A patient knows that
he is sensitive to pollen or a pet or a certain food. This helps in diagnosis.
The physician can perform sensitivity tests for various common allergens. True
bronchial asthma almost always responds to certain medications, and the relief
provided by these constitutes still another aid in diagnosis. Not all cases of
asthma are clearly allergic. There are asthma patients who seem to be reacting
to infections of their bronchi or sinuses.
Some physicians believe that such
patients are sensitive to allergens in bacteria or' viruses (intrinsic asthma).
Other doctors believe that there is an extrinsic allergen which is not apparent
and that the infection only intensifies symptoms. The conflict is hard to re-
solve because it is difficult to desensitize patients to the many bacteria and
viruses that inhabit and infect the respiratory tract and sinuses.
There is also a type of asthma which seems to be entirely
emotional. Yet, many allergists believe that in such cases there is a basic
sensitivity to some allergen such as house dust and that emotional tensions act
as a trigger or intensifier of symptoms. All of this must be considered by the
physician when he diagnoses asthma and the outlook for the patient.
If attacks
are definitely related to an inhalational allergen such as ragweed or cat
dander, then the physician knows the outlook is good. The patient will either
avoid the allergen or be desensitized to it. And if avoidance or
desensitization is not 100 per- cent productive, the patient will do well with
one of the medicines used for treating asthma. Similarly, a patient with a
strong emotional component can be helped greatly by psychotherapy.
For the patient with frequent attacks without clear-cut
cause, there are several possibilities:
(1) The patient may do very well on the medications to be
discussed shortly and with the help of other preventive measures.
(2) The patient may not respond well to treatment, may
experience almost constant breathing difficulty, and se- verity may be great
enough to en- danger the lungs through slow development of emphysema.
(3) In addition to the outlook described in (2), the patient
may experience repeated bronchial infections not easily controlled with
antibiotics.
(4) The patient may have frequent, extremely severe attacks. During such attacks, called status asthmaticus, the patient be- comes
blue from lack of oxygen, exhausted from straining to breathe, and seems on the
verge of death. Fortunately, with modern asthma therapy, death is rare but
intensive care in a hospital is required. Windows should be kept closed,
with a door ajar into an adjoining room with window open. Parched, dry air in
the home should be avoided.
An electric humidifier is valuable. Short of that,
pans or trays of water can be kept on radiators.
