Asthma: It might wake you at 4am, but it will never leave hair on the couch.

Most readers of this blog will know that I am a dalmatian lover, and can often be found being dragged around the streets at the other end of a  lead. To most people hearing the word ‘dalmatian’ conjures up a picture of an obedient, elegant, spotty dog (word to the wise, Disney got that obedience bit Lottie for blogwrong). When I hear the word, I think of being jumped on for a 4am hug, I think of hair on the sofa and all over my clothes, and I think of company whilst I sit at the computer writing blog posts. And I think of an instinctive hatred of cats.

Words have meanings and connotations. They come about to describe a thing, but get layers of extra meaning put on them by experience. No where in my work is this more apparent to me than when I start to explain asthma. This is not surprising. The situation is often one of an unwell child being brought in by a worried parent, so bringing up the possibility of asthma is asking the parent not only to address the immediate illness of their loved one, but also their own experience and preconceptions about asthma. Puffers, nebulisers, oxygen, hospitals all pop into mind.

When someone is first told they may have asthma there is lots to learn and it can bring on anxiety and uncertainty. All the anxiety and uncertainty can be dealt with, but to be able to deal with it and take control over the condition, it is useful to understand what it is you’re dealing with. That’s what I hope this explanation does, because to a doctor, asthma is a word with a specific meaning. A word used to describe a process happening in the lungs that causes specific issues and is treated in specific ways.

Just a word.

So I’m going to try an experiment. Here is my explanation of asthma, except I’m not going to call it asthma, I’m going to call it dalmatian.

Imagine the lungs are an upside down tree with the windpipe as the trunk and the leaves as the end bits where the gas exchange with the blood happens. Dalmatian is a condition that causes issues in the medium sized tubes – the branches – higher than the twigs and leaves but lower than the trunk. In dalmatian 3 things happen in and around these tubes all of which serve to narrow the middle of the tube and restrict the room through which air can flow. These 3 things are:

1 – The cells lining the tube get swollen (inflamed) and puffy. These puffy cells take up more room, and hence narrow the tube.
2 – Those inflamed cells not only take up more space but also produce mucous. Mucous is made by inflamed cells (it’s also made when those cells are inflamed due to infection, although infection is not necessarily present in dalmatian).  The mucous sits in the tubes narrowing them further.
3 – Muscles that ring the outside of the tubes go into spasm. This squeezes the tube and narrows the hole through which the air can travel.

That’s what dalmatian is. That’s it. The inside of the tube is narrowed due to these processes. That makes getting air in and out harder, it causes cough (the body detects a blockage so coughs to try to get rid of it), wheeze (the air whistles through narrowed airways) and breathlessness (cos stale air builds up in the lungs with not as much fresh air replacing it due to the narrowed tubes). It can also sound deceptively wet and bubbly (especially in kids) due to the mucous production.

There are several things that can set dalmatian off. The commonest is having a cold, but allergies, pollens and other environmental factors (such as smoke) can all act as so-called triggers.

So we treat it in 2 ways. Firstly we use medication that relaxes the spasm in the muscles ringing the tubes. Ventolin (also known as salbutamol) works in this way. It is quick acting but short-lasting, and can quickly open up the tubes. The second group of medications used to treat dalmatian are anti-inflammatory steroids. Steroids (another word with connotations and medical meanings!) are a group of drugs that act in a cell in a certain way to reduce the process of inflammation. As inflammation is behind 2 of the 3 processes involved in dalmatian, reducing it reduces mucous production and reduces the size of the cells lining the tubes thus opening them up.

Of course there is more to dalmatian than that. How it is treated in the immediate setting and the longer term preventative approach is a subject for another post (and individual asthma plans), and a person’s preconceptions and experiences about (I’ll use the word) asthma, do need to be discussed and addressed. But I hope that setting aside those preconceptions for a couple of minutes has allowed you to understand what I mean when I use the word.

Asthma: A group of 3 processes in the lungs. Like a dalmatian it can sometimes wake you at 4am, but it can be trained not to, and it never leaves hair on the couch.

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