Asthma is a chronic disease of the airways with links to the immune system. Inflammation occurs in the airways that lead to the lungs, known as bronchial tubes, causing blockage and breathing difficulties. However, the understanding of asthma has developed over time and continues to do so.
More than 26 million people in the United States have asthma, and roughly 6 million of these are children. The World Health Organization (WHO) estimates that this number has increased over 60 percent since the 1980s and that the death rate from asthma has doubled in the same time, but this is not a new condition.
Doctors and medical figures have been aware of asthma since ancient Greece, and what they know about not only treatments but the disease itself has changed dramatically alongside medical technology.
In this article, we explore how the diagnosis of asthma has changed over the millenia.
While scriptures from China as far back as 2,600 B.C.E. and ancient Egypt mention symptoms of breathlessness and respiratory distress, asthma did not have its name or unique characteristics until Hippocrates described it over 2,000 years later in Greece.
Hippocrates, a figure people often label as the grandfather of modern medicine, was the first person on record to link asthma symptoms to environmental triggers and specific trades and professions, such as metalwork.
Hippocrates only saw asthma as a symptom, and it was not until around 100 A.C.E. that a Greek physician called Aretaeus of Cappadocia composed a detailed definition of asthma that was similar to the modern understanding of how the disease develops.
His suggested remedy of drinking a concoction of owl's blood and wine, however, is thankfully no longer a recommended intervention for asthma.
The ancient Romans also explored the condition. In about 50 A.C.E., Pliny the Elder found links between pollen and breathing difficulties and was one of the first to recommend a predecessor of epinephrine, a beta2-agonist common in current quick-relief asthma treatment, as a treatment for these respiratory issues.
As medical technology has developed, researchers and physicians have been able to take new approaches to asthma.
In the 19th century, a doctor named Henry Hyde Salter achieved acclaim for his accurate descriptions and medical drawings of what happens in the lungs during asthma attacks.
He defined the condition as:
"Paroxysmal dyspnoea of a peculiar character with intervals of healthy respiration between attacks."
In 1892, Sir William Osler, one of the co-founders of the John Hopkins Medical School, set out his own definition of asthma.
Bronchial spasms featured high on his list, and he noted the similarities between asthma and allergic conditions, such as hay fever, as well as asthma's tendency to run in families and start in childhood. He also identified specific triggers of asthma, such as climate, extreme emotion, and diet.
However, his focus on airway blockage as the result of smooth muscle spasms in the airways rather than inflammation meant that doctors and pharmacies began to distribute medications called bronchodilators to calm airway spasms in people with asthma. These became available over-the-counter (OTC) as an asthma treatment.
As these might have soothing effects on a short-term basis without addressing the deeper immune problems that drive asthma, the over-reliance on these medications meant that the number of deaths from asthma surged through the mid-1960s and 1980s.
This epidemic of mortality from asthma called into account the standards of treatment at the time, and researchers once again started to reshape their understanding of the condition.
In the 1980s, a better comprehension of asthma as an inflammatory condition developed.
Clinical trials during the previous decade had demonstrated the helpful effects of corticosteroid medication in the daily management and control of asthma.
The role of the immune system in causing this inflammation and the need to manage asthma on an on-going basis, even when symptoms do not occur, has only become clear in more recent years, especially within the decade.
Future treatments might involve trying to identify and alter the genes that cause certain changes in the lung tissue cells and the way they communicate with immune cells, such as T-cells, that cause inflammation.
Asthma remains a complex, untreatable condition, but human civilization became aware of the condition early on.
From the ancient Egyptians describing breathing difficulties in scripture to Hippocrates' discoveries of links between asthma and environmental triggers, people have been attempting to soothe the condition for thousands of years.
Sir William Osler made great strides in specifying the symptoms and possible causes in the late 19th century. However, throughout the 20th century, his emphasis on the muscle spasms that cause airway inflammation meant that medical professionals began to overprescribe bronchodilators and disregard longer-term management.
This led to an epidemic of asthma deaths in the 1960s and 1980s that led to the exploration of asthma as an immune-triggered condition and shaped much of the effective asthma treatment available today.