This is a full-blown asthma attack, something millions of people suffer. An inhaler or an injection can bring some relief. Sometimes the victim is rushed to the emergency room. More than 25 million people suffer from asthma in the U.S.; each year about 3,600 people die from acute attacks.

 

The disease is not this severe for everyone who has asthma, but any asthmatic can tell you that even a mild attack is uncomfortable and frightening, and makes physical activity and mental concentration difficult. Half of all children with asthma miss school because of the disease. And a third of all adults with asthma miss work regularly.

 

Asthma is a condition at least as old as recorded history. There is reference to a respiratory condition described as "noisy breathing" as early as 2,600 B.C. in China. Hippocrates (circa 400 B.C.) was the first to use the term asthma. It comes from a Greek verb, aazein, which means to pant, to exhale with open mouth, to take a sharp breath. Doctors in Roman times described the condition. Moses Maimonides, 12th-century Jewish rabbi, scholar, and physician, wrote a treatise on it. By the end of the 19th century, physicians came to view asthma as a distinct disease with a specific set of causes and treatment requirements. But it was not until the late 1960s that significant therapeutic advances were made.

 

Asthma is a chronic (meaning long-term) disease of the respiratory passages, making it hard to move air in and out of the lungs. Two things create this difficulty. First, the airways themselves narrow as the tissue becomes inflamed, swells, and produces mucus. Second, the muscles around the airways tense and tighten causing further constriction. The result is the cascading flow of symptoms - tightness in the chest, labored breathing, wheezing, pain, tenseness, and shortage of oxygen.

 

Asthma often starts during childhood. According to the Asthma and Allergy Foundation of America, 6.3 million U.S. asthmatics are under 18 years of age. Asthma is more common in boys than girls, but more common in adult women than adult men; almost 65 percent of those who die from asthma are women. Asthma is more prevalent among African-Americans and Hispanics, especially Puerto Ricans; 16 percent of African-American children have asthma. The overall asthma death rate is highest for people 65 years or older. In rare instances, childhood asthma can diminish and even disappear in adulthood, but this is so unlikely that the disease is considered "chronic."

 

At present, no one has identified a "cause" for asthma. Researchers know about the chemical activity during the swelling of the air passages and the mucus production. But there is no bacterium or virus known to produce the symptoms. Instead, physicians and medical researchers have identified triggers -- substances and events that precipitate an attack. The triggers are sometimes used to differentiate between different types of asthma.

 

In exercise-induced asthma, the attack is triggered by physical activity, often exacerbated by air temperature and air quality. Cold, dry air seems to worsen the attack. Occupational asthma is triggered by exposure to chemicals or dusts in the workplace, which can cause an allergic reaction that irritates the airways. Allergic asthma is set off by many different allergens. Among them are cockroaches, dust mites, indoor mold, pets, pet dander, pollen and outdoor mold, strong odors, sprays, smoke -- especially tobacco smoke, and various foods. As already noted, weather and air quality can be triggers as well as colds and respiratory infections. Further, stress can set off asthma, usually along with other triggers.

 

Finally, some researchers identify still another type they call nocturnal asthma, because symptoms often worsen during the night. There are a number of possible reasons: exposure to allergens in the bedroom, particularly dust mites; delayed allergic response, which may occur three to eight hours after exposure; chronic sinus problems and/or post-nasal drip; gastroesophageal reflux; airway cooling from a drop in body temperature; decreased effect of medications during early morning hours; or sleep apnea.

 

In a basic way, asthma is simple; the reality is that the victim cannot get enough air. But because of the interconnection of physical and environmental factors, the difficulty in identifying actual causes, and the profusion of triggers, asthma becomes a highly complex phenomenon -- a reality compounded by the widely accepted view that asthma can be inherited. Though the gene or genes involved have not been identified, it is well known that asthma is found within families.

 

One of the most curious and perhaps even perverse characteristics of asthma is that it may result from an immune system that works too well. It may be that the immune system itself overreacts to everyday substances such as dust, pollens, mold, cat dander, etc. In shutting down the airways to keep the allergen out and protect the victim, it blocks the very air that keeps the victim alive. Research is proceeding on many fronts to understand better the role of genetics, infection, exposure, and the immune system in the etiology of asthma.

 

Though doctors are no closer to finding the root cause of asthma, they have made strides in treatment and management. There are many medications, some to reduce inflammation of the airways, others to relieve constriction. Some are designed for quick relief. Some are taken long term as the doctor deems necessary.

 

The quick-relief medicines are called bronchodilators, and they relax the muscles around the airways. They are used to reduce symptoms and are generally delivered with an inhaler. This is a pressurized tube with a small delivery chute that you place in your mouth. When you press on the metal tube, an atomized burst of medicine is sent into the chute, at which time you take a deep breath and inhale the medication, holding it in your lungs as long as possible.

   

The longer-term asthma medications are taken daily, whether there are symptoms or not. They are anti-inflammatories, which means they reduce the inflammation in the airways of the lungs. These are used for prevention and control, not for immediate relief. One frequently used medication to combat inflammation is a corticosteroid, taken daily with an inhaler. For asthmatics for whom corticosteroids are not enough, there are monthly injections of an immunomodulator, which inhibits the antibodies released by the immune system.

 

Sometimes a medication combines a corticosteroid for long-term, anti-inflammatory relief with a bronchodilator. This combination is delivered by an inhaler and is used daily to prevent symptoms, not to give quick relief.

 

But for people with asthma, medications are only part of the effort. They benefit from careful management through an asthma action plan. This might include:

At the foremost respiratory hospital in the country, National Jewish Health, in Denver, Colorado, where patients with severe asthma often go for treatment, a comprehensive, multidisciplinary approach includes sophisticated testing not found elsewhere, psychological assessment and treatment, nutrition counselling, patient education, physical rehabilitation, and assistance in developing a management plan.

 

Research seems to indicate that asthma rates are rising across the world. Some say that the increased pollutants in the atmosphere are acting as triggers. Another theory called "The Hygiene Hypothesis" suggests that asthma is the perverse result of a more hygienic environment in the developed countries. In the critical time after birth, the immune response is derailed by a clean household. An article from the  U.S. Food and Drug Administration states, "The problem with extremely clean environments is that they fail to provide the necessary exposure to germs required to 'educate' the immune system so it can learn to launch its defense responses to infectious organisms. Instead, its defense responses end up being so inadequate that they actually contribute to the development of asthma." There is data in support of this hypothesis, but the research is not conclusive. 

 

In the end, asthma is something of a puzzle. Humans have suffered from it for at least four millennia, but we still don't know why. It is a debilitating condition and can be frightening to the person having an attack. If you are its victim, it robs you of breath, movement, activity, and even speech as you gasp for breath. There are modern medications that bring relief and help control symptoms, and alternative approaches that may be helpful. Still asthma can kill, and in a particularly unpleasant way. Your own body suffocates you.

 

So, asthma is a serious disease. If you have it, your condition may improve, but you can never get away from it. At best it's inconvenient. At worst it's dangerous. You have to find a way to live with it, and there is nothing funny about it. Yet there are websites with asthma humor and cartoons. A life-long asthmatic named Joe Bottrell lists "The Seven Benefits of Having Asthma." They are perspective, vulnerability, religiosity, empathy, intelligence, sharing, and cleanliness.

So during Asthma Awareness month, we take this occasion to understand this curious disease, to sympathize with its victims, and to celebrate those who live and thrive in spite of it.