Asthma is a common enough problem in the US. It affects roughly 7-8% of people worldwide, though in the developed world at least, it doesn’t trigger much concern. Many children are diagnosed with it and then outgrow their symptoms.
But statistics show that asthma cases have been steadily rising since the 1960s, likely due to increases in air pollution, though improved diagnostics also play a role in these numbers. And there are still severe cases. Roughly 11 people die of asthma attacks in the US each day. For reasons I can’t quite fathom (she said in a voice dripping with sarcasm), women make up 65% of asthma related deaths, while black women are three times more likely to die of asthma than white men.
And this is just in the course of every day life, when asthmatics are exposed to things like air pollution on their commute, dust in the work place, pet dander at a friend’s house, or maybe overdoing it a bit in gym class. Earlier this month, an OSU grad was murdered when she was hit with tear gas during a peaceful protest in Columbus. She was asthmatic.
In middle school, our medications were tightly controlled by the school. I had braces and had to leave my Advil with the school nurse; I could only take it with permission from the school, and the individual pills would be doled out to me by and adult. And that was just a basic pain killer. Everything from Midol to medications for diabetics, anti-seizure meds, anti-depressants to Epipens and rescue inhalers had to be controlled by the school. Students caught with their own medications, whether it was Tylenol or a life-saving medication that might arrive too late if retrieved from the office, were subject to suspension or expulsion.
Our gym teacher was infamous among the female students. He was pickier with us when it came to dress code. If a girl fell during a soccer game, he would yell for her to walk it off, even if she was bleeding. If a boy took a similar fall, he would call a time out to make sure the student was okay.
Every year we had the Presidential Fitness tests. Everyone hated them. Even students who played sports had trouble passing, and it was even worse with Mr. H. The day of the endurance run was always the worst.
It started with one girl, C, falling on the third lap around the gym (we had to do 20 or something, because there wasn’t an outdoor track). She hurt her knee and could barely walk, but Mr. H snapped that she was fine, and if she didn’t complete the run he would fail her. In tears, she limped around the track for the remaining 30 minutes, several friends at her side, walking the course in solidarity and keeping her upright.
Then there was J. J was incredibly athletic, a soccer player. Mr. H kept pushing her. Through the entire class we had to hear him telling us how terribly the girls were doing, that we needed to run faster.
So J did. She ran and ran and kept running. And after class, I found her wheezing in the locker room, laying on a bench with her feet up.
I asked if she was all right. She waved me off. Eventually, in broken words, she explained she was having an asthma attack. I asked if she needed her inhaler, but she shook her head and continued to wheeze.
It wasn’t the first time someone had an asthma attack in class. It wasn’t the first time a girl had an asthma attack in class. So as three of us stood around J, waiting for her breathing to return to normal and ready to run to the office if we needed to, we also knew Mr. H wouldn’t excuse her to go to the office. We also knew it was too far away–up a flight of stairs and on the other side of the school.
Thankfully, J was fine. But I’ve never forgotten the way she sounded, laying there on the bench. And I’ve never forgotten the sexism and the senseless rules that could have cost her her life.
Sadly, this is the attitude faced by many women–especially black women–when admitted to the hospital, be it for asthma attacks or otherwise. The idea of “female hysteria” is still strong, making medical professionals believe that symptoms are exaggerated when in fact–as the numbers show–they are life threatening.
Was it always this way, though? How was asthma treated in the past, before rescue inhalers and preventative medicine?
Asthma is a long term reoccurring condition involving inflammation of the bronchial tubes (the tubes leading to the lungs), which obstructs airflow and causes spasms. These symptoms occur when exposed to allergens or irritants. These might come in the form of pollen, dust, or pollution. In some cases, attacks can be caused medications or stress. Today, acute attacks are treated with medications like Abuterol, which reduce inflammation and relax the muscles that cause the attacks, as well as preventative medications like inhaled corticosteroids (which reduce immune responses and keep the airways open), leukotriene modifiers (which prevent aggressive immune responses to allergens that might cause the airways to seize up), long acting beta agonists (which relax the muscles but do not prevent or reduce inflammation), or IgE suppressants (which prevent mast-cell responses to allergens).
Since this is a history blog, not a science blog, I’m not going to get too much into what the differences between those medications are, but essentially it boils down to this: many asthmatics have attacks when they are exposed to allergens and irritants. In this example, we’ll say tree pollen. It’s not uncommon for a normal, healthy person to cough or sneeze when exposed to tree pollen, but an asthmatic’s body often over-reacts to this. Think of the person as a shopping mall, and the tree pollen is some jerk in a ski mask who is up to no good. Instead of calling in the local rent-a-cop, their immune system panics and calls the Marines, who decide to nuke the pollen from orbit. Preventative medications essentially cut off that 911 call so the rent-a-cop can do his job, kicking out the guy in the ski mask without getting run over by a tank in the process.
Asthma has been known to humanity for thousands of years. It was first recorded in Ancient China around 4,600 year ago, was known in Ancient Egypt, and finally got its name in Ancient Greece around 600 B.C.E. It means “panting.” Hippocrates studied it, and his knowledge of how the disease works is pretty much identical to what doctors know today. His prescription of owl blood and wine, however, was less than effective.
A few years later in Rome, Pliney the Elder connected it to environmental factors (like pollen), and prescribed an early form of ephedrine. Ephedrine is still used to treat asthma and allergies today.
For the several centuries, the knowledge and treatment of asthma stagnated, though a few new remedies were added, including smoking tobacco and marijuana (marijuana can reduce muscle spasms in small doses, though the smoke of either is not recommended today), cocaine, and opiates. In the 1920s a popular medication consisted of alcohol, water, menthol, and cocaine.
The late 1800s though the 1980s, however, saw a dark period in asthma treatment and diagnosis. With the rise of alienism (psychology) in the 1880s and 90s, many doctors came to believe that asthma was a psychological problem rather than a physical one, especially in so-called hysterical women. It wasn’t until the 1930s that it once again began to be treated as a disease rather than a psychosomatic reaction to stress. Sadly many of these attitudes remain, with the idea that when a woman goes to the ER with an asthma attack, she “did it to herself” or is “exaggerating.”
By the 1940s asthma attacks were treated with ephedrine injections, and by the ’50s Prednisone began being prescribed, and remains a staple of severe asthma treatment today.
In the 1960s, bronchiodialtors went into mass production and were available over the counter. The over-reliance on these medications actually caused more deaths than they prevented, and asthma-related deaths rose into the 1980s when medical professionals finally began to re-evaluate their treatments and access to medications.
Research in the 1970s produced corticosteroids which became available in the 1980s. Doctors finally began to understand the delicate balance between preventative treatments and rescue medications. Now, more research is aimed at controlling the side effects of these medications, which often stimulate the heart causing heart attacks, and refining the progress of the past.
Now if only would could take the racism and sexism out of the equation.
Past, Present and Future Therapeutics of Asthma: A Review
Asthma: 100 Years of Treatment and Onward
A Brief History of Asthma
History of Asthma
A Brief History of Asthma and Its Mechanisms to Modern Concepts of Disease Pathogenesis
Summing Up 100 years of Asthma
How Inhalers have Evolved
Very Well Health: Asthma Treatment
Like what you see? Check out Would this Kill me in the 1800s: Influenza.