My Story: How Anxiety Impacted My Asthma

I don’t really consider myself an asthma advocate. I’m a blogger at heart. I like to write; I don’t like to talk. A few years ago, I went to Washington D.C. to “advocate” on Capitol Hill. I had to speak with Congressmen to try to convince them to vote for asthma-related bills. And honestly, I hated every moment of it. It was incredibly uncomfortable for me to talk to people in that setting.

Advocating in that way just isn’t for me. Others in the asthma community do it and do it well, but not me. My advocacy comes through my writing. This is my gift. Writing is what I do best, and I will continue to write about asthma until everyone is aware of the disease—or until asthma is no longer a problem.

And I’ll keep doing this, even if I end up repeating myself. Thankfully, even after doing this since 2007, I’ve never truly repeated myself. Somehow, I keep coming up with new ideas for asthma-related topics on a weekly, sometimes daily, basis. It’s because this is my passion. Writing about asthma is what I love. I don’t do videos, and I’ll never return to Washington D.C. as an advocate. That’s simply not my gift.

I want to share something personal with you today, something I’ve never shared before. As a child, I would often suffer from asthma attacks for hours, sometimes days, before I gathered the courage to tell my parents. Can you imagine that? There were times when I could only take in half a breath in my bedroom in the middle of the night. I’d even poke my head out the window, hoping the fresh air would help (and, to be honest, it did help a little).

There were moments when I cried in frustration. But still, I didn’t tell my parents. I wrote about this on my blog several years ago, and one fellow asthma blogger commented: “Why wouldn’t you tell your parents if you were feeling so bad?”

At the time, I didn’t have an answer. I simply replied, “I don’t know.” I still don’t fully understand why I was so afraid to ask for help. My parents were loving and caring, yet I still held back. This wasn’t a one-time thing—it happened many times. I suffered in silence, unsure how to reach out for help.

You might ask, “How did your parents not notice?” Well, it was because of me. I was an expert at pretending. I’d walk by my parents, shoulders down, holding my breath so they couldn’t see how badly I was struggling.

Eventually, I found the courage to wake them up. Every time, they were empathetic, rushing me to the hospital. So, why did I wait so long to tell them? That’s a question I couldn’t answer—until recently.

In 1985, I spent six months at an asthma hospital in Denver, where I was diagnosed with social anxiety disorder. It wasn’t caused by my asthma. It was a completely separate issue. The doctors explained that my anxiety was exacerbating my asthma. They worked with me to help manage my anxiety so I could better manage my asthma and seek help immediately when I needed it.

The thing is, I could speak just fine in comfortable settings. But when I was in an uncomfortable situation—like feeling miserable and needing to wake my parents—I’d freeze. I couldn’t communicate when I felt stressed. This was true at school too. Surrounded by people, I would rarely, if ever, raise my hand to speak with teachers, and my grades suffered as a result.

Looking back, I can see how anxiety and asthma were intertwined. Learning to address my anxiety has been key to managing both. And by sharing my story, I hope others can find the courage to speak up when they need help.

Living with Asthma and Anxiety: A Journey of Growth

I started blogging about my asthma back in 2007. It didn’t take long before I met other people with asthma who were also blogging. We formed a tight-knit group, all sharing our struggles and triumphs. One day, I wrote about a severe asthma attack I had when I was 10, "A Tough Evening In A Smoke Filled Room." I didn’t tell my parents right away, even though I was scared and struggling to breathe. Eventually, I woke them up, and my dad rushed me to the emergency room.

One of my fellow bloggers asked, “Why didn’t you tell your parents sooner?” At the time, I wasn’t sure why. It seems like the obvious thing to do when you’re sick, right? But for me, I didn’t. I replied to my friend, “I don’t know. Sadly, it happened a lot when I was a kid.”

Looking back, it’s a little sad. It’s hard to admit that I had to deal with asthma alone sometimes. Even harder to admit that I was afraid to wake my parents. But looking back, I can also see how much I’ve grown and how much we can learn from experiences like these.

In 1985, I was admitted to an asthma hospital in Denver, Colorado. They treated me for asthma but also recognized something else: anxiety. They told me that my anxiety was making it harder for me to manage my asthma. And that’s when everything started to make sense.

I talked to counselors, psychologists, and even a psychiatrist. The psychologist diagnosed me, and the psychiatrist prescribed me some medication to help with my anxiety. At just 15, I was open to all of it. I wanted to get better, and I wanted to learn how to live my life without fear.

Having both asthma and anxiety wasn’t easy, but over time, I’ve learned how to manage both. Yes, it takes work, but I’ve proven that it’s possible to live a full, healthy life with both conditions. Here’s the thing: managing asthma and managing anxiety go hand in hand. When you focus on controlling one, you’re also helping the other. But it’s not always simple—admitting you need help with anxiety can be a big challenge, especially when it feels irrational.

I was fortunate to be diagnosed and treated early. Not everyone is so lucky. Many people with anxiety never get an official diagnosis, and many don’t seek help. But treatment is possible, whether through relaxation techniques, therapy, or medication. It’s not always easy, but it’s worth it.

What Is Anxiety?

I’m not a doctor, so I’ll share what anxiety feels like from my own experience. To me, anxiety is about fear, worry, and nervousness. It’s a constant sense of dread, like a weight on your chest. You feel uneasy, even in situations that shouldn’t cause fear.

Two Types of Asthma Anxiety

There are two kinds of anxiety that I’ve personally experienced, and I think they’re both important to recognize.

1. Anxiety Caused by Asthma: This one’s pretty straightforward. When you can’t breathe, you get scared. Everyone with asthma has probably felt this. It’s the panic that sets in when an asthma attack hits, and it’s hard to control the fear of it getting worse. But,  this anxiety can be helpful. It reminds you to get the help you need, whether it’s reaching for your inhaler or calling for help.

2. Anxiety That’s Always There (Not Caused by Asthma): This kind of anxiety is more subtle and harder to recognize. It’s the anxiety you feel all the time, whether or not you’re experiencing an asthma attack. It can be fear of what others think or worrying that you’re bothering someone (like I was afraid of bothering my parents). It’s irrational, and yet, it’s there. This kind of anxiety can be hard to pinpoint, and many people go through life without realizing they have it. But it’s real. And it can be managed.

Finding Strength in Anxiety

The good news is, anxiety doesn’t have to control your life. It’s natural to feel anxious when you’re having trouble breathing, but it doesn’t have to prevent you from seeking help. If you’re a child, you wake up your parents. If you’re an adult, you call your doctor or head to the emergency room. Anxiety can drive you to take action, to do what you need to do to get better.

But anxiety can also be harmful when it stops you from asking for help. When asthma and anxiety combine, it can create a barrier to getting the care you need. That’s why it’s so important to address both asthma and anxiety. Once you acknowledge both, you can start to take control of your health and your life.

Living with asthma and anxiety may be a challenge, but it’s not a life sentence. You can learn to manage both. I’m living proof of that. Through therapy, medication, and learning to manage my asthma, I’ve been able to live a fulfilling life. It takes work, but it’s worth it.

So, if you’re struggling with asthma and anxiety, know that you’re not alone. There’s hope. With the right support, the right tools, and a willingness to ask for help, you can manage both and live your life to the fullest. It’s not always easy, but it’s always possible.

Did Our Diets Cause The Asthma Crisis?

Asthma, once a rare condition, became a modern health crisis in the 1980s. Today, more than 300 million people around the world live with asthma, and that number continues to grow.

In the United States, the age-adjusted asthma death rate increased by a shocking 46% in the 1980s. From 1980 to 1989, it jumped from 1.3 to 1.9 per 100,000 people. By 2019, asthma caused 262 million cases and 461,000 deaths globally.

Compare that to the early 1900s when asthma was hardly known, and asthma-related deaths were virtually non-existent before 1920. Back then, the condition was a rare curiosity, mostly misunderstood by the medical community.

But as the mid-20th century rolled in, mortality rates began to rise, signaling the growing problem. By the 1980s, asthma wasn’t just uncommon anymore; it was an epidemic.

The increase in asthma cases became especially visible in schools, where children started carrying albuterol inhalers. This wasn’t an isolated problem but a widespread health issue, and the reasons behind this surge are still debated. Several theories point to the changing landscape of our diets.

By the 1980s, processed foods—packed with preservatives, artificial ingredients, and additives—became dietary staples. Companies like Kellogg's marketed sugary cereals, promising a healthy start to the day, all while adding little nutritional value. These chemicals and additives are believed to contribute to inflammation and allergic reactions, weakening the immune system and creating the ideal conditions for asthma to develop.

Another major factor is the environment. With rapid urbanization and industrialization, exposure to chemicals in our surroundings became more common. Less time spent outdoors, coupled with a more sedentary lifestyle, likely exacerbated the problem.

Asthma treatments have come a long way since the 1950s, when asthma cigarettes and inhalers containing epinephrine were common. These early treatments were not just ineffective but often dangerous. In the 1960s and 1970s, medications like Alupent and theophylline offered more relief, but still had risks. Over-the-counter remedies like Tedral and Bronkaid became popular, despite their potential side effects.

Then, in the 1980s, albuterol arrived on the scene as a game-changer. This fast-acting rescue medication became a lifesaver for millions, providing quick relief from asthma symptoms. But with its widespread use, the increasing prevalence of asthma became all the more apparent.

Today, asthma is everywhere. It’s almost impossible to find a classroom without a few kids with inhalers tucked into their pockets or bags. In public spaces, it’s common to see people using inhalers without thinking twice. What was once a private, even embarrassing moment for asthmatics has now become completely normalized.

The rise in asthma begs an important question: could it be the food we’re eating that’s contributing to this modern health crisis? Bobby Kennedy, the current nominee for the Department of Health and Human Services, has suggested that our processed diets may be a major factor. I agree with this theory.

The chemicals, preservatives, and artificial ingredients in our food have created a perfect storm for diseases like asthma to flourish. These substances can cause inflammation, oxidative stress, and a range of other issues that we are just beginning to understand. It’s not just about asthma; it’s about the way we are fueling our bodies, and how these modern diets are affecting our overall health.

To solve this problem, we need to focus on what’s in our food and how it’s impacting us. It’s not enough to just manage the symptoms of asthma; we need to address the root causes. By reevaluating our diets and taking action, we can start reversing the trend and working toward a healthier future for the next generation.

The increase in asthma should serve as a wake-up call. It’s time to stop and think about how the foods we eat are shaping our health. We have the power to make changes now, so that future generations can breathe easier.

Are Asthma And COPD The Same Disease

I have read this in a few research articles. There are actually several theories attempting to explain asthma and COPD. One is that asthma and COPD are the same disease with different presentations. So, is it possible this theory is true?

I don't know. No one knows. And I bet the theory is not without many critics. However, if true it would certainly make sense. Consider the following: 

• Both diseases are caused by abnormal immune responses to substances in the air. With asthma its harmless substances like allergens. With COPD it's harmful substances such as chemicals released from burning biomass (tobacco smoke, wood smoke). 
• Exposure to certain substances causes oxidative stress. This stress causes cells to release substances like Reactive Oxygen Species. This triggers an immune response.
• In response, immune cells release pro-inflammatory markers. These are your prostaglandins, cytokines, and chemokines and the like. These cause your airway inflammation. 
• If you're always exposed to these substances, the inflammation becomes chronic over time. And here you get your eosinophilic inflammation in asthma and neutrophilic inflammation in COPD.
• Although there is some overlap. There are some asthmatics with neutrophilic inflammation and some COPDers with eosinophilic inflammation. 
• Eosinophilic inflammation responds best to beta adrenergics and corticosteroids. But, neutrophilic inflammation responds poorly to these treatments. It responds best to muscarinics. Other than that, there is not effective treatment for neutrophilic inflammation. 
• So, because it's treatable, those with eosinophilic inflammation can obtain good control of their disease (mostly asthma, but sometimes COPD). Since it is less treatable, those with neutrophilic inflammation often experience some degree of shortness of breath every day (mostly COPD, but sometimes asthma). 
• Some people with severe asthma have presentations similar to COPD. They may even have something now sometimes called Asthma/ COPD Overlap Syndrome (ACOS). However, some cases of severe asthma are not ACOS yet still present similar to COPD.
• There are 100 plus known asthma genes. Each asthmatic has a random assortment of these genes. This causes each asthmatic to present somewhat differently. There is only one known COPD gene. Still, less than 50% of people who smoke develop COPD. So, is it possible that all COPD is genetic just like asthma? And, is it possible that asthma genes are also those genes that cause COPD (it just has a unique presentation)? 
• Asthma genes are all immune genes that have mutations on them. These mutations cause a change in the recipe how that gene makes a specific protein. So, it seems it would make sense that the same genes might also cause COPD, another disease caused by abnormal or overactive immune response. 
• Some asthma genes are active when we are born. But, most are only activated when exposed to certain environmental factors (allergens, cigarette smoke, increases or decreases in female and male hormones, etc.). COPD is known to be caused by an immune response to harmful substances that are inhaled. So, is it possible that different "keys" unlock different asthma/ COPD genes? And this causes the uniqueness of the presentation. 

So, this is an interesting subject. I'm just giving you my extemporaneous thoughts on the subject. It's education guided by common sense. In the future I'm going to investigate this further and report my findings. 

Many Changes To How Asthma Is Classified

Over the past 20 years, there have been many changes to the ways asthma is classified. The most significant change is that away from the idea of asthma as a homogeneous disease. The shift was toward the idea of asthma as a heterogeneous disease. This lead to the redefining of asthma as a single disease to one with many subgroups (phenotypes /endotypes).

As a homogeneous disease, all asthmatics were treated the same. They were all treated as allergic asthmatics. They were all assumed to have allergies. And the treatment for them were inhaled corticosteroids and bronchodilators. These were the recommendations of many of the original asthma guidelines from the late 1980s.

This strategy worked great for about 85-90% of asthmatics. It helped them obtain ideal, or at least better, asthma control. The problem was that about 10-15% continued to have poorly controlled asthma despite optimal treatment. And it was treatment for this group that encompassed a majority of the overall healthcare cost for treating asthma as a disease nationally and worldwide.

So, this group encompassed a majority of asthma research funds over the past several years. And this research seems to be showing promise. The best evidence of this is the discovery of over 100 asthma genes. Researchers now believe every asthmatic has a random assortment of these genes. And that may explain why each asthmatic experiences it in different ways. For instance, one doctor once chimed, "If you've seen one asthmatic you've seen one asthmatic."

Still, this research has resulted in the creation of asthma subgroups. Fancy terms for this are phenotypes and endotypes. Subgroups loop asthmatics with similar presentations into certain groups. For instance, childlhood-onset and allergic asthmatics are lumped under the subgroup Allergic Asthma. The 10-15% of asthmatics who continue to have poorly controlled asthma despite the best treatment are lumped under the subgroup severe asthma.

Some asthma subgroups are now well accepted. These include allergic asthma, exercise induced asthma, eosinophilic asthma, severe asthma. Others are not so well accepted, such as neutrophilic asthma, premenopausal asthma, obesity associated asthma, Aspirin exacerbated respiratory disease, and nervous asthma. For these less recognized subgroups you'll see various names bandied about mainly due to the fact these are poorly understood.

And that is the reason for doing more research, so all of the different subgroups can be better. understood. And when they are understood better, specific treatments may be developed to better help asthmatics of a given subgroup. And this will lead to better, more specific guidelines for each subgroup. This is all in an effort to help all asthmatics obtain ideal asthma control.

A Unique Asthma Presentation: Not All Asthmatics Wheeze

What if there is no wheeze? It still might be asthma. 

So, we are taught the standard presentation of asthma. We are taught auscultate and listen for wheezing. If wheezing is present we determine the symptoms are caused by asthma. The treatment is a breathing treatment with albuterol.

But, when no wheezes are heard, we often diagnose the patient as having anxiety or some other disorder. Here, no breathing treatment is indicated. Still, we often give one for the psychosomatic effect.

Here, I would like to contend that not all asthmatics wheeze. This is a view that not many health experts have expressed. I have discussed this with many of my coworkers. They have lectured me about if airways are narrow, you will hear a wheeze.

But, I spend lots of time in asthma communities. Many of my asthmatic friends contend that they don't wheeze. Some say they were poorly treated because their healthcare teams heard no wheezing. So, when this happens, and the person truly does have asthma, it can lead to poorly controlled asthma. It can lead to death.

So, let's go with the notion that not all asthmatics wheeze. I can tell you for a fact that I rarely wheeze. I did as a kid, but rarely does this happen as an adult.

I said this to a friend of mine. He said, "Well, if that's the case, then your doctor should do a PFT. If your lung function is diminished you have asthma. Or, if you did a peak flow, your peak flows should go down. That would prove that you have asthma."

I said, "In 1997 I ended up in the hospital for 10 days for severe asthma. My peak flows were 750 on the day I was admitted. If your theory holds true, then why did my peak flows not drop?"

He had no answer.

And I didn't mean to put him on the spot. I was just trying to make the point that not all asthmatics present the same. And that means that some asthmatics don't wheeze. And some asthmatics do not have drops in peak flows. Their FEV1 may be normal even during their worse asthma attacks.

And why would this be? A doctor did explain this to me once. She said that it's because my asthma is occurring in my smallest airways. Peak flows and spirometry measure flow through your larger airways. They do not measure flow in your deepest airways. So, if this is where your asthma is occurring, you will not wheeze. Your peak flows will probably be normal. Yet you are still having asthma.

To add to this, most inhalers do not get that deep. For instance, I was taking Advair for the longest time I had pretty good asthma control. But, it wasn't as controlled as I liked. When I sprinted, for example, my chest would get tight. I was still able to do it, but the chest tightness irritated me.

So, I did some research. I learned that HFA inhalers got deeper into airways than CFC inhalers. Likewise, HFA inhalers get deeper into airways than DPI inhalers. By deeper I mean better airway distribution. HFA particles seem to get into the smallest airways, or deeper down than the other types of inhalers.

I discussed with with my doctor. He changed by prescription to Symbicort. Since then I have not experienced this tightness when running. I have had better asthma control. So, I think this is because Symbicort gets deeper into my lungs.

Now, my control still isn't perfect. But, it's far better than if I would be if I didn't do my own research. It's far better than if I wasn't my own best advocate. It's way better than, say, if I didn't present with these symptoms until adulthood, and my doctor said I didn't have asthma because I don't present like a typical asthmatic.

So, some asthmatics do not present as typical asthmatics. Some of us have unique asthma presentations. When this happens, it's best to not brush us off as having anxiety. Sure, it could be anxiety. But, if a patient says they have asthma, it's best to listen to your patient. What you were taught should be heeded. But, what your patient says should be heeded as well.

Asthma Christmas Wish List

The following was written by me and published at healthcentral.com/asthma on December 18, 2015.

Our Asthma Christmas Wish List

I recently participated in a brainstorming session with a group of respiratory therapists.  Our goal was to create a list of medicines asthmatics would like to find under the Christmas tree. That in mind, here’s our list of fake, or yet to be developed, asthma medicines.  This is our wish list we sent to Santa.

1. Probiotic Magic.  Probiotic is a fancy way of saying good, or healthy, bacteria that are essential for maintaining a healthy body.  Microflora is a fancy term for describing all the microbes inside our body, good and bad, such as parasites and bacteria.  The Microflora Hypothesis states that a normal balance of good and bad microflora inside our gut prevents an abnormal immune response that leads to asthma and allergies.  It also states that our modern diet, and antibiotic use, is killing off good microflora, leaving a microflora imbalance. A probiotic pill would, when swallowed, help the gut and immune system prevent allergic asthma.

2. Pig Vaccine.  The Hygiene Hypothesis states that our own cleanliness causes an abnormal immune response that leads to asthma. The idea is that, lacking certain “good bacteria” early in life when our immune systems are developing, it gets bored and starts attacking innocuous substances ingested or inhaled, leading to asthma and allergies.  This theory first came to light when it was observed that asthma rates were relatively low in underdeveloped countries. Studies actually showed asthma rates were lower among children who grew up on farms, particularly near pigs. A theory was postulated that animals, like pigs, carry the “good bacteria” our immune systems need to mature properly.  So our vaccine would involve a one time injection during the first month of life when the immune system is still developing, particularly in those infants shown to have an asthma gene.

3. Super Safe Steroid.  Systemic steroids are often used in emergency situations to end asthma attacks by reducing inflammation and swelling in asthmatic lungs.  Even though they make breathing easy, they cannot be taken long term due to some pretty awful side effects.  What we need is a synthetic version of this medicine that allows us to get the desired effects without the unwanted side effects. Ingesting a super safe steroid pill would prevent asthma symptoms.  A bonus is that it would also prevent other inflammatory diseases from flaring up, like arthritis.  So, along with better breathing, you’d also be pain free, too.  

4. Anti-Allergy Drops.  Three drops in the morning, placed gently on your tongue, would prevent your immune system from attacking innocuous substanceswithout causing drowsiness.  In other words, it would prevent allergies from happening sans side effects.  If we can prevent and control allergies, we can also prevent asthma attacks in those with allergic asthma.  This would allow those with allergic asthma to live normal lives, as they no longer would have to avoid their asthma triggers. No more avoiding dusty basements.  No more avoiding your aunt with all the dogs and cats.  Yes, you could just be a normal person for a change (aside from having to use the drops every day, but that’s an acceptable trade off).  

5. Fortnight Asthma Puffs.  This is an inhaler that is inhaled once every two weeks to prevent and control asthma. It’s a combination inhaler that contains both Probiotic Magic and Super Safe Steroid. It’s timed delayed action lasts two weeks, making it an ideal asthma medicine.  All you have to do is remember to mark your calendars, or download the Fortnight Asthma App for your iPhone which will remind you when your puffs are due.

Look, pharmaceuticals have come a long way to creating some great asthma medicines to help us live better lives.  Yet there is still some work to do, and this is where Santa comes in handy.  Here’s hoping Santa keeps us asthmatics in mind this Christmas season. Wishing you easing breathing this Holiday season!

You May Also Enjoy Reading

• Christmas Trees May Make You Sneezy And Wheezy
• Six Common Christmas Asthma Triggers
• Santa’s Elves Working On New Asthma Medicines

Learning Basic Lungsounds

The following was written by me and published at healthcentral.com/copd on January 25, 2016

Lungs 101: Learning Basic Lung Sounds

I have been listening to lung sounds for 20 years now, and every so often someone wants to know what I heard and what it means. That said, here is a pithy lesson on the five basic lung sounds and what they mean. 

First, however, a few definitions. 

Auscultation: The process of listening to lung sounds.  It can be done ear to chest, although most health professionals prefer to use a stethoscope. 

Stethoscope: It's a medical device used to auscultate (hear) lung and heart sounds.

Listening to lung sounds is an important part of assessing a patient. Based on what is heard can help a caregiver both diagnose and treat patients, and determine the progression of lung diseases over time. 

There are basically only five lung sounds.  You'd think that would make listening to them easy, but that's not always the case considering every patient is different. Regardless, here are the basic five and what they might mean.

1.  Clear.

This is a normal lung sound. It means the airways are open and air is easily moving through airways.

2.  Diminished.

This means that air movement is difficult to hear. It's quite common for COPD patients to develop diminished lung sounds, perticularly in the bases, or in the lower lobes. This is most commonly found when emphysema is present, as there is less lung tissue to move air. Of course it may also be due to a COPD flare-up where airways are obstructed by bronchospasm and increased secretions. This may indicate a need for a bronchodilator (like albuterol).

3.  Rhonchi. 

This is the sound of air moving through secretions.  It is a low-pitched, continuous sound that is best heard on expiration. Some describe it as coarse lung sounds, as it sounds coarse. Some say it sounds like snoring. It's usually lower than a wheeze because it's occurring in the larger airways.  It is also sometimes audible, and sometimes occurs with gurgling. Quite often rhonchi clears up with a good cough. Since this is common among COPD patients, we often teach methods to make a cough more effective.

4.  Wheeze. 

This is a high-pitched continuous sound heard on inspiration, expiration, or both. It's most commonly heard on expiration, though.  It is the sound of air moving past an obstruction in the airway. This can occur in the large airways or smaller airways.  An obstruction in the larger airways may produce an audible wheeze.  However, obstructions in the smaller airways, as what occurs with asthma and COPD, will cause a wheeze that can only be heard by auscultation.  Wheezing is a symptoms of bronchospasm, and may clear up after using a bronchodilator.

5.  Crackles. 

This is often described as a discontinuous sound, like the sound of velcro being torn apart. It usually needs a further qualification.

• Fine Inspiratory Crackles.  This is when the crackle is heard on inspiration. A cause might be the popping open of an air sac (alveoli) that had been collapsed. This is a common sound in the lung bases of people with COPD, and it can become a normal sound for them.  When crackles are heard in one lobe, this can be a sign of lobar pneumonia.
• Coarse Crackles (Rhales):  This is when crackles are heard on inspiration and expiration, and is the sound of air moving through fluid.  The fluid can be excessive secretions the patient is unable to cough up, or it could be pulmonary edema caused by heart failure. It means that the lungs are wet (the patient has wet lungs). Usually, but not always, this lung sound is heard on both sides of the lungs equally, as fluid is not prejudiced to one side of the lung. 

People with asthma should have clear lungmsounds when their asthma is controlled, and between asthma attacks. You can have clear lungs ounds with COPD too.  After using a bronchodilator, diminished lung sounds may become clear.

Or, sometimes, as airways open up, wheezing may occur. This we consider good, as it means air is moving better, and so wheezing can now be heard. So, you see, wheezing can be good, too. So auscultating before and after rescue medicine usage is one tool we have to determine if it's working (a peak flow meter is another such tool). Of course another tool is you, because you can just tell us that you feel better.

Pneumonia is a common complication of chronic bronchitis.  Fine inspiratory crackles can often be heard before pneumonia shows up on an x-ray, allowing your physician to start treating you early. As the pneumonia improves the crackles may go away. So, in this way, you can see how auscultating lung sounds can show how your illness is progressing over time.

Keep in mind that lung sounds are subjective, so every person may describe them somewhat different. Still, the basic principles are the same. It takes some practice to be able to hear and describe the different lung sounds. Nonetheless, I hope this post gives you a little better idea of what lung sounds are and what they mean. 

To hear the lung sounds described above you can check out practicalclinicalskills.com, "Auscultation Lesson." You can also check out UCLA's "Auscultation Assistant."

See More Helpful Articles

• Best Coughing Techniques For COPD
• What Is A Nebulizer?
• What Is Rescue Medicine
• What is a Peak Flow Meter?
• How Does Chronic Bronchitis Affect the Lungs?

Asthma linked to chronic migraine

The following was written by me and published at healthcentral.com/asthma on January 29, 2016

Asthma (Possibly) Linked to Chronic Migraine

Evidence already links asthma with allergies, anxiety, gastrointestinal reflux, and insomnia. The latest research seems to suggest asthma may also be linked withchronic migraines (more than 15 migraine headaches in a year).

Researchers at the University of Cincinnati studied 4,500 individuals who suffered from occasional (less than 15 in a year) migraines. Participants were divided into two groups: those without asthma and those with asthma.  They were then asked to fill out questionnaires in 2008 and 2009.  

The results concluded that that only 2.5 percent of participants without asthma were diagnosed with new onset chronic migraine, while 5.5 percent of participants with asthma were diagnosed with new onset chronic migraine.  This means that asthmatics with occasional migraine were more than twice as likely to develop chronic migraine.

What to make of this data?  Asthma involves an overactive immune response where otherwise innocuous substances (asthma triggers) in the air are treated as enemies (like bacteria).  When inhaled, your immune system sets off a series of chemical reactions that includes the release of inflammatory markers that cause inflamed airways. This ultimately causes asthma and sets off asthma attacks.  

Researchers believe the link may have to do with the fact that both asthma, and some headaches, are caused by inflammation of smooth muscles. Asthma is caused by inflammation of smooth muscles wrapped around airways, and some headaches are caused by inflammation of smooth muscles wrapped around blood vessels.

Researchers now believe that the release of inflammatory markers may do more than just cause and trigger asthma. They suspect they may be the reason many asthmatics also suffer from anxiety.  This recent study has them now suspecting they may also lead to chronic migraine.

Interestingly, while other studies show depression may also lead to chronic migraine, this study suggests that individuals with asthma are at even greater risk than those with depression.  

Keep in mind this is just one study and one theory.  Research estimates that about 10 percent of individuals develop migraines, and only one percent develop chronic migraine. While this study may seem to indicate a link between asthma and chronic migraine, it does not prove anything as it is just one study.  While the theory that asthma-related inflammation may lead to migraine progression sounds like a valid theory, it is, in fact, just a theory.  Further studies will be needed to prove the link, and to show what the true cause and effect is.  

In the meantime.  Yes, some asthmatics (including myself) do suffer from episodic migraines, and some do suffer from chronic migraine.  It is strongly recommended that if you experience headaches you let your doctor know, as there are many safe and effective ways of treating headaches.  This may also be key to preventing the progression of episodic headaches to chronic migraine.  

See more from the other side: Progression to Chronic Migraine Impacted by Asthma

Further reading:

• The Times of India: Asthma May Lead To Never Ending Migraine
• Mayo Clinic: HeadachesWhat is the asthma syndrome?
• Asthma: More Than Just A Lung Disease

Asthma linked to heart disease

The following was written by me and published at healthcentral.com on January 19, 2016

Asthma (Possibly) Linked to Heart Disease

We now know that asthma isn't just a disease of the respiratory system, that it is a syndrome linked with the immune system, nervous system, and even the intestinal system.  The latest research now suggest a possible link between asthma and the cardiovascular system. 

The study was performed at Northwestern University and published in the December 8, 2015, issue of the Journal of Allergy & Clinical Immunology. It involved a survey of 13,275 children from all 50 states, and showed that those with allergic asthmatics were twice as likely to be diagnosed with high blood pressure and high cholesterol than those without asthma. 

It should be known here that most cases of asthma diagnosed in childhood (childhood onset asthma) also involve allergies.  It should also be known that about 75 percent of asthmatics overall also have allergies.  The asthma subtype involved here is sometimes called allergic asthma or eosinophilic asthma. 

 

It should also be known that both high blood pressure and high cholesterol, (particularly the bad kind of cholesterol), is linked with heart disease.  High blood pressure results from arteries that are constricted, and this causes the heart to work hard to push blood through them. This can cause strain on the heart.

 

The bad kind of cholesterol are called low density lipoproteins (LDL). According to the American Heart Association, it contributes to the buildup of plaque inside arterial walls that can make the arteries less flexible or hard. This is a condition called atherosclerosis.  It makes the arteries increasingly narrow, leading to high blood pressure.  Clots may form and block arteries, leading to a heart attack or stroke.

 

What's the connection?

We must keep in mind this is only one study, so ongoing studies will need to be performed to confirm the link.  Likewise, researchers are unsure of the cause or effect of the link. 

 

However, one theory is that asthma is an inflammatory disease, and that inflammatory markers may cause more than just asthma. Evidence already suggests inflammatory markers may cause anxiety in some asthmatics. Some evidence even suggests inflammatory markers may cause migraine headaches in some asthmatics that lead to chronic migraine.  Researchers guess that the same inflammatory markers may also lead to heart disease.

 

The study also showed that asthma occured in 14 percent, exzema occured in 12 percent, and allergies in 16.6 percent.  All of these are associated with higher rates of obesity, which may also be a contributing factor leading to the link between allergies and heart disease.  Asthmatics may also be more sedentary than non-asthmatics, and this may also contribute to heart disease.

 

So you can see that further studies will be needed to confirm the link, and to confirm cause and effect.

 

Regardless, this might be reason enough to suggest that the path to heart disease may begin early in life among those with allergic asthma. This should encourage physicians to screen all asthmatic patients to make sure they do not have high blood pressure or high cholesterol. If these are diagnosed, they can easily be prevented and controlled, thus lowering the risk of heart disease later in life.

 

See More Helpful Articles

• Science News: Children with common allergies have twice heart attack risk
• Asthma: More Than Just A Lung Disease
• AMA: Good -vs- Bad Cholesterol

Exercise Proven to Improve Asthma Control

The following was written by me and published at healthcentral.com/asthma on January 4, 2016.

9 Ways Exercise Improves Asthma Control

If you have asthma, you should be exercising on a regular basis. The evidence of the benefits of exercising is abounding, and even shows that regular exercise can help you obtain and maintain good asthma control. If you already do it, great! If you don't, here's nine reasons to begin your exercise program today, especially if you have asthma.

This is because exercise...

1.  Makes your heart and lungs stronger.  Exercising builds up muscle strength. Your heart is a muscle, so when you exercise, you are, in essence, making it a stronger pump. The Mayo Clinic explains that this makes it easier for it to pump blood through your lungs and body, making you feel less winded. This also increases oxygen and nutrients to the various tissues of your body to help your cardiovascular system work more efficiently.

2.  Boosts your energy. Even though you may feel fatigue today, forcing yourself to exercise everyday should give you more energy in the long term. One recent study performed at the University of Georgia showed that low-intensity exercise boosted energy by 20 percent and reduced fatigue by 60 percent.  The theory is that regular exercise makes your cardiovascular system more efficient at pumping nutrients and oxygen to the various tissues of your body, in turn giving you more energy every day.

3.  Boosts your immune system.  Keep in mind here that respiratory viral infections (or your common colds) are the most common cause of asthma attacks. Having a strong immune response is perhaps the best way of fending off nasty viruses, and making colds less severe when you do get them.

4. Helps you lose weight.  Exercising alone probably will not cause you to lose weight.  However, when coupled with a healthy diet, exercising can help you lose weight.  For one thing, it causes you to burn calories.  Fitness expert John Hussman explains that a pound of pure muscle burns up to 50 calories a day, so if you gain ten pounds of muscle that's an extra 500 calories your body would be burning even when you're just sitting around. He said, "The more lean muscle you have, the easier it is to burn fat." So exercising does help you lose weight, and losing weight helps you gain better asthma control.

5.   Curb obesity and therefore asthma.  Studies actually link obesity with asthma. One theory is that adipose tissue (fat tissue) releases a hormone called leptin, which in turn causes inflammation in asthmatic lungs. While all asthmatics have leptin, it's levels are higher in obese asthmatics. So losing weight, and maintaining a healthy weight, should help you obtain better asthma control.

6.  High fat foods trigger asthma. When eating healthy you should be avoiding high fat foods, and this alone may improve your asthma.  One theory suggests that asthmatic immune systems recognize saturated fat as an enemy, and sets off a series of chemical reactions to rid it from the body. Inflammatory markers released during the process causes asthma and asthma symptoms. This basically means that saturated fat is an asthma trigger that should be avoided to obtainbetter asthma control.

7.  Makes you healthier overall. Exercise increases the production of high-density lipoprotein (HDL), which is the good cholesterol. This keeps your blood flowing smoothly and protects against high blood pressure, heart disease, stroke, depression, some cancers, arthritis, and falls. When you consider that a recent study found a link between heart disease and asthma, this benefit is all the more impressive.

8. Makes you happier. It is a proven fact that asthma is often linked with anxiety and depression even when your asthma is well controlled. Exercise stimulates the brain to release a chemical called endorphins. They act like analgesics such as morphine to diminish the perception of pain, causing a sedative effect, reducing stress, warding off anxiety, warding off depression, boosting self esteem, and improving sleep. This is why people sense a feeling of euphoria after running.

9. Increases your memory. It stimulates the brain to release a chemical brain-derived neurotrophic factor (BDNF) that rewrites memory circuits so your memory becomes better. So if you are a student, or simply trying to figure out how all these new complex asthma medicines work, this is a HUGE incentive to exercise. In fact, some experts recommend children immediately exercise when they get home from school, and then sit down to do their homework. Supposedly this facilitates learning.

Start your exercise program today. Look, Hippocrates recommended a healthy diet and exercise to maintain good health as long ago as 400 B.C. Lacking better remedies, this was the advice of many physicians over the years to help asthmatics, including a young Teddy Roosevelt. Today we have many studies that have confirmed these benefits, even explaining why. Again, if you already exercise, wonderful! If you don't, there's no better time than right now to get active, get fit, and breathe better. 

You may also enjoy reading:

• 14 Tips To Exercising With Asthma
• Does Obesity Cause Asthma?
• 6 Steps to Better Asthma Control
• Links Between Asthma and Anxiety
• Top 10 Asthma Medicines

How I conquered exercise induced bronchospasm

The following was written by me and published at healthcentral.com/asthma on January 11, 2016

How I Conquered Exercise Induced Asthma

To say I never exercised as a kid is not telling the whole truth.  A more accurate statement would be to say that I rarely exercised when my asthma was acting up.  And considering I had brittle asthma as a child, there were many times I was unable to exercise with it.  Now I exercise every day, so what changed?

Essentially, I conquered exercise induced asthma (EIA), or what is now referred to as exercise induced bronchospasm (EIB). Here are five reasons I credit for helping me conquer EIB.

1.  Brittle asthma.  During teenage years airways increase in scope and size with the rest of your body.  So my airways are now bigger and less brittle.  Now, this does not mean they are less sensitive.  It just means when my airways spasm, there is more room than there once was. So now, when I'm exposed to a potential asthma trigger, it doesn't close off my airways the way it once did. 

2.  Better medicine.  The medicines available today are much better than when I was a kid.  For instance, most modern inhaled corticosteroids are stronger and last longer than previous ones. The same is true of bronchodilators.  Not only that, combination medicines make it so you can take all your inhalers in one or two puffs once or twice a day. 

3.  Better compliance.  Better medicines have resulted in better compliance.  Or, worded another way, the fact that most modern medicines only need to be taken once or twice a day has made it easy to stay compliant with a medicine regime.  Basically, I take my medicine when I brush my teeth.  Puff and then brush.  This is a far easier routine than 8 puffs, 8 times a day of Azmacort, or three time of remembering to take my theophylline pill at 6 a.m., 2 p.m. and 10 p.m. 

4.  Better wisdom.  Back in the 1970s it was known that inhaled corticosteroids worked to control asthma.  However, doctors were still concerned about the side effects.  So, as I was being discharged from yet another hospital admission for asthma, my doctor would write the following: "Have this boy take his Vancerin inhaler for a week or two until he feels better, then stop it."  You see, one of the reasons I had such poor asthma control was because I wasn't taking the medicine meant to prevent it.  Thankfully, later studies showed that not only do inhaled corticosteroids work, they are very safe.

5.  Doctors.  Back in the 1980s regional physicians were left to learn about asthma on their own, and were often left with incomplete wisdom.  This was why I had to be shipped to Denver in 1985 so that I could learn how to gain control of my asthma.  Today, asthma guidelines, and the Internet, make it so regional doctors are kept up to date on the latest asthma wisdom in order to best help asthmatics like me.

Bottom Line.  Even as recently as 1997 I was forced to get a medical excuse to get out of a college gym class.  Just since that time I have tackled my EIB to the point that I can now exercise whenever I want. This is amazing in that it shows how far asthma wisdom has improved just in my short lifetime. 

You May Also Enjoy Reading:

• What is Exercise Induced Bronchospasm
• EIA Troubles Many, Even Olympians
• My Extended Stay for Asthma
• RT Cave Facebook Page
• RT Cave on Twitter

What is Severe Asthma (Asthma/COPD Overlap Syndrome)

The following was written by me and published at healthcentral.com/asthma on November 4, 2015.

What is Severe Asthma? 

Researchers have learned that 5-10 percent of asthmatics do not respond well to traditional asthma medications, making their asthma difficult to control.  In order to better help these asthmatics, researchers now categorize them under a specialasthma subtype called Severe Asthma. So, what is severe asthma, and what does it mean if you have it?

What is it?  Sally Wenzel, professor of medicine at the University of Pittsburgh, defines severe asthma as “patients who require high dose inhaled glucocorticoid (GC), or continuous or near continuous oral GC treatment to maintain asthma control or who never achieve control despite that treatment.”  It was defined as an asthma subtype less than 15 years ago.

What is it not?  Severe asthma must not be confused with other causes of difficult to treat asthma, including:

• Asthma exacerbated by uncontrolled asthma triggers (You have allergic asthma and have attacks when exposed to molds)
• Asthma that is poorly controlled due to nonadherence (You do not take your medicines)
• Disorders that mimic asthma (you have sinus infections)
• Asthma exacerbated by comorbid conditions (you have asthma and allergies, or asthma and GERD; controlling one means controlling the other)

 What does a diagnosis of severe asthma mean? It means that you have:

• Chronic Airway Inflammation.  This makes airways hypersensitive to asthma triggers, exposure to which causes the smooth muscles that wrap around them to spasm. This narrows or obstructs the airways. A second response is increased sputum production, further obstructing airways.  This causes asthma symptoms like wheezing and shortness of breath. This response is completely reversible, and can be prevented and treated with typical asthma medications.  This is seen in all asthmatics.

• Airway Remodelling.  This is also referred to as airway scarring.  It’s associated with a permanent thickening of the walls lining airways, particularly smaller airways. This makes them chronically narrowed or chronically obstructed. The cause of this remains a mystery, although some speculate it has to do with asthma left untreated long-term, or too many severe asthma attacks. It makes you feel short of breath even on a good asthma day. This response is irreversible, and there is at present no treatment.  This is similar to what happens in COPD, and is only present in severe asthmatics.

These two components together act as a "double whammy," making asthma difficult to control.  This probably means you also have: 

Air trapping.  Air can get past chronically narrowed airways but has a hard time getting back out.  This causes air to become trapped inside your lungs.

Airflow limitation.  This is best observed by a prolonged expiration. Sometimes it may seem you can exhale forever and never get all the air out. You can't generate enough flow to blow out a candle. 

Fewer treatment options.  No medicine treats airway remodelling. You respondpoorly to traditional asthma medications, like inhaled corticosteroids. However, a new treatment called bronchial thermoplasty does show promise.

More frequent and severe asthma attacks. Their airways are increasingly brittle and narrow making them increasingly prone to more severe attacks compared to those with typical asthma.   

Lots of doctor appointments. They'll need to see doctors who specialize in this type of asthma.  They are also prone to more frequent and unscheduled doctor visits compared to those with typical asthma. 

Lots of fees.  While they consist of only 5-10 percent of asthmatics, they consume up to half the cost of asthma in both the U.S. and Europe.

Unanswered questions.  So, why is it that only 5-10 percent of asthmatics develop severe asthma? Researchers are working overtime to answer this question and to create special guidelines and medicinal options to help them achieve optimal control of their disease.  

Here is some of what is presently understood. Researchers believe the immune response that occurs in severe asthmatics is different than what occurs in traditional asthmatics. For instance, immune cells (called CD4-T cells) secrete different inflammatory proteins (particularly interferon gamma) than the same cells in traditional asthmatics. This makes their airways hypersensitive in such a way that does not respond to corticosteroids.

So what does this mean?  It signifies hope for better treatment options. Researchers also discovered that mice that lacked the interferon gamma protein may develop traditional asthma but not Severe Asthma.  Using computer models, they compared gamma protein with asthma genes, and learned that as interferon gamma levels rose, a protein called leukocyte protease inhibitor (SLPI) dropped. They later learned that boosting SLPI levels reduced airway hyperreactivity in animal models.

Other names.  There is no consensus on what to call this asthma subtype. Some refer to it as Severe Asthma, while others as Therapy Resistant Asthma or Asthma COPD Overlap Syndrome.

The Burden.  The true impact of severe asthma on people's lives was revealed in a survey released in September, 2015.  Of 850 severe asthmatics surveyed, 25% reported daily symptoms, and 71% reported weekly symptoms. Likewise, 32% said it affected their social life, 23% said it affected their working life, 18% said it affected their family life, and 17% said it affected their sex life.

Conclusion.  A proper diagnosisan may lead your doctor to the best treatment options to helping you obtain ideal control of your disease. Ongoing research should equal better breathing in the near future for all asthmatics.

Related Links and References:

• Two types of asthma: typical and atypical
• What are asthma subtypes?
• What is double whammy asthma?
• What is bronchial thermoplasty?
• PR News Wire: New study shows the true impact of severe asthma on people’s lives
• Eureka Alert: Severe asthma fails to respond to mainstay asthma treatment
• Up To Date: Treatment of severe asthma in adolescents and adults
• Up To Date: Evaluation of severe asthma in adolescents and adults
• “Difficult to Treat Asthma,” 2011, edited by S.E. Wenzell and K.F. Chung
• PR Newswire: New Survey Reveals True Impact of Severe Asthma on People's Lives
• RT Cave Facebook Page
• RT Cave on Twitter

Links Between Testosterone and Asthma

The following post was originally published by me at healthcentral.com/asthma on September 11, 2015

Links Between Testosterone and Asthma

Even though asthma was first described over 2,500 years ago, why some people develop it, and why some have it worse than others, remains a mystery.  Yet by observing trends between male and female asthmatics, researchers now suspect a link between asthma and a hormone called testosterone.

Researchers have been studying asthma for many years now, and are well aware of the following trends regarding male and female asthmatics.

1. Boys are more likely to have it than girls.
2. During teenage years this trend reverses, and women are more likely to have it than men.
3. Women are more likely to have allergic asthma.
4. Women are more likely to have difficulty controlling asthma. 
5. Therefore, women are more likely to suffer from more severe asthma than men.
6. Women are also more likely to develop adult onset asthma.
7. Women are more likely to have an adverse reaction to drugs.

Some experts speculate these trends may be due to a male sex hormones (androgen) called testosterone.  It is produced in the testes of males and ovaries of females. How much testosterone is produced is determined by the hypothalamus and pituitary gland at the base of the brain.  

When the hypothalamus determines testosterone levels are low, a signal is sent to the pituitary gland to release a hormone called Luteinizing hormone (LH), which causes the testes or ovaries to produce testosterone. When the hypothalamus determines testosterone levels are high, a signal is sent to the pituitary gland to decrease LH production, which in turn decreases testosterone production.  

Testosterone is present early on in human development and is responsible for the development of male sex organs. During puberty, testosterone levels significantly increase, resulting in boys becoming men. It later plays a role in the development of sperm cells, abdominal fat, and hair loss. It impacts bone density, muscle growth, and libido (sexual desire).

The hormone is produced in significantly lower levels in women than men.  It is for this reason that testosterone has been studied in recent years to see if it is the reason why asthma affects women worse than men.

Experts surmise testosterone to be linked with asthma because evidence suggests the hormone (or one of its metabolites) may also play a role in maintaining a balance between:

• Autoimmunity.  Your bodies ability to fight off invading viruses, bacteria, and parasites
• Protective Immunity.  Immunity from infectious diseases developed by previous exposure to the infecting agent

Testosterone accomplishes this by preserving the number of regulatory cells, or T-cells, which  are important for the development of asthma. They are a type of white blood cell that form in bone marrow and mature in the thymus gland in the brain. They roam the blood looking for invaders, such as viruses and bacteria, that may be harmful to cells and cause diseases.  

Asthma and allergies are the result of an overactive immune system, whereby T-cells attack substances that are innocuous (harmless).  A good example of this is the allergic response. The first time you’re exposed to an allergen (say dust mites) your body produces T-cells specifically trained to recognize dust mites.  

The next time you inhale dust mites, these specially trained T-cells recognize the allergen and set off an immune response that causes inflammation of the cells lining your respiratory tract.  This is what causes allergies and allergy attacks.

This inflammation becomes chronic over time, making your airways hypersensitive to allergens, strong smells, emotions, smoke, pollution, and certain weather conditions. This is what causes asthma and asthma attacks.

The theory holds that testosterone is an immunosuppressant: it suppress the immune response responsible for it becoming overactive. In other words, it prevents allergies and asthma.

Rising testosterone levels in asthmatic teenage boys may suppress the allergy and asthma response, making their asthma less severe and more easy to control than their female counterparts. The theory also holds that higher testosterone levels may make it less likely that adult males will develop adult onset asthma than females.

A few studies have shown that administering testosterone to boys with asthma resulted in better lung function, although more studies are needed to confirm these results.  Still, the main concern at the present time is the safety of administering testosterone to boys, as it may result in unwanted side effects (like accelerated bone maturation).

Researchers will continue to study the link between testosterone and asthma with the hope that this may lead to better treatment options, better asthma control, and ideally an eventual cure.

Further reading and references.

• Testosterone Congeners-- Advances in Research and Application: 2012 Edition: pages 151-2
• PubMed:  Do low testosterone levels contribute to the pathogenesis of asthma?
• AAIR: Genetic Specific Asthma Treatment
• Testosterone: Action/ Deficiency/ Substitution, 4th ed. 2012, page 391
• What are asthma triggers?
• Why do allergies trigger asthma?
• RT Cave Facebook Page
• RT Cave on Twitter