Joseph Cramer, M.D.: Asthma is a bummer; our air doesn't have to be
Asthma is a bummer. More precisely, people who suffer from asthma sometimes have to work really hard to get in one tiny breath of air. Known to the ancient physicians, the word "asthma" is the Greek word for “panting.” It is properly named.
Science today defines asthma as a chronic recurring reactive inflammatory disease of the small airways of the lungs. In other words, people with asthma pant.
Asthma is the swelling of the breathing tubes, causing them to narrow or close off completely. In goes the good air and out goes the bad air doesn’t happen. Besides the edema and mucus from the overzealous reaction to a variety of triggers, the airways are surrounded by smooth muscles that go into spasm. This contraction of the muscles combined with the inflammation is the reason for the difficult and sometimes impossible breathing.
The characteristic wheeze, with its high-pitched squeaky sound, is a product of the air whistling through the squeezed passages. The lungs become a human pipe organ. In the midst of an attack, when there is no wheezing at all, that is the time you worry. If the airways are sealed off, no air gets in or gets out. Silence is deadly.
The causes for asthma are a combination of genetics associated with allergies, eczema, hay fever or food reactions. Then there is the clean theory. Our bodies are becoming more reactive to the world because of the lack of early exposure. Being too clean prevents accommodation to normal dirty-world stuff.
As the theory goes, if a person is exposed to dogs and cats from birth, he or she becomes immunologically acquainted with the animals. Because of the early introduction of these foreign proteins, the body doesn’t react to them as the enemy. It is only when the dust, the mites, the feathers and the fur show up for the first time later on that the body freaks out.
There is also the general state of enhanced inflammation. Stress causes inflammation. Low vitamin D is also in the lineup. There is talk about overuse of acetaminophen contributing. Diets poor in omega-3 fatty acids and rich in the omega-6 of corn oil upset a delicate switch. The attack dogs of our defense system are turned on, not off.
However, damaged lung tissue makes everything worse. Tobacco smoke is vaporized poison for the lungs. Kids with parents who smoke are more likely to come visit us for a couple of days in the children’s hospitals to be hooked up to IVs, monitors and oxygen tubes. For those who continue to puff, please know that we care about your child as you do. We also care about you. We want you to be healthy. Don’t beat yourselves; use rewards in your personal daily victory over addiction and anxiety.
Now let’s imagine we are all locked in a large prison bus filled with smoke. We can’t open the windows, and we can’t fan the smog away. We are trapped in a gas chamber of pollution.
With every inhalation, we breathe in trash. This airborne garbage triggers the immune system to call a 200-alarm fire response. The cells roll into action, stuffing the airways and throwing the whole respiratory system into a spastic tizzy. This is when the doors to the emergency rooms and doctors' offices swing open to let the gasping and coughing wheezers in for a breath of fresh oxygen. With inversion, it is out goes the bad air, in goes the bad air.
We doctors cannot pass a law outlawing asthma. However, the people’s representatives can help. By restricting the burning of carbon fuels, we can open the window of our gas chamber a smidgen. Lower the price of public transportation. Synchronize traffic lights or switch them to flashing yellow and opposite red after 11 p.m. and before 7 a.m. Law-abiding citizens sit in smog-spewing machines, waiting for the stupid light to turn green, when there is no other car in sight. Tax tobacco more. It is pure economics beyond partisanship. Compensate for the cost of pollution by imposing user fees on cars, factories and gasoline for generating the toxins.
Asthma is a bummer. Our air doesn’t have to be.
Joseph Cramer, M.D., is a board-certified pediatrician, fellow of the American Academy of Pediatrics, practicing physician for 30 years and a hospitalist at Primary Children's Hospital and the University of Utah. Email: firstname.lastname@example.org
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