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Friday, March 28, 2014

Bronchodilator Reform: Some things never change

Sometimes wisdom advances ever so slowly, or, in the case of respiratory therapy, not at all.  Consider the following passages from Nathaniel Chapman, the founder of the American Medical Association, from his 1844 book "Lectures on the more important diseases of the thoracic and abdominal viscera,":
Difficult breathing, which constitutes the most prominent feature of this disease, seems to have attracted medical attention from the earliest antiquity. The Greek writers, as we learn from Celsus, distinguished it according to its gradations,—calling it when moderate, dyspnoea—when more severe, asthma—and when of the utmost violence, orthopnoea. In the progress of time, these terms underwent considerable fluctuations in their meaning andapplications, till finally that of asthma was made to embrace every case of embarrassed respiration, whatever might be its nature, or the manner in which it was induced. But this condition presents such infinite varieties in these respects, that a more precise and limited definition was required. Later authorities, therefore, restrict its use to a peculiar form of this affection —recurring in paroxysms, each of which, having a quotidian aggravation, coming ontowards evening or in the night, and subsiding in the morning, usually with more or less expectoration.
I thought this was an interesting observation by a smart physician, especially considering 170 years later we are still treating every case of embarrassed respiration as asthma.  

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