Managing and treating asthma.

• Author: Koenig, Harold M.
• Position: Medicine & Health

"I KNOW WHEN an asthma attack is starting. I cough; then my chest feels tight. I struggle for each breath and I get tired. I feel like I am suffocating. I fear my next breath will be my last.... Between attacks I feel fine." That is what a "typical" asthma sufferer experiences with this very serious disease.

Asthma is characterized by wide and sometimes rapid fluctuations in people's ability to move air in and out of their lungs. For some patients, symptoms are intermittent, while, for others, they are chronic. Cases of asthma are increasing at an alarming, even epidemic, rate. Asthma is more than a disease; it is a hot political topic. It is important to use this political will to generate a national commitment to learn more about the condition so, in the long term, it might be prevented and, in the short term, it can be managed better.

Former U.S. Surgeon General David Satcher stated, "One of the real issues is, why are we seeing the increase in asthma? And we don't know the answer to that. Until you understand why you have an increase, and you have documented it, it is very hard to say you have a strategy that is going to make a difference."

The first appreciation that asthma might be caused by a reaction to external factors was in 1552, when Girolamo Cardano relieved a prolonged severe episode of airway obstruction in the Archbishop of St. Andrews by removing his featherbed and leather pillows. Two centuries later, J.B. Van Helmont identified some of the causes of hypersensitivity in asthmatics, notably inhaled dust and foods. He also reported the hereditary susceptibility of the disease, effects of climate and weather, and impact of emotional upsets.

In the 17th century, Benardino Ramazzini, considered the father of occupational medicine, was the first to detail the asthma seen in bakers, starch makers, animal handlers, and those working with vegetable matter. Asthma caused by exercise was formally described by Sir John Floyer in 1698.

In 1864, Henry Hyde Salter documented the correlation of asthma with cold air, vapor and fumes in the air (smoke, dust, pungent fumes, etc.), and inhaled animal and vegetable particulate matter. From 1900 onward, asthma came to be regarded as the pulmonary response to previous sensitization to a variety of allergens. In 1910, S.J. Meltzer suggested that asthma could be the result of an allergic phenomenon, and, eight years later, I.L. Walker presented the classic classification of asthma based upon skin test sensitivity. The latter remains in use in some form to the present day.

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