Do most asthmatics avoid Advair like the plague?

Perhaps one of my fellow asthmatics can help me out with this one. I recently saw a new asthma doctor, and, when I asked to have my prescriptions refilled he said, "You like Advair?"

"Yes! I love it!" I said.

"Wow! You're one of the few asthmatics who can stand it!"

"What!"

"Yeah. Most of my other patients hate that medicine." I will assume that he is also referring to any medicine like Advair too, such as symbicort.

"What do they take for their asthma then."

He smirked and said, "Well, nothing. They come in every 6 months complaining of asthma problems."

"Interesting," I said. The conversation moved on from there, although the idea that Advair was as unpopular as he was saying is still wobbling around in my mind, hence this post. I guess the naive person inside my head "assumed" if there's a medicine that works as well as Advair and Symbicort do to control asthma, that most asthmatics would at least try to like it.

Although, according to doctor Axel, that's not the case. Yet I think one of the reasons this threw me off guard is because my old doctor, Dr. Best, told me the opposite: "Most of my patients love Advair."

It's interesting the different perspective a doctor can have on a medicine. Yet this latest discussion about Advair has me wondering: do most asthmatics remain ignorant and continue to have

I wonder, though, if most asthmatics hate Advair if it has to do with the long-acting beta adrenergic medicine (Serevent) in it. I wrote here how it actually took me 10 years to get used to Serevent, and that I actually had to wean myself onto Advair.

Yet I don't think most doctors think about weaning onto a medicine, and when a patient says they can't take it, that's the end of the discussion. Yet I will contend, if you have uncontrolled asthma, Advair may just be the key and you should wean yourself onto it. You should try gallantly to get your body used to the stuff.

So, facts confirm Advair works wonders for asthma. Yet, is it a fact that most asthmatics continue to avoid Advair (and Symbicort) like the plague? If you have any greater wisdom on this cue your wisdom into the comments below or email me. .

Just this once I'm going to gloat

If you're going to set a goal, you might as well work hard at it. I've seen many of my co-workers and friends get vexed that they haven't been losing weight, yet when you ask them about their diet and exercise you can tell right away the reason.

Basically, there is one sure way to lose weight, and that is to work hard. The most important step is diet. If you put in less fuel than your body uses, you'll lose weight. If you add muscle, your metabolism rate will increase, and this will help you lose weight faster. If you do both, you're sure to lose weight.

The bottom line is: you have to change your diet and exercise routine. You have to change something. You certainly aren't going to wish your weight away. That's what I think some people do. They try to wish it away. Fat chance.

Yet as a few of my coworkers have whined recently: "Why are you losing weight and we aren't. It's because you're a guy," or, "It's because you got more time."

Wrong! It's because I make an effort. I work hard. I give 110% to my goal. And I don't let little minor set backs cause me to quit. I have weak moments where I can't help but to eat that cookie or cake or whatever, yet once that's done and fully enjoyed I move on and get back on the train and keep on a rolling.

Yet I never say that, except to my few closest friends. Most people who complain to me get a simple, "Well, that stinks." Yet, what I won't give them is the old," well, maybe you're just at your natural weight," which is what I think some of them want. I don't give out sympathy. I don't because I worked my ass off to finally get down to 189.4, which is what I weighted in at today.

And, I'm sorry, yet as I stepped on the scale, thinking of that 210 that I weighed in as on April 4, 2010, I couldn't help to think, as I saw the scale tip out at 189.4: Woo Hoo!

No sympathy for winy butts here, and no gloating either. Your humble RT and fellow asthmatic knows as well as the next kid in town that what one works arduously to obtain can disappear in a heartbeat if one isn't careful.

So, since I can't gloat in the real world, since I'm forced to be humble, just this once I'm going to gloat: WOO HOO! I won't do it again.

Burnout!! Time for vacation

I have some empathy for all those whiners on the Biggest Loser as I've been putting myself through a rigorous routine of working out the past few weeks in preparation for final weigh-in for the biggest loser competition we've been having at work.

Today I put myself through my own version of the last chance workout, where when I got done I was so worn out I could hardly move my arms to wash myself. That was a great workout, and perhaps my best ever. Hopefully it shows on the scale tomorrow. Yet, even if it doesn't, I'm happy with the results.

After I weight in I'm going to take three days off. I'm going to Mackinac City (no not to the island) with my wife and kids for vacation, and I'm not going to think about exercise and diet. I'm going to eat and drink and not exercise all I want. Then when I get back I'll get back on the train.

It's kind of a lifestyle I'm trying to maintain here, so I think days off are good. If you go to long not doing the things you enjoy you're going to set yourself up for the inevitable crash, and I don't want that to happen this time (it's happened many times before).

As I've written before, when an asthmatic is going on vacation he can't just walk out the door and leave. He has to plan ahead. So the Advair is packed and so is the box of generic Claritin and benadryl . These are must packs to PREVENT the inevitable allergens that hide in hotel rooms from irritating my allergies and asthma.

Oh, and definitely the Albuterol inhaler. Even now, the day before, bronchodilator anxiety is setting in. I've checked about 10 times to make sure my inhalers were where I put them. And, I know, once I get in the car I'll check my pockets. It's insanity. It's like my obsessive compulsion.

We're probably not going to have ideal weather for this time of year, but so long as it doesn't rain we will all be happy. And, regardless -- even if I have to sit in a hotel room for three days -- this RT will come back fully refreshed, and hopefully with a few blog ideas.

Burned out from working out too hard and working too hard. I've been running every day, rain or shine. And now I'm paying for it.

So, for sanity purposes, I'm outa here -- tomorrow.

See ya!!

Wheezing in the front seat

I met my mother at a local restaurant a few days ago and somehow the discussion evolved into car seats, and how my 1.5 year old daughter is still in a rear facing seat, and my 7 year old uses a booster seat.

Yet then we traveled down memory lane back to 1977 when I was the 7-year old, and my older brother was 8 and my younger brother 6. Not only did we not have car seats and booster seats, we didn't even wear our seat belts. In fact, we didn't even sit.

Mom said, "I remember you guys all standing. In fact, I remember you falling asleep in the front seat, and when I had to stand on the breaks I instinctively put my arm out to prevent you from falling forward. It's funny how you never even though about this back then as being dangerous.

"In fact," she continued, "I think you are the one who always had to be in the front seat because your brothers couldn't stand the way you breathed. They were picky that way, and very irritable. They'd tease you and start fights. So I had to put you in the front seat."

"You were sneezing and sniffling and your mouth breathing was loud, and you were always wheezing. You were always sick like that. So that's why we had you in the front seat."

I think it's neat how we have progresses as a community. My mom actually let me wheeze and sniff and sneeze because there wasn't really anything she could do. And, to prevent me from fighting from my brothers, she made me stand in the front seat, where I was even at greater risk from dying of a head contusion than of asthma.

I was thinking this, although I didn't say it to her. I guess this is all proof that we do the best we can with the wisdom before us, yet as we know better we do better. Now, if our kids are wheezing and sniffling, we treat it and hopefully prevent it. And we definitely secure our kids in their car seats. Well, at least my wife and I do.

The fox and the fawn

Even while most health experts recommend doing your high interval aerobic workout in the morning, due to my schedule it's something that's a rarity for me. Although this morning the opportunity presented itself.

It's a nice trail I take at the city park. It allows me to get my daily dose of the wild, although there are wildernesses all over where I live. There's the Manistee National Forest, and then there's where I grew up which is pretty much in the woods.

During my training sessions through the city park where I walk around a 0.93 mile paved bike path that takes me through the woods, to a lake with a dock, past the city campground, and then back deeper into the woods where the path comes full circle back to the docks again.

It's a city park, so you can hear cars whooshing in the distance. Yet it's still the middle of the woods. There's talk of building a dog campground, which is a fenced in area where people can walk their dogs. I'm hoping this doesn't distract from the outdoorsiness.

I see lots of wild animals, although mainly just the common one's like rabbits, squirrels, chipmunks, snakes and the like. It's neat, however, how you can get up to a few feet from a deer, and the deer will stand still and stare at you without taking off -- which is what they normally do. In a sense, all this wildlife is tame to humans.

Today I saw a doe twice, and both times it was scared away. Actually, the first time it I took it as an opportunity to stop, and it stared at me for a few minutes, until it decided it better not take it's chances with me. After completing my workout I decided to walk the 0.93 mile circuit through the park when it started to lightly sprinkle.

So here I was completely alone, never passing a soul. I was thinking how cool it was to be out here by myself, listening to the birds chirping, the constant shuffling of leaves as one squirrel was chasing another, or a raccoon shuffled across the creek to my right. There's always a lot of wildlife activity in the woods, but never as much as there was today.

There are also signs placed here and there with one animal track on each one. When you lift the sign up you can see what animal's tracks is represented. I passed one that said "Cougar" and observed that the top of the sign had been ripped off, probably by vandals. I was thinking how cool it would be to see a cougar. I had never seen a cougar before.

You think about cougars as something you'd see out west in the mountains, but believe it or not they have been spotted up here in northern Michigan. However, I think in the west they are called mountain lions, but the truth is both cougars and mountain lions are one and the same. I think that's true anyway.

So here I'm walking in the rain and there's all this wildlife. You here a lot that wildlife goes into hiding during the rain, and that this is often a sign that it's going to rain. Yet I don't think that's necessarily true either, unless the animals sense a severe storm. Right then it was just lightly sprinkling. It was a cool rain, at the temperature was 65, but it was raining nonetheless.

About half way around the circle I was closing in to the point where there is a pond to my right, and I could hear the croaking of frogs even though I couldn't yet see the pond. On the other side of this pond was a city campground, which gives you an idea how close people are to where I was. Although I was, by all means, in the middle of the woods.

So it was about at this spot that I'm thinking how cool it would be to be one of the few people to see a cougar. There are also bear in the area, but you don't hear about them unless they get into the city and start wandering around. Bears are curious animals. I heard a story recently by one of my patients about a bear coming right up to their house and getting into their trash. When she woke in the morning she could see the tracks. I've also heard of cougars walking right up to screen doors and my friends that happened to be inside the house watched as the cougar ran off.

You hear these stories from time to time, and occasionally there is a story in the paper about a cougar track, although to actually observe one of these critters is a rarity. In fact, it's so rare some people don't even believe these animals exist.

So, I'm thinking about this, and then I hear a scuttling of leaves to my left. I'm thinking it's just a squirrel, or a bird, or a chipmunk, or a snake, or a skunk, or a rabbit, or a deer, or some common animal like that I see often. Yet what I saw was a little red fox, no larger than a rabbit, running through the woods. Then, right behind it, was that same doe that I had scared away twice while running earlier.

The fox and doe both disappeared in the woods, but it was in the direction my path was heading. So, after I passed the pond and a track which lead to the campground, the path turned left. I was on the lookout for the deer or the fox. I saw, standing in the woods, a fawn. I stood there and stared at it for at least five minutes. It moved maybe once or twice, but if you weren't observant you might not even have spotted it. So, now I'm thinking, what I saw must have been this doe, and not a fox.

Yet, at about the five minute mark, a fox sprinted from behind the fawn, and the fawn chased the fox into the bushes right next to the track ahead of me. Now I was reminded of the fox and the hound, only in this case it was the fox and the fawn. I figured I'd certainly see the duo again as I passed the bushes they ran into, yet there wasn't a peep. They had disappeared. If I wanted to I probably could have scared them out, but I continued on my way.

While there's lots of foxes up here, you don't see one very often. I grew up 20 miles from where I do now more in the country, and I only saw a fox once scamper across the yard. I knew of a
few fox dens, yet never actually saw one.

Anyway, it's just neat what you see when you're in the woods. Sometimes I find painters sitting in the woods drawing what they see. Sometimes I stop to talk, although most of the time I decide they don't like to be bothered. Well, actually, most of the time when I'm out there I'm busy doing my workout routine.

It's moments like this I wish I could carry my camera when I'm running. Yet I never do and probably never will.

The First Detroit Tiger Perfect Game

Life is a humbling sport. It's a game of what ifs. It's a game of failure. Oh, and so is the game of baseball.
Watching that game last night in the 8th inning with two of my co-workers, we were cheering for the Tigers to put together a couple insurance runs.

The irony of that moment was, not one of us had any idea the historical impact of that game. Not one of us even knew who was pitching, let alone that Andres Galarraga was in the process of throwing a perfect game.

Well, it was a perfect game. Even though this game had nothing to do with my life, and that if the Indians had gotten a real hit my life would have been impacted in no way. I still would have asthma. I still would be at work with only 2 patients and nothing productive to do for the next 11 hours.

Yet, my heart started pounding like hay fire when I clicked on my computer moments later and learned via a yellow flag on top of cbssports.com that there was a perfect game in process, and it was the game we were just watching.

I saw it. I saw the out. I was jumping up for joy. Then I shouted loudly, "What! He was out! How can you call him safe! What!" Then I realized I was alone, and the people walking past the room were looking at me with wide eyes, as if thinking, "What an idiot!"

I am an idiot. Yet I'm a big Tiger fan. I'm a bigger Tiger fan than anything not real life related. Some of us guys cling to a sport because in real life we are failures. We fail at nearly everything we do. We ultimately accept failure, and see what we have as success. It's religion perhaps that does that to us. Humbling religion.

Yet here I am all irate, when in fact the game was won by my Tigers. I should be happy. Never do I ever remember being unhappy when my team won, especially when it was in April, not October. This was not a World Series. This was not a playoff. This was a single game early in the season.

Yet, only 21 times in Major League Baseball history did someone throw a perfect game, and it never occurred twice in the same season before 2010. Now it was going to be done (was done) by this Tiger, and the ump blew it.

Yet, I can humbly say that, in this game of life, if I were that pitcher I'd do the same as Galarraga did, and hug the crying umpier who admitted he did it. Now it's up to MLB to overturn the call, of which it has done in the past. It's time to give that young man, and Tiger fans worldwide, what they earned -- the first perfect game in Detroit Tiger History.

It was hard to work the rest of the night. It was hard to work, even though the Detroit Tigers have really no real impact on it.

In fact, reality set in later in the night when a man came in not breathing. Hiis family had something to really be upset about. Yet, even as I pulled the plug on the ventilator as the family of the 92 year old man decided to make the right decision, all four family members in the room were smiling, happy, and alright about it.

Yes. Life is a humbling game. It's a game of failure. It's a game of death. Yet we must all have something intangible to hold on to so we don't let all the failure drag us down. Life is great, and seing them smile assures me I'm right in my assertion.

Perfect game or not, life will go on, and we should all enjoy it to the end. Still, I hope MLB makes the right decision in the end. If nothing else, it'll create a lot of smiles.

History of Asthma Definitions

As we travel back in time we will learn the definition of asthma has grown through the years.

• 30,000 B.C.:  Diseases are noted by their symptoms as opposed to their causes.  The symptoms of shortness of breath, wheezing, anxiety, nausea, headache, itchy and watery eyes, runny nose, etc are caused by the unseen spirits and gods.  
• 10,000 B.C.: Theories started to evolve in most societies that diseases (symptoms) were caused by some kind of imbalance inside the body.  These types of theories would hold strong through most of history.  
• 5,000 B.C.:  Asthma-like symptoms were described in ancient Egypt, although no respiratory diseases were described. 
• 2,697 B.C. Chinese physician Ch'i Po provides the first description of asthma (maybe):  "Those who do not rest and whose breathing is noisy have disorders in the region of Yang Ming (the 'sunlight').  The Yang of the foot in descending causes the present disturbance and is ascending it causes the breathing to be noisy."  You can read more by clicking here. 
• 800 BC?  The first reference to asthma was made by Homer in his epic poem The Illiad.    "asthma" was derived from the Greek word aazein, which means to exhale with an open mouth or to pant.  Actually, asthma is derived from the Greek word Panos which means panting.  Homer used the term to reference any dyspnea, including shortness of breath after exertion from fighting in a battle. So here asthma was basically an umbrella term that represented all causes of dyspnea (asthma, hay fever, bronchitis, emphysema, kidney failure, heart failure, pneumonia, tuberculosis, etc.)
• 400 B.C.:  Hippocrates introduced the term asthma into the medical community, using it to describe any medical condition that caused dyspnea.  Pneumonia and tuberculosis are the first two respiratory diseases taken out from under the asthma umbrella.  The cause of asthma was the same as any other disease, it was caused by an imbalance of one of the four humors: Blood, Phlegm, Black Bile, Yellow Bile.
• 1 A.D.: Celcus was the first to distinguish dyspnea from asthma.  He defined dyspnea as Moderate, unsuffocative breathing without a wheeze (it's chronic); he defined asthma as Vehement breathing that is sonorous and wheezing (it's acute)
• 100 A.D.: In India, asthma-like symptoms were referred to as Tamaka Swasa, with swasa meaning breathlessness.  It's a condition that closely resembles our modern description of asthma such as wheezing, shortness of breath, increased phlegm and coughing (kawa).  When severe it may result in sweating, trouble lying down and trouble speaking.
• 100 A.D. Aeretaeus of Cappadocia defines asthma this way: "If a difficulty of breathing is produced either from running, excessive exercise, or any other cause, it is denominated asthma, or any other cause, it is denominated asthma: that disease likwise known by the name orthopnea, is called asthma, because the patients during the paroxysms are affected with difficulty of breathing, it obtains the appelation orthopnea from the patients not being able to breathe easily, unless in an erect posture of body, in a reclining state, there is danger of suffocation taking place." The cause was "coldness of breath with moisture: the matter consists of thick gutinous humors lurking internally." Treatment was based on your age and sex. 
• 150 A.D.: Galen mostly agreed with Hippocrates that asthma was a humoral disease, and he was the first to define asthma as a disease of wheezing.  He noted that "if the breathing is rough and noisy it indicates that a large amount of thick and sticky humors in the bronchial tubes of the lungs has accumulated and become annoying because it is difficult to expectorate." 
• 650 A.D.: Paulus Aegineta defines the asthmatic as "those who break thick without fever, like those who have run fast...The affection arises from thick and viscid humours becoming infarcted in the bronchial cells of the lungs... Dyspnea is a common symptom which accompanies these and many other complaints... 
• 960 A.D.: Haly Abbas, like Galen, refers to asthma as a collection of gross phlegm about the cells in the lungs. His remedies are of an attentuant and incisive nature, and he particularises the vinegar of squills.  He cautious asthmatics to be aware of indigestion, and, therefore, forbids exercise after food, but recommends it before a meal.  After exercise he enjoins hard friction, no doubt with the intention of favouring the cutaneous perspiration
• 1000:  asthma was a chronic disease in which patients often suffered 'acute paroxysms with similarity of epilepsy and spasm.'  The flow of thick humours from the head to the lungs produced a situation in which 'the patient finds no escape from rapid panting, like the labored panting of one who is being choked or rushed'. 
• 1180:   Maimonides might have been the first to describe nervous asthma when he wrote how a patient who is "mentally agitated" causes his physical well-being to suffer and eventually he becomes physically ill. He was also to think asthma might be caused by pollutants in the air.  He believed asthma usually began with a cold and advanced to shortness of breath. 
• 1400:  Korean physicians believed asthma-like symptoms or coughing were caused by excessive eating, fear and shock.
• 1600: Jean Baptiste Van Helmont was the first to describe asthma as anything other than simply a symptom.  He was the first to propose the idea that asthma was a disease of bronchospasm when he wrote:  "The lungs are contracted or drawn together." He was the first to describe asthma as a nervous disorder. 
• 1650:  Thomas Willis is actually given credit for the nervous theory of asthma because he wrote more extensively about it. He described asthma as "obstruction of bronchi by thick humors, swelling of their walls and obstruction from without." He describes three types of asthma: 
• Pneumatic Asthma:  Dyspnea is a result of air passages in the lungs being obstructed or not open enough
• Convulsive Asthma:  The primary fault of dyspnea comes from the lungs themselves, "in the moving fibres or muscular coats of the air vessels or in the diaphragm and muscles of the chest or in the nerves of the lungs and chest or of the origin of those nerves in the brain."
• Mixed Asthma:  Both pneumatic and convulsive.
• 1675:  John Floyer described a hereditary component of asthma, and numerous exacerbating factors such as air pollution, infection, cold air, exercise, sleep, psychological stress, and tobacco smoke, and astutely observed the benefits of clean air and environmental change.  He was the first to separate asthma from other causes of shortness of breath.  You can read more here. 
• 1700 Bernardino Ramazzini was the first to describe occupational asthma.  
• 1750 William Cullen was the first to start removing lung diseases out from under the umbrella of asthma, defining asthma as dyspnea caused by spasp.  He defines 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."
• 1800:  Robert Bree believed asthma was a humoral disease and not a spasmotic disease.  He believed that some sort of paroxysm was present in the air tubes that caused asthma.  As the asthma fit progressed, the asthmatic would ultimately cough up some sputum, and with the sputum would be expectorated the causative agent. 
• 1850:  Henry Hyde Salter believed asthma was a condition of airway spasms or convulsions caused by a nervous disorder.  He strongly inculcated the idea that asthma was nervous.  He was the first to state that asthma was not a humoral disease, but an actual disease of the lungs and mind.  
• 1859: American physician J.A. Swett acknowledged that bronchospasm was important, but regarded 'bronchial inflammation' as the 'principal exciting cause of the paraxysm'. (1, page 109, 110)
• 1859: Berkart rejected the idea that 'mysterious derangements of the nervous system' caused asthma, yet he saw little evidence that anti-spasmotics of that time benefited the disease. Based on this wisdom he believed asthma was a product of transient obstruction of the bronchi. (1, pp. 110)
• 1873: Charles Harrison Blackley argued that symptoms of hay asthma (hay fever) were due to inflammation of the 'submucous cellular tissue' of the bronchi rather than 'spasm of the circular muscles of the bronchial tubes'. (1, pp. 110)
• 1870s: Mucus plugs were discovered in the lungs of asthmatics(1, pp. 110)
• 1890s: Eosinophils in both the sputum and the blood of asthmatics were found, which confirmed that inflammatory exudates layed a pivotal role in bronchial asthma (1, pp. 110).
• 1892: In The Principles and Practice of Medicine, William Osler believed the theory of bronchospasm was not proven, and he suggested attacks of asthma were due to 'swelling of the bronchial mucus membrane' (later referred to as inflammation), otherwise referred to as inflammation of the smaller bronchi. He also believed asthma was caused by a reflex spasm of the diaphragm and other respiratory muscles. He acknowledged asthma as neurotic. He believed the relationship between hay fever and asthma deserved attention, because he believed if the changes in the mucosal membranes that occured with hay fever were to occur in the lungs, this would further explain a paroxysm of asthma (1, pp. 111, 112).
• 1894?: Edouard Brissaud condisered the symptoms of asthma to be the product of both bronchospasm and hypersecretion, which constituted a form of 'bronchial urticaria' (1, 111).
• 1895: Arthur Foxwell suggested attacks of asthma were characterized by a combination of bronchial oedema, bronchial constriction, and contraction of blood vessels in teh lungs (1, pp. 111).
• 1959: The Condition of subjects with widespread narrowing of the bronchial airways changes its severity over short periods of time either spontaneously or under treatment. (American Thoracic Society: Am Rev Respir Dis 85: 762-785, 1962)
• -- Asthma experts at this time were working hard to differentiate asthma from COPD. Although it was basically defined, in 1959, as a form of intermittent airway obstruction that could be reversed with bronchodilators. Chronic bronchitis was defined as productive cough, and emphysema was defined as dilation of the air-spaces distal to the terminal bronchi.**
• 1962: Asthma is a disease characterized by an increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (Ciba Foundation Guest Symposium: Thorax 14: 286-299, 1959)
• 1975: A chronic condition is characterized by recurrent bronchospasm resulting from a tendency to develop reversible narrowing of the airway lumens in response to stimuli of a level or intensity not inducing such narrowing in most individuals (World Health Organization: Bull World Health Organ 52; 251-260, 1975)
• 1985: Reversible Obstructive Airway Disease: The acronym R-O-A-D was what I was taught in 1984 during my time at National Jewish Hospital/ National Asthma Center.
• 1987: A clinical syndrome is characterized by increased responsiveness of the tracheobronchial tree to a variety of stimuli. Major symptoms are paroxysms of dyspnea, wheezing, and cough, which may vary from mild and almost undetectable to severe and unremitting (status asthmaticus). The primary physiological manifestation of this hyperesponsiveness is variable airways obstruction. This can take the form of fluctuations in the severity of obstruction, after the use of bronchodilators or corticosteroids, or increased obstruction caused by drugs or other stimuli. There is evidence of mucosal edema of the bronchi, infiltration of the bronchial mucosa or submucosa with inflammatory cells, especially eosinophils; shedding of epithelium; obstruction of peripheral airways with mucus. (American Thoracic Society: Am Rev Respir Dis 136: 1285-1298, 1987)
• 1991: A lung disease has the following characteristics (1) airway obstruction that is reversible (but not completely so in some patients) either spontaneously or with treatment; (2) airway inflammation; and (3) increased airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: Guidelines for the diagnosis and management of asthma, NIH pub no 91-3642, Bethesda, MD, 1991.)
• 1992-1997: A chronic inflammatory disorder of the airways in which many cells play a role, particular mast cells, eosinophils, and T lymphocytes. In susceptible individuals this inflammation causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough in early morning. These symptoms are usually associated with widespread but variable airflow limitation that is at least partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway responsiveness to a variety of stimuli. (National Heart Lung and Blood Institute, National Institutes of Health: International Consensus report on diagnosis and management of asthma, NIH pub no 92-3091, Bethesda, MD, 1992
• 2010: A lung disease that is associated with chronic inflammation of the air passages (bronchioles) of the lungs. The bronchioles are therefore sensitive to various stimuli (asthma triggers) that should be harmless. The degree of inflammation determines severity. When exposed to asthma triggers the inflammation worsens, thus causing acute spasming of the muscles of the air bronchioles (bronchospasm) which causes the bronchioles to become narrow, thus trapping air inside the lungs. This is called an asthma flare, and results in coughing, wheezing, chest tightness and shortness of breath. The episode is reversible sometimes on its own, and sometimes with therapy. Between episodes breathing is normal for most patients.