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 increase 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 are adamant that asthma is 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 untreated asthma is a mechanism that ensures that CO2 levels don’t fall below critical levels an hence allow the body to maintain a sufficient levels of oxygen. That is something every asthmatic could be proud of! Alas, this perception is not shared in the modern understanding of asthma cause and treatment.

Asthma treatment first focused on alleviating smooth muscle contractions and the effectiveness of the first bronchodilators coupled with lacking knowledge of side effects meant people used them fairly carelessly.  This caused an epidemic of asthma deaths reported in Australia, the US and the UK that peaked in the mid 1960s with a second peak in New Zealand in the mid 1980s.

By the 1980s, the allergic component of asthma was finally understood. Worldwide about 75% of asthmatics exhibit allergic causation. This started new treatment of anti-inflammatory drugs (cortico-steroids) with clinical trials showing their effectiveness as controller drug for asthma when taken daily.

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 the only treatment that has been shown to improve symptoms and status but is dismissed or ignored.

The 2018 GINA Report, Global Strategy for Asthma Management and Prevention again 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

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