It’s World Asthma Day today so a perfect time to look back, reflect and take stock!

  • the word “asthma” originates from Greek meaning short of breath
  • the standard treatment for hundreds of years was coffee – it contains the natural anti-asthmatic compound theobromine (also found in chocolate, cola and tea)

Sir William Osler, considered to be the father of Modern Medicine, listed the following characteristics of the asthma in 1892:

  • Bronchial muscle contractions cause difficulty in breathing
  • Swelling of the bronchial mucus membrane and thick mucus that is difficult to expel
  • Asthma is hereditary and often started in the patient’s early years
  • Causes for an asthmatic attack include climate and atmospheric changes, psychological shock, a variety of specific food items, and being diagnosed with a virus or cold

Interestingly, death from asthma was unheard of prior to the 1930s. All physicians writing at that time were adamant that asthma was not a lethal disease. On the contrary, even Sir William Osler stated that “the asthmatic will pant into old age” and that “the outcome is not unfavourable even if left untreated.”

The reason for this could well be that reducing airway size means that CO2 levels don’t fall below critical levels.  This is also the reason why breathing training is effective in reducing asthma severity, incidence of attacks, and use of medication: re-establishing normal CO2 means airways do not restrict to begin with, and mucus production is reduced as well. We can even teach you how to successfully manage an asthma attack in its early stages so you may not need your reliever medication.

Do NOT stop taking your asthma medication until you have conferred with your GP and breathing practitioner that it is safe to do so! Continue to carry your reliever inhaler with you at all times in case of emergency! Preventer medication too should be reduced only in consultation with your GP and breathing therapist!

Asthma treatment primarily focuses on forcing smooth airway muscle open (reliever). This coupled with a lack of knowledge of side effects (restlessness, shaking, racing heart, headaches, etc) meant people often use them carelessly even today. Asthma deaths peaked in the mid 1960s (AUS, US, UK) with a second peak in New Zealand in the mid 1980s. If asthma deaths were rare previously why are they more common once wide-spread medication started?

By the 1980s, the allergic component of asthma was finally understood. This resulted in a new treatment using anti-inflammatory drugs (cortico-steroids = preventer). When taken daily these are also very effective.  Side effects for inhaled corticosteroids include oral thrush, sore throat, hoarseness and potentially slow growth in children.

Despite, concerns about side effects including death, combined medication (bronchodilator+cortico-steroid) is the mainstream treatment of asthma to date. While these drugs are able to control a rapid disease progression they will not improve symptoms or disease status over time. Breathing training is a treatment option that has been shown to improve both symptoms and disease progression. The 2018 GINA Report, Global Strategy for Asthma Management and Prevention lists breathing exercises as useful adjunct strategy on page 54.

References:

A Brief History of Asthma and Its Mechanisms to Modern Concepts of Disease Pathogenesis, Stephen T Holgate

Leave a Reply

Your email address will not be published. Required fields are marked *