Asthma is a chronic disorder of the airways, and as old as history itself.
The Chinese Yellow Emperor, Huang Di (2697-2598 BC) is said to have referred to it; Egyptians mentioned it in the Ebers papyrus; Hippocrates thought it was caused by something in the environment; and Pliny the Elder had cases induced by pollen! We have inherited the Greek description: asthma meaning 'to pant' or 'to breathe hard.
' In a nutshell, asthma is an inflammatory condition of the bronchial tubes which makes them 'hyper-reactive'.
By this we mean two things.
In the first place, the bronchial tubes are always (chronically) inflamed, even in cases of very mild or episodic asthma.
Secondly, the inflamed airways are very sensitive to change.
They are twitchy, if you like, and they very easily overreact to environmental stimuli.
When they do overreact, they go into spasm and become even more inflamed.
Here again, the mast cell plays an important role.
The sequence of events is easily understood.
1.
The lining of the bronchial tubes becomes inflamed and swollen.
2.
The inflamed lining secretes thick mucus into the airway.
3.
The muscle surrounding the bronchial tubes gets twitchy and goes into spasm.
Each step in this process is marked by a further reduction in the bore (size) of the airways.
Think of it like this.
You're in a movie, and you're on the run from an enemy.
He's armed, you're not.
You come to a river, too wide to cross in a hurry.
You turn around and see the bad guy in hot pursuit, so you jump in and hide amongst the bulrush.
Fortunately, the director hands you a length of hosepipe, and you slip underwater breathing through the pipe.
All goes well until the director decides that a drinking straw would have more dramatic effect.
He makes the switch.
You now have to breathe through a much smaller bore.
Not only do you have to suck the air in with much greater force but you have to blow it out forcibly.
Breathing is much more difficult.
This is what happens in asthma: you're being asked to breathe through a smaller airway.
The symptoms of asthma are the direct result of inflamed and constricted airways.
Patients experience: 1.
difficulty breathing/shortness of breath and/or 2.
tightness in the chest and/or 3.
wheeze and/or 4.
cough Although most patients will experience all of these symptoms, many will not.
Indeed, some patients may complain of only one symptom, such as a chronic cough, or fatigue.
That's one to watch out for - a cough that just won't go away, or that goes away during the day and comes back at night.
Anyone who has a cough lasting more than four weeks should he checked out for asthma.
Don't wait for the wheeze, it may never come! Mr.
Dunne was an interesting case.
He was sixty-two years old and complained of fatigue.
Nothing very specific, just a loss of energy.
It came on him gradually over the past two years or so.
Yes, he did feel a bit depressed, and yes, he was rather fed up at work.
He looked forward to retirement but couldn't imagine being able to do anything with his time.
The only abnormality on examination was the presence of a wheeze in his chest.
He couldn't hear it, and I couldn't hear it without the stethoscope, but he had a wheeze.
A few more simple tests confirmed that he had asthma.
Within one month of starting treatment with two inhalers he felt much better, a return of the old sparkle! Fatigue may be the only symptom of asthma.
The Chinese Yellow Emperor, Huang Di (2697-2598 BC) is said to have referred to it; Egyptians mentioned it in the Ebers papyrus; Hippocrates thought it was caused by something in the environment; and Pliny the Elder had cases induced by pollen! We have inherited the Greek description: asthma meaning 'to pant' or 'to breathe hard.
' In a nutshell, asthma is an inflammatory condition of the bronchial tubes which makes them 'hyper-reactive'.
By this we mean two things.
In the first place, the bronchial tubes are always (chronically) inflamed, even in cases of very mild or episodic asthma.
Secondly, the inflamed airways are very sensitive to change.
They are twitchy, if you like, and they very easily overreact to environmental stimuli.
When they do overreact, they go into spasm and become even more inflamed.
Here again, the mast cell plays an important role.
The sequence of events is easily understood.
1.
The lining of the bronchial tubes becomes inflamed and swollen.
2.
The inflamed lining secretes thick mucus into the airway.
3.
The muscle surrounding the bronchial tubes gets twitchy and goes into spasm.
Each step in this process is marked by a further reduction in the bore (size) of the airways.
Think of it like this.
You're in a movie, and you're on the run from an enemy.
He's armed, you're not.
You come to a river, too wide to cross in a hurry.
You turn around and see the bad guy in hot pursuit, so you jump in and hide amongst the bulrush.
Fortunately, the director hands you a length of hosepipe, and you slip underwater breathing through the pipe.
All goes well until the director decides that a drinking straw would have more dramatic effect.
He makes the switch.
You now have to breathe through a much smaller bore.
Not only do you have to suck the air in with much greater force but you have to blow it out forcibly.
Breathing is much more difficult.
This is what happens in asthma: you're being asked to breathe through a smaller airway.
The symptoms of asthma are the direct result of inflamed and constricted airways.
Patients experience: 1.
difficulty breathing/shortness of breath and/or 2.
tightness in the chest and/or 3.
wheeze and/or 4.
cough Although most patients will experience all of these symptoms, many will not.
Indeed, some patients may complain of only one symptom, such as a chronic cough, or fatigue.
That's one to watch out for - a cough that just won't go away, or that goes away during the day and comes back at night.
Anyone who has a cough lasting more than four weeks should he checked out for asthma.
Don't wait for the wheeze, it may never come! Mr.
Dunne was an interesting case.
He was sixty-two years old and complained of fatigue.
Nothing very specific, just a loss of energy.
It came on him gradually over the past two years or so.
Yes, he did feel a bit depressed, and yes, he was rather fed up at work.
He looked forward to retirement but couldn't imagine being able to do anything with his time.
The only abnormality on examination was the presence of a wheeze in his chest.
He couldn't hear it, and I couldn't hear it without the stethoscope, but he had a wheeze.
A few more simple tests confirmed that he had asthma.
Within one month of starting treatment with two inhalers he felt much better, a return of the old sparkle! Fatigue may be the only symptom of asthma.
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