Asthma (cont.)

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What is asthma?

Asthma is a chronic inflammation of the bronchial tubes (airways) that causes swelling and narrowing (constriction) of the airways. The result is difficulty breathing. The bronchial narrowing is usually either totally or at least partially reversible with treatments.

Bronchial tubes that are chronically inflamed may become overly sensitive to allergens (specific triggers) or irritants (nonspecific triggers). The airways may become "twitchy" and remain in a state of heightened sensitivity. This is called "bronchial hyperreactivity" (BHR). It is likely that there is a spectrum of bronchial hyperreactivity in all individuals. However, it is clear that asthmatics and allergic individuals (without apparent asthma) have a greater degree of bronchial hyperreactivity than nonasthmatic and nonallergic people. In sensitive individuals, the bronchial tubes are more likely to swell and constrict when exposed to triggers such as allergens, tobacco smoke, or exercise. Amongst asthmatics, some may have mild BHR and no symptoms while others may have severe BHR and chronic symptoms.

Asthma affects people differently. Each individual is unique in their degree of reactivity to environmental triggers. This naturally influences the type and dose of medication prescribed, which may vary from one individual to another.

From the past to the present

Physicians in ancient Greece used the word asthma to describe breathlessness or gasping. They believed that asthma was derived from internal imbalances, which could be restored by healthy diet, plant and animal remedies, or lifestyle changes.

Allergy jargon

  • Asthma is derived from the Greek word panos, meaning panting.
  • Chinese healers understood that xiao-chiran, or "wheezy breathing," was a sign of imbalance in the life force they called qi. They restored qi by means of herbs, acupuncture, massage, diet, and exercise.
  • The Hindu philosophers connected the soul and breath as part of the mind, body, and spirit connection. Yoga uses control of breathing to enhance meditation. Indian physicians taught these breathing techniques to help manage asthma.

Allergy fact

Maimonides was a renowned 12th-century rabbi and physician who practiced in the court of the sultan of Egypt. He recommended to one of the royal princes with asthma that he eat, drink, and sleep less. He also advised that he engage in less sexual activity, avoid the polluted city environment, and eat a specific remedy: chicken soup.

The balance of the "four humors," which was derived from the Greco-Roman times, influenced European medicine until the middle of the 18th century. In a healthy person, the four humors, or bodily fluids -- blood, black bile, yellow bile, and phlegm -- were in balance. An excess of one of these humors determined what kinds of disorders were present. Asthmatics who were noted for their coughing, congestion, and excess mucus (phlegm) production were therefore regarded as "phlegmatic."

By the 1800s, aided by the invention of the stethoscope, physicians began to recognize asthma as a specific disease. However, patients still requested the traditional treatments of the day, such as bloodletting, herbs, and smoking tobacco. These methods were used for a variety of conditions, including asthma. Of the many remedies that were advertised for asthma throughout the 19th century, none were particularly helpful.

As early as 1892, the famous Canadian-American physician Sir William Osler suggested that inflammation played an important role in asthma.

Bronchial dilators first appeared in the 1930s and were improved in the 1950s. Shortly thereafter, corticosteroid drugs that treated inflammation appeared and have become the mainstay of therapy used today.

Medically Reviewed by a Doctor on 12/6/2013

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