Asthma has been with us for millenia. The ancient Greek physician Hippocrates, inventor of the Hippocratic Oath, first used the term (from the Greek aazein, “to pant”). The Greeks had treatments- adding ephedra (an epinephrine-like drug) to red wine, and smoking stramonium, an atropine analog. They weren’t entirely on the ball though, thinking that adding owl’s blood to the wine helped too.
Asthma has become more common in children in recent decades. This is because of changes in kids’ environments, and because of the Hygiene Theory. Hygiene Theory posits that since children’s lives have become cleaner, more infection-free, their immune systems attack their own tissues, having nothing else to do. Also, it seems that when kids had intestinal worms from contaminated food, the worms put out substances that kept the immune system quiet. This protected the worms from immunity, while lessening immune aggravation of the kid’s lung tissue too. Now, no one’s advocating giving children tapeworms to lessen their asthma. Yet.
The environmental issues are more clear. Modern housing emphasizes energy saving with better sealed doors and windows. This means less fresh air circulates into the house through those leaky portals. Thus kids breathe more house dust, which irritates lungs. People also open their windows less and make air conditioners and heating systems, which accumulate and circulate dust and other irritants, do more work. Kids also spend more time indoors than out with TVs, computers, games, and phones; thus breathing that dusty indoor air more. Less exercise clearly worsens asthma- kids need exercise to prevent it. This may seem counter-intuitive, since exercise can sometimes trigger or worsen individual asthma attacks. However, in the long run, more active children have fewer attacks.
These are clues to prevent asthma in children, and prevention is the mainstay of treatment. Once kids start having asthma it’s a lot of trouble- they visit Emergency Departments for attacks, and sometimes get hospitalized. They miss school, and parents miss work. Occasionally kids end up on life support in the Pediatric Intensive Care Unit, or die. Makes tapeworms sound better and better.
Continuing our asthma history lesson from above, asthma theory took a weird turn in the early 20th century, with Sigmund Freud’s theories of the subconscious mind. Since anxiety attacks were known to trigger asthma, some over-enthusiastic Freudians believed that all asthma was psychological; even when patients had audible wheezing, that high-pitched whistle from deep down the throat. They thought that whistling was generated subconsciously as a tiny scream for help from the patient’s buried anxiety.
Fortunately, in the 1940s and ’50s, physiologic understanding of asthma prevailed. That understanding holds today, that asthma comes from two glitches in the airway. First, the muscles that control airway diameter overreact to noxious stimuli like dust, allergens, and viruses. When those muscles contract, they narrow airways to keep out the irritants. But doing that keeps out the air too. Second, after too much stimulation, the airways become inflamed, causing swelling into the passage, and excess mucus production. With airways narrowed by muscle contraction and swelling, and clogged with mucus, no wonder it’s hard to breathe.
Asthma treatment is two-pronged. First, we use medicines inhaled as a mist, like albuterol. Albuterol breathed into the airways relaxes the muscles lining them, opening the passages up. Second, we use steroids, which decrease inflammation and mucus production. Steroids have minimal side effects. Sometimes when people hear steroids they think “anabolic steroids,” the kind that some athletes take to build muscle mass. These aren’t the kind we use for asthma- kids aren’t going to bulk up, grow beards, and have rage attacks.
The most important treatment for asthma is prevention. Like we mentioned above, regular exercise prevents asthma. As kids exercise less these days, asthma has become more common. Since individual asthma attacks can be worsened by exercise, some parents restrict their asthmatic kids’ activity. However, over the course of childhood, regular exercise actually lessens asthma. Also, like we said above, kids should get outdoors more to breathe fresh air, instead of dust-laden indoor air.
Children can take medicines to prevent asthma attacks as well, particularly for air-borne allergen sensitivities, like to molds and pollens. Those kids can play outdoors too. Talk to your doctor about treatment plans, prevention medication, and exercise plans for your child. Asthma’s another good excuse to get your kids away from their screens and into the real world.