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Sunday, August 8, 2010

RT history: All SOB still treated as asthma

You see me write often on these pages about how Ventolin and Xopenex and Atrovent are -- much like Tylenol -- given to patients way more often than they need to be. Like tylenol, bronchodilators are among the most abused medicines on the market.

Yet there is a historical reason behind this abuse. If we go back just 50 years you'll see many myths about asthma, and many myths about asthma treatments. Well, if you've ever heard the myth that chicken noodle soup will cure the common cold you'll understand where I'm coming from.

Actually, a really good example of how history can effect how we think today all you have to do is look at the history of the name of America. We know that Columbus discovered America for Europe, yet America was named after Amerigo Vespucci.

The king of Spain had it named so because Columbus didn't write about his ventures, Amerigo did. Years later when it was learned Columbus discovered America first historians tried to change the name to Columbia, but by then it was too late: the name America was already firmly planted in the minds of many.

So you can see it's hard to change old thinking, even if it's wrong.

If you read books about asthma that were written prior to the late 1990s, you will not see asthma defined the same way it is today. In fact, asthma, as defined prior to the 1930s may not even be asthma at all.

Now I'm sure Teddy Roosevelt had the disease, yet even physician's like J.B. Berkart, who wrote his version of "On Asthma: It's pathology and treatment" in 1878 noted the following:

"ALL early historical traces of the affection at present called asthma are lost. Although the disease is said to be mentioned in the Bible, and described by Hippocrates, Areteaus, Galen, and Celsus, there is not the least evidence that those remarks apply to the asthma of to-day. For in the former systems of medicine, all cases presenting the same conspicuous symptoms were, regardless of their anatomical differences, considered as of a kindred nature, and grouped into classes according to imaginary types."

In this regard, any disease that caused shortness of breath, or dyspnea (being winded) were all called asthma. Chronic bronchitis, emphysema, COPD, cystic fibrosis, pneumonia and heart failure all result, at times, in symptoms similar to asthma, and, thus, were all grouped in the class of asthma.

Now, it should be important to note that since this is the old way of thinking, it only makes sense that many doctors STILL often confuse these diseases, and often treat all that wheezes and all that causes shortness-of-breath as asthma. So now perhaps you'll understand why I often make fun of this on this blog.

The funny thing is, that even while Berkart noticed this, he himself believed asthma was caused by Rickets, and he also believed asthma was psychosomatic. Likewise, he himself said that he had never performed an autopsy on an asthmatic and not seen emphysema. Emphysema, as you and I know today, causes permanent air trapping in the lungs, while asthma causes air trapping only during an exacerbation (with a few exceptions). Yet that wisdom is relatively new.

During most of the 19th century asthma was thought to be a psychosomatic disease, in that asthma experts believed asthma was all in the head of the asthmatic. With good psychiatric care, and good medicines like opiates and caffeine, one asthmatic was expected to relax and the asthma attack will go away, and asthma itself will go away with age (a fallacy that still exists).

In fact, there are and were (are) so many asthma myths that I can hardly scratch the surface, although I try in this post.

I have also observed that once science proves something to be true, it usually takes about ten years to convince physicians at larger hospitals to change. Then, once larger hospitals adapt new policies based on facts (which may take up to 10 years), it takes another 10 years for smaller hospitals (like Shoreline) to catch on.

So, you can see, progress is slow. While the wisdom may be out there, progress is frustratingly slow.

So this should explain why we are STILL giving bronchodilators for all that wheezes. It also explains why we are still overoxygenating newborn babies even though every study ever done of the subject going on 15 years now shows that oxygen, even to term babies, has been linked to cancer later in that child's life.

I guess this is why they say: patience is a virtue. When you work in the hospital you have to be exceptionally virtuous.

1 comment:

Respiratory Therapy Education said...

Thanks for the interesting and informative post. I enjoyed reading it and look forward to more in the future.