Does obesity cause asthma

The following is a post originally published by me at Asthmacentral.com/asthma on September 26, 2011.

So much evidence links fat with asthma that some folks like to call it Fasthma.  In fact, I was recently emailed this question:   "What are your thoughts on "Fasthma" a.k.a. "Fat Asthma" or obesity related asthma?"

I recently wrote a post  Can Eating High-Fat Foods Trigger Asthma?  I wrote about a 2010 study that determined lung function was worse after eating a high-fat meal.  One theory suggests that your asthmatic immune system might recognize saturated fat as an enemy and promptly acts to rid it from your system.

This response results in an increase in markers of inflammation such as leukotrienes and hystamine, and these increase inflammation in your respiratory tract. This causes muscles lining your air passages to constrict, and thus an asthma attack is the result.

If your exposed to something that's triggering the inflammatory response often enough, this inflammation may become permanant, and thus asthma is the result.  

Experts at the Harvard School of Public Health came up with two more theories why obesity may lead to asthma: 

1. Shallow breathing
2. Hormones released from fat tissue

Breaths are shallower than normal due to fat tissue making less room for the lungs to expand. Full stomachs also puts added pressure on the diaghragm, which further restricts the ability of the lungs to expand.

This shallow breathing increases the probability inflammation will exist in the air passages of the lungs, and this causes the airways to narrow.

Inflammation in of air passages is also believed to be caused by hormones, such as leptin, released from fat tissue. Leptin is present in all asthmatics, but it is elevated in the obese.

Likewise, people that are obese are less likely to have a hormone called adiponectin, which is an anti-inflammatory hormone.

On the flipside, inactivity due to asthma may cause obesity.  It's was also interesting to learn that researchers at Kings College in London discovered that Th2 cells responsible for causing inflammation in the lungs in asthma also a protein called PMCH which is known to increase appetite. 

In another post, Alright Asthmatics! Here's Your Incentive to Get in Shape This Year, I explained several studies that concluded that excissive adipose tissue -- fat tissue -- can cause asthma.  Or in other words, these studies show that obesity causes asthma. 

Consider the following:

• A study completed by the Center for Disease Control showed that obese adults were 66 percent more likely than normal weight adults to have asthma.
• Experts at the University of South California did a study that showed obese children were 1.5 times more likely to be diagnosed with new onset asthma.
• Results from the National Health and Nutrition Examination Survey 2005-2006 showed that "Obese children were about 26 percent more likely to have allergies than children of normal weight".
• Researchers from Kaiser Permanente, Massachusetts General Hospital and Harvard Medical School, people with asthma are five times more likely to be hospitalized for asthma, have a lower quality of life, and have worse asthma control as compared to those with asthma at a normal weight.
• According to a study released in 2007 by researchers at Emory Crawford Long Hospital, obese asthmatics are more likely to have persistent or severe asthma.
• This 2005 study by experts at the Harvard School of Public Health notes that 75 percent of emergency room visits are among asthmatics that are obese.
• Researchers also found obesity to make asthma medicines work less well, and in some cases require higher doses than normally recommended.

Surely a sedentary life from a lifetime of hardluck asthma can cause obesity.  Yet the evidence appears to be overwhelming that obesity can cause asthma too.  With the rising obesity rates of late, this may be something to be concerned about.

Regardless, this is all the more reason to eat a healthy diet and exercise -- especially if you have asthma.

960 A.D.: Haly Abbas writes mammoth book

Ali Ibn al-Abbas al-Majusiin was in Persia sometime around 930 A.D.  Haly Abbas, of which he is most commonly referred to, was the Latin version of his name.  He was physician who was a critic of the medical books available during his time, including those written by fellow Arabic physicians (Rhazes, Oribasius, Serapion, Paulus Aegineta).    So he set out to write a book of his own, one that was not as voluminous and costly as the Continent of Rhazes, and not as concise as the writings of Hippocrates.(1, page 158)

Yes, it's true!  He was even a critic of the Hippocratic writings.  He said:  

Hippocrates who is the prince of the medical art and the first physician who ever wrote a book on this art, is the author of many treaties on all sorts of medical topics.  But he writes in such a very concise manner that much of what he says is obscure, and as a consequence the reader, if he wishes to understand him, is obliged to seek the aid of a commentary."  (1, page 158)

So he gathered as much medical knowledge as he could obtain, which included the books of his Arabic contemporaries and the same ancient books they used in writing their books, and created, in 400,000 words, "a well organized medical encyclopedia of medical knowledge in the tenth century."
 (1, page 158)

Historian Thomas Bradford said he called the book Almaleki (the Royal Book), although he also referred to it as Liber totius medicinae (the whole book of medicine) (4, page 69)

In the past many physicians obtained all their wisdom from books, and Abbas preached against this:

It is incumbent that the student of this Art should consistently attend hospitals and sick houses; pay unremitting attention to the conditions and circumstances of their inmates, in company with their most acute professors of Medicine; and enquire frequently as to the state of the patient and the symptoms apparent in them, baring in mind what he has read about these variations, of what they indicate of good or evil."  (1, page 158)

Historian Thomas Bradford said of him:

His reputation for learning was so great that he was named the sage, and so almost supernatural were his powers and skill in healing that he was also called the magician.  It is (he) who left us the fullest account of medicine among the Arabians, and the names of their medical writers. (4, page 64)

He wrote about many diseases in his book, and he also wrote about asthma, which is where our interest lies.  Since his book is difficult to come by unless you have $2,000 to spare, we'll allow Paulus Aegineta to describe his views regarding asthma.  He said:

"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 cautions 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." (3, page 479)

Not a bad analysis for asthma considering the era.  He lived most of his life in Baghdad and died around 982-994 A.D. 

References:

1. Robinson, Victor, "The Story of Medicine," 158-60
2. Fourgeaud, V.G., "Medicine Among the Arabs: Historical Sketches, XIV, Haly Abbas, Avicenna, Albucasis, Avenzoar, and Averrhoes," volume 7, edited by V.G. Fourgeaud and , pages 193-4
3. Aegineta, Paulus, "The Seven Books of Paulus Aegineta," translated by Francis Adams, volume I, 1844, The Snydenham Society,
4. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

Creative places to store an inhaler

The following is a post originally published 9/6/11 @ healthcentral.com/asthma

We asthmatics are quite creative.  We come up with some unique and creative places to store our inhalers -- at least I do anyway.  Below I'll provide some examples of creative places I often store my inhalers.  

• Under couch cushions
• Under furniture
• Under beds
• Under pillows
• Under car seats
• In glove compartments
• In the hamper
• Stuffed in the recliner
• Under random dresser
• In any random drawer
• stuffed under stuff
• In the washer or dryer
• In the refrigerator
• On the bedside stand (where I prefer it)
• In the medicine cabinet (one would hope)
• In my wife's purse
• Pocket
• Stroller pocket
• Work or school locker
• On Desk
• In desk -- somewhere, maybe deep within, maybe under, maybe behind...
• Hidden in a toy box
• Clipped under the toilet seat

Now that last one has got to be my most creative of all time.  My son got a hold of it and, about four hours after the toilet seat slammed, my wife took the above picture.  We had a good laugh.

 

Sometimes, though, it's not such a good thing to be this creative -- like when you need it. It's probably also a good idea to keep it out of the reach of your kids, yet not always so easy.

 

Yet when you need to lug it around wherever you go -- which is the recommendation these days -- we're prone to get creative -- well, at least I am.  I know from talking with many of my fellow asthmatics I'm not alone in my creativity here.  

 

It's because of this creativity, and not because of overuse, that my doctor writes a prescription for three inhalers each month.  I purchase three and within a few days find a creative storage spot. 

 

The problem with this creativity is knowing which of the above places to look first when you need it, or when you need to go someplace and want to take it with you.

 

If any of you guys have advice on how to be a little less creative, please speak up. Yet I'm not sure you can teach an old asthmatic a new trick.

 

Likewise, if you have a creative storage place for your inhaler -- present or past -- please share in the comments below.  

1864: Alfred Newton's Dry Powdered Inhaler

People have probably inhaled powders of certain dried and crushed herbs for their perceived benefits since the beginning of time.  Yet the first device for assisting with this process was patented in 1864 by Alfred E. Newman.  His device was the first dry powdered inhaler.

The book "Controlled Pulmonary Drug Delivery" describes the inhaler this way:

In 1864 another step forward with dry powder inhalation took place. Alfred E. Newman applied for a patent in London after correspondence with Dr. James in New York.  The dry powder device resembled a mantle clock with an orifice at one side, inside was a mesh and a crank shaft with feathers to beat the powder creating a dust, which would pass through the mesh towards the mouth.  It was not especially portable, but Newton recognized that the powder needed to be pulverized into a fine dust and that it should be kept dry, two essentials of modern dry powder inhalers. The device was designed for the delivery of potassium chlorate which today is recognized as a lung irritant. (1, page 60)

The authors also note that while dry powder inhalation was "in vogue" during the 1860s, it was generally meant to treat diseases of the throat such as laryngitis.  Still, it was a revolutionary concept and a precursor -- albeit large, bulky, un-portable, and probably -- to modern dry powder inhalers.

The device may also have been used for tuberculosis.  (2).

Quality pictures of the device can be observed by checking out either of the links in the references below.

References:

1. Smyth, Hugh D.C., Anthony J. Hickey, editors, "Controlled Pulmonary Delivery," 2011, New York, Springer, page 60-61
2. Sanders, Mark, "Pioneers of Inhalation: Vapour Trails and Powder Monkey," from Inhalatorium.com: Online Museum of inhaler technology, slide show presentation, accessed on 11/13/12

865-925: Rhazes describes allergies

Rhazes didn't choose to become a physician until he was
into his 40s, and this may have helped the man become among
the most well respected physicians of his era.  He wrote about
asthma, and is thought to be among the first physicians to
describe allergies. 

The first known writer to describe allergies was the Arabic physician Rhazes, yet it would be over a thousand years after his death before "allergy" was defined by the medical community.  So it's easy to see that he was a physician ahead of his time. 

He was born Abu Bekr Mohammed ben Zechariah in the year 865, and is known best by the name of Rhazes. He was born in a town in Persia, in the province of Baghdad, in d town called Rai, "and it is from this that his last name was derived -- Ar-Razi,"  said historian Thomas Bradford in his 1898 book "Quiz questions on the history of medicine."  (9, page 62).

He was originally a musician, playing the flute in his youth. And even while he was a "passionate lover of music," he put this love aside in favor of philosophy and medicine, claiming "that music proceeding from between mustachios and a beard had no charm to recommend it," said V.J. Fourageaud in an 1868 article in the Pacific Medical and Surgical Journal. (1, page 164)(9, page 62)

Yet this turned out to be a great thing for the medical community, as "he is said to have been the ablest physician of his age; a master of all kinds of learning; skilled both in the theory and practice of medicine, said Bradford." (9, page 62)

He started studying medicine in his forties, explained Bradford, and traveled abroad to "Jerusalem, Syria, Egypt, Persia, and Spain, the better to perfect his knowledge by conversing with botanists, oculists and surgeons. Having thus become master of his profession, he settled in Bagdad, and so great was his learning that he was selected from over a hundred eminent competitors as the director-in-chief of the grand hospital in that place.  He is said to have been the ablest physician of his age; master of all kinds of learning, skilled both in the theory and practice of medicine." (9, page 62-63)

By this position he was "director of the hospitals of Ray (the same town he was born in), Jondisabour, and Baghdad, said Fourageaud..  (1, page 164)

Bradford and Fourageaud both said that his reputation was so great as an Arabian professor that students traveled from far away to hear him speak. (1, page 164)(9, page 62)

Edward Withington, in his 1894 book, "Medical history from the earliest times, said he became the "first and most original of the Arab physicians."   (2, page 145)

He is considered by many historians as the most independent thinker among the Arabic physicians.  (5, page 156)  He encouraged physicians to practice by empirical means (experience and observation) and in this way became the first physicians to encourage scientific based medicine. (3, page 31)

He wrote over 150 books, although some say he wrote as many as 220.  He wrote on philosophy, medicine, history, and chemistry, although his passion was medicine.  Unfortunately most of these works are lost to history, said Fred Ramon in his 2006 book "Albacasis."  (8, page 62) (9, page 63)

While he copied many of the idea of ancient physicians, such as Hippocrates and Galen, it's his scientific descriptions of diseases that make him among the most well known of the Arabic writers.

He became famous while being among the few Arabic physicians who did not earn a medical license.  And, despite his fame, he did not become rich, mainly because he chose to practice among peasants who could not afford much.  This type of 'boldness and originality' earned him the title "The experimenter," said Withington.  (2, page 145)

Among the medical community he is best known for writing the "oldest existing treaties on smallpox and measles," said Withington.  (2, page 146)(9, page63) and he is the first to have described fever as a defense mechanism of fighting off diseases.

He's also the first to describe asthma as a specific disease, and the first to mention allergies.  He was a chemist and pharmacist, and by this he gathered a collection of remedies (some of his own too) and recorded them in one of his publications.  Some of the remedies were for asthma, said Ramon. (8, page 70)

As noted by these writings, coupled by his writings about asthma and coryza (inflammation of the nasal passages/ hay fever), he was the first to write a treaties on the diseases of children.  (6, page 175)

During his life he would create voluminous volumes for the medical community.  In his Hawi or Continens, which exceeded the length of the works of his contemporaries (including the Canon of Avicenna) he gives an account of asthma and it's remedies: (2, page 146)

Ben Musue (an Arabian physician of the 8th century) said, 'Let persons troubled with asthma or shortness of breath take two drachms of dried and powdered fox lung with decoction of figs in their drink.'  Galen (De med. simple.) said that many cure asthma with owls blood given in the drink, or by giving owl's flesh with the blood in spidebeg(?), and taking it's blood afterword in wine. I say that owl's blood is not to be given in any case of asthma, for I have seen it administered, and it was useless."

Maimonides wrote of the remedies for asthma, and in doing so mentions Rhazes:

Maimonides endorses a remedy of Rhazes' to clear the lungs of moisture, ease respiration, and eliminate the cough: soak wheat bran over night in hot water, filter, and add sugar and almond oil; place on the first until it resembles a julep and drink when lukewarm.  (7, page 27)

Also of significance is he was the first to write a book about hay fever:  A dissertation on the cause of the coryza which occurs in the spring when the roses give forth their scent.  (3, page 31)(4, page 338)

In his work Essay on the cause of why Abu Zayd al-Bahli is subject to rhinorrhea in springtime when smelling roses, he described the inflammation and runny nose that occurred in the springtime when the roses were blooming.

Many consider this the first description of hay fever, or what would eventually be considered as springtime allergies, sinusitis, hay fever, seasonal allergies or rhinorrhea.  In a sense, he may also have been the first to describe allergic asthma.

Fourageaud said that near the end of his life he approached Al-Mansur, the Prince of Chorasan, in Baghdad to present to him a book on alchemy he dedicated to the prince.  The prince loved the work and rewarded Rhazes with a thousand dinars. (1, page 64)

The Prince said, "I wish for you to put into practice what you have laid down in this book."
Rhazes said, "That is a task for the execution for which ample funds are necessary, as also various implements and aromatics of genuine quality; and all this must be done according to the rules of art, so that the whole operation is one of great difficulty."

The Prince said, "All the implements that you require shall be furnished you, with everything necessary for the operation; so that you may be in the practice the rules contained in your book."

Rhazes said he was unable to perform the task, at which time the Prince said, "I should never have thought a philosopher capable of such faleshoods in a work represented by him as a scientific treaties, and one which will engage people's hearts in a labor from which they can derive no advantage.  I have given you a thousand dinars as a reward for this visit, and the trouble you have taken, but I shall assuredly punish you for being guilty of a falsehood." 

The Prince struck Rhazes in the head with a whip and sent him on his way with provisions to complete the task.  Rumor has it this is what made him blind, although some say it was because he was because he ate too many beans.

Believing his blindness was caused by cataracts, an "occultist" was about to operate on him when Rhazes said something like, "How many membranes does the eye have?" 

The occultist had no response.  Rhazes then said something like, "I will not entrust my eyes to someone who is ignorant of their structure."

Later, when further urged to have the operation, he said, "No, for I have seen so much of the world that I am weary of it."  (1, page 64)

So most historians describe his as a very wise man, and Bradford credits him with the following wise sayings: (9, page 63)

• When you can cure by regimen, avoid having recourse to medicine
• When you can affect a cure by a simple medicine, avoid a compound one.
• When a wise physician and an obedient patient, sickness soon disappears.
• Treat and incipient malady with remedies that will not prostrate the strength. (9, page 63)

Exactly when he died remains unknown, although much speculation of modern historians has the date at 925 A.D. Regardless, he was a renowned physician in his day, and was one of the Arabs who helped save medicine while a dark cloud hovered over western medicine.

References:

1. Fourageaud, V.J., "Historical Sketches: XIII: The epidemics of the sixth century, the plague, small pox, and measles.  Ahrun, Bachtishwa, Mesue the Elder, Honain, Serapion, Alkhandi, and Rhazes," Pacific Medical and Surgical Journal,  Medical and Surgical Journal, edited by V.J. Fouregaud and J.F. Morse, Volume VII, 1864, San Francisco
2. Withington, Edward, "Medical history from its earliest times: a popular history of the healing art," 1894, London, The Scientific Press 
3. Colgan, Richard, "Advice to the Young Physician: on the art of medicine," 2009, New York
4. Lehrer, Steven, "Explorers of the body: Dramatic Breakthroughs in Medicine from Ancient Times," 2006, United States
5. Fantini, Bernardino, Grmek Mirko editors, Antony Shugaar, translator., "Western Medical Thought from Antiquity to the Middle Ages," 1998, U.S., 
6. Gee, Samuel, "A Survey of the Literature of the Diseases of Childhood:  An address delivered at the offering of the section of diseases of children at the annual meeting of the British Medical Association in Liverpool, August, 1883, The Medical Times and Gazette, Vol. II, 1883, London, Pardon and Sons
7. Rosner, Fred, translator, "The Medical Legacy of Moses Maimonides," 1998, KTAV Publishing House, U.S.
8. Ramen, Fred, "Albucasis (Abu Al-Qasam Al-Zahrawi):  Renowned Muslim Surgeon of the 10th Century,"  2006,New York
9. Bradford, Thomas Lindsley, writer, Robert Ray Roth, editor, “Quiz questions on the history of medicine from the lectures of Thomas Lindley Bradford M.D.,” 1898, Philadelphia, Hohn Joseph McVey

1896- 1906: Wompole's Hypno-Bromic Comp will cure your asthma x

Around the turn of the 20th century asthma was still considered as a nervous affliction, and one of the noble ways of treating it was medicines that eased the mind.  One such remedy was Wompole's Hypno-Bromic Comp.  

According to a 1904 article in the New Albany Medical herald:

"If you want to give your patient relief from asthma, and a good refreshing sleep from which he will wake greatly refreshed, Just try wompole's hypno-Bromic Comp.  It will give quick and satisfactory results. Give this relief to the next case of asthma you are called to treat." (1, page 584)  

According to an 1898 article in Medical Progress, cocaine and morphine can be prescribed to help a nervous person sleep, although Wompole's Hypno-Bromic Comp. not only worked better, but was safer.  The article wrote about one case where morphine was trialed, although after a while it allowed her to "sleep an hour or two.  She was given a teaspoon of Wompoles Hypno-Bromic Comp. each night immediately after she had come out of the bath.  This remedy had a most happy effect." Two other cases noted suggested essentially the same thing.  (3)

A recipe for this product can be made in your own kitchen: 

Chloral hydrate gr. 480
Potassium bromide gr. 240
Extract of henbane gr. 4
Extractofcannabisindica.gr. 4
Morphine sulphate gr. 2
Simple syrup fl. dr. 4
Comp. spirit of orange. fl. dr. 1 Water, enough to make. fl.oz. 4 Make a concentrated solution of the chloral hydrate in water, triturate the extracts with this solution; add the potassium bromide and the morphine each dissolved in water, the spirit and the remainder of the water, and filter clear.(2)

References:

1. "Medical Gleanings," New Albany Medical Herald, volume 22, No. 286 October, 1904, New Series Volume 11, Number 157 
2. Hiss, Emil, "Thesaurus of Proprietary A recipe for this product can be found on page 271 of Emil Hiss's 1898 book "Thesaurus of Proprietary Preparations and Pharmaceutical Specialties," 1898, Chicago, G.P. Englehard and Company page 272
3. "Suggestions on the management of nervous trouble," The Medical Progress: A monthly history and medical progress,John S. Moreman, M.D., editor, July 12, 1896, volume 12, new series number 79, old series number 126, pages 248-248

1995: The end of the asthma institution

National Jewish Health Campus today

So I ended up on the phone in May of 2009, talking with the person in charge of public relations at National Jewish Health.  She had posted on the National Jewish Health Facebook page that she had copies of a book of stories from former patients published in 1998 for the 100 year anniversary of the opening of National Jewish Hospital for Consumptives. 

I requested that book, but I had so many other questions. And since I had her on the phone I asked away.  She didn't have all the answers, yet she did know that the program I participated in in 1985 no longer existed.  She said, "7-Goodman, 8-Goodman and 2-May no longer exist." 

"Wow!" Is all I could say.  Yet it didn't surprise me.  One of the reasons I became a respiratory therapist in 1995 was because I wanted to take care of asthmatic patients, particularly asthmatic kids.  Yet I never got to take care of hardly any of these kids, because asthma is treated so much better than it was back then. There may be more asthma patients today, although most of them are treated at home, and most are able to maintain good control by seeing regional physicians as opposed to traveling to places like Denver.

She explained how the program was changed to an inpatient program to an outpatient program in 1995.  The main reason she noted was homesickness, and how difficult it was to care for kids who were separated from parents.  Plus I had my own memories of things teenagers did at the asthma hospital, so I could only imagine not having asthmatic kids roaming the halls of a hospital was a major relief for the staff there. 

Yet the major reason she noted was probably because there are so many better asthma medications today, and so much better asthma wisdom.  And the doctors at National Jewish Health have a program where they meet with regional doctors from time to time to educate them with the state of the art asthma wisdom.  In this way, asthma doctors all over the world have access to the same medicines, the same wisdom, as doctors at National Jewish. 

Another major reason was probably cost, as noted on the NationalJewishHealth.org website.  When I was a patient my insurance company approved for me to go there, and the only part of my stay they didn't contest was my stay at PSC, which was just like a regular hospital.  They contested the daily charge of me staying on 7-Goodman and 2-May because, as they noted in letters to my parents, I could have just stayed home and had those tests as an outpatient.

So in order to provide more cost effective medicine, National Jewish created the Pediatric Outpatient Program in 1995.  Children received treatment only during the day, and at night they stayed either at home or in one of Denver's many hotels.  An adult day program was introduced in 1996. If a patient required a hospital stay (like I required a stay at PSC) they would be transferred to one of Denver's hospitals, such as The University of Colorado Hospital or The Children's Hospital. (1)

So this kind of negated the need for 7-Goodman, 8-Goodman and 2-May.  Those were the halls we kids resided in.  Those were the places staffed with nurses specially trained to take care of asthma kids.  Those were the places that housed dormatories for boys and girls aged five to 18. 

Statistics show that asthma rates continue to rise, although most regional physicians are fully capable of helping asthmatics of all ages control and prevent asthma.  Regional doctors even treat many of the kids with intractile asthma today, and with good success.  However, when needed, National Jewish Health still has a program for kids.  Only it's an outpatient program. 

References:

1. Clinical History, NationalJewishHealth.org, http://www.nationaljewish.org/about/whynjh/history/clinical/clinical-history3/, accessed 11/7/12