When I was in college, I volunteered at a homeless shelter. Back then people were allowed to smoke indoors, and after a night shift I would leave with my hair stiff with cigarette smoke. Then I caught a cold, and a cough that did not go away. I hacked all day and woke up through the night coughing. After a month of misery, I went to the infirmary. The Physician Assistant there said I had a cold and gave me some cough drops.
Weeks later, still hacking, I went back. The PA did the same things, to no effect. Weeks after that I went back yet again, insisting on seeing the doctor. The doctor listened carefully to my story, said I had mild asthma from the combination of the cold and the cigarette smoke, and gave me an inhaler. Within days my cough was gone.
Many people find asthma confusing and complex. It is sometimes hard to diagnose, like my episode above. It can be triggered by many things and the medicines can be confusing- what do I give my kids when they are sick? How do we use an inhaler? What medicines should they take when they are well? How do I avoid asthma attacks?
Asthma, simply put, is wheezing that can be reversed by medicines. In asthma, the airways in your lungs are extra sensitive to irritants. The airways close up to keep out those irritants: cold viruses, pollen, cigarette smoke, extra cold air. When the airways narrow and close, the wheezing you hear and feel is your breath whistling through those skinnier passages.
To reverse airway narrowing, we use two classes of medicines. The first are called bronchodilators, that open up (“dilate”) your airways (“bronchioles”). These medicines are breathed in through inhalers and nebulizers. the second medicines are steroids, like prednisone, which take away the swelling in inflamed airways. Prednisone is a different steroid from the steroids athletes abuse. For the four-to-seven day courses we use for asthma, prednisone does not cause weight gain, hair growth, or rage attacks. For people with really bad asthma, there are medicines to take daily to make the airways less sensitive and help prevent attacks. These are called “controller” medicines.
More important than treating asthma is avoiding asthma and its attacks. Asthma is increasing in the population in the past 25 years, and many of the things that cause asthma are all around us. Pollutants like smoke, soot, and diesel exhaust eat at our lung tissue as we breathe. We live more and more indoors these days, and therefore have more exposure to indoor lung irritants like dust and mold. The more time we spend indoors too, the more time we are exposed to our fellow humans and the cough and congestion viruses they give us.
All those irritants assaulting the lining of our air passages add up. Some people have lungs that can take the abuse. Those with more sensitive lungs, like kids, get asthma. As we talked about above, when the air passages have had enough, they close up to keep out the bad stuff. Unfortunately, when they close up, they also keep out the air we need to live. What little air we can move in and out whistles through those narrowed air passages and we wheeze, and we have to pull and tug to get the air in and out.
So how do we and our kids avoid all those irritants? First, let’s not be so hard on the Environmental Protection Agency (the EPA). The EPA is not there to shut down factories, it is there to help those factories do less damage to our lungs from air pollution. Second, we need to avoid cigarette smoke. Smokers should never smoke indoors, at home with children, or at work or at bars with adults. Heck, smokers should see a doctor for help to quit! Finally, we and our kids need to spend more time outdoors, away from indoor dust and mold and sick people. Exercise is good for the lungs (and the rest of the body too) so outdoor activities are a double win.
So if you or your kids have a cough that won’t go away, or wheeze, see your doctor. You should talk about how to avoid asthma irritants, medicines to take for attacks, and if need be, medicines to prevent attacks. You and your kids should be allowed to breathe easy.