By Dr. Paul Ehrlich
In some ways, the more we learn about asthma, the less we know. To be sure, the science is getting better, but despite the similarities between symptoms that we see in our office, there are crucial differences among patients. Dr. Anthony Gagliardi, a pulmonologist who worked at the late, lamented St. Vincent’s Hospital in New York, says that the study of asthma “is the study of one.” That is, you have to study each patient as an individual to get at the root causes of his condition, and find the right treatment.
Some things that look like asthma are not. As we say in our book, asthma describes a set of symptoms known as “asthma syndrome,” that may be triggered by many allergic or environmental causes, or, by bacterial infection. We have to solve the mysteries, and treat them, one at a time.
I was reminded of this recently when a patient came into my office whose chief complaint was difficulty inhaling; it would bother her for several days and then subside spontaneously. She experienced no wheezing and did not respond to an inhaler prescribed by her primary care physician [PCP]. While she felt this way she did not have any trouble sleeping, and it never woke her up—common symptoms of asthma.
A detailed history revealed a few minor allergies, but I asked her how she felt when taking a deep breath. She said that she felt as if she just “couldn’t quite take a deep enough breath.” Occasionally, she tried to hold her breath because if she let it go she would have the initial problem again.
I drew a graph with a horizontal line, and asked her to consider it a kind of peak for deep breathing when she was anxious. I asked if breathing above that line gave her relief. She got excited saying, “Yes, yes exactly.”
The rest was easy. Her pulmonary function was normal. I asked if she considers herself a Type A personality. She said she had a very stressful job. She is the oldest of four children, always the one who “needed to succeed” and the tough economy was “doing me in.”
I told her that she was quite healthy and had what is called “anxiety breathing.” For the next ten minutes we talked about life, problems at home and work. The fact that anxiety could make her feel this way was totally understandable, and she left with a peak flow meter to be used when she felt this way. I asked her to call me if the test at home was abnormal (I knew that it wouldn’t be). She thanked me for taking the time to ask these questions. So far, so good.
These are tough times. Lots of us are anxious. Misinterpreting symptoms associated with asthma can lead us up blind alleys. People may end up taking inappropriate medications. Inhaled corticosteroids and bronchodilators are literally life saving for people with asthma, but they are powerful drugs that shouldn’t be used when they aren’t warranted.