Managing and Treating Asthma. (Medicine & Health)

By Koenig, Harold M. | USA TODAY, July 2002 | Go to article overview

Managing and Treating Asthma. (Medicine & Health)

Koenig, Harold M., USA TODAY

"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.

Thus, it is obvious that asthma is not a new disease. It has been around for centuries and so have the efforts of the medical profession to find cures or at least ways to minimize the symptoms. The first class of drug used in treatment was the anticholinergics (atropinelike). These were utilized from the 1850s in the form of cigarettes and burning powders. The isolation of theophylline in 1888 and epinephrine in 1889 enabled the regular use of these agents for asthmatics in the early 1900s.

The first half of the 20th century saw many advances, with the development of ephedrine for oral use (1925) and aminophylline, synthesized in 1908, for intravenous use (1937). Aminophylline was the staple for emergency treatment from 1937 into the 1970s.

It was not until 1950 that corticosteroids were found helpful in treating asthma, and not until 1972 that the first inhaler of a corticosteroid came into regular use. That same year saw the first derivative of atropine, which lacked its unacceptable side effects, such as dryness in the mouth, thickening of secretions, and mental changes. The next major advance in the therapy of asthma did not occur until 1997, when a new class of agents-leukotriene modifiers--became available.

The Centers for Disease Control did not start tracking asthma prevalence in the U.S. until 1979. The number of Americans suffering from asthma increased from 6,700,000 in 1980 to 17,300,000 in 1998, while the total population rose from 220,000,000 in 1980 to 280,000,000 in 1998. …

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