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Asthma – My “SOB” Friend

Asthma – My “SOB” Friend
Asthma – My “SOB” Friend
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It goes without saying that if you’re reading this you’re breathing.   And for that blessing, let’s all be grateful.  Most of the time we breathe mechanically. In fact, we breathe unconsciously 14-16 times every single minute of every single day, and will, until we don’t. That’s when we say goodbye to the world.  Hopefully, this will happen to neither of us for a very long time, but you could be short of breath many times before that final one.

The first time I was ever really short of breath, I was running. Now, I don’t mean out of breath, I mean short of breath. Big difference. My shortness of breath that day also introduced me to its always-lurking pals – cough and wheeze. “You have asthma, young man,” said the doctor in the starchy, white coat, as if she was handing out free passes to Disneyland. It’s no fun being a teenager and being told you’re mortal.  What, me, mortal!?!  Get outta here…

Not like I had much of a choice, but over the years, I got used to inhalers and steroids for flare-ups. These drugs open up the airways and dampen down the inflammation causing asthma’s shortness of breath, cough, and wheeze. Once, around my med school finals, my asthma was so severe that I let the ER doc give me epinephrine. An old treatment, old even then, not one I would recommend now, but it worked. It was amazing just being able to suddenly take a free, unhindered breath. The sensation of that gushing air hitting my suddenly wide-open lungs was like being filled with life itself. It was as if a massive weight was magically lifted off my chest. God, it felt glorious!

So what exactly is asthma? The problem is in the airways that connect your mouth to alveoli (oxygen exchange units that are deep inside your lungs). Think of airways as pipes that simply transport oxygen. Kind of like pipes that bring water to your home, but with this big difference – airways aren’t rigid. They’re dynamic. They can go from wide open to almost shut in a heartbeat. When the airways narrow, coughing, wheezing, and shortness of breath quickly follow.

The other thing to understand in asthma is that most of the action is in expiration. Think of it this way, it’s not that we asthmatics can’t get a breath in, we can. Getting the breath out is the big deal. This is called “air trapping.” That’s why asthmatics are “barrel-chested” in acute flare-ups.  Literally we’re full of trapped air. Or as my friends like to say, I’m more full of hot air than normal. Let me tell you, “air-trapping” makes breathing really tiring and hard work.

You may be surprised that breathing is work, but it is. You’re using muscles. Muscles contracting is work. Eventually they can get so tired and worn out, they simply stop working. They quit. If you’ve ever been to the gym and just couldn’t squeeze out one more push up, if you’re life depended on it, you know what I mean.  Respiratory muscles are no different.  They can get worn out too and simply quit.  Let me explain…

Breathing in is active. You use your diaphragm. The diaphragm is a big muscle that separates your abdomen from your chest. Breathing out is passive. You use the elastic recoil of your lungs. Picture it this way. Your lungs, when you take a breath in, are like a rubber band pulled taut, stretched apart, by your diaphragm. Once the diaphragm relaxes, and the stretching force on the lungs is gone, the lungs return to their normal unexpanded state using their natural, elastic recoil just like a rubber band would, when you remove the force pulling it apart. This means breathing out is a freebie, as in no energy required – until it’s not, like in acute severe asthma.

When you’re short of breath, everything is sped up. Think of how you pant after a long distance run. It’s not just your diaphragm moving in and out now. The whole top half of your body is moving – your chest wall muscles and your neck muscles are going gangbusters. Now you’re burning fuel. Now you’re breathing at a rate of thirty to forty breaths per minute. And this you can’t do forever. No more than you could do push-ups forever.

Not being able to do one more push up is one thing; not breathing is another. This means, of course, there’s no taking a rest for your respiratory muscles. They can’t stop for five minutes and start over. If they do, it really is over. That’s where ventilators come in.  We put you on this machine and it breathes for you.  Like magic it does the work of breathing, allowing you to rest while you’re asthma gets treated. I’m fortunate that this has never happened to me; I’ve never been on a ventilator.

My asthma is well controlled these days. It doesn’t limit what I can do. It doesn’t define me. I don’t allow it. And even though I’m an asthmatic for decades and a doctor, I don’t treat myself during flare-ups. The reason is simple: like most asthmatics I’m a poor judge of how sick I actually am during a flare up, so I get one of my colleagues to treat me.

Let me wrap up with the three things that I tell all my patients they should know about their asthma:

  • How their inhalers work – the difference between “rescue” inhalers like albuterol and preventive inhalers like Advair.
  • How to recognize a flare up and to have a step up plan worked out in advance with your doctor. This plan should be individualized but it may involve a crash course in steroids that you always have on hand.
  • When to seek help in Urgent Care or ER (e.g. you’re up all night coughing and wheezing. This is not normal. Get help.)

And one more thing, the medical acronym for shortness of breath is “SOB”.  Need I say more?

 

 

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