Asthma & Stress

We have always known that stress can aggravate asthma. Stress can aggravate a lot of illnesses, from coronary heart disease to peptic ulcer disease. But can stress cause disease where none previously exists?

From 1994 to 1996, researchers at the Channing Laboratory at the Brigham and Women’s Hospital in Boston, studied 496 children recruited from a Boston hospital within 48 hours of birth. They wanted to determine if the level of caregiver stress could cause an increased risk of asthma in children who had a genetic predisposition to asthma.

Of the 496 children, 287 (58%) never wheezed during the 14 months of the study, 116 (23%) had one episode, 47 (9) had two, 28 (6%) had three and 18 (4%) had four asthma attacks. After correcting for maternal smoking, breast feeding frequency, number of respiratory infections, birth weight, parental asthma, ethnicity and socioeconomic status, they found that higher levels of caregiver stress predicted an increase risk of wheeze. White caregivers had a lower level of stress than Hispanics. Divorced and single caregivers showed a higher level of stress than those that were married. As household income increased, stress levels decreased.

In a related study, allergic reactions to a potent German cockroach allergen can cause severe asthmatic attacks which may result in emergency room visits for sensitive asthmatic children. This allergen elicits immunoglobulin E (IgE) response in 60-80 % of allergic patients. Cockroach allergen (Bla g 2) is not linked to enzymatic activity as dust mite allergens have shown. The “enzyme hypothesis” for allergic reaction was originally developed to explain why dust mite allergens are so strongly associated with the development of allergic responses. This hypothesis is based on the fact that dust mites are enzymes.

For more complete information, please visit the American Thoracic Society Online Web Site: www.atsjournals.org

Coughing & Asthma

On my semiannual trip to the dentist’s office, the hygienist casually mentioned that her husband has had intractable coughing for the past ten years. It was worse after exercise and during the night. He’d been to a doctor who felt allergy skin tests were in order. At another doctor, he was given an inhaler to use prior to running or vigorous exercise. My hygienist said her husband didn’t go back because he didn’t like taking medications.

Coughing is frequently the first symptom of asthma. The bronchi are trying to go into paroxysms of constriction which is bronchospasm or coughing. If they stay constricted, then the air passes through a smaller tube, wheezing becomes apparent, and we call it asthma.

A specific form of asthma is exercised induced or cold induced. The rapid movement of air in and out of the airway causes constriction and wheezing. This is generally treated by taking an inhaled bronchodilator 15 minutes prior to working out or exercising. Some people, on walking into a frigid environment such as a wintry outdoors or a freezer, will experience constriction of the bronchi causing coughing or wheezing. This can usually be eliminated by taking one or two puffs of a bronchodilator 15 minutes prior to entering the walk-in freezer or stepping out into sub-zero weather.

Allergic hay fever and asthma are generally caused by inhaling pollens. This is referred to as seasonal hay fever or asthma and is usually due to trees blooming in the spring, the grasses in the late spring and early summer, and the flowers and weeds during the summer and fall.

Allergic perennial rhinitis and asthma may also be caused by the above three types of pollen, as well as house dust, molds and animal danders. These symptoms are year round.

The first evaluation of hay fever and asthma, like any other disease, is a thorough medical history and physical examination. The medical history should make the proper correlations so that the allergen can be removed, in the same way that penicillin is eliminated if you are allergic to penicillin. One does not need a skin test to penicillin. It can be dangerous, if not fatal. Similarly, other agents are removed from the environment, such as feather pillows and bedding, foam pillows which collect molds, and kapok pillows generally found in overstuffed furniture. If one has symptoms from pets, whether cats, dogs or birds, these should be removed from one’s indoor environment.

The doctor who treated this man obviously made the correct diagnosis of exercise-induced asthma, which has a straight forward treatment of the inhalation of bronchodilators prior to exercise. However, his doctor did not make the correlation of his intractable coughing at night. My first question was, “Does he sleep on a feather pillow, a feather mattress or under a feather comforter?” She answered that they slept on a feather bed. For most asthmatics, sleeping on a feather mattress or under a feather comforter or on a feather pillow is almost like dying. I recommended that she stop at Penney’s or Gottschalks’s on her way home, purchase Dacron-Polyester pillows and comforters, and remove all the feathered contents from her house. If they have emotional value, seal them tightly in plastic. Don’t place them in another room of the house if you have central heat or air. Surely you’ve noticed people sneezing on their back porch because of the trees blooming a hundred yards away. Having the feathers inside the house would not be healthy.

Here we see a common problem played over many times a day in thousands of offices. Bureaucratic medicine pushes doctor to spend such a short time with their patients, that it is easier to spend hundreds if not thousands of dollars on unnecessary testing, rather than spend 10 extra minutes to determine the diagnosis. It would be less costly to actually pay the doctor directly for a $100 office call, than the 20% copay of a thousand dollar lab evaluation which would still not give the answer or suggest the right treatment in the case outlined above. We need health insurance for the expensive operations or hospitalizations for which we can’t plan-not the office call. When the government takes over healthcare, the number of people without appropriate healthcare will far exceed the 40 million without insurance today. Just look at what’s happening in Canada where 80% of the people wanted government medicine and now only 20% are still for it. Or the case in Britain, where the waiting lists are years long as in a third world healthcare system.