Wednesday, October 14, 2015

My Double Whammy Asthma

So, after 45 years of living with asthma, and 20 years of being a respiratory therapist, I believe I can finally describe what makes my asthma so different than others.  For most of my life my doctors told me I had asthma, or brittle asthma, or high risk asthma. In recent years my asthma friends have tried to convince me I have a sub-type of asthma called Severe Asthma.  All of these descriptions of my disease are either incomplete or inaccurate.  So allow me to explain. 

First, allow me to say that I do not have Severe Asthma.  This is an asthma subtype that consists of about 10 percent of asthmatics who take all their asthma controller medicines exactly as prescribed yet still have difficult to control asthma.  Severe Asthma means you have a double whammy of chronic airway inflammation, making your airways hypersensitive to asthma triggers, and airway remodeling, making your airways chronically narrowed.  This is not unlike what occurs in patients with chronic bronchitis, or COPD.  In fact, it is Severe Asthma that is most commonly associated with COPD, and might sometimes result in a diagnosis of Asthma/ COPD Overlap Syndrome.

My friend Stephen Gaudet does have this form of Double Whammy Asthma.  However, after years of thinking I had this, I can tell you that I do not.  For one thing, as my doctor confirmed to me during a recent appointment, if I had this it would show on my pulmonary function tests.  My FEV1 would be lower than 80%.  This is not the case, as my FEV1 is consistently 80% or better, even on a bad asthma day.  This means that I do not have airway remodeling.  I do not have Severe Asthma. I do not have COPD.

The fact that my asthma responds very well to traditional asthma medicines, particularly corticosteroids, is further confirmation that I do not have Severe Asthma.  

Okay, so good, then what the heck do I have.  What subtype of asthma do I have? While I do not have Severe Asthma per se, I still do have severe asthma, or more severe asthma than your typical asthmatic.  I have severe asthma because I too have a Double Whammy Asthma, but my double whammy is the asthma subtype Allergic Asthma.  My double Whammy is chronic underlying airway inflammation and allergies.

Now, it is estimated that about 90% of childhood onset asthma is allergic asthma, and about 50% of adult onset asthma is allergic asthma. So, why would my asthma be more severe than theirs. Well, it is because I have severe allergies to dust mites and pollen. This makes it nearly impossible to avoid allergy symptoms when any of these are in the air. 

This is what makes my asthma hardluck; this is what makes my asthma more difficult to control even though I am very compliant with all my asthma medicines; it's what makes my asthma difficult to control even though I make a gallant effort to avoid my asthma triggers.  It's because it is next to impossible to avoid all of my asthma triggers.  It's not possible to avoid getting colds.  It's impossible to avoid inhaling pollen.  It's impossible to avoid inhaling dust mites from time to time.  

So my Double Whammy is chronic underlying inflammation and allergies.  Chronic exposure to the things that are innocuous to most people causes an abnormal immune response inside my body that caused by airways to become inflamed.  Because I was chronically exposed to these allergens, this inflammation became permanent.  That is what asthma is: permanent or chronic underlying airway inflammation.  

In turn, this makes my airway not only over sensitive to my allergens, but also over sensitive to colds, strong emotions, exercise, and strong smells.  Unlike with the Severe Asthma subtype, asthma controller medicines do help me a great deal, and make it so that my asthma is well controlled on most days.  Still, either because the underlying inflammation in my lungs is so severe, or because the abnormal immune response in my body is so exaggerated, even slight exposure to my asthma triggers causes the allergy and asthma responses.

Let me give you an example.  Every day I take one puff of Breo.  This helps reduce airway inflammation so my asthma is controlled on a good day.  In fact, it works so well, that on most days, I do not need my rescue medicine.  On most days, I can live a normal life.  But not really.

Let me give you a further example of why I say not really.  Actually, I give examples of this all the time on this blog.  Normal people can go into their basements and move boxes around.  I do this because I want to clean and organize my basement, and I'm exposed to dust mites.  I have a severe allergy attack. The allergy attack leads to a full blown asthma attack.  I am down for the count. Not only does this cause an asthma attack, I usually have to deal with the ramifications of it for weeks afterwords.  And, in the future, I'm afraid to go into my basement. I have to avoid it, even though I don't want to.  This, as I described recently, is what I sometimes refer to asthma frustration.

You see, all of this combined is what makes my asthma more severe than others.  I have, what you might say, is called hardluck asthma because I have severe allergies to go with my asthma. I have my own Double Whammy. I have severe asthma, or more severe asthma than most people, because I have Allergic Asthma. This is why I can still describe myself as having Hardluck Asthma.  

No comments:

Post a Comment