The psychological aspect of asthma is undeniable – even to witness a severe attack makes your own breath alter – but the causal link hasn’t been proved. Ask experts and sufferers alike if high stress and emotional upset contribute to asthma, and almost everyone will say yes without being able to prove it. The fact that relief can come from practicing yoga, doing daily meditation, or training oneself in conscious breathing techniques (known as Pranayama or yogic breathing) is not disputed. Some sufferers stand by acupuncture treatments as well, even though no studies have proven its efficacy.
The picture that emerges, then, is of a disorder that mysteriously links mind and body. There is no proven cause for asthma, a fact that is underlined by the unexplained increase in cases that has occurred since 1970. Our lungs are sensitive to pollutants, yet asthma is 8-10 times more common in developed countries than in the developing world. As with the sharp rise in allergies, which is also more common in the developed world, the situation is baffling – air quality and pollutants are worse in those countries that are not affected, or less affected, by the rise in disease. (In the US, about 7% of adults and 9% of children have asthma.)
No disease can be fully understood without a cause. However, every cell in your body is intimately connected to your breath, and therefore a whole complex of factors seems to be involved. Completely healthy athletes, including 15% of those participating in the 1996 Summer Olympics in Atlanta, are diagnosed with asthma in numbers two to four times higher than the general population. Yet exercise is good for increasing your lung capacity and strengthening the muscles you use to breathe.
Let’s look at the basics of the disorder, most of which are physical at this stage of medical understanding.
Asthma is a chronic inflammation of the airways in your lungs, tiny pockets called alveoli where oxygen and carbon dioxide are exchanged as you breathe; there are a vast number of alveoli, about 500 million. The state of inflammation exists invisibly even when there is no visible attack. I simplest terms, when lung tissue is inflamed, oxygen can’t enter the bloodstream as easily and carbon dioxide cannot be expelled. Patients are test for lung capacity through a simple test where the amount of exhaled air is measured. The condition will be diagnosed as mild to severe in a range where the FEV (forced expiratory volume) is no worse than 80% of normal to less than 60%. In acute attacks, however, the patient may be completely unable to breathe, even with an inhaler, and death can result.
As soon as the word “inflammation” is sued, medicine faces a larger mystery. Inflammation is the immune system’s healing response to injury, a normal and necessary process. Once the pathogen has been disposed of – meaning an invasive danger to the body like a virus or bacteria – or the injury has healed, inflammation subsides. It isn’t needed anymore. But in asthma, the inflammatory response becomes self-perpetuating. Airway tissue becomes filled with immune system cells, which actively recruit other immune cells to the site. Blood flow to the affected airways increases. Mucus is released, airway tissue becomes filled with fluid and swells.
It is indisputable that this kind of inflammation represents a breakdown of the healing process. What is supposed to help the body starts to harm it. In some way, the body’s innate intelligence has made a mistake and keeps making it. The same can be said of allergies, where your immune system attacks harmless dust, pollen, and animal dander as if protecting you from a threat. My long-held position – seconded by a wide range of physicians, both mainstream and alternative – is that we must learn what causes such drastic mistakes to be made.
Unfortunately, every event in the mind-body system is connected with the body’s intelligence, and since doctors are trained to be focused only on one aspect, the physical, research results in asthma remain largely confined to physical findings, such as the following:
Triggers of asthma include indoor air pollution and allergens such as tobacco smoke, animal dander, dust mites, and mold and mildew. Outdoor triggers include irritants and allergens such as pollen, dust, air pollution, pesticides and fertilizers, and car fumes. Cold air, nonsteroidal anti-inflammatory drugs (NSAIDs), and viral respiratory infections can also trigger asthma attacks. About half of asthma sufferers have allergies. Avoiding such triggers becomes a major part of managing the disorder once you develop asthma.
There are many risk factors for asthma. Some can be controlled; some can’t.
Risk factors that can be modified include
- Obesity. The greater a person’s body mass index (BMI) and waist circumference, the greater their risk of asthma.
- Secondhand smoke exposure
- Exposure to environmental pollutants and irritants (for instance, household cleaners, industrial chemicals, dust mites, pollen, and animal dander)
- Taking nonsteroidal anti-inflammatory drugs (NSAIDs) including aspirin, ibuprofen, and naproxen
Risk factors that can’t be modified include
- Gender. Before adolescence asthma is more common in boys, but when asthma occurs in adulthood it is more common in women.
- Genetics. A tendency to develop asthma can be inherited, but environmental factors are just as important.
- Having allergies
- Mother smoking during pregnancy, which leads to impaired lung function in the baby
- Premature birth
The symptoms of asthma vary from person to person. The four major symptoms are:
- Coughing spells, usually worse after exposure to cold air
- Shortness of breath that gets worse with exercise or at night
- Wheezing, especially when exhaling
- Feelings of tightness or pain in the chest
Asthma attacks are a worsening of existing symptoms. Exposure to a trigger makes the ongoing inflammation in the lungs worse. The bands of muscle surrounding the bronchioles normally constrict in the presence of an irritant or allergen, but then they release. In asthma, they stay constricted. Edema (swelling) increases. Excessive amounts of mucus are released by the airway lining. The airways become swollen, constricted, and clogged by mucus, and both inhaling and exhaling become more difficult.
But what is considered an attack varies widely between individuals. For people who have no symptoms of asthma most of the time, an occasional coughing spell might be considered an attack. For someone with chronic symptoms, however, such as coughing and wheezing, an attack might include those symptoms along with new ones, like chest pain and shortness of breath.
A very severe asthma attack can come on over a period of hours or become serious in only a matter of minutes. These attacks are very dangerous because very little air moves in and out of the lungs, and the airways don’t open in response to bronchodilators. Emergency treatment is required.
Asthma control has made considerable advances, which is why, even though incurable, asthma is successfully controlled in various ways.
Medications. There are two main types of asthma medication: quick-relief medications (bronchodilators), used before exercise or when you are having an attack, and maintenance medications, used even when symptoms are not present in order to keep inflammation under control.
Monitoring. By monitoring symptoms and keeping track of when they occur, you can understand what triggers your attacks. Using a peak flow meter, you can find out when your lung function is getting worse and take action.
Trigger avoidance. Once you’ve found out what triggers attacks, you can take steps to avoid or eliminate the triggers. For instance, if you are allergic to dust mites, you can encase your pillows in mite-proof covers. If pollen is a trigger, you may want to avoid exercising outside when levels are high.
Exercise. Some people with asthma avoid exercising because they fear exercise-induced asthma (EIA), but this is a mistake. Exercise strengthens your breathing muscles and increases your lung capacity, as we discussed. To minimize the risk of EIA,
- Take maintenance medications regularly if they have been prescribed for you
- Use bronchodilators before exercising
- Warm up before you begin exercising and cool down afterwards
- Wear a scarf or mask over your face if you exercise outdoors in cold weather
So far, no treatment for asthma without medication has proved successful. Complementary treatments like meditation, stress management, and yoga are used in addition to your regular medication—they are not alternatives.
Even so, I feel that the conquest of asthma, along with associated disorders where the immune system makes drastic, sometimes lethal mistakes, depends on understanding the innate intelligence in every cell. Intelligence has physical markers that everyone agrees upon, such as the brain, but we now know that no part of the body lacks a kind of supreme intelligence. Right now medicine is only beginning to comprehend what this intelligence is and how we control it – or it controls us. When we put much more effort into expanding our knowledge, I’m confident that the breakdown of the body’s intelligence will be repaired by that same intelligence.