Magazine article FDA Consumer

Asthma Is All in the (Head) Chest

Magazine article FDA Consumer

Asthma Is All in the (Head) Chest

Article excerpt

Asthma sufferers rarely die from an asthma attack, but the feeling of suffocation as their airways begin to close often makes them fear that they've already gasped their last breath.

Asthma (the word is from the ancient Greek, meaning "to breathe hard") is a chronic disease involving a reversible obstruction of the airways, specifically the bronchi and bronchioles--the large and small tubes that carry air into the lungs. Asthma affects an estimated 9 million Americans, including 2 to 3 million children. There is no cure for asthma, but the episodic attacks that characterize the disease--the shortness of breath, wheezing and dry coughing--can be controlled. Left uncontrolled, asthma can be extremely disabling.

Asthma can affect anyone at any age, although it does tend to run in families. About half of asthmatics develop the disease before the age of 10; about another third before age 40. For reasons unknown, more boys than girls get asthma, but the gender breakdown equals out in the adult population.

There is nothing a person can do to avoid getting asthma. It is not true, as used to be thought, that asthma is an emotional or psychological disorder. Although worry and fear can bring on an attack, these are only "triggering" aspects of a basic asthmatic constitution. The emotional problems asthmatics often have a generally a result, rather than a cause, of the condition. According to Jonathan Weiss, Ph.D., of the Department of Psychiatry, Cornell Medical Center, "Emotions and actions can affect the severity or the frequency of symptoms. But they cannot, as far as we know, cause a person to get asthma in the first place." Kenton L. Burns, Ph.D., of the National Jewish Hospital/National Asthma Center in Denver, advises: "Clearly the simplistic notion that 'it's all in the head' of the sufferer is unjustified, unhelpful and harmful."

Asthmatics simply are born with, or develop, extra-sensitive bronchial tissue. An asthmatic attack occurs when some irritant stimulates the autonomic (or involuntary) nervous system, which controls the muscles of the body's breathing apparatus. Or some irritants can directly cause a chemical reaction in certain cells that line the bronchial tubes. Either way, the bands of smooth muscle around the bronchi and bronchioles contract; and the mucous membranes lining the bronchial tubes swell and increase their production of thick mucus. All three action narrow the airway and leave the sufferer gasping for breath.

Asthma attacks vary widely in severity and frequency from person to person and even for the same person at different times. They can begin slowly, with increasing severity, or they can come on abruptly. They often occur in the middle of the night. Usually they are mild and brief, subsiding within a few minutes, sometimes even without therapy. Or they may persist for several hours or even days. Between attacks some individuals are entirely free of symptoms. Others have mild coughing much of the time, punctuated by severe episodes of struggling for breath.

An acute asthma attack is alarming for both the sufferer and any onlookers, and panic can make it worse. But except in the most extreme cases, asthmatics are able to get their breath and need not fear the possibility of suffocation.

When hospital care is necessary, it is often because the disease has progressed to its most serious and dangerous form, a condition known as status asthmaticus. The patient suffers severe, uncorrectable wheezing and can't speak more than a few words without stopping for breath. Acute attacks can last for days, unresponsive to the usual drugs. Oddly, in these severe attacks, the wheezing sound may actually diminish. But rather than a sign of relief, this "silent chest" can mean impending respiratory failure, with the need for artificial breathing assistance.

Even for those with less severe asthma, the disease may have a significant effect on their lives. …

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