she said the doctor has to cover her butt.  Yet I said, "A doctor should also respect the wishes of the parent.  A parent knows her child more than a doctor does.  Not to disrespect the wisdom of that doctor, yet she really needs to respect the parents, especially when the parents are a nurse, and an RT who is a lifelong asthmatic.  It's not like there's no experience here.  We're not your typical ignorant parents."

This is exactly the reason I never go to the ER when my asthma acts up.  The last time I was an ER patient they took me off my theophylline and almost killed me.  Eight days later a different doctor put me back on my theophylline and I miraculously got better.  So if you have asthma, and you know what works for you, and the doctor wants to do something totally different, who's right? 

That steroid shot gave my daughter almost instant relief.  She ran around the living room that night the way I'm accustomed to seeing her, all happy and cheerful.  In the end, that's what's most important.  As far as the rotten ER doctor, she was a rental doctor and both my wife and Dr.B. reported her arrogance to the powers that be.

Thank God for asthma hybernation

Thank God for asthma hibernation.  This awkward disease has a way of hiding in the sand for years making it's owner think the beast has left the building.  Then just as you think it's gone WHAM!  it hits you like a mack truck smashing into a possum on an expressway. 

Thank God for asthma hibernation.  It made for five good years.  It made for five hunting camps.  It made for five years of emptying boxes and moving furniture in the basement.  It meant five years of raking leaves.  It means five years of playing catch with my son.  It means five years of rolling in the grass with my younger kids.

Yet asthma hibernation has it's own dark side, and this can be deadly for some.  Because by not showing it's ugly head you might think the asthma beast is gone forever, and you enjoy yourself too much.  You spend time around your allergens.  You tempt the beast this way.  There's this old rule that you never mess with a sleeping giant.

Thank God for the sleeping giant.  Yet while surely you should enjoy the days when it's gone, you should never tempt it.  You shouldn't stand by the fire at hunting camp, inhaling the fumes and scents, even though that's what everyone else does.  You can't because the beast may strike.  The beast did strike.

Thank God for the sleeping giant.  Yet while surely you should clean your basement, you should limit yourself to a few minutes on the job as opposed to working until the job is done.  Because in doing this your allergies struck, and then it hit your lungs.  And then it wiped you out. 

Thank God for asthma hibernation.  Thank God the beast goes away for a while.  Yet we also thank God for the medicine in the cabinet that can make the beast's tail loosen up its squeeze on your air passages. 

Thank God for that five year old thralling pill that finally gave me my breath back last night.  Those three continuous breathing treatments didn't do a thing. The panic was real.  The anxiety was real.  Yet that five year old pill, the one you weaned yourself off of after 30 years of chronic theophylline dependence, was staring at your face.  "Why not?  What do you have to lose?"

It went down.  You laid down to get some rest, hoping, praying you'd fall asleep -- eventually.  You sit high up on the pillow, concentrating on each breath.  The breaths didn't go in all the way.  Dyspnea.  Air hunger.  panic.  Calm.  Calm. You try to convince yourself

Than, 30 minutes later, unexpectedly, it came in all the way.  Did it really happen.  You inhaled again, the asthmatic did.  He inhaled.  It went in again.  A feeling of euphoria ensued like he knew he could never explain to someone who didn't have this disease.  The 5 year old theophylline pill worked.  It worked.  Sleep came.  Rest.  Rest.

The next day you could feel the allergies.  Your eyes are sore and red.  Your chest burns from all the heaving of each breath the night before.  Yet you feel joy knowing the breaths came in.  Air. Fresh air.  What a joy.  Yes.  We asthmatics will never take air for granted, as others do. 

Thank God for air.  Thank god for the ability to breath it.  Happy Thanksgiving.

1710 to 1790: William Cullen the nosologist

As we enter the 18th century in our history of asthma we can see that the personal opinion of the so called asthma expert started to take a back seat to scientific theory. One of the first to base his asthma writings on studies he performed was William Cullen.

According to Encyclopedia Britanica he was born in 1710 to the lawyer of the Duke of Hamilton.  In 1734 to 1736 he studied medicine at the University of Edinburgh, and it was here that he became interested in chemistry.  In 1736 he started a medical practice in his home town of Hamilton and lectured on science at the University of Glasgow.

William Cullen (1710-1790)

He quickly earned himself a good reputation.  In 1741 he married and had children who would also earn fame.  Throughout most of his adult life he would study natural medicine, and was particularly interested in scientifically classifying diseases. He thus became a nosologist.

 He believed that most diseases were fostered by some kind of disorder of the nervous system, and that the muscle was "a continuation of nerve."  This belief affected his description of asthma, it's causes, and the remedies to treat and prevent it. (1)

Still, when it came to asthma, he found the task of classifying it as a disease, and distinguishing it from other forms of dyspnea, to be a major challenge.  The main reason was because most physicians of his day were stuck on the idea that all or most shortness of breath was asthma.

Cullen became one of the first asthma experts to base his beliefs, or at least try to confirm them, based on studying signs and symptoms of that disease while a person was alive, and comparing it with what he saw in autopsy.  This would become a common trend followed into the 19th century.

The fact that he saw defining asthma as a challenge can be observed by the following quote from 1794: 

"The term asthma has been commonly applied . . . , even by many . . . specialists, to every case of difficult breathing. ... By not distinguishing it with sufficient accuracy from other cases of Dyspnea, they have introduced a great deal of confusion into their treatises on this subject." (2)

He then wrote in his book, "First lines of the practice of the phych****," that asthma "may be most properly applied, and should be confined, to a cafe of difficult breathing that has peculiar symptoms, and depends upon a peculiar proximate cause which I hope to assign with sufficient certainty." (3)

He likewise notes that even while some authors have defined asthma as spasmotic asthma, they have not distinguished the term from other forms of dyspnea. Cullin would propose that the term asthma be used to denote spasmotic asthma alone, and not other conditions that cause shortness of breath. 

Thus, in his 1772 book "synopsis Nosologiae Methodicaei*," he defined asthma as:

Difficult respiration recurring at intervals, with sense of stricture in the breast, respiration performed with a wheezing noise; difficult cough at the beginning of the fit, sometimes none, free towards the end; and often with copious discharge of mucus."  (4)

In his book, "The first lines of the practice of the psychic****(page 397)," he described asthma as: "spasmotic, constriction of the muscular fibres of the bronchiae: which not only prevents the dilation of the bronchiae neccessary to a free and full inspiration, but gives also a rigidity which prevents a full and free expiration like many other convulsive and spasmotic affections is readily excited by a turgescence of the blood, or other cause, of any unusual fulness and distention of the vessels of the lungs (inflammation?)"  (5)

He also noted the following "facts" about the diseas****:

• It's hereditary
• It seldom occurs early in life, and hardly to the time of puberty, or after it
• It effects both sexes, but most frequently the male
• I have not observed it to be more frequent in one temperature or another
• It does not seem to depend upon any general temperment of the whole body, but a particular constitution of the lungs alone (it's not psychosomatic?)
• It frequently attacks... but hardly ever continues to be repeated for some length of time without occasioning an emaciation of the whole body
• Attacks are generally in the night or toward the approach of night (yet occassionally in the day)
• It comes about suddenly
• It may go into remission
• It is there for the person's whole life
• Returns happen with different circumstances with different persons
• Fits are more frequent in the summer
• It may threaten immediate death, seldom occasions it
• Many persons have lived long under this disease
• Seldom entirely cured
• It effects each person differently
• Each patient has unique external triggers  (6)

The following are the signs and symptoms of asthma****:

• Sudden dyspnea
• Tightness of of stricture across the breast
• A sense of straightness of the lungs impeding inspiration
• Desire to get into an erect position
• Desire for free and cool air
• The difficulty of breathing goes on for some time
• Both inspiration and expiration are performed slowly
• With a wheezing noise
• Speaking is difficult and uneasy (in violent fits)
• Often some propensity to coughing, but it can hardly be executed
• Sometimes the pule is increases
• Sometimes fever (usually with increased pulse)
• If urine is voided early it's usually with little colour or odour
• If urine voided late it's usually of a high color and sometimes deposits a sediment
• Sometimes the face is flushed and turgid, more commonly pale and shrunk
• After long continuance, it often ends in a hydrothorax
• Occasionally some aneurism of the heart or great vessels (it thereby proves fatal) (7)

Even after some sleep and the breathing becomes easier and easier, the following signs and symptoms may continue for some time:

• Feels some soreness across chest
• Cannot breathe easy in horiontal posture
• Can hardly bare any motion of his body
• In afternoon has uneasy flatuency of his stomach
• Unusual drowsiness
• Difficulty of breathing returns toward evening
• May occur for several nights
• Followed by remission (especially after coughing up copious sputum) (8)

These symptoms may continue for many hours, "then a remission takes place by degrees; the breathing becomes less laborious and more full, so that the person can speak and cough with more ease, and, if the cough brings up some mucus, the remission becomes immediately more considerable, and the patient falls into a much wished for sleep."  (9)

Causes are generally unique from person to person.  The following are what Cullen would describe as asthma triggers, or things that cause the disease to be "readily excited"****:

• External heat (weather or warm chamber)
• Warm bathing
• Summer weather (particularly dog days)
• Changes of weather (especially sudden colder to warmer)
• Full meal
• Air in stomach
• Exercise (or whatever else can hurry the circulation of the bloos)
• Cold
• Excitement of nervous system, as by passions of the minds
• Odors
• Smoke
• Dust  (10)

He wrote that while the disease cannot be cured "by our art" the patient "can escape the disease by escaping the occasional or exciting causes, which I have endeavered to point out above."

He observed the disease is seldom cured and therefore he "cannot profile any method of cure which experience has approved as generally successful."  However, he does propose some remedies that his observations have shown to be successful during an accute attack or to prevent such an attack.

The remedy generally depends on the cause of the symptoms.  From here he classifies asthma into three groups**:

1.  Idiopathic:  Without manifest cause, or being accompanied with other disease

2.  Symptomatic:  From erruption or other acrid effusion being repelled

Two varieties:

• Gouty (asthma arthriticum): I believe here he's referring to asthma that results from swelling of the air passages. He calls it gouty becasue it mimics the inflammation from gout or arthritis.
• Syphilitic (asthma venereum): Again, this is possibly referring to inflammation in asthma being similar to that of syphilis. (11)

3.  Other asthma dyspneas and orthopnea symptomatic of cardiac and pulmonary difficulties and obstructions (what we might now refer to as heart disease, heart failure, heart attacks, etc.) or what we might refer to as cardiac asthma)

Thus, if asthma arrises from "difficult transmission of the blood through the vessels of the lungs (swollen broncheolar muscles), threatening suffocation," the best remedies are noted below. (12)

It should be noted here that instead of basing his asthma remedies on his own experience, Cullin performed studies. Based on his research, he determined the following remedies for asthma:

• Blood letting (less and less necessary as disease progresses)
• Emollients (empty stomach is beneficial)
• Moderately laxitive glysters (have been found to give considerable relief)
• Gentle vomits by emetics (flatuency of stomach are frequent attendants, and very troublesome for asthmatics, used to prevent and treat asthma)  (more useful in winter than summer****)
• Acids and neutral salts to treat asthma fits excited by turgescence of blood (also recommended by Floyer "On the Asthma."
• Ether (an antispasmotic found to give relief but not long lasting)
• Opium (Best antispasmotic has been found effectual and safe)
• Good diet
• Gentle exercise (riding horseback, going in a carriage, sailing, 
• Flowers of zinc**

The following he proved to not work:

• Purging (seldom found to relieve vessels of thorax)
• Blistering between shoulders or on breast (rarely found it useful)
• Fetid gums (an antispasmotic proved not to work and be sometimes hurtful)
• Musk (antispasmotic not properly tried)
• Liquors (few asthmatics can bear strong, warm, tepid drinks because it weakens nerves of stomach)
• Tea
• Coffee
• Emetics***** (The effects of full vomiting cannot be durable, nor its operation be conveniently repeated, so full vomiting cannot always be employed to prevent the recurrences of the... spasm)

Of interesting to note is Cullen's opinion about opium.  He may have been the first to describe the use of antiispasmotics to relieve a fit of asthma, and he said that in pure asthma opium has been proven to work, and when it hasn't worked he beleives the reason is because the dyspnea was probably not caused by spasmotic asthma but some other cause. 

If asthma is of the pure spasmotic form opium may be used opium may be used "both to prevent and to moderate fits with great advantage.  However, with other forms of asthma "where the disease depends upon turgescence of the blood in the lungs, opium can hardly be used with safety.***"

He adds that, "even when the disease is of the catarrhal kind (nasal inflammation), if it be fit to use opium to relieve the catarrh, it may be likewise employed to relieve the asthma depending upon it.  But I must conclude by remarking, that in both the spasmotic and catarrh asthma, I have frequently employed opium in moderating the disease; but have never found it to prove an entire cure of it***."

Yet he concluded asthma in the "pure spasmotic form" worked quite well according to his studies.

Click here for more asthma history.

References:  (This post is currently being edited for accuracy, sorry for the inconvenience, Rick, 1-31-12)

1. ???
2. ???
3. ***Cullen, William, Benjamin Smith Barton, "Professor Cullen's treatise of the materia medica," Philadelphia, 1812, page 175
4. Cullen, William, "Synopsis Nosologiae Methodicaei," *
5.  ****Cullen, William, "The first lines of the practice of psychic," Vol. III, Edinburgh and London, 1784, pages 387
6. Cullen, ibid, pages
7. Cullen, ibid, pages
8. Cullen, ibid, pages
9. Cullen, ibid, page
10. Cullen, ibid, pages
11. **Jackson, Mark, "Asthma, Illness and Identity," The Lancet, Volume 372, Issue 9643, Pages 1030 - 1031, 20 September 2008
12. ????

1.  
2. *Cullen, William, "Nosology: or, a systematic arrangement of diseases, by classes, orders," London, 1800
3. to 410
4. *****Cullen, William, "A treaties of the Materia Medica," Vol. II, Edinburgh, 1889, page 469

Other readings:

• Cullen,William,"The Edinburgh practice of physic, surgery, and midwifery" Vol. II, London, 1803

I think I can... I know I can...

Like the little Engine that could...

1. I think I can be patient today
2. I think I can go a week without complaining
3. I think I can lose 15 pounds by January
4. I think I can be a better husband
5. I think I can be a better dad
6. I think I can be a better coworker
7. I think I can be a better respiratory therapist
8. I think I can spend more time with my 13-year-old
9. I think I can be a more active American
10. I think I know what I'm talking about

Like the little Engine that could...

1. I know I can be a good dad
2. I know I can be a good husband
3. I know I be a good teacher
4. I know I can spend more time reading
5. I know I can get myself in better shape

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

1138 -1204 A.D.: Maimonides writes asthma book

Maimonides (1138-1204 A.D.)

While few may know this, the Muslums may be credited as saving ancient Greek and Roman medical theories for modern times.  This is because while the Western world was engulfed in the dark ages, the Eastern world was full of rising societies.

Europeans were so busy feuding amongst themselves and destroying towns and libraries, the Muslims were growing a society in Arabia and Spain.  In essence, through their travels, the Muslums brought Greek and Roman medical wisdom to Spain.

Maimonides was not a Muslim but a Jew who lived from about 1138 to 1204 AD.  He was among the most famous writers, physicians and philosophers of his day.  He was born in Muslim controlled Spain and learned from his father, who was a Jewish teacher and Rabbi.

Fred Rosner, in his book "The medical legacy of Moses Maimonides" explained that Maimonide's father, Maimon, instilled in him an interest in the sciences and philosophy.  He was blessed with a mixture of Ancient Greek, Roman, Medieval Arab and Hebrew wisdom of all ages. (1)

Despite all his writings, he left very little along the lines of opinions about everyday life, so we know little about his life and personality.  (2)

He was born during the the time of the crusades where Christians traveled to the Holy land to free the city of Jerusalem from the Muslims, who captured the Holy lands from the Bryzantines in 638 A.D.  In order to avoid religious persecution in Spain, Maimonide's family fled Spain and ended up in Fez, Morocco.

While in Morocco, Maimonide's became an avid reader of many of the medical writings obtained from the ancient Greek and Romans, particularly those of Hippocrates and Galen. 

He later wrote that Galen observed Hippocrates to be wrong in many areas of his writings.  But instead of saying, "Hippocrates was wrong," he would cover for Hippocrates, even to the point of changing Hippocrate's meaning, or crediting the error to other writers and not Hippocrates himself.

The family ended up in Egypt, and this is where Maimonide's skill as a physician took off.  The author's of Emergency Medicine  write that "he became appointed as the physician to the great Saladin and then became physician to the Saladin's son, Prince Al Afdal Nur ad Din ali, when the Prince assumed the throne at age 40 in 1193." (3)

Maimonide's wrote a lot during his lifetime, and most of his books were written to someone who requested some type of medical advice.  For example, in the last 14 years of his life he was asked by the Prince to provide some advice on how to live with his asthma.  Maimonide wrote to him that asthma was usually started with a cold and advanced to shortness of breath.

Maimonides ended up writing his "Treaties on Asthma," where he recommended against trying any magical cures for any ailments, and any such remedies should treat the cause as opposed to just the symptoms.  Treatment should also be based on age of the patient and the season, as the disease might be seasonal.

He wrote that ultimately during the course of (an asthma attack) the patient later gasped for air and coughed up a wad of phlegm.

Rosner explained that Maimonides might have been the first to describe psychosomatic medicine when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. (4)

Rosner wrote that Maimonaides also adds that "gaiety and joy gladden the heart, and stimulate the blood and mental activity.  Excessive indulgence in the pursuit of pleasure, however, is injurious to one's health.  The avoidance of illness induced by such excesses is by conducting oneself according to ethical and moral principles."

He likewise noted that asthma usually starts as a cold during the rainy season.  However, modern historians aren't sure if Maimonide's description is asthma or some other similar malady.

He's also perhaps the first to describe how city air pollution may be the cause of asthma.  He writes:

"Town air is stagnant, turbid, and thick; it is the natural result of its big buildings, narrow streets, and garbage... Air winds carry stealthily inside the houses and many become ill with asthma without noticing it.  Concern for clean air is a foremost rule in preserving the health of one's body and soul."

He recommended many herbs to be inhaled and was the first to recommend chicken noodle soup as a remedy for breathing trouble.

Aside from chicken soup, his remedies included:

• Clean air
• Healthy eating (he recommends eating certain foods and avoiding others)
• Healthy drinking
• Controlling emotion (was this an early reference to psychosomatic asthma?)
• Exercise
• Rest
• Sleep
• Wakefulness
• Excretion
• Retention of wastes
• Bathing
• Massaging
• Avoid gas producing foods (causes bloating)
• Chicken soup (acute asthma only and only if patient is afebrile)
• Moderate exercise prior to eating
• No exercise right after a meal
• Dry months
• Small quantities of wine
• Enemas to cleanse the bowels (induce bowel movement and to drain thick juices)
• Emetic (severe cases only)
• Aromic herbs (to fortify the brain and dry out any humidity therin)
• Emetics to cleanse the stomach (cause vomiting)
• Sleeping after bathing is good, yet bath water should be warm and contain salt
• Various compound remedies (5)
• Travel to dry regions 
• Moderation of sexual activity (6)

He advises against the following common "excessive" remedies from other physicians because they "involve strenuous physical and emotional exercise.":

• Sexual intercourse
• Blood letting
• Hot baths
• Urine stimulation (such as diuretics)
• Purgation (never on healthy people because it doesn't preserve health)
• Sleeping immediately after meals is harmful
• Washing with cold water after meals is harmful
• Excessive bathing during acute attacks (due to wet climate created)
• Opiates (except in severe cases (7)

Possible triggers:

• Wet seasons
• Excessive drinking
• Pollution (8)

Maimonides makes a point to emphasize what Hippocrates noted years earlier, which is to put your life in the hands of someone who bases his wisdom and remedies on scientific training as opposed to someone who treats based on superstition or faith. Worded another way:  Science is better than quackery.

 Likewise, in many instances it may be better to do nothing than to risk greater harm to the patient.

References:

1. Rosner, Fred, "The medical legacy of Moses Maimonides," Chapter 2, "A Treaties on Asthma,"   page 13
2. Yellin, David, "Maimonides," Israël Abrahams, Jewish Publication Society of America, Philadelphia, 1903, page 3
3. Brenner, Barry E, editor, "Emergency Asthma," 1998, New York, page 13
4. Rosner, op cit
5. Rosner, op cit
6. "Asthma History -- Through the Ages," Medical News Today
7. Roster, op cit
8. Roster, op cit

What is the blog "Hardluck Asthma" all about?

Your humble question:  If you were in an elevator and someone asked you about your blog, what would you tell them? 

My humble answer:  On my Hardluck Asthma blog I write about what it's like to live with asthma.  What are the day to day challenges of being an asthmatic?  I also write a lot about the history of asthma.  I try no write from a unique perspective of the disease as to not make my blog a repeat of other asthma blogs, although I sometimes fail at that.  I have three other blogs, and this one is my ME blog.  This is where I get to write about me, my asthma, and how it effects me personally.  I also spend some time writing my asthma story, or what it was like living with asthma when I was a kid.  I had it bad, so bad in fact that I once made over 17 visits to an ER one year, and once spent six months in a hospital.  I like to write about that and a whole lot more asthma stuff.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Heed the warnings on asthma medicine

Task for the day:  Open a book.  Point to a page.  Free write for 10-15 minutes on that word or passage.  Post without editing if you can.  

My response:  I'm looking at a page in "Asthma:  The Biography," by Mark Jackson.  This is a remarkably thorough read about the history of asthma.  The page I'm looking at discusses fatal asthma.  

In the 19th century many doctors wrote that they rarely ever observed any one dying of true asthma.  It was a disease that caused some suffering for a few days, yet usually let up eventually.  My asthma is like this.  I have an attack, it can be terrible, yet in a few days I know I'll get better whether or not I take medicine for it.  The difference between now and the 19th century is today we have medicine to relieve our suffering.  No one should have to suffer from a bad asthma attack anymore.

Yet no one died from asthma back then.  That changed in the 20th century.  It changed when epinepherine was used to treat asthma in 1900.  Asthma deaths spiked again after the rescue inhaler was invented in 1952, and the first long acting rescue medicine was invented in the 1970s.  

The first impression of asthma doctors was to blame the same medicine that helped asthmatics.  They believed the medicine was killing asthmatics.  The main cause of death was considered to be due to the cardiac effect of the medicine.  This usually resulted when patients would abuse the medicine.

I think this may have contributed to some deaths, yet I think these scientists got it all wrong.  I think the reason asthma deaths started to rise in 1900 is because more people were diagnosed that weren't previously diagnosed.  I think one of the reasons is that you had medicines to help asthmatics if they were diagnosed.

Even recently Advair is blamed for killing some asthmatics.  Yet I don't think that medicine would kill a fly.  The medicine in Advair is no different that ventolin, it's just the longer acting version of ventolin.  I've used an entire inhaler of Ventolin plus taken extra hits on my Advair and still survived.  

I think the reason Advair gets blamed for asthma deaths is because the EMTs arrived at the person's home and saw the Advair clutched in the hands of the asthmatic. So the Advair was given the blame for the death.  Yet the true reason was because instead of calling for help the asthmatic relied on the medicine.  The medicine wasn't working, but by the time the patient realized this it was too late.

So I believe the reason for the rise, at times, in asthma deaths is due to lack of education.  It has little to nothing to do with the medicine.  And I think that black box warnings on such inhalers, or taking them off the market, does more harm than good.  It prevents asthmatics from getting the medicine they need to help them.

So thus is my unedited rant.  

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Do asthmatics have a barrel chest?

Your humble question:  Do asthmatics have a barrel chest?

My humble answer:  During an acute exacerbation of asthma you will have air trapped in your chest, and this can give you a barrel chest.  

What is a barrel chest:  The mayo clinic defines it best:  The term describes a rounded, bulging chest that resembles the shape of a barrel.  Barrel chest isn't a disease, but it may indicate an underlying condition.

Is a barrel chest permanent:  When I was a kid I often was told I had a barrel chest, but I do not have one now.  For asthmatics it's only temporary until the asthmatic attack is resolved and the excess air is allowed to escape from your chest.  In this way, part of the definition of asthma is that it is completely reversible, either with time or medication.  However, patients with emphysema may have permanent lung destruction that results in air being permanently trapped in the lungs.  This may result in a permanent barrel chest. 

If it's not broke don't fix it.

I love blogging.  I love blogger for providing me with access to blogger for free.  I think the gift of blogs is among the greatest give ever to both the writer and anyone who loves to read, learn and share ideas in the arena of ideas.

There are some people who want to tax profits made on blogs.  There are many who want to tax profits made on the Internet.  Yet all the money I make on my blog goes right back into my blog.  It's a minuscule profit at best, and taxing blogs would make it so fewer people would share ideas.

So if it ain't broke, don't fix it.  Leave the Internet alone.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

How to improve charitable givings

Your humble question:  What do you consider to be the best way to get people to become more involved in the community?  What do you think needs to be done to get people to donate more of their time and money to help those in need?  

My humble answer:  I'm going to get a little complicated here, yet bare with me.  

Statistics show that in the 1980s charitable givings increased by the greatest margin in U.S. history.  The reason for this was, I believe, is because the top marginal tax rate was cut from about 70 percent to about 20 percent.  Plus regulations were slashed.  People had more money left over in their paychecks when their bills were paid, and this resulted in more money available to donate.

I believe that one of the best ways to increase charitable givings is to allow people to keep more of the money they earn.  This would entail cutting back on government regulations that cut into the profits of companies (small and large) and provide them with more leeway to either hire more workers or provide better benefits and pay.

I believe that this would also improve the value of the dollar.  When someone earns a dollar and 50 cents goes to taxes, that leaves only 50 cents left to pay the bills.  After the bills are paid, that might leave that person or company with only 20 cents to spend in the marketplace.  

In this way, while a dollar might have bought a loaf of bread in 1980, it would only purchase a quarter of a loaf of bread in 2011.  This is referred to as a reduction in the value of the dollar.  So instead of a buck buying one loaf of bread, it takes four bucks to purchase a loaf of bread.

What this means is that the dollar travels less.  It purchases less goods and services.  With a dollar that went further, this would allow people with more money to save and invest in such things as charities.  So, by improving the value of the dollar, charitable givings would increase.  

This whole process starts by cutting back on entitlement programs, cutting taxes, and freeing companies and individuals from all the regulations that act as a disincentive to do anything.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Tooting my own horn

Your question:  As a health activist you are a front-facing leader.  What do you imagine you look like to your readers?  What qualities do you possess.  It's ok to toot your own horn today -- you hav efull permission to indulge.  And don't hold back.  

My humble answer: I think the best description of my writing comes from my good friend and former co-worker Jane Sage.  She put it best when she wrote:

"First of all, John doesn't see himself as a health activist.  He sees himself more of as a philosopher.  He comes up with ideas for others to use in their activism.  His is a fun, pithy writer.  He's to asthma what Mitch Album is to the sports column.  Album is a pithy, fun sports writer.  He was the most award winning sports writer of his era, winning sports columnist of the year for over a decade.  Rick's readers see Rick as having the ability to make complex things about asthma simple.  His readers also see me as having a knack for finding humor and optimism in an otherwise life altering disease we call asthma.  If there was an annual award for best lung blog, Rick would most surely win."

For the above I am most truly humbled.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

1633 to 1714: Bernardino Ramazzini

Hippocrates was the first to write about a possible link between asthma and occupation.  Yet Bernardino Ramazzine was an Italian physician who defined occupational asthma as a common industrial lung disease.

Ramazzine was born in Carzi in 1633 and studied medicine at the University of Parma where he first became interested in occupational diseases.  He was the professor of practical medicine at the University of Moderna from 1682 to 1700 where he was appointed chair of theory of medicine. 

Giuliano Franco and Francesca Franco, in their article, "Bernardino Ramazzini: The Father of Occupational Medicine," in the (Am J Public Health. 2001 September; 91(9): 1382), write that it was during this time he extensively studied workers in various industries, he observed their working conditions, the symptoms they complained about, and the questioned them about their illnesses.

It was in 1700 that the first edition of his book, " De Morbis Artificum Diatriba " was published and the results of his work discussed.  One common industrial symptom was shortness of breath and caobservation of workers of several occupations describing dificulty of breathing as a result of their work. 

Yet it must be noted that while he described it as asthma, it's also possible a good portion of the patients may have suffered from other lung ailments, such as farmer's lung or pneumoconiosis, also.

He recognized the following professions as possibly causing asthma:

• Bakers from (wheat and rye flour)
• Mill workers (grain dust)
• Farmers (animal dander)
• Gilders
• Tinsmiths
• Glass workers
• Tanners
• Stonecutters
• Ragmen
• Runners
• Professors (fumes and gasses)
• Horseback riders (dust)

Bernardini Ramazzini ((1633-1714)

Based on his recognition of asthma and other diseases that might be caused as a result of certain jobs, Ramazzine is considered by many to be the father of occupational therapy.  Likewise, due to his recognition of asthma that resulted from exercise, he is also often referred to as the first to describe exercise induced asthma, and the father of sports medicine. 

Tova navarra in his 2003 book "Encyclopedia of Asthma and Respiratory Disorders," wrote that Ramazzini was the first physician to recommend to doctors that they ask their patients complaining of shortness of breath and cachectia with questions, such as, "Where do you work?"

Ramazzini recognized a link between inhaling fine particles at work and "shortness of breath and cachectic and rarely reached old age."  He generally defined individuals with such a disorder as suffering from an occupational hazard.

While occupational asthma is now considered to be the cause of 10 percent of asthma cases, it wasn't until recently that occupation, and more specifically occupational asthma, was considered a legitimate type of asthma.

Click here for more asthma history.

3 facts and 1 lie about me

The following are three facts about me and one lie.  Can you tell which one is the lie?

1.  I once spent six months in a hospital
2.  I once had a "code blue" called on me
3.  I once was in the hospital 14 times in one year
4.  I was once put on a ventilator

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

So what slows me down?

Your humble question:  Is there anything that gets you down and slows down your writing?  Is there anything in your life that simply gets you down, burns you out, or makes you sad?  If so, what do you do about it?

My humble answer:  I tend to be a worrier.  Ever since I was a little kid I let things whirl around in my head too long.  I think about conversations I had and what I should have said.  I usually don't remember names and faces, but a conversation is something I never forget.  This, I suppose, is good because it makes for good writing material.  Yet sometimes I mull things over so much that it causes some anxiety.  In the past this caused a passive aggressive behavior on my part, but after some counseling (way back in 1985 when I was at the asthma hospital)  allowed me to control this.  

On a similar note, I also have anticipation anxiety.  There could be something I want to do, like teach a class about oxygen 101, yet I have this desire to be the best I can be so much that I worry about it.  The same thing about the commission I'm a part of.  I have a meeting once a month in which I am the chair, and I want to be the best chair I can be.  So I find myself researching Robert's Rules of Order before every meeting, and then I mull it over and over in my head if this is something I want to do.  I sometimes convince myself I don't want to do it any more.  Yet during the meetings I love it.  During class I love it.  I suppose in a way this is what makes me such a good teacher/writer.  

To remedy this problem is that I twist it around and make it an advantage.  I know that by the time I enter a classroom, or a meeting hall, that I'm the most prepared person in the room.  I also know that what I described above is common among responsible persons.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

I'm a writer not an activist

I do not consider myself to be a health activist.  I am a blogger and that's it.  I share my opinions.  I like to consider myself a person who thinks of ideas that other people can act on.  I would consider myself a philosopher if anything. 

If I was an activist, however, I would change the health care industry to where the costs were lower and health care was affordable to everyone, including those -- especially those -- who do not work.

I hate it when an asthmatic comes to me and say he can't afford his asthma medicine, and therefore he ends up with unfortunate asthma, which is asthma as a result of not being able to afford asthma medicine. 

Advair is one of the best asthma medicines in the world (and Symbicort and Dulera). These medicines work to prevent asthma, yet they cost over $100 if you don't have insurance.  They cost over $30 with insurance.

The reason medicine like Advair cost so much has nothing to do with the pharmaceutical industry, so I hate it when people come up with solutions that involve fixing prices.  That's not the solution.  Al that will do is punish the people who create the medicine that we so much need. 

If we consider pure economics 101, if the demand of a product goes up, and the supply stays the same, the price will go up.  This is what has happened to the healthcare industry.  In the 1960s when there were no government regulations on the healthcare industry people could see a doctor and pay for it out of pocket.

Yet since then many government regulations have been made, and welfare has been created.  What this did is make health care free for many people.  When something is free what do people do?  They take advantage of it.  So, instead of staying home and dealing with a simple cold on their own, these folks inundate emergency rooms.

Yet what's free to one person someone still has to pay for, and the people who pay for it are the rest of us who use health care services.  Every time we go to the ER, for example, we not only pay for our visit but we pay for those who got it for free.  Thus, we are paying more than what should be the market price.

Likewise, as the supply of patients increases due to government programs and regulations (hospitals aren't allowed to turn any patient down), and the number of nurses and doctors stays the same, the price of this care will go up to those who pay. It's simple economics 101.

I would like to create a health care system where everyone can go to the hospital and be able to at least somewhat afford it.  Surely we should take care of the people who truly need medical services -- including those who can't afford it.  But government involvement in the health care industry has resulted in skyrocketing prices.  I would like to stop this.

5 things that have changed my life

Your humble question:  What are five things that have changed your life?  For the better?  For worse? 

My humble answer:  This is a great question.  I'm going to focus on things that changed my life for the better.  Some of the things I list here may have been very difficult events, and even horrible events at the time, yet in the end they all resulted in changing me for the better.

1.  Horible asthma:  As a kid I endured many long and agonizing nights suffering from hardluck asthma.  Many days were spend in ERs and hospital beds.  Yet I took it in stride as best I could, and in the end it made me what I am today.  I actually wrote about it here and here. 

2.  National Jewish Health:  By January 1985 my asthma became so bad I was admitted to National Jewish Hospital/ National Asthma Center (now National Jewish Health) for six whole months.  It was fun at times, yet often very challenging.  It was events that occurred here that made me what I am today, especially all my talks with counselors and physiologists. 

3.  Getting fired:  I was hired as a journalist at a small town newspaper.  It was my lifetime dream to become a journalist because I loved to write, yet once I got this job it was like my mind went blank.  It didn't help that I was fresh out of school and I was in charge of the newspaper.  In essence I was hired to do a job that was way over my head, and after three months I was let go.  That event hit my confidence hard, yet in retrospect it was that event that made lead me to the job I was meant for -- a respiratory therapist.

4.  Getting a job as an RT:  If it weren't for all the events above I never would have become an RT.  In a way, getting a job of respiratory therapist was my fate -- respiratory fate.  It was because of this job that I met my wife.  It was through this job I created this blog.  It was through this job that I created a wonderful family and group of friends. 

5.  Meeting my wife:  I always wanted to write, yet even though I had tons of time I never did.  Then I met my wife, got a job as an RT, had kids, and even though I had hardly any time, with her encouragement, I created my blogs.  My wife disciplined me.  She made me the modest RT. 

So there you have it.  It was those five events that made me who I am.  If it werent' for bad asthma as a kid I never would have spent time at National Jewish.  If not for that experience I never would have become an RT.  If I never would have become an RT I never would have met my wife, and my blogs never would have come to be.

How does smoking effect bronchodilators?

Your humble question:  How does smoking effect bronchodilators?

My humble answer:  Smoking will have no effect on how a bronchodilator (like Albuterol and Xopenex) works.  However, smoking can make asthma worse, and smoking can also do further damage to your lungs and cause and worsen COPD.  So if your smoking further damages your lungs, this may make it so the albuterol has less effect, or may make managing your lung disease more difficult.  

What happens after you press publish?

Your question:  So you've been blogging for a long time now.  You have more than three blogs you seem to keep up to date.  What do you do after you publish a post?  Do you tweet it immediately?  Do you continue to edit? Do you admire your work? 

My humble answer:  Great question.  First of all I think it should be known I write because I love to write.  I love my blogs because they are the few things in my life I feel I have complete control over (most of the time anyway).  Yet another interesting thing about the way I write blog posts is I rarely write the same day something is posted.  Usually I get in a writing mood one day a week, or two, or three.  It's on those days where I sit and write all the ideas that have piled up in my head.  Often during the course of the week I take notes as I'm working.  Sometimes I come up with ideas when taking a shower, or when I wake up in the night, and I take notes.  So one day a week I sit down and create posts.  Then I set them to be scheduled for a certain date. 

There is this sense of pride when I look at my blog and read my daily post.  I usually do reread it to make sure it's saying what I intend, although usually by the time it's published that job (and any editing) is completed.  Although quite often these days, in the hustle and bustle of life, I am too busy to get a chance to admire my work.  So you can see, for this reason mistakes may be made.  In essence, in this way, I may actually write something I might intend to one day take out so I don't get in trouble by what I say, or don't offend.  If I had an editor this would be his job. 

Another neat thing about blogging is many bloggers like to promote their blog posts through emails (spam), Facebook or Twitter.  I do some of this, but for the most part I like my writing to stand on it's own.  I believe if something I write is worth reading people will find it on their own. 

I love my blog and I'm proud of my work.  Usually I just leave it at that.

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

Dear 18 year old me

Today as part of my effort to participate in HHBPM 30 health posts in 30 days I will write a letter to my 18 year old self.

Dear Rick Frea


11-3-2011


Hi.  I am the future you.  Through the magic of the Wellsphere Time-iMail machine I have been told this letter will be distributed to you on your 18th birthday.  I've decided this would be a great opportunity for me to provide you with some tips.

First of all, call National Jewish Health and send for your medical records.  This is important because in the future you will want to write about your story, and you will require your medical records. 

Your future self -- that's me -- sent for these records, yet all he received was 34 paraphrased pages. NJH destroys your medical records after 25 years, so don't wait.  Send for them now before they are destroyed.

Another thing I want you to do right now is sit down and write your asthma story while it is still fresh in your head.  Don't worry about grammar and spelling and style, just write down your story.  You can sandpaper your story in the future, because you will become a pretty darn good writer. 

Also, make a copy of your story "Escapes from the Lost."  I say this because by the time you turn 24 you will lose this story and have to rely on your memory to rewrite it in the future.  Make a copy now and put it someplace safe.

Don't worry so much about your dreams that have yet to be answered.  Yet keep praying and don't be afraid to step out of your comfort zone.  Likewise, don't worry about what people think about you.  Be yourself and be happy with who you are.

Other than that, I'm not going to give you any further tips because both the good things and the bad things that happen in your life make you -- me -- who I am.  You will use your experiences -- the good and the bad -- to create some great writings.  Be yourself, have fun, and rest assured your most important prayers -- like the ones you made at NJH -- will come true.

Your friend:


Riok Frea

This post was written as part of NHBPM – 30 health posts in 30 days: http://bit.ly/vU0g9J

1649-1734: John floyer upholds the supernatural

Sir John Floyer

The early 18th century centered around a struggle by Western men who were losing their enchantment with the old world and increasing curiosities about the truth obtained by scientific progress and thought. John Floyer was born into this world in 1649 and he rejected it.

In fact, it was because he rejected it that he became one of the most interesting and popular personalities of his generation. He put forth a defense against modern logic and a defense for Ancient ideas, yet at the same time he provided a stunningly accurate description of asthma based on his own experience and experimentation

Floyer lived at about the same time as Jean Baptiste van Helmont and Thomas Wilson, yet it was Floyer's ideas regarding asthma that were more readily accepted by his generation. The reason was partly because Floyer had asthma and he used his own experiences to describe the disease.  Yet also because he disregarded science and accepted old superstitions that were popular, while the other two endorsed science.

It's true.  Floyer rejected the ideas of van Helmont and Wilson and other "quacks" because they "know little of Anatomy, and the Nature of Animal Humours."  Likewise, Floyer accepted the ideas set forth by Hippocrates and Galen that all diseases were caused by some external poison that caused an imbalance of the humors:  black bile, yellow bile, phlegm and blood. (1)

Floyer's Treaties of the Asthma (a)

Since this was the accepted dogma of the day -- the paradigm that mankind was stuck in at the time -- Floyer's ideas were much easier for other physicians to accept.  

Floyer was born in 1649 in the small town of Staffordshire, England, the same year as the execution of Charles I.  He suffered from asthma as a child and through much of his adulthood, and it was because of this he would later take up the study of this disease. (2)

He received his medical degree from Oxford in 1680.  Shortly thereafter he returned to Lichfield which was only a few short miles from his birthplace and became an important member of the British society, and he was even knighted by James II in 1686. (3)

Floyer's A History of Cold Water Bathing

He was an ardent supporter of cold water bathing, and in n 1701 he published "A History of Cold Bathing: Both Ancient and Modern." He would often recommend this book to his many patients including his asthmatic patients. (4)

In 1682 Andreas Cleyer's Specimen medicinae Sinicae introduced the West to the ancient Chinese method of counting a pulse to diagnose diseases.  Floyer liked this idea, and he expanded it and made taking a pulse a routine task when assessing a patient. (5)

To make the task easier he invented a "pulse watch" that had a second hand that ran for one minute.  Alex Sakula, "Sir John Floyer's A Treatise on Asthma (1698)," wrote that one of the reasons this "pulse watch" was so important for his study was because he believed that each disease was associated with a specific pulse. (6)

He wrote about his watch in "The Physician's Pulse Watch" volume 1, in 1707.  You can read about it in more detail here.  The pulse watch was advanced many times even during Floyer's own life, and it soon became a popular site to see your neighborhood physician with a pocket watch. The practice of taking vitals, a pulse and respiratory rate, became commonplace.

The art of watching the hands of a watch revolve is often attributed to Sir John Floyer.

In 1698 he published his book A Treatise of the Asthma.  In this book Floyer became the first asthma expert to make the case for asthma as a separate disease from other lung disorders.  He also divided asthma into four parts, which are basically broken down as:

Floyer's A Treaties on Asthma (1698)

1.  Symptoms (a history of the fits) or the asthmatic attack. It's generally based on his scientific description of bronchospasm:

• The attack usually begins at one or two of the Clock in the Night
• The breath if very slow (early sign)
• Fullness of stomach (early sign)
• A slight headache (early sign)
• Sleepiness (early sign)
• Feeling rigid
• Feeling stiff
• Feeling inflated (head seems to be filled with Fumes or Serous Humour)
• Began to suck in breath
• Straitness of breath, seems to be for want of an easie Inspiration
• Urge to sit in an erect Posture, that the weight of the viscera may pull down the diaphragm
• Enlarging of the breast during inspiration
• Muscles of inspiration strive and labour more vehemtly
• Muscles of expiration cannot easily perform the Contraction of the Thorax, being hindered by the Stiffness or Inflation of the Membranes in the Thorax
• Expriation is easier than inspiration
• Expriation is very slow, and leisurely (and wheezing)
• The patient can not cough, sneeze, spit or speak freely
• The diaphragm cannot contract itself to move downward
• Bronchi and trachea has its membranes and nervous fibres contracted which results in wheezing (mainly expiratory)
• Muscular Fibres of the Bronchia and Vesiculae of the Lungs are contracted adn that produces the Wheezing noise, which is most observable on expiration
• Convulsive cough before fit (inconsiderable)
• Phlegm is spit up (inconsiderable) 

2. The nature of asthma as he saw it, which is basically based on Galanic principles:

• A flatulent slimy Caccochymia which is bred in the stomach, and creates inflation there, and gives an effervescence in the blood and an inflation in the membranes in the lungs
• At 2 a.m. the Chyle is more plentiful in the blood.. and the viscid Chyle and Lymph will not easily circulate through the lungs of the asthmatics
• The Asthma is a High, Slow, Rare and Laborious Respiration, which depends immediately on the inflation of the Membranes of the Lungs by Windy Spirits, rarefied or propelled through the Glands of the Brain, either by external Accidents or periodic Febrile Effervescence (bubbling) of the Blood. 

3.  Triggers (Accidental causes) or lifestyle causes or factors that precipitate an asthma attack:

• Great heats or cold
• violent motions of the body or mind
• Excess in eating and drinking
• Venereal Pleasures
• Heat of the bed
• Changes of the weather to rain
• Snow
• Change in weather from frost to thaw
• Alteration of clothes
• Changes of the air at spring and fall (change in barometric pressure)
• Moist air (dry air is good for the asthmatic)
• Heat and smoke of from fires
• Fumes
• Perfumes
• dust
• Strong liquors and food
• Exercise
• Anger (makes humours more viscid)
• Fear
• Shouting
• Excessive study (upset the spirits)
• Any strong smells (candles put out, Smoak of tobacco, winie fermenting, soap making, burnign metals, etc.)
• Sadness makes humours more viscid 

4.  Treatment (The cure of the fit) and preventative measures:

• Cold water bathing
• Light diet (fasting on day of attack with a light diet thereafter)
• Gentle Exercise
• Bleeding (performed in small quantities, but only in extreme cases)
• Blisters (Applied to limbs and shoulders)
• Narcotics/ opiates (if induced by sleep 'when nerves are filled with windy spirits'/ induce sleep)
• Abstinance of anger or shouting
• Emetics (to induce vomiting/  if excessive may bring on asthma/ monthly vomiting recommended)
• Feather in throat (another option to promote expectoration of viscid sputum
• Oxymel of squills (to induce expectoration)
• Clysters (laxitives) or Purges (violent purging should be avoided, but regular purges are recommended)
• Late sitting up (staying up late)
• Avoid extreme climate changes
• Febrifuges and Sudorifics to help fevers that accompany the asthma
• Diuretics such as millipedes and woodlice

Floyer was not a fan of other more modern remedies for asthma that were prescribed by other physicians of his day.  In fact, he flat out rejected many of them, and instead preferred the more supernatural remedies such as those proposed by Hippocrates and Galen.

Floyer described respiration as "preparing the blood or air vessels by tumours or by injury to the muscles of respiration or to the 'spirits, moving those Muscles.'"

He describes asthma this way:  

When the Muscles labour much for Inspiration and Expiration, through some Obstruction, or compression of the Bronchia, &c. we properly call this a Difficulty of Breath:  But if this difficulty be by the Constriction of the Bronchia, 'tis properly the periodic Asthma: And if the Constriction be great, it is with Wheezing; but if less, the Wheezing is not so evident; the Pulse being stopt in the Asthma Fit, the Respiration is Rare."

Then he describes two forms of asthma:

1.  Continued:  Dyspnea was the result of other diseases such as dropsy, empyema, tubercles in the lungs, thoracic tumors, abdominal tumors, and spinal conditions such as scoliosis.  He used continued the way we use chronic, meaning that the "asthma" is always there.  We now know this is not really asthma but other conditions

2.  Periodic:  This is bronchial constriction due to "windy spirits" occurring after fevers, catarrh (nasal inflammation or what we now call allergies or hay fever), and hypochondriacal fits or as what he referred to as "flatulent slimey cacochymia, which is bred in the Stomach."

Floyer described his own asthma as periodic, and it is this type of asthma that covers the majority of his Treaties on Asthma.  Floyer noted that continued asthma is known to take the life of the asthmatic, yet most people with periodic asthma lived a normal life span.  However, periodic asthma did take a life from time to time.

Floyer became the first to describe seasonal asthma.  Floyer wrote how he kept a "diary of his disease, out of what I can give a more true Account than if I had now recollected what has long since passed."

He observed that he never had any problem with his asthma while he was at Oxford, yet when he returned to Staffordshire he "usually visited with a severe Fit or two.  The air of a Town makes the Fits more severe when they happen; but I do not think the Asthmatic so much expos'd to the Accident of the Weather in a City, as in the Country."

He noted that his asthma was worse in the summer than winter, and worse during "the change of the moon."  Barometric pressure can also affect asthma, he proposed, and that is why he recommended changes in weather as a probable cause of asthma.

He may also have been the first to describe how tobacco fumes from smoking cigarettes may trigger an asthma attack, yet his reasoning for this is quite supernatural:

"During the Fit of the Asthma, the Smoak of Tobacco is so offensive that it very much straitens the Breath, if it be smoaked the first Day of theFit, and much endangers a Suffocation.  There are many Asthmatics that cannot bear the smell of it; therefore its Foetor is injurious any time, its Heat thickens the Phlegm and rerefies their aerial Spirits, making them restless; all the good it can do is to discuss the Windiness after the Fit abates, and to help the coughing up of Phlegm."

Floyer may have been among the first to note that very few people die of an asthma attack, and that between such attacks the asthmatic can live a relatively normal life.  He wrote:

"I have met with some Asthmatics who have been so for Fifty years, as they informed me, and yet in tolerable Health without any considerable Decay of their Lungs, or Disability to perform their usual Employments; which I oft reflect on to encourage my patients, and myself, who yet can study, walk, ride, and follow my Employment, eat, drink, and sleep, as well as ever I could; neither am I yet sensible of any Decay in my Lungs."

Sakula noted that while Floyer's acceptance of Galanic principles would later be proven false, "his treatise shows that he was familiar with the multifactorial basis of asthma -- heredity, occupation, atmospheric pollution, hypersensitivity, infection, exercise, and psychological influences."

Because his theories about medicine were more readily accepted by society in the 17th century, Floyers is often given credit as the first to define asthma as a disease of it's own, more specifically as a disease of bronchospasm, even while this wasn't true.  Regardless, he did play a significant part in defining asthma.

Floyers would die on February 1, 1734, yet his teachings would be studied by physicians for the next hundred years, and his practice of measuring a pulse and respiratory rate became a common medical practice that is still used to this day.

Click here for more asthma history.

References:

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6. Sakula, Alex "John Floyer:  A Treaties on Asthma," Thorax, 1984, 39: 248-254
7. Floyers, John, "A Treaties on Asthma," 1698, London, pages

Photos:

1. (a) Photo compliments of http://www.nlm.nih.gov/hmd/breath/breath_exhibit/Asthma/IIIAa1.html
2. ***Photo compliments of http://193.62.111.58/broughttolife/themes/science/measurement.aspx