This week’s guest columnist is Dr. Traci Bourgeois, a Family Practice resident at the University Hospital and Clinics here in Lafayette.
My great-grandmother Regina Thomassie, born in 1897, lived in the small farming town of St. Amant, Louisiana. Because doctors and medications were scarce, she used many home remedies. While her hot toddies and thrush salves have stood the test of time, her asthma treatment has been, well, superseded. She would first have the asthma patient inhale over steaming hot coffee and then sip it- fair enough. But then she sent the patient out to catch a fish, then breathe into its mouth, to transfer the asthma to the fish.
Luckily for both humans and fish, our treatment of asthma has improved beyond trout and coffee. Asthma is an over-reaction to things inhaled from the environment, like dust, viruses, smoke, cockroach droppings, and other allergens. The muscles in the airways constrict to keep out the offending agents. Unfortunately, too much constriction also keeps out the air! After more irritation, the airways become inflamed; swelling and producing mucus to wash away the irritants. This swelling and mucus production further clog air passage, and breathing becomes labored.
To prevent airway inflammation (and visits to the Emergency Department!), we have several tools. One is daily inhaled steroid to keep the inflammation and mucus down. It’s important to use this medicine every day before your child is sick, even if they feel great. If you begin the medicine when your child’s already coughing and wheezing, it’s not strong enough to fight inflammation, only to prevent it. Another daily prevention medicine is montelukast (Singulair), which also inhibits inflammation. Again, prevention means using this every day, before your child gets sick!
The best prevention is avoidance. Dust is the most common airway irritant that triggers asthma, and is partly why asthma is so bad in winter. When kids are trapped indoors in school or by bad weather, they breathe more indoor dust. Dust is hard to avoid, requiring minimal carpeting, curtains, and bedding, which collect and hold dust; and lots of mopping. Cockroaches are also hard to avoid- it’s Louisiana after all! So keep your exterminator busy.
Back to my great-grandmother Regina Thomassie from above, who treated asthmatics by having them transfer their asthma to a fish by breathing into it’s mouth. During the 20th century when she practiced, more effective asthma treatments were developed. Injection of adrenaline, the hormone responsible for our fear reaction, proved effective in relaxing muscles in constricted airways, opening them up. For eons humans have known the effects of adrenaline: when confronted by a sabre-toothed tiger, the human would develop a racing heartbeat, muscle tremors, and wide-open airways, to prepare for a foot race with its predator. About when Regina was born, 1897, scientists isolated the compound, and by 1914 had demonstrated its usefulness in asthma.
Today’s mainstay of asthma treatment, albuterol, acts like adrenaline but with less agitation. Albuterol relaxes muscles in airways that have constricted to keep out irritating agents like dust, smoke, and viruses; with less tremoring and racing pulse. Adrenaline, a.k.a. epinephrine, lives on in other important treatments: injected for severe allergic reactions (the “epi” in your epipen), cardiac arrests, and severe asthma attacks.
Another mainstay of treatment, steroids, was developed in the 1940s. Steroids decrease inflammation, like the airway swelling in asthma. As discussed above, supersensitive lung tissue in asthmatics is easily irritated by dust, pollen, smoke, and viruses. Steroids soothe this irritation, decreasing swelling that narrows airways and occludes air passage. Mythbuster: steroids don’t work faster when injected. “Cortisone shots” don’t take effect sooner than pills or liquids. In the Emergency Department we give it to kids orally, unless they’re breathing so hard they can’t swallow. Then it’s given IV.
Of course the best asthma treatment is prevention; don’t get an attack! Besides avoiding asthma triggers, it’s important to get flu vaccine every year. Flu virus is particularly hard on asthmatics, is highly contagious, and the season is coming fast. Get your asthmatic that vaccine!
Another important, often overlooked, prevention is exercise. Getting kids outdoors and moving not only decreases dusty interior air exposure, it somehow makes lungs stronger. Though it seems paradoxical, given that exercise sometimes triggers asthma, in the long run (get it?) activity makes kids less susceptible to attacks.