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From the desk of Mindles H. Dreck:

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Funny that Jane should write about albuterol and asthma. I did not realize we had the affliction in common.

As a child my asthma was quite serious. I was hospitalized several times, and asthma and fear of asthma interfered with many activities.

The letter Jane reminds me of the bad old days. As a kid in the '70s, most of the "controller" therapies were not available at all in the U.S., so we relied on bronchodilators such as albuterol. Incidentaly, albuterol was not available until about 1976 and is far superior to its predecessors (theophylin and isopreterenol-based, if I remember) in terms of side effects such as jitters and stomach discomfort.

I believe the only "controller" available in the U.S. in the early 1970s was Cromolyn Sodium ("Intal"). Intal works primarily to prevent the histamine reaction by coating the mast cells. Intal was helpful for allergic asthma, but it was no panacea. One of its additional drawbacks back then was it could not be atomized (Cromolyn and its successors are atomized now). In order to get it into your lungs, you had to use a spinhaler. A Spinhaler consists of a propeller mounted in a special sleeve. You place a capsule full of powder in the windward side of the propeller, slide the sleeve down to puncture holes in the side of the capsule, then suck hard through the sleeve. Centrifugal force brings the powder out of the capsule where it is sucked through the propeller into your lungs. It was both uncomfortable, awkward and conspicuous, as Spinhalers make noise like a Rock'em Sock'em Robot losing its head.

The asthmatic's saviour is inhaled steroids. Nothing keeps the airwaves quite so smooth as a regular application of cortisone or Fluticosone. Interestingly, while I was stuck with my Intal turbo-prop, Canada had approved steroid sprays for prescription use. In 1977 we began to smuggle in Vanceril, one of the first formulations. That was the beginning of the end of my asthma problems. Of course it was many years before we could subscribe it in the U.S. Since about 1984, these medications (Flovent being the most common) are ubiquitous, and form the backbone of almost any asthma treatment.

Oral steroids (pills) are likewise an incredibly powerful means of calming a severe attack, although they are not fast-acting. In today's emergency rooms the standard procedure is to administer steroids in liquid suspension and give the patient bronchodilators via nebulizer.

But that's a recent development. When I was hospitalized in the late '70s and early '80s, they just kept pumping me full of Epinephrine and Aminophyllin, which caused a racing heart beats and heightened anxiety. These side effects actually aggravated the asthma attack to some degree. Doctors in the U.S. had a real problem with the potential side effects of steroids. My specialist had to argue with my school physicians and hospital attendings endlessly to get me treated with oral and spray steroids as appropriate. These medical professionals always seemed to be worried about side effects, such as sterility, that are associated with anabolic steroids (and see Dayn Perry in Reason for some skepticism on the other effects). They also seemed to react very defensively to specialist advice.

I am still an asthmatic, but today's medications (such as Advair)make it easy to control with minimal effort. I even run middle and long-distances now, which continues to amaze me. I took a few lessons from my experience:

• The lifestyle benefits of modern medicine are priceless. I would be dead without them. Medicine may be getting more expensive, but we are getting infinitely more for our money.
  
• Doctors, while men/women of science, are often married to the science they were taught in medical school. As they get older, they often become reactionary and close-minded. (incidentally, my father, brother, father-in-law and sister-in-law are doctors)
  
• The FDA is too damn slow approving new medications. I've got the unpleasant experiences and permanent lung-scarring to prove it.
  

Incidentally, Jane's writer is correct. We would be better off getting Flovent available over the counter than giving everyone albuterol. While it is possible to take too much topical steroid and damage your lungs, it is unclear why anyone would do so.

Bronchodilators are much more tempting to overdose, as athletes use them and they come to hand in periods of high stress, as they did to Jane. Too high a dose of common bronchodilators can actually make asthma worse, and an overdose can kill you. It happened to a model some years ago, but I forget her name.

Asthma has apparently become a serious problem in inner-city areas. My doctor tells me there are some recent studies indicating a correlation between the incidence of childhood asthma and the concentration of atomized tire-rubber in air samples. Then again..

I'm obviously not a doctor or medically trained. I just play one when I medicate myself...

Posted by Mindles H. Dreck at December 15, 2002 09:26 PM | TrackBack | Technorati inbound links