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Friday, January 4, 2008

From asthma cigarettes to a normal life

Millions of people are alive today becuase of modern medicine, as would probably be true of a majority of the patients we as RTs take care of on a daily basis.

When I was a kid, as I puffed on my Ventolin inhaler for the umpteenth time, or visited the hospital and was given instant relief after a shot of Susprin (Epi), I often wondered if I had lived a hundred years earlier if I would have lived to be a year old. Chances are I would not have.

I remember my grandma telling me the story of her peering through a slightly ajar door into a small room at the old Mercy Hospital as doctors picked up her little brother and frantically held him upside down, patting him on the back, trying to clear the junk from his lungs.

Her little brother didn't live to his second birthday.

He had bad genes, as I have bad genes, as probably do most of our respiratory patients. And, perhaps, had he survived that illness, he would have grown up to have asthma, and probably would have lived miserably as the treatment for that disease was primitive.

When I worked for the museum in Port City they had a shelf with a bunch of 100 year old medicine from an old pharmacy, and one of the medicines was an old box of "Asthma Cigarettes." During an exacerbation of asthma patients were encouraged to smoke.

The medicine had a drug called Stramonium, which, according to this article by the American Journal of Respiratory and Critical Care Medicine is a "dried leaf and the flowering or fruiting tops of the plant, Datura stramonium. This is also referred to as the thorn-apple plant. The active ingredients in this were alkaloids of belladonna, which we now know had the effect of inhibiting cholinergic neurotransmission and thereby reflex bronchoconstriction."

Preventative medicine, also according to this article, was used in the treatment of asthma back then just as it is today. And still, however far we have revolutionized the treatment of asthma, "It is still somewhat controversial as to whether allergen elimination leads to an improvement in asthmatic status. There have been recent controlled clinical trials in which selective covering of mattresses with house–dust-mite–proof covers failed to show a benefit in asthma severity or lung function."

The Belladonna plant was used in the ancient world as far back as Ancient Greece, but more as a sleep aid or as a opiate for poisons rather than as a bronchodilator.

A derivative of the Belladona plant called Atropine was used in the treatment of asthma until the early 1990s when a more toned down version called Atrovent was developed, which basically has fewer side effects.

I remember taking Atropine as a child, and when I accidentally splashed it into my eyes I'd be blurry for a while until the medicine wore off. It was kind of annoying actually. And the only way to take it was via the nebulizer.

But these drugs are used more so as prophylactic or secondary therapy as opposed to as a rescue medicine, since now we have the miracle drug Albuterol (Ventolin) and Levalbuterol (Xoponex).

The iron lung was invented in the mid 1950s as a means of keeping kids alive who had become paralyzed by the polio-epidemic. And the evolution of this ventilator pretty much engraved the career of Inhalation Therapy, now known as respiratory therapy.

This was a negative pressure machine that required for the patient to be inside a box as it sucked the chest out and forcing the patient to breath that way. These machines were complex, and made taking care of the patient difficult.

Later positive pressure ventilators were invented, but these entailed respiratory therapists to get out their watches and calculators and use formulas to determine adequate tidal volumes, pressures, etc. These were a far cry from the microprocessor ventilators we use today that make our job easy as eating pie.

And, they make life for the patients better too, as they have, as I like to tell my patients, mini brains inside them that allows the patient to control the ventilator instead of the other way around. Now, instead of having a patient linger on the ventilator for weeks or months, he or she can be weaned in days.

When I was in respiratory school in the late 1990s, we were informed that nearly all infants born with diseases or prematurely died. By 1998, nearly 80% of infants born survived, and infants as small as 750 grams had a 40% chance of surviving. I'm certain those numbers have risen since then.

So, not only does modern medicine keep people alive longer, it allows them time on this planet that they otherwise wouldn't have had. I know I'm stating the obvious, but it's interesting to think about.

I'll put it this way: 100 years ago most of those infants would have died. It's simply amazing how far modern technology has come in helping people stay alive. It's to the point where we almost take it for granted.

It's thinking of this that makes me wonder if it is modern medicine that has caused the rapidly growing cases of diseases such as asthma as opposed to simply living in the modern, clean environment as proposed by the hygiene hypothesis.

Sure, technology up to about the mid 20th century provided some relief with knowledge that asthmatics must avoid allergens, and with the ironic asthma cigarettes, but in 2008 no asthmatic should have to live anything other than a normal life.

Basically, due to modern technology, any person with a disease that affects breathing, from asthma to COPD to cystic fibrosis has a chance to live a normal life.

And, perhaps, some day in the future this same technology will lead to an outright cure.

Modern technology basically keeps people alive long enough so that we can have statistics. That's a good thing in my book. Not only has modern technology kept me alive, it's provided me with a really cool career.


Asthma Mom said...

This is a fascinating, fascinating post. I love niche history like this and had no idea the Iron Lung and the dev. of inhaler technology were at all related.

And also, asthma cigarettes? Wow. I knew a crazy assortment of things like nicotine and alcohol were considered asthma treatments at some time, but actual asthma cigarettes? Never would have guessed.

I think a lot about the relationship between the "asthma epidemic" and better diagnostics and treatment. After all, people used to talk about their "annual bronchitis" or their constant "summer colds" w/out knowing those were possibly symptoms of asthma.

And on a personal note, I talk quite often about how my daughter has asthma despite my (and my husband's) good lung health and no family history. Yet on my mother's side, many distant relatives died of lung disorders mostly attributed to the fact that they lived in western PA and worked in the steel mills there--I wonder how many of them possibly had asthma AND complications from the mine work, or just asthma alone. It could very well run in my family.

I'll end this rambling post here--thanks for the great information.

Marilyn said...

Nice blog. Keep up the good work. Cheers:-)

Anonymous said...

a nurse in the early 1950's. I worked at a TB SAN, and went to the drug store to buy this cig. for some patients. I also worked with the Iron Lung patients. Then they had a rocking bed that helped, which I worked with. Then we were the first ones to use the IPPB machine. Large tank of O2 with gauges applied and a container for fluid to mix up. What a time we had figuring this setup and how to use it. The doctor didn't know how. Then the table type came out and finally the hand held one, which every body knows of today.

Freadom said...

I bet there are some interesting stories you could tell.

vishal said...