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Tuesday, December 24, 2013

Is asthma all in your head?

This post is the edited version of a post originally published at on 5/13/13

Dr. Henry Hyde Salter, in his 1868 book "On Asthma: It's Pathology and Treatment," wrote that "asthma is essentially a nervous disease." Through his detailed descriptions of asthma he was able to convince his peers that this was a fact, as opposed to just another theory.

He offered the following as proof:

  • Many patients feel fine as soon as they enter the doctor's office 
  • Mental emotion can bring on a paroxysm of asthma
  • Mental emotion can resolve a paroxysm of asthma 
  • Remedies that relax the nervous system resolve asthma, such as tobacco, alcohol, morphine, and especially chloroform. 
The belief that asthma was nervous in origin persisted even into the 1980, and this was despite it being disproved in the 1950s. Dr. Salter did such a good job inculcating the idea that asthma was nervous, that many asthma websites and books still describe asthma as a nervous disorder. 

Dr. Salter was a very good doctor for his time, yet his idea that asthma was "all in your head" was incorrect. 

But he wasn't the only asthma expert to be fooled, as so too were Hippocrates (the father of medicine) of the 5th century B.C., Galen of the 1st century, Thomas Willis and Jean Baptise van Helmont of the 17th century, and even William Osler (the father of modern medicine) of the early 20th century.

They were fooled mainly because asthma, in its uncomplicated or pure form, leaves no visible scars on the body. Even upon autopsy, doctors found the lungs of asthmatics to be normal. So physicians simply speculated it must be nervous in nature. 

We don't fault them, however, because they didn't know about the immune system. Dr. Osler probably knew about it, but not enough to link it with asthma. 

Today we know asthma is a disorder of the immune system; it's an autoimmune disease. It occurs because the asthmatic immune system is tricked into thinking things that are innocuous (harmless) to most people, things such as dust mites, mold, fungus, and cockroach urine, are harmful. Asthmatic lungs, therefore, become hypersensitive to these asthma triggers, and subsequent exposure to them may trigger an asthma attack. 

The asthma experts at National Jewish Health honor the latest wisdom regarding asthma, as they note the following on their website: 
“Emotions do not cause asthma, but can make asthma worse because strong feelings can lead to changes in breathing patterns. Times of ‘good’ stress and ‘bad’ stress can cause problems for people with asthma. However, it is important to express your emotions, and good asthma management can minimize the effect of stress.”
Modern physicians do not fault Dr. Salter for his error, because he tried to do the best for his asthma patients with the wisdom available to him. However, as we learn better we do better. Today we know asthma is not all in your head.


tavie2is4u said...

I truly appreciate your articles. I'm a Respiratory Care student in my 2nd semester. I would appreciate any articles or tips you may have when it comes to mechanical ventilation or neonatal care due to that being part of my courses of my upcoming semester. Thanks!

Anonymous said...

One needs to distinguish between allergic (atopic/eosinophillic) asthma and non-allergic asthma. Allergic asthma makes up 80% of the pediatric population but only 50% of the adult population. If they are exposed to something they are allergic to, they will have an exacerbation. And things that modify allergic responses (such as IGE inhibitors/Xolair and leukotriene inhibitors/Singulair) can lessen these exacerbations. You can measure the allergic response with exhaled nitric oxide measurements.

One the other hand there is non-allergic asthma, where we don't fully understand the causes. Anxiety can definitely be a large part of this.