Discreet inhaler use

I've noticed from reading other asthma blogs that I'm not alone in being discreet about using my inhaler. Yes, even though I've had this disease 40 years, and even though I'm an adult and most people around me know I have it, I still hate to use my rescue inhaler (my Albuterol) in front of other people.

It's been this way my whole life. It was 1980, and I was 10, when I got my first Alupent inhaler. My mom made me take it to school. Considering I was small for my age, and the inhaler was slightly bulkier than the ones we have today, that inhaler created a bulge in my pants. Yes, that in itself was embarrassing for a kid.

So, needless to say, I created a seat in the back of the class and stayed back there unless I absolutely had no choice. And when I was having asthma symptoms, that inhaler stayed put. I didn't want anyone to know I had it. I didn't want to answer whatever questions people had. I didn't want people to know I was sick. And, most important, I didn't want to be in the spotlight where the teacher and other kids would notice the bulge.

And, since my teachers never noticed I was having asthma symptoms, my asthma often went untreated while I was in school.

I know this sounds stupid, but it's how it was. And during recess I would stand by the side of the building instead of playing with the other kids. It was easier to not participate than risk being the center of attention. Of course the fact I was allergic to everything outside, and had exercise induced asthma, didn't help.

This behavior, coupled with the fact my nose was always dripping, ultimately lead me to being the easy person to pick on. Of course, one would hope, this type of thing would never happen today, as most parents and teachers are better educated about asthma, and asthma in children is better controlled by modern asthma wisdom and asthma medicine.

So, needless to say, there were many days I conveniently forgot my inhaler.

Ironically, one of the kids who picked on me when I was 10 later became a good friend of mine. We worked together at a local A&W when we were teens. One day the topic of my asthma was brought up, and she said, "I remember we picked on you because you were the little, easy to pick on kid who was always coughing and wiping his nose. I feel really bad. I never would have picked on you if I would have known you were sick."

"The thing was," I told her, "is I didn't think of myself as sick. To me, it was normal to be short-of-breath all the time. As a kid you don't know any better."

Yet, even as an adult, I still hate to use my inhaler in public. I will openly discuss my asthma, but I will rarely use my rescue inhaler in public.

When I first started my job as an RT at Shoreline Medical in 1998 I would use my inhaler whenever I needed it. And, before long, people were looking at me awkward and asking me questions, and I'd be forced to explain to them why I was using it. Since I don't like to be the center of attention, I chose to use my inhaler when no one else is around.

One day it was really busy, and I so happened to have a cold, and asthma symptoms. We were in the ER working on a sick patient, when I turned around and puffed on my inhaler. I think I did it more out of habit than anything. I needed it, and I used it.

Once things calmed down, the nursing supervisor cornered me, "Rick, you're sure using your inhaler a lot. Are you okay?"

I am? Shoot! I better be more careful," I thought. "No, I'm doing fine," I said.

"If you're fine," she said, "then why are you using it so much?"

"Ummm, ahhh, eeee, ahhhhh...."

See! It's easier to be discreet. It's easier to find a closet. It's easier to find an empty room. It's easier to wait to use it until you find a moment where you are alone to use it.

Out in the real world, it's easier to be a discreet inhaler user, unless you like the spotlight.

Reasons most asthmatics don't use spacers

It has been proven that a rescue inhaler like Albuterol works 175% better if used properly with a spacer device. That said, only 20% of asthmatics use their inhaler with a spacer.

Here's my list of why this might be:

1. Grew up in the no spacer era
2. Carrying a spacer is too inconvenient
3. Spacers are too bulky to carry around
4. Laziness
5. Never showed proper inhaler technique
6. Don't know what a spacer is
7. Don't know advantages of spacers
8. Spacers make being discreet impossible
9. Personal preference
10. Don't need 175% more medicine
11. It works just fine without a spacer
12. Can't afford one

Please help me add to this list.

Rescue inhalers

So let's talk rescue inhalers. You know what I'm talking about: Albuterol. Well, there are other ones out there too, but for me the bronchodilator (rescue inhaler) of choice is Albuterol.

It didn't start out that way though. I was first introduced to Alupent in 1980 shortly after my 10th birthday. I remember sitting on the edge of the doctors table, and the doctor entering the room with this little white thing. "This is an inhaler," he said. "We'll see if it helps you breathe better."

He held it a finger's length from my mouth, and I inhaled (as instructed) as he squirted. As most asthmatics do on their first inhaler breath, I choked on the nasty taste, and white mist spewed from my mouth, into the room and disappeared.

"Fine," he said as I coughed and gagged, "Let's try again."

Despite the nasty taste, the procedure went fine the second time, and that was the beginning of my love affair with the bronchodilator inhaler. Soon thereafter the stuff became tasteless.

Quite frankly, I don't know how I ever got along without it before that time, nor why I wasn't introduced to it earlier. It was simply an adorable little object.

I remember thinking how would I have survived back in the days before the inhaler was invented. I bet I would have died as a kid.

Yet, in retrospect, I now wonder if it was a gift or a boon.

Now, I'll stop myself here a moment. Most of you probably read that last sentence and said to yourself, "What? How could an inhaler be a boon?" Well, that's where what you'll learn by reading my blog will differ from what you will hear about asthma anywhere else. Allow me to explain.

I read a while back that none of the asthma experts of the 19th century noted that asthma caused their patients to die. In fact, Henry Hyde Salter mentioned in his book, "On Asthma," that none of his asthmatic patients died. They had a high morbidity, but nill mortality. It wasn't until epinepherine was invented in 1903 that asthma deaths started to spike (you can read more about this by clicking on the links that follow this post).

Before 1980, before I was introduced to Alupent, whenever I had an asthma attack I told my parents (well, eventually I would), and they'd take me to see Dr. Oliver or to the emergency room, depending on how bad I was, or what time of day I revealed my secret. I say secret because few people know how to pick up on the signs of bronchospasm -- at least back then anyway. It's a skill. You have it. I have it. Most people don't have it. Many doctors have no clue either.

At the doctor's office, or the ER, I would be given a shot of susphrine (long acting epinepherine) and it worked within 5 minutes to open my lungs and make my breathing easier. Then I'd be given a shot of systemic steroids, a pack of roids for the road, and be sent on my merry way back home with mom.

Now, with the inhaler in my possession, now I have a way to treat myself. Now I can puff and puff and puff to my hearts content. Thus, once I realized I wouldn't die by taking extra puffs (which didn't take too long by the way), I would take my inhaler instead of telling my parents.

Now, do you know how many asthmatics were found dead with that old faithful clutched in their grip? Right? Neither do I. But there were many. The same philosophy holds true for the Serevent, Adviar, Symbicort, Formoterol, and those types of medications. These meds have been blamed -- linked -- blamed for many asthma deaths.

Yet, when I take extra puffs of my Alupent-Albuterol-Serevent-Advair, I don't die. If I died, I certainly wouldn't be writing this right now would I? I dont' think so. So, the fact of the matter is, those meds don't kill. So, what does kill?

What kills is the false belief that these medicines will actually make your asthma get better when what you really need to do is seek professional help. And that, my asthmatic friends, is why I think the new asthma guidelines are a gift.

While they say it's fine to use rescue inhalers, and they recommend all asthmatics have one, they highly recommend to doctors that increased use of rescue inhalers is not going to kill the patient, but is a sign of poorly controlled asthma or worsening asthma. Yet, back in 1980, or in 1981, or even in 1985 when I was at the asthma hospital, or 1990, I was not taught this.

Of course in 1985 my asthma was controlled to the point I needed my rescue inhaler less often. Yet, still, increased rescue inhaler use was not linked to worsening asthma. It was linked to noncompliance. It was linked to bad asthma. But it was not linked to worsening asthma. Or, at least I don't think it was as a general rule.

Yet, over time, when Alupent hit the dust and along came the Albuterol, which had a stronger beta 2 effect on the lungs and much less of an alpha effect on the heart, well, now we had an inhaler that we could abuse even more.

So there was another medicine like Serevent and formoterol -- perhaps it was formoterol -- that was released in the 1970s, and asthma deaths spiked. So, instead of introducing asthmatics to this medicine in 1970, long-acting bronchodilators were not made available to the public until the mid to later 1990s. Why? Because areas where this long-acting bronchodilator were trialed, asthma deaths skyrocketed. I wonder how many asthmatics were found dead with this medicine clutched in their grip.

The same was true for Serevent. There was a time a few years ago that the FDA considered taking this medicine off the market because many asthmatics were found dead with this medicine clutched in their grasp. Thankfully, someone realized something here was amiss. Thankfully a warning was put up, "Take as prescribed. Take only twice a day."

Yet, still, was it really overuse of the Serevent that killed these patients, or because these asthmatics waited too long? Did these asthmatics have too much faith that the Serevent would get them over the hump that they died waiting? That's what I think.

With exceptions of course, I think most asthmatics don't die becasue they take extra puffs of their rescue inhalers, or long-acting bronchodilators. I think they die because of poor asthma education. And, thankfully, this area has been greatly improved in recent years.

Now you see medicines like Symbicort being approved to be used as rescue inhalers in Europe, Australia and Canada as part of the SMART program. This is currently being investigated as a possible option for asthmatics here in the U.S.

However, it must be noted that I am not endorsing the overuse of beta adrenergics. What I am endorsing is a common sense approach to asthma therapy. I endorse educating doctors, researchers, scientists and patients as to how rescue inhalers really work. I endorse asthma action plans. I endorse asthma wisdom.

Too much Albuterol has been proven to be safe, yet to what extent? What patient will die from too much Albuterol (I have yet to here of a patient die from too much Ventolin). I went through an inhaler in one day once (or probably more often than that), and I'm still here. So we know Albuterol didn't kill me. Or, was I lucky?

I wouldn't take that gamble with long acting bronchodilators like Serevent and Formoterol. I do think it's safe to use them more than just twice a day, but I wouldn't go overboard. And I wouldn't do anything with these meds without permission first from my doctor. And I highly recommend you don't either, unless you're the gambling type (like I was when I first got my Alupent inhaler).

There has to be a limit somewhere. The SMART program recommends using Symbicort -- I think -- no more than 8 times a day. I think that's a good place for a patient to stop. The FDA, however, and the asthma guidelines still have not approved this medicine for any greater use than twice a day for asthma. The black box warning still exists for both Advair and Symbicort.

So while I don't think these meds at their face value kill asthmatics, I still think we asthmatics can lean too much on these meds. They, in a sense, become a clutch. Yet I most humbly, and from my own personal experience, recommend that all asthmatics not use their rescue medicine -- and especially their long acting bronchodilators -- as a clutch.

And, in that sense, I often wonder if me using my Alupent as a clutch caused me to wait too long too many times, and that's how I developed worsening asthma as I aged from 10 to 15 when I was admitted to the asthma hospital. Or, would I have gotten worse regardless what I did.

I honestly was never admitted to the hospital once before I had a rescue inhaler, and between 1980 and 1985 I was to ER God knows how many times, and admitted God knows how many times. In 1984 alone I think it was 14 trips to the ER, all because I waited too long to seek treatment.

By 1985 my parents and doctors thought I was going to die if something wasn't' done. That's how I ended up at the asthma hospital for 6 months. In fact, I know I was thinking along these lines even as a 15 year old, because I remember talking to my counselor at NJH about my rescue inhaler overuse.

So, in a strange way, I wonder if all this would have been avoided if I simply was never given that device in the first place. I wonder if I wasn't given that first Alupent, if I would have sought out help instead of staying home and letting my asthma get all that bad that many times, thus every one of those bad attacks led to worsening scarring.

I say this because we know if an asthma attack is treated swiftly and correctly that further damage can be prevented, and asthma can be treated. Yet, I also know asthma wisdom was different back then. While doctors knew that inflammation occurred during an acute attack, they didn't know there was chronic inflammation that needed to be treated DAILY with inhaled steroids. Of course, inhaled steroids were feared back then as much as systemic steroids.

So who knows. Perhaps I'm thinking too hard. What do you think?

Related posts:

1. Modern meds may cause fatal asthma
2. Is it possible pure asthma is not a fatal disease
3. Advair/Symbicort: Is overuse really deadly?

Peak flows

From what I can remember, peak flows were not used as part of any asthma action plan when I was a kid. Basically, they were used to monitor the course of an asthmatics lung volumes over time. They were also used before and after breathing treatments to determine effectiveness of therapy.

My doctors and respiratory therapists had me use them, and always encouraged me to use them at home, yet I rarely did. When I was at the asthma hospital I blew into a peak flow three times a day and recorded the results. During the last three months at the asthma hospital, I monitored peak flows and I blew into a spirometer twice daily and monitored these results too.

When I was discharged, however, I do not remember any mention of me monitoring my peak flow results to help me determine (based on downward trends) if I should take my rescue medicine, or call my doctor, or get my lungs to the ER. If I remember right, no such asthma action plan existed back the. However, my memory may not serve me right.

I was however, taught to learn my signs and symptoms of asthma, and to use these to determine if I should use my rescue inhaler, let my parents know, or call my doctor. Trending down peak flows was not listed as a symptom. I have the list of symptoms, and it's not on it.

I think the asthma action plan as we know it today was started around 1997 or so when the first Asthma Guidelines were released. Still, I could be wrong.

Regardless, when I was a kid my peak flow number rose and fell based on how well my lungs were doing, and monitoring them would have been an ideal way for me to determine how to treat myself. As an adult, however, I find that my peak flows are the same (between 600 and 650) regardless of how well I feel.

As a matter of fact, when my asthma was so bad in 1998 that I was admitted for 10 days for it, my peak flows were still between 650 and 700. Now how I could be short of breath and still have my peak flows being normal was and still is beyond me. My doctor was perplexed by this too.

And while those Q1 hour breathing treatments provided me relief (yes, that's what it took for up to four days before I caught my breath), my pre and post peak flows still never changed.

So, while I blow in my peak flows and record the results from time to time just in case they decide to tank, I'm unable to use peak flows as part of my asthma action plan. I therefore have no choice but to use symptom monitoring.

In the course of being an RT I have, however, encountered a few asthmatics similar to me, where peak flows were relevant as a kid and yet irrelevant as an adult. In fact, I had such a patient just the other day.

I do have a theory for this. In fact I read this somewhere. It's that the degree of chronic inflammation was the same in my childhood lungs as my adult lungs, yet my childhood lungs were smaller and more sensitive to my asthma triggers, and thus more brittle. My larger adult lungs are less sensitive to my asthma triggers, and less brittle.

Likewise, even during one of my adult flares, the degree of "obstruction" may cause me to feel dyspneic, but doesn't block my airways as bad as they did when I was a kid with smaller airways.

I have no evidence here, but I THINK this (airways getting larger as we grow older) is why asthma quite often seems to disappear as asthmatics get older. Well, at least this is one of the reasons. The other is, as we get older, we are removed from asthma triggers, and thus our asthma becomes so mild we barely know we have it (of course that's a discussion for another day).

So while I continue to teach my asthmatic patients about the importance of peak flows, and while I do pre and post bronchodilator peak flows on all my asthmatic patients, they really serve no purpose for me.

However, just in case, I do blow into one from time to time just for fun. Or, perhaps I do it just in case I'm wrong. I am wrong from time to time. If you don't believe me, just ask my wife.

Undetectable bronchospasm

Well, I've been a little slow getting this blog off the ground. The battle of keeping my blogs going is a constant challenge as I also have a job, three kids, a pregnant wife and a life to balance around. And I assure you I rarely spend time at the computer when my kids are around, or if I have real work to do at work.

Plus writing has been a challenge since I am no longer working nights 36 hours a week. When I was doing that, there was plenty of time for writing at work. Days here at Shoreline Medical are a lot busier than nights -- most of the time anyway. Despite adjusting to my new life of working mostly days, and trying not to melt in the daylight, I still have the undying urge to write, although less writing (blogging) time.

Since I'm stuck working a rare evening shift tonight, and since work is exceptionally slow, I find I have time to jot a few notes here (let's pray the beeper stays silent). The asthma is doing exceptionally well of late. I say that even though I spent several hours in the basement cleaning yesterday. That's something I never would have been able to do three years ago without having a bad attack. So, I'm living proof things can get better.

Like most asthmatics, and like most days, I woke up feeling sort-of tight this morning. I believe, however, that my description of tightness would be "undetectable" by even a majority of asthma experts. My parents never noticed when I was a kid, and my wife rarely does today. I'm pretty certain I could sit in my doctor's office and he'd never have a clue unless I said something.

However, I have a Hardluck Asthma friend (of whom I promised in my last post I'd write about), who does notice even my "undetectable" asthma episodes. How she can tell I have no clue, yet I imagine it's because she has similar episodes. Plus she's observant, a skill I lack.

So even on my good days -- which all my days have been the past few years (fingers crossed) -- I wake up with "undetectable" tightness. Sometimes if I'm patient, I can simply take my Advair, wait an hour or so, and this "undetectable" tightness disappears. Although most of the time I'm too impatient. Either that, or I just love the taste, the feel, of that inhalant in my mouth.

Still, this "undetectable" tightness is nothing compared to what it used to be. Yet that's a discussion for some other post.

I took another 2 puffs of my Albuterol about 2:30, and then I came to work without my inhaler. For some reason, I find I rarely need it when I'm working. Although, you must consider I work in a hospital, and I'm a respiratory therapist, so if I need a bronchodilator all I have to do is reach into my pocket and find a quiet room. While I've done this even as recently as a week ago ( I had a cold), I have managed to make this a rare occasion these days.

My boss found the evidence that I took a treatment at work once, and she was fine by it. Of course it helps that she was an RT who took care of me when I was a kid. I wrote about this here.

In fact, I actually feel a little "undetectable" bronchospasm as I write this, yet I have no desire to use my rescue inhaler. Well, of course it helps that I don't have it in my possession. Yet, I also find that if I wait it out, the long-acting bronchodilator that is in my system usually comes to the rescue at some point.

Of course you guys should also note here I'm a recovering bronchodilatoraholic, and when you're recovering it's best you don't have the substance. Yet, when it's breathing we're talking about, it's hard to get away from the substance. It's kind of like trying to overcome an addiction to eating when you HAVE to eat to survive.

So I can pretty much assure you I will not use my rescue inhaler (old faithful Albuterol) until bedtime, which, since I don't get out of work tonight 'till 11:00 p.m, will probably be around midnight. I'll use it whether I need it or not.

This may sound funny, but even when I don't need my rescue inhaler, if I use it I still get some relief. I think this is because I have some degree airway remodeling. I don't know if this is true, but this is what I believe.

When you suffer an asthma attack, all the systems that work to cause your body to attack itself, to cause the bronchospasm, cause damage to your airways. When the attack is over, or ending, your body has to heal itself. In the process, a certain degree of remodeling is inadvertently caused.

This is ironic, considering our immune systems are meant to attack real threats to our bodies, and asthma (and allergies) attacks "perceived" threats, or things that are not harmful at all to people with normal lungs. So here, in the process of healing from our bodies own attack on itself for no real reason (or for inexplicable reasons), permanent damage is caused.

So this remodeling, this permanent damage, however slight, often provides me with some degree of shortness of breath, however "undetectable." In this sense, this permanent "undetectable" bronchospasm I have, might be what is referred to as the link between asthma and COPD.

For those who aren't so fortunate, these permanent changes lead to difficult to manage asthma, and perhaps even permanent dyspnea that is only partially reversible with asthma treatment. This, most definitely, is within the Asthma-COPD link.

However I digress. Yep, at the moment, as I take in a deep breath (yes I can get it in all the way comfortably) I notice very, very mild "undetectable" bronchospasm. It's there, but I barely notice it as I go about my business. You'd never know it either. You'd think I was just a normal person with normal lungs.

Well, you wouldn't because you knowI have asthma. But you know what I mean.

Hardluck Asthma

Any one who's followed my shareposts on MyAsthmaCentral.com, or my respiratory thearpy cave blog, knows that I have asthma. I'm going to continue doing both of those, yet I wanted a place where I could give asthma the full attention it deserves.

When I originally came up with the idea of starting a blog back in 2007 I wanted to start an asthma blog, yet I wasn't too keen on the idea of writing about myself. So that's why I created the RT Cave. Although, on occasion I did write about my own asthma, I still hated it.

That was until I was recruited to write for MyAsthmaCentral. The editors at this website wanted me to write about asthma, and I took up the challenge. Yet, the goal for me was "not to write like every other writer."

I was to write about what it's like to live with asthma. I was supposed to write asthma humor, if that's possible. Yet, when you live long enough with something, you eventually learn how to find humor in it, which I did here. In fact, I even wrote a list once about the benefits of having asthma.

Believe it or not, I actually got some hate email for that one. "How can you find something good in something as bad as asthma?" one emailer wrote.

Then word got out to my editor that I spent six months at an asthma hospital, and she wanted me to share my experience. So, I sent for all my medical records, pulled old letters and diaries from dusty scrapbooks, and (an asthma attack later), I wrote a novel about my asthma experiences. Well, needless to say, a novel is way too long for a sharepost, so that idea was scrapped.

Instead, I have been putting my asthma experience on my respiratory therapy cave blog, yet I really don't think my fellow respiratory therapists care much for my asthma experiences. Well, I'm sure they care, but that's not what that blog is all about.

Thus, after a lot of thought, I decided to create Hardluck Asthma. While I might write some in depth stuff here, this is going to be more of my spontaneous asthma blog. If I'm having a bad asthma day, or a neat asthma experience, this is my place to share it.

Like Breathin Stephen, Kerri, and all the other asthma bloggers out and about (here's a list of asthma bloggers), I spent most of my life wondering if there was anyone else who has asthma as bad as myself.

When I was 25 I met Sammy, who was a fellow respiratory therapy student. I soon learned she had asthma as bad as me, and was even a bronchodilatoraholic just like me. (Tomorrow I'll write about Sammy's asthma, and the her unique form of hardluck asthma.)

Sammy and I became good friends because, before we met, we both thought we were alone in the asthma world. Yet, while it took me 25 years to discover I was not alone, now asthmatics around the world can communicate right here on the web via asthma communities, or in the blogosphere.

So stay tuned, we have some cool asthma stuff to write about in the days to come.

Introduction to Hardluck Asthma

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Dear readers:

If you read books about asthma that were written prior to the late 1990s, you will not see asthma defined the same way it is today. In fact, asthma, as defined prior to the 1930s, may not even be asthma at all.

Now I'm sure Teddy Roosevelt had the disease, the same as you and I do, yet even physician's like J.B. Berkart, who wrote his version of "On Asthma: It's pathology and treatment" in 1878 noted the following:

"ALL early historical traces of the affection at present called asthma are lost. Although the disease is said to be mentioned in the Bible, and described by Hippocrates, Areteaus, Galen, and Celsus, there is not the least evidence that those remarks apply to the asthma of to-day. For in the former systems of medicine, all cases presenting the same conspicuous symptoms were, regardless of their anatomical differences, considered as of a kindred nature, and grouped into classes according to imaginary types."

In this regard, any disease that caused shortness of breath, or dyspnea (being winded) were all called asthma. Chronic bronchitis, emphysema, COPD, cystic fibrosis, pneumonia and heart failure all result, at times, in symptoms similar to asthma, and, thus, were all grouped in the class of asthma.

(Naive doctors still often confuse these diseases, and often treat all that wheezes and all that causes shortness-of-breath as asthma, as I often make fun of in my sister blog, respiratory therapy cave. Examples of this are here and, better yet, here.)

The funny thing is, that even while Berkart noticed this, he himself believed asthma was caused by Rickets, and he also believed asthma was psychosomatic. Likewise, he himself said that he had never performed an autopsy on an asthmatic and not seen emphysema. Emphysema, as you and I know today, causes permanent air trapping in the lungs, while asthma causes air trapping only during an exacerbation (with a few exeptions). Yet that wisdom is relatively new.

During most of the 19th century asthma was thought to be a psychosomatic disease, in that asthma experts believed asthma was all in the head of the asthmatic. With good psychiatric care, and good medicines like opiates and caffeine, one asthmatic was expected to relax and the asthma attack will go away, and asthma itself will go away with age (a fallacy that still exists as you can read about here). I wrote about old and wacky asthma remedies here.

In fact, there are and were (are) so many asthma myths that I can hardly scratch the surface, although I try in this post.

When I was a kid growing up in the 1980s it was known that corticosteroids worked to end an asthma attack by reducing inflammation, yet it was believed this inflammation was only present during an acute attack. Therefore, as soon as my asthma was doing better, I was told to quit taking my Vanceril or Azmacort (as you can see by my medical records here).

And, when I was 10, my doctors introduced me to the rescue inhaler, which has since become my best friend (I wrote about this here).

Ah, even since I was a kid asthma wisdom has grown. I was correctly taught in 1985 that asthma was a reversible obstructive airway disease, and that during an exacerbation bronchospasm and swelling (inflammation) of the air passages in my lungs occurred.

Yet, it was in 1985 that the first studies were completed showing that asthma wasn't just a disease the resulted in inflammation during an asthma attack, but that this inflammation was always present -- chronic. And that the repair process from that first acute asthma attack, and subsequent ones, often results in airway changes that may lead to permanant airflow obstruction and, perhaps, hardluck asthma. Yet, sometimes hardluck asthma is simple pure asthma that's difficult to manage.

I had the pure asthma part of hardluck asthma as a kid, although with modern medicine and good compliance, I am no longer a hardluck asthma. Other than the fact I take meds twice a day, or the occasional flare up, or by writing about it as I'm doing here on this blog, I often forget I even have the disease these days.

Thus, today, most asthmatics who are compliant, who are gallant asthmatics, rarely have to experience asthma. In fact, I bet most asthmatics don't even know they have the disease.

Yet, as we all know, there are some asthmatics, both gallant and goofus, who continue to have problems with their asthma regardless how well their asthma is managed. These are your hardluck asthmatics, and thus is what I chose to name this blog.

I was a hardluck asthmatic until a few years ago. Technically speaking, I'm probably still a hardluck asthmatic considering in order to keep my asthma tamed my wife has to fork out $80 a month for asthma medicines. Actually, my co-pay just increased, so starting next month I'll have to pay over $100 a month. The fact I have to fork out so much money is "hardluck" in and of itself.

Asthma is hardluck in more ways than one. It's hardluck in that it remains a conundrum for scientists, asthma experts, and thus doctors, and has remained so for over 5,000 years. Asthma is an inexplicable disease in that scientists remain baffled as to what it is and what causes it. They are also perplexed as to why it has a tendency to seem to disappear for days, months and even years, and then come back with a vengeance.

Scientists have recently discovered a gene they think is linked with asthma, emphysema, COPD, and certain diseases of atopy like psoriasis and eczema. In that sense, will in the future scientists link these disease processes? Is it possible that COPD only occurs when the patient has the asthma gene -- I think so.

Some doctors think of asthma more as a syndrome (as I write here) more than just a disease, as it is linked to the immune system (allergies and atopic dermititis), acid reflux that causes airway changes and leads to asthma (GERD), the upper respiratory tract (polyps, sinusitis, crooked nasal passages) and mouth breathing, anxiety, and perhaps more yet to be discovered pathologies.

What is asthma really? While I think we are closer now than ever to knowing all the secrets of the asthma conundrum, so too did Henry Hyde Salter think he had all the answers when he described asthma as a psychosomatic disease in his book "On Asthma: It's pathology and treatment" in 1860, and so too did Berkart when he linked asthma with Rickets and emphysema.

Hippocrates -- of Hippocratic oath fame -- actually was closer to the true definition of asthma when he said it was caused by "broncho spasms" way back in ancient Greece than Salter was in 1860. Although Salter did accurately predict asthma to be a disease passed on by the parents (although he didn't know about genes). Salter also suspected certain "things" brought upon an attack, although he didn't understand about dust mites and cockroach urine.

Likewise, Salter and most doctors who followed him even up until the 1950s when the "atomizer" (inhaler) was invented often prescribed asthma cigarettes and even marijuana as asthma cures. While these remedies showed bronchodilating properties, they also made asthma worse, and maybe even caused COPD in many of these asthmatics, or at least made asthma worse. Yet, how were they to know.

I will delve into these topics and more on this blog and my myasthmacentral blog.

So I tackle asthma in my weekly sharepost at MyAsthmaCentral.com, and I have tackled it on my RespiratoryTherapyCave blog. I will continue to write a weekly sharepost at MyAsthmaCentral, and I will continue the RT Cave, although I will reserve asthma wisdom to this blog starting in July, 2010.

This blog is our opportunity to delve into this disease further, and to fully understand it. As you can see I have a Passion for history, and what we experience now is in every way linked to the past.

I will learn along with my readers, share the latest (and oldest) asthma wisdom, and share asthma experiences. I will share facts blended in with my opinion, and an occasional splatter of asthma wit.

What I will not do on this blog is reiterate what is in the news. For that I will reserve you to my Twitter account or to other online resources. We'll see where this goes. Perhaps it'll end in the trash heap of blogs for all I know.

Sincerely,

Rick Frea.

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