Chapter 1: Struggling for Breath
Four-year-old Sophie had a cold and tenacious cough, as she often did these days. Her father wiped her stuffy nose, tucked her into bed, and read her a story until she nodded off to sleep. Thinking all was well, he finished his chores and went to bed. Around 3 o'clock in the morning, he and his wife awoke to sounds of a loud barking cough. They raced into Sophie's room to find her pale faced and wheezing between the fitful barking sounds. As they rushed her to the hospital emergency department, Sophie's father wondered how a cold could make his little girl so sick. He never imagined the cause was asthma.
Fourteen-year-old David was helping his family by shoveling a thick blanket of snow from the driveway and sidewalks. The previous night's blizzard had resulted in subzero temperatures today, but David was warmly dressed. David attacked the snow vigorously. After about 20 minutes, though, David felt winded. He stood still, coughing and gasping, trying to catch his breath. A sickening feeling washed over him, and it continued for 30 minutes after he came in and sat down. David felt embarrassed by the incident and was relieved when his parents decided to take him to the doctor. Neither David nor his parents ever suspected his problem could be asthma.
Fifty-year-old Janet was getting ready for bed. She had spent a long day cleaning in her basement, which had become mildewed after a flood. Something caught in her throat, making it hard for her to breathe. She coughed and choked, then went for a drink of water. When that didn't work, she blew her nose, thinking mucus from a persistent nasal drip prompted the surprise attack. Nothing eased the choking sensation. Her chest and back felt tight and heavy, so she vowed to be more diligent about her back exercises. For now, however, Janet tried desperately to clear her throat as perspiration beaded on her face. The catch in her throat disappeared in a few minutes, but her inability to take in a full breath lingered. Finally, she drifted into a tight sleep, only to awaken exhausted in the morning. Janet did not realize then that her symptoms added up to asthma.
Few people are aware of the many forms asthma can take. At one time, physicians thought people with asthma produced a characteristic wheezing sound. Even the name asthma comes from the Greek word panos, meaning to pant or breathe heavily. Doctors followed the logic that asthma caused breathing difficulties because blocked airways prevented air from entering the lungs.
Through the centuries, prevailing wisdom dictated a variety of theories for the blockage -- some accurate, some not. Physicians connected asthma to a seizure disorder of the lungs prompted by such outside irritants as feathers, smoke, strong perfumes, or animal dander or by psychiatric causes. Treatment focused on reducing a person's symptoms once airways became obstructed. Little was documented about how asthma changed the body's internal systems or the possibility of multiple causes of asthma.
Today, though researchers know more than before, much remains unknown about asthma. An exact cause or cure evades discovery. A few researchers suggest that the different patterns of asthma will one day translate into separate lung conditions. A predisposition to asthma seems to be inherited in some people. Yet, doctors cannot say with certainty why some people get asthma and others do not. The closest thing to an explanation is that certain children and adults have supersensitive airways.
Still, people like Sophie, David, and Janet have reasons to be hopeful. More is known about asthma now than ever before in medical history, and new medications are being developed and made available for hard-to-control symptoms. Although severe asthma can be fatal, the airway narrowing it causes is reversible with proper management. Modern treatment also focuses on prevention, so children and adults with asthma can stop problems before they begin. With symptoms under control, people with asthma can and do lead normal, active lives. The keys to managing your asthma include identifying and avoiding triggers that can cause an attack, recognizing the early warning signs of poorly controlled asthma, and working with your physician to control your environment and use your medications appropriately.
WHY BE INFORMED? With escalating numbers of diagnosed cases each year, asthma can creep into almost anyone's life. You may be able to name some friend, neighbor, or relative with asthma. Asthma may affect you or someone in your home, and that fact might have drawn you to this book.
As you learn to manage the disease, you may meet people who promote themselves as experts. They may offer their ideas about how you and your family should approach asthma. Most people mean well, and you can assume their guidance is well intentioned. But the advice they give may be based on outdated or inaccurate information. Their recommendations may actually put a person with asthma at risk. This book is designed to help you and your family filter this information.
Except for extreme medical asthma emergencies, many asthma symptoms appear more subtle -- unexplained coughing (especially coughing spells in children at night), breathlessness, wheezing. Unless you know someone who has asthma, you may just think you are sick, out of shape, or allergic year-round. Learning about asthma helps you identify whether you or a family member may have the condition.
Asthma has many puzzling aspects. Your asthma symptoms may differ from someone else's and require different treatment. Your symptoms may also wax and wane with the seasons throughout the year. Being attuned to the changes that are likely to occur in your disease can help reduce the frustration that can come from trying to handle so many variable factors.
Along the health-care highway, there are many potholes: quack treatments, dangerous or ineffective medications, and insensitive or unaware health-care providers. Obtaining information about asthma lets you know you have options. Information on asthma is available from both the physician's point of view and the patient's. The knowledge you gather from this book gives you the tools to help yourself.
Once you are armed with information, you can take a more active role in your own health care. If you are uncomfortable with a diagnosis, get another opinion. If your medication seems to be hurting you rather than helping you, request a change. Learn to become your own best health-care advocate.
WHAT IS ASTHMA? Asthma is an inflammatory disease in which the airways in your lungs become both hyperreactive and hyperresponsive to irritants. Hyperreactive means your lungs are more sensitive than most people's and may become inflamed (swollen) when exposed to such irritants as cold air, cat dander, tobacco smoke, or grass. Hyperresponsive means your body overreacts to the irritants by tightening the airways and filling them with mucus. Narrowed airways interfere with the movement of air in and out of the lungs, making breathing difficult.
What differentiates asthma from other lung diseases is that asthma symptoms rarely occur continuously. Instead, they come and go in attacks or episodes. Unlike other lung diseases that respond poorly to treatment, asthma symptoms are reversible with proper medication.
The length of an attack depends upon the person and reason for the flare-up. Episodes can be acute, or sudden, or they can build gradually. Asthma can also be chronic, meaning symptoms surface on and off for years.
Although most people with asthma develop it before age 5, asthma can develop at any age. About 25 percent of new asthma patients are older than 40, with 10 percent over age 65. Some asthma symptoms improve or worsen over the years. Episodes in childh