There is no universally accepted definition of asthma. The Concise Oxford Dictionary describes it as “a disease of respiration characterised by difficult breathing, cough etc.”. Any good medical book will describe it in more technical terms but ‘difficult breathing’ is the part with which any asthma sufferer is familiar, even if it varies from mildly uncomfortable to life-threatening. Asthma is news now. There was a dramatic increase in the condition in the late twentieth century to the extent that an estimated 100 to 150 million people in the world are now affected by it, but it is not a recent phenomenon. (1)
The term “asthma” is a Greek translation of gasping or panting, and the problem was treated as far back as 2000 BC by Chinese doctors with the herb Ma Huang. The first known recording of the symptoms was about 3,500 years ago in an ancient Egyptian manuscript called Ebers Papyrus. Throughout the ages, asthma has received varying degrees of attention; the symptoms and their accompanying anxiety have been described by many prominent historical figures, including the famous Greek physician, Hippocrates.
Over the centuries, there has been an assortment of different theories about the causes of asthma, and so an eclectic range of remedies has been advised, including horse riding, strong coffee, tobacco, faith healing, chloroform and even drinking the blood of owls in wine, as practised by the ancient Romans. Van Helmont who lived in the early part of the seventeenth century claimed that asthma was epilepsy of the lungs due to the sudden and unpredictable nature of an attack. Based on his own experience of asthma, English physician Thomas Willis said that “the blood boils”, and that “there is scarce anything more sharp or terrible than the fits thereof”.
It was not until the eighteenth century that Lavoisier provided the first real account of the functioning of the lungs, thereby providing the basis of modern-day understanding of the respiratory system. Prior to this, it was commonly believed that air was drawn into the lungs to cool the body. Lavoisier’s contribution was that air is drawn in to be converted to energy by the metabolism, and that carbon dioxide and heat are produced as end products of the process. Lavoisier’s work recognised that oxygen is essential to sustaining life.
Asthma now affects more people throughout the world, particularly in more developed countries, than at any other time in evolution. It inflicts greater economic and social damage in Western Europe than either TB or HIV, according to the World Health Organisation’s (WHO) April 2002 report on the links between ill health in children and the deteriorating environment.
According to the 1998 International Study of Asthma and Allergies in Childhood (ISAAC), the countries with the highest twelve-month incidence of asthma were the UK, Australia, New Zealand and the Republic of Ireland followed by North, Central and South America. The same report found that the lowest rates were in centres in several Eastern European countries, followed by Indonesia, Greece, China, Taiwan, Uzbekistan, India and Ethiopia. Other studies show that the rate of asthma among rural Africans who migrate to cities and adopt a more ‘western’ urbanised lifestyle increases dramatically. According to the UCB Institute of Allergy in Belgium, the incidence of asthma in Western Europe has doubled in the last ten years. (1)
In the Western world, asthma crosses all class, race, geography and gender boundaries. Although it causes persistent symptoms among seventy per cent of all people diagnosed with it, asthma causes only minor discomfort to the majority. In fact, some of the most influential people of our time in all walks of life were asthmatic, including Russian Tzar Peter the Great, actors Liza Minnelli, Jason Alexander and Elizabeth Taylor, revolutionary Che Guevara, and former US presidents John F Kennedy, Calvin Coolidge and Theodore Roosevelt. All these have lived life to the full or are still living it.
What are the symptoms?
So what is asthma and what are the symptoms? The condition consists of inflammation, tightening and swelling of the airways in the respiratory system, resulting in obstruction of the flow of air to and from the lungs. The symptoms of asthma include breathlessness, wheezing, coughing and chest tightness. Sufferers may also have a blocked nose and hay fever, or rhinitis. The symptoms and their severity are peculiar to the individual, and they vary from season to season and according to the individual’s susceptibility to a wide range of triggers.
An ‘asthma attack’ is the term used to describe an episode of breathing difficulty. In some cases, this may follow exposure to a specific trigger, such as dust, pollen, or certain foods. In other cases there appears to be no particular trigger. Some people have a cough and no wheeze, while others may have a wheeze and very little coughing, but each case is accompanied by some level of breathing difficulty. Symptoms may occur periodically, on a day-to-day or season-to-season basis, or they may be more or less continuous.
A ‘trigger’ is something that makes asthma worse. The most common triggers include (in alphabetical order): allergies; cigarette smoking (and cigarette smoke for non-smokers); colds and ‘flu; cold air; dust mites; exercise under certain circumstances; moulds; noxious fumes; pollens; stress, and weather types such as fog and damp. In some instances an asthma attack may be triggered by a combination of catalysts. Anxiety can be caused by the variations on the asthma theme, particularly where a child is involved. Sometimes, there may be confusion between doctor and patient when a diagnosis is being made.
There is also a wide variety in the symptoms of asthma. The following is a list of those most commonly experienced by sufferers.
This is a high pitched whistling sound produced when air is forced through narrowed airways. If you blow through a Biro pen when the ink refill is removed, the sound is similar.
This is the feeling of not being able to take in enough air. There is a need to breathe out while, at the same time, a compulsion to breathe in. If this symptom develops to an extreme level it can be frightening for the sufferer and very distressing for those close to him or her.
This may be either a repetitive dry cough or a cough with phlegm, often occurring during the night or early morning. Repetitive coughing can put a strain on the heart and drives sputum deeper into the lungs. Patients with this symptom may feel like they are on a conveyor belt: the more they cough, the more they feel the need to cough again.
• Chest tightness
Trapped air in the lungs generates a feeling that the chest is over inflated. This is often described as someone squeezing or sitting on one’s chest.
• Frequent yawning
When asthma symptoms are at their worst, sleep is interrupted by difficult periods of breathing which contributes to tiredness.
Non-asthmatics can, of course, observe these symptoms, but they will not appreciate the feelings of tension, panic, uncertainty and helplessness which accompany them, particularly when the asthmatic struggles to breathe. If you are not an asthmatic, imagine trying to breathe while a pillow is being pressed firmly over your face. That feeling you imagine is the feeling someone with asthma has during an attack. In your case, the imaginary pillow can be easily removed to allow you to breathe effortlessly; for an asthmatic, the remedy is not so simple.
Given the variety of symptoms and their severity, diagnosing a condition that has no commonly accepted definition is not an exact science. Many asthma symptoms are also the symptoms of other conditions, such as chronic bronchitis or bronchiectasis, for example. Diagnosis has to take into account the chronic nature of asthma and the constriction of the airways due to inflammation by various cells and chemicals. Generally, diagnosis of asthma is based on the following factors.
• History of the patient
This includes establishing if the patient has experienced asthma symptoms while at rest, during exercise or after exposure to a known trigger.
• Lung function tests
The peak flow meter measures the maximum speed at which the patient can exhale air in one second. A person with asthma usually produces a lower reading, and, generally speaking, a more inconsistent range of results than a person who doesn’t suffer from the condition. Spirometry measures both the speed and volume of air which is exhaled with each breath, thereby providing additional airway obstruction information.
• Effect of reliever or steroidal medication
In part, diagnosis of asthma is based on the effects of medication, and whether or not it leads to a temporary reversal of symptoms. Other conditions which demonstrate common asthma-type symptoms, such as emphysema, include irreversible airway obstruction.
• Provocation test
The patient inhales a broncho-constricting agent, such as histamine or methacholine. The airways of people with asthma are far more responsive to inhalation of these substances; agents like these will provoke more extensive narrowing of air passages in people with asthma.
• Skin tests to determine allergies
A number of common allergens are selected, such as dust mites, pollen or animal dander. One at a time, the allergens are placed on the forearm, and the skin is then gently pierced to allow the substances to penetrate. After fifteen minutes, the skin surrounding this spot may develop a small rash. While this test is not always conclusive, the presence of a rash and the size of the weal indicate an allergy to a specific substance.
• Chest x-ray
X-ray is used to rule out other respiratory diseases in a person who has the symptoms of severe chronic asthma. X-ray charts show irreversible damage to the airways, and this aids the diagnoses of other respiratory disorders.
Your respiratory system
Before you commence breathing retraining, it is important for you to have a basic understanding of the roles played by the respiratory system and carbon dioxide in your body. Your respiratory system consists of the parts of your body used for the delivery of oxygen from the atmosphere to your cells and tissues, and for transporting the carbon dioxide produced in your tissues back into the atmosphere. If cells and tissues are to function properly if you are to live your body needs the atmosphere’s oxygen. Your nose, mouth, pharynx, larynx, trachea, bronchi and lungs are all part of your respiratory system.
Part of your airways is your nose and mouth. Through them, air enters your body and flows down a flexible tube called the trachea. This tube eventually divides into two branches called bronchi: one branch enters the left lung and the other branch enters the right. Within your lungs, the bronchi further subdivide into an estimated twenty-five smaller branches called bronchioles. The bronchioles run into alveolar ducts and at the end are small air sacs called alveoli.
Look at it another way. Imagine an upside-down tree. The trachea is the trunk; at the top of the trunk are the two large branches of the bronchi. From each of these large branches grow the smaller branches of the bronchioles. At the end of each smaller branch are the ‘leaves’, the round balloon-shaped sacs called alveoli.
When you breathe in, air enters through your nose or mouth and flows into the trachea, the bronchi, bronchioles and eventually alveoli. The grape-like alveoli after which they are named are surrounded by tiny blood channels called capillaries. Oxygen enters the blood by passing through a very thin barrier between the capillaries and air sacs. It is then carried by what is called haemoglobin within the blood to tissues and cells. There are approximately three hundred million alveoli in the lungs, each of which is surrounded by tiny blood vessels.
To put this huge number in context, think of Wimbledon and imagine a tennis court. The area of contact between your alveoli and blood capillaries is equivalent to the size of a tennis court; as you can imagine, this massive area provides scope for an efficient transfer of oxygen from the air to your blood. Carbon dioxide is produced as an end product of the process of breaking down the fats and carbohydrates that you eat, and this gas is brought by your venous blood vessels to your lungs where the excess is exhaled. Crucially, part of your body’s quotient of carbon dioxide is retained when you exhale, and correct breathing results in the required amount of carbon dioxide being retained in your lungs.
There are two main aspects to the way you breathe. Your rate is the number of breaths you take in one minute and your volume is the amount of air drawn into your lungs. Although the two are separate, one generally influences the other.
The volume of air we inhale and exhale is measured in litres, and measurements are usually taken over one minute. In conventional medicine, the accepted number of breaths a healthy person takes in one minute is ten to twelve, with each breath drawing in a volume of 500 millilitres. In a full minute, this provides the body with a total volume of five to six litres. If a person is breathing at a higher rate of twenty breaths, for example, then the volume will also be higher, and vice-versa. To visualise this amount of air, imagine how much air would be contained in a two-litre soft drink bottle.