The A Word

By Dr. Paul Ehrlich
On Doctor Radio, my host asked me why her son’s doctor is reluctant to call the boy’s “reactive airway disease” asthma. I told her, allergists joke about this phenomenon–we refer to it as “the A Word.” Reluctance to label a child with the A word is not just an exercise in beating around the bush. Parents and doctors are wary of branding children with a chronic disease that can cause trouble later on. For example, insurance companies, which we will have to contend with for the foreseeable future, will remain wary of a history of chronic disease. The child may also be limited about participation in sports and other activities. These are legitimate concerns, although not necessarily medical.
However, there are also reasons pertinent to the state of medical science. We are becoming more sophisticated in our understanding of asthma. As we explain in chapter 3 of Asthma Allergies Children: a parent’s guide, “asthma” is now frequently described as “syndrome”—that is a set of symptoms such as airway inflammation and constriction rather than a disease with one underlying cause, such as allergies. Infections and air pollution can also cause what the British call “twitchy” airways. We have to understand what’s behind the symptoms and treat that as well as the symptoms.
As Dr. Jeffrey M. Drazen and Dr. Erika von Mutius wrote in an editorial in the New England Journal of Medicine in March:
“[T]he onus lies with the treating practitioner to follow patients closely and to be sure that they improve as a result of the therap[y]. If there is no improvement, the patient should be switched to an alternative medication and again closely monitored…For the patient whose asthma is hard to control, there is simply no substitute for attentive individual follow-up. The words of Francis Weld Peabody remain true today, that ‘the secret of the care of the patient is in caring for the patient.’”