History of asthma: 1981 (alcohol and asthma)

I recently wrote a post on the effects of alcohol and asthma as you can see here. I spent hours trying to find proof that alcohol dries out the lungs and has mold in it, when all I had to do was look in the handout I was given when I was a patient of National Jewish way back in 1985.

In the pamphlet I was given titled, "Learning about asthma," the following was written about asthmatics drinking alcohol. I think this was emphasized in the book because in the 19th century asthma was believed to be physiological (all in your head), and alcohol was sometimes recommended to calm the mind and soothe the effects.

Yet while recent studies do show alcohol has some bronchodilating effects, I would imagine the negative consequences of drinking it negate any good results.

So I know some of my teenage friends at National Jewish did some drinking on the side, and this was a warning to them. So since alcohol was perceived to be an issue with teenagers, and many of us were, this was a warning to us:

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C. Alcohol -- becoming the biggest problem with teenagers in the U.S.
1. A habit-forming drug which can cause severe damage to all bodily functions when used in excess, especially stomach, liver and brain cells. In a 14-year-old, cirrhosis of the liver can occur in 20 months of excessive alcohol consumption.
2. Problems for asthmatics

• a. interaction with asthma medications can cause serious problems
• alcohol is made from molds and can cause allergic reaction to those with mold allergies
• dehydration, leading to thickening of mucus in the bronchial tubes, causing more difficulty getting the mucus out
• depresses bodies ability to cough out mucus and fight off attacks

3. Cause many social problems

• 3 million alcoholics between 10 and 19 years old
• 1/2 of all automobile deaths
• 1/2 of all murders
• 1/4 of all suicides
• also child abuse, crime, job absenteeism, shoddy workmanship, job loss are all traced in large part to alcohol abuse

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So you can see that the negative consequences of alcohol on asthma were known way back in 1985. Yet in 1988 when I started college and was pressured into my first few drinks, I had completely forgotten what I had learned just a few years earlier.

Yes, I have noticed that when I do drink my asthma is worse the next day. Coincidence? I think not. Anything in moderation is a good thing. Anything abused, especially alcohol, can lead to poor asthma control for us asthmatics.

History of Asthma: 1981 (Marijuana warning)

Until the 1980s cannabis (marijuana) was a viable option for asthma, and it still is in some third world nations.  Studies proved it improved lung function by as much as 25 percent, plus it helped relieve the feeling of air hunger.

Yet by 1980 it was learned that smoking the drug came with the risk of damaging lungs and turning asthma into chronic bronchitis.  So the risks of smoking it far outweighed the advantages.

I was a patient of National Jewish Health in 1985 and one of my fellow asthmatics had a problem with smoking the weed.  In fact, it was such a problem at the time that the hospital made an effort to mention recent studies that mentioned that smoking cannabis can harm a young asthmatics lungs.

I received the packet in 1985 and it's dated 1981.  I still have it in my collection.  It was titled:  "Learning about asthma."

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Marijuana
1. Again, all smoking is harmful to the lungs, including marijuana to smoke.

• a. rumors persist that marijuana acts like a bronchodilator: while THC, the active compound in marijuana, may have mild dilating effect, the effect is short-lived and would only occur if ingested orally. Smoking nullifies any bronchodilating effect and, in fact, will cause bronchoconstriction.
• b. use of marijuana can lead to unstable peak flows due to changes in theophylline metabolism
• c. studies show that marijuana usage can lead to adverse effects on short-and long-term memory function.

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History of Asthma: 1981 (Asthma medicines)

To start our history of asthma, let's travel back to 1981. This information is from a package I received when I was a patient in 1985 at National Jewish Health (NJH). Back then the hospital was called National Jewish Hospital and Research Center/ National Asthma Center (NJH/NAC), and the package was titled, "Learning about asthma."

In the last section of the packet is a list of all the medicines used to treat asthma at that time. Most of these medicines I was on, and if you had asthma in the 1980s, chances are you were on one or more of these too.

So, without further adieu, here is the list of the top line asthma medicines for 1981. Or rather, here is the medicine and the facts about them as per 1981 wisdom. I'm going to reproduce it here as it was actually written in lecture format:

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I. Facts about medicine for the child with asthma

A. No curative medicine
B. Control asthma when taken as prescribed
C. Medicine must be evaluated for effectiveness
D. Take only the medicine prescribed for you

II. educations

A. Theophylline

1. Most effective and used medicine
2. Action on the bronchial muscles and known as a "bronchodilator"

3. Prescribed under many brand names:

• Aminophylline
• Somophyllin
• Choledyl
• Elixophyllin
• Theolair
• Slophyllin
• Theodur
• Theospan and many others

4. Side effects

• Gastro-intestinal system
• Central nervous system

5. Evaluated by blood level determinations

B. Beta2 Adrenergics and related medicines

1. Medicines similar to epinephrine and are bronchodilators

• Metaproterenol (Alupent and Metraprel)
• Terbutaline (Bricanyl and Brethine)
• Isoetharine (Bronkosol)
• Isopreterenol (Isuprel)
• Epinephrine (Adrenalin)

2. Side effects

• Gastro-intestinal system
• Central Nervous system

C. Cromolyn (Intal)

1. Acts by lessening response of lungs to triggers
2. Needs to be taken regularly
3. No effect after wheezing starts
4. Inhaled as a dry powder and may stimulate coughing

D. Steroids

1. Related to cortisone, a hormone naturally secreted by the adrenal glands
2. Inhibit inflammatory reaction
3. Most effective medicine for a flare-up of asthma symptoms
4. Side effects

• Change in body shape: (1) Increase appetite, (2) Weight gain, (3) Round-faced look
• Change in growth: (1) Growth interfered with during long term use, (2) Severe asthma my interfere with growth
• Adrenal suppression: (1) Adrenal glands become "lazy", (2) Gradual reduction of steroids to stimulate production of glands again

5. Common medicines

a. Prednisone (Deltasone, Paracort, Meticorten)
b. Prednisolone (Sterane, Delta-Cortef)
c. Methylprednisolone (Medrol)
d. Beclomethasone (Vanceril, Beclovent)

• Inhaled into lungs
• Avoid side effects of steroids taken by mouth
• Disadvantages: (a) Difficult for small children to use, (b) Not effective for acute attacks of asthma, (3) May irritate the throat, (4) May allow thrush to develop in mouth

E. Other medications

1. Decongestants and Antihistamines
a. Given for relief of congestion and/ or allergic rhinitis
b. Many brand names

1. Antihistamines: (a) Chlortrimeton, (b) Teldrin, (c) Atarax, (d) Benadryl
2. Decongestants: (a) Sudafed
3. Combination (Antihistamines and Decongestants): (a) Drixoral, (b) Actifed, (c) Dimetapp

c. Side effects

1. Drowsiness
2. Hyperactivity

2. Anti-Cholinergics

a. Atropine

1. Inhaled

III. Administration of medicine

A. Take as prescribed by physician
B. Learn all about the medicine
C. Devise a system of taking medicine to help with compliance

1. Self-care model

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So you can see there have been a lot of changes as far as medicine is concerned when it comes to treating asthma since the 1980s. I was actually surprised to see Theophylline as the #1 asthma medicine, but I shouldn't have been. It was a top line medicine from the 1950s until about 2000.

This era was right at the peak of trying to prevent asthma attacks as opposed to just treating acute asthma symptoms. Yet it was known back then that airway swelling (inflammation) was involved in the acute asthma attack, it was not known asthma was a disease of chronic (always there) inflammation.

Theophylline is now rarely used, and Intal is off the market. Epinepherine is rarely used, replaced by Ventolin (continuous if necessary) in emergency rooms. All the other beta adrenergics listed above are no longer available due to side effects.

I was surprised to see that Ventolin, Azmacort and Atrovent weren't on the above list, as they were all on the market.  One reason may be (I'm guessing here) was that they were all under patent and more expensive than other options on this list.  Of course this list was made in 1981 and I was a patient in 1985, and was prescribed a ventolin inhaler and azmacort.

Some pretty good opitons were available back then.  We asthmatics were pretty fortunate compared to... well, we were just fortunate.

Your pessimism is my motivation this time

As most of you guys are well aware, it's hard to exercise and stay in shape even if you don't have asthma. Yet when you have this disease it's even harder, yet all the more important that you do so.

It often seems that every time you get on the exercise horse and start making some headway, something in life happens that provides you the excuse to quit and to take a week off. Of course taking a week off usually leads to taking a months off and then two.

Then all of a sudden you realize you're winded walking up steps again. You're upset with yourself that you fell off the horse. Now you are looking for some sort of motivation to help you get back on.

Sometimes the best motivation comes from pessimism. Seriously. Sometimes the best motivation to becoming a better person comes from people who tell you you can't or shouldn't do something. When I'm ready to get back on the wagon, often I look for something to motivate me.

I have asthma. I have a very good friend who has asthma. We met about 15 years ago in RT school, and we became best friends because we had something in common -- we both have asthma.

Two weeks ago the topic of losing weight was brought up. My friend is constantly dieting (as am I), and she's actually showing. I said her diet must be working because she's "looking good."

So we started talking about see-saw dieting. How we both have decided it's simply the norm.

And I said something like, "You hear a lot about how see-saw dieting is bad. But I think it's good. It means that you're smart and aware of the importance of exercising. See-saw dieting is proof of how hard it is to get into, and how much harder it is to stay in shape. Yet it's also proof that you have the strength to keep getting back on the horse every time you fall off. In that way, see-saw dieting is good."

"Good point," she said.

Yet then the conversation took a turn. I said, "Back in July I was doing so well on my exercise routine I was up to 4 miles a day -- running. After taking the last 2 months off, when I started up again last week I could only run 1 mile. Yet I got back out there and ran."

"YOU RUN!!!" she said. "You run with your asthma."

"Yeah," I said. "Why would that be surprising?"

"You have asthma."

"I find so long as I take my Advair every day I don't have a problem. I even have a bad cold right now and I don't let that stop me."

"Wow!" she said, "I don't think you should be running."

Instead of trying to find excuses, I wanted to say, I keep trying NOT to find excuses. Yet I held my tongue. I held my tongue because I respected her, my good friend.

Yet I took what she said to heart. It was motivation. It was motivation for me to get back on the wagon -- back on the horse that knocked me off two months ago.

You see, I was knocked off the horse because I had eye surgery, and that provided me an excuse not to work out for a couple weeks. And then my 4th child was born, and that provided me an excuse not to work out another month.

Before I knew it, I was back up to 202 pounds. I was staring in the face, as I looked at the scale, that I had gained 15 pounds since my low of 186 on July 8, 2010. I had to stare into the face that I was on my way back to 210 pounds, and it was creeping up on me fast.

I was facing a choice we all face from time to time. I could either keep on with the sedentary and eat everything I feel like eating attitude, or I could get back on the horse. The wise man gets back on and keeps on going, so long as his body is willing and capable.

Yet is asthma an excuse to quit? I think not. I know not. So, for the 30th time in the past 10 years, this asthmatic got back on the horse. And he did so with pessimism breathing down his back. He used that as motivation.

So it's been two weeks and five pounds lost. Ten more and I'll be back to the 186 I was at 2 months ago. Sure it's frustrating, yet it's life. Life happens. Yet you can't let life stop you from
doing what you know is right.

"YOU CAN'T RUN BECAUSE YOU HAVE ASTHMA!"

I might just highlight that and paste it to my word processor and make it as large as I can, cut it out, and put it right on the wall next to my bed.

Thanks my friend. You were wrong, and I won't tell you you were wrong. Yet I will use your comments as motivation to get back on the horse I keep falling off of yet know I need to somehow stay on to live the good life we all seek.

So I can't run Hey? Take that!

Since you made that comment I've lost 5 pounds with more loss coming. Yet I won't tell her she motivated me. I won't because we feed off each other in a way. When one of us is succeeding, that too acts as a motivator.

In that way, success breeds success. The more I get into shape the greater incentive to get into better shape, and when I see others succeeding, I find that I want to do the same. It's kind of a human nature thing.

And usually we all fall off the horse at the same time. Yet the wise among us know when it's time to get back on the horse and come up with incentives to stay on.

"You can't run because you have asthma!" That's my motivation this time.

To pee or to breathe, that is the question

So yesterday I wrote about the asthma conundrum. Well here's another asthma conundrum. What do you do if you just arrived at home, your asthma is really, really bad, and you also have to pee like a horse? What do you do? Do you take a treatment first, or do you take care of your breathing?

The wise person says take care of the ABCs of resuscitation first: Airway, breathing, circulation. Yet when I was a kid faced with this dilemma once upon a time, it was a race to the toilet. I hovered over it, braced the back lid to support my high shoulders, and whizzed for an agonizingly long time. Tears flushed my eyes, my chest burned, air was hardly available, yet there was a job to be done.

I think of this every time we have a difficult breather come in who says, "I have to pee real bad," and we say, "Just let it go. Once we get you breathing better we can clean it up."

The Asthma Conundrum

Right now a cool, refreshing, even soporific, breeze is blowing through the open window to my left. The temperature is, according to Weather.com, 75 degrees with a humidity of 51%, which is ideal for any asthmatic let alone any person.

The temperature is so perfect that you could either bundle up under the covers and feel comfortable that way, or you could lay stark naked with the windows open and feel comfortable that way too. I mean it's just awesome weather (Yet don't tell that to my mother, because I'm certain she has the heat on right now).

So you'd think that at 03:45 in the morning, and since the weather is so "perfect" as I describe it, that I'd be sound asleep like a baby. Yet unfortunately that's not the case. It's not the case because -- and unfortunately for us allergy sufferers -- along with this great weather also comes what some experts describe as one of the worse fall allergy seasons in a long time.

Fall is already described by the experts as a bad time for allergies. If you don't believe me, and do and want to learn more, you can check out a post like this one.

Yes this article explains that it will be worse in 2011. The article, by Megan Moore at News Channel 10, "Allergy Sufferers Brace For Rough Season," explains that 2011 might be one of the worse allergy seasons because of all the rain we've had lately. The more rain, she explains, the more ragweed. The more ragweed, the worse off allergy sufferers -- like me -- will have it.

So that might explain why I've been up the past seven days at 3:45 a.m. amid a pile of used and unused tissues watching TV or, as I'm doing now, blogging. I've also been going through antihistamines like Lays potato chips to the point the wife is probably going to start lecturing me about abusing them.

It's says Claritin should only be used once a day, but I'm finding the only way I can make it through the day is by using it twice a day, and supplementing it with a benadryl before bed. The benadryl makes sure I at least get a couple hours sleep.

The kicker her is my allergies feel fine for most of the day, unless I'm near my asthma triggers, of which are present in large degrees under my bed, in the closets under and over boxes, and in my man cave in the basement. If I move boxes, or shuffle through old clothes, I'm done for the day. Which basically means I'm reserved to playing chess with my son, or memory games with my daughter, which I suppose isn't so bad.

Which sucks.

So, you may be wondering, how does this effect my asthma? Well, that's the conundrum. You see, I don't think my asthma will ever put me in the hospital again. We can get into that discussion later, but it's more of a Nemesis and burden than something I fear will end my life.

By this I mean it causes me bronchospasm, and some air trapping, but not enough to prevent me from doing my daily chores, at least considering I have a job indoors, in the air conditioning, and my asthma nor my allergies rarely bothers me when I'm working. It's just when I'm exposed to those dreaded asthma triggers -- the dog gone rag weed, molds, fungus, and pollens.

And you can't avoid them. They are everywhere. They are ubiquitous.

So I can feel the asthma right now. I can feel the little bronchospasms in my chest, which kind of feels tight. Yet I can take in a normal breath, and my peak flows are normal. Plus I rode 2 miles on the bike yesterday and my asthma didn't bother me. Yet still I'd estimate I went through about half an Albuterol in the past 48 hours.

Hence, you have the asthma conundrum. I could go to my doctor complaining of my symptoms, he'd do PFTs on me (I did one on myself the other day at work ant my FEV1 was 80%, which is good), and he'd find nothing out of the ordinary.

I don't have an infection, nor a cold. Yet here I am using as much Ventolin as I did 12 years ago when I had my last hospital stay and my last time on a steroid pack. Yes, believe it or not, it's been that long. Not saying I haven't needed one in the past 12 years, I've just fought through the few troubled spots with the meds I have here at my home.

Of course self treating myself might be something some of you new to asthma might frown upon, or any doctors reading this might frown upon, or perhaps my own doctor would frown upon, yet if you've had asthma the way I've had it for 40 years now, you wouldn't think twice about it.

If you new me the way my parents, brothers, wife and children do, you wouldn't think twice about it either. It's not like someone wants to call his doctor every time he has to cross a mole hill. You wouldn't think twice when you saw me puffing every 30 minutes through the course of the past 48 hours, gradually puffing out the contents of my Albuterol into my airways.

Which is why when I went to a family picnic on Sunday I had to set my plate on the table as I was putting food on it, lest someone might have observed how unsteady my hand was.

As I make my way through work today not one of my patients will notice their respiratory therapist has asthma, because there will be no symptoms of it other than the shaky stethoscope upon their backs. I'll be fine at work. It's allergy free.

And as I'm sitting at the desk charting, and my doctor sits down next to me to interpret his EKGs at around 10 a.m., I probably won't even think about asking him for his advice. Because, quite frankly, I don't think there's anything he can do even if he wanted to.

My asthma is treated, and I think that's why this doesn't end me up in the hospital like it might have 12 years ago. Yet there's still no cure for the allergies. And yes, I did go through the allergy shot thing, and I have gone through allergists as you can see one such experience here.

Okay, so now you might be thinking: why doesn't he just shut the windows and allergy proof his house? Great question. And I've already thought of that. Money is the reason. Plus, consider that last year I only needed my air conditioner one time in July, as July 2009 offered only one plus 80 degree day. In 2010 there were 20 days when the temperature exceeded 80 degrees.

If every year was like 2010 it would be an easy decision to splurge and pay the $1500 to put in central air. Yet with four kids, $1500 must be spent wisely, especially considering my 2 older kids are already wearing braces. And when those come off I'll have to pay for college.

My man cave is also the unfinished part of the basement. So you can get me there too. Yet if you want to loan me the money to finish it I'd be more than happy to finish it off. My email is above and my password for paypal is my email address.

So you see, in the ideal world allergies would go the same way I wish mosquitoes would go. In the ideal world the windows would be shut and some air filter system on. Yet air filter systems cost money.

Funny thing is, though, that even if I had air right now, there's no need for it. I'm reassured by that by the cool, refreshing breeze wafting over me as I type. I love it. I love it except for the ragweed wafting over my nares, some entering....

Hence you have the asthma conundrum. Or should I call it the allergy conundrum.

History of asthma

So I've been reading a lot of old texts about asthma in an attempt to learn about the evolution of this disease. At some point I plan to share what I've learned, but that will be a job for the winter months when there's more time for writing (or so one would hope). So that's coming to Hardluck Asthma at some point in the future.

In the meantime, I would like to send my readers to a great site I found that has a neat time line that details the history of asthma. I have to say it's pretty cool. Here's the site. Enjoy.

When you're done viewing the timeline, check out the inhalatorium. When you're done with that you can read Mark Jackson's book, "Asthma: A biography." It's really cool too.