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hard at the Buteyko exercises for two months to make the improvement. I still play a lot of sport—rugby, running, swim- ming, and I mountain-bike. I seldom get asthma any more, and if Ido I use Buteyko to get me through," says Robert, who currently lives in Taiwan with its ever-present smog and humidity. Doctors might say that Robert grew out of his asthma, just like they thought he grew into it. However, his parents are convinced that it was taking bronchodilator medication every day as part of a regular regime that made his asthma worse. When he followed the education that is provided as part of the Buteyko program—to use the nebuliser only when it is actually needed as well as doing the special exercises—he rapidly improved. The connection between daily bronchodilator usage and wors- ening asthma was first made in the 1960s when the world's first asthma "epidemics" occurred in England and Australia. These epidemics and the ones that followed are linked to the overuse of these types of medications.'*"' hard at the Buteyko exercises for two months to make the While today there is no single thing that is considered to cause improvement. I still play a lot of sport—rugby, running, swim- asthma to start in the first place,” theories presumably run thick ming, and I mountain-bike. I seldom get asthma any more, and if —_ and fast in the heads of researchers because they do endless Ido I use Buteyko to get me through," says Robert, who currently studies about this. The first divergence in regard to the cause of lives in Taiwan with its ever-present smog and humidity. asthma is whether it is genetic or environmental.” Doctors might say that Robert grew out of his asthma, just like Those who support the gene theory have not yet been able to they thought he grew into it. However, his parents are convinced identify successfully which gene, or how many genes, could be that it was taking bronchodilator medication every day as part of a _involved;™ but this theory holds weight because the airways of an regular regime that made his asthma worse. When he followed asthmatic are abnormal. There is up to seven times more smooth the education that is provided as part of the Buteyko program—to muscle wrapping the airways of asthmatics compared with non- use the nebuliser only when it is actually needed as well as doing asthmatics; there are five times more mast cells in their airways the special exercises—he rapidly improved. releasing inflammatory chemicals such as histamines; the mucus- The connection between daily bronchodilator usage and wors- producing cells are larger and there is a greater number of them in ening asthma was first made in the 1960s when the world's first asthmatic airways; and the basal tissues of the airways are asthma "epidemics" occurred in England and Australia. These thicker.****’ These distinctions make the airways "twitchy" or epidemics and the ones that followed are linked to the overuse of _ overreactive to things that normally cause no harm to humans. these types of medications.'*"' If the cause of asthma is purely genetic, then this knowledge needs to be applied so that it can prevent the problem or at least What is Asthma? improve patient care. There have been studies done on the size of An alternative name for asthma is "reversible obstructive newborn babies, for example, which seem to indicate that, if a airway disorder" (ROAD), which means that the typical baby is over a certain length or the head is more than 37 centime- symptoms of chest tightness, wheeze, tres in circumference, there is a margin- cough and shortness of breath are not ally greater chance the baby will there all the time. These symptoms develop asthma.” While this might be also occur with other conditions, such . interesting in an academic way, the as bronchitis or a cold. To add to the It has been known since 1990 practical application of what you dilemma, asthma has no that taking a short-acting would do about the baby who has a efinition; instead, diagnos ased . larger head appears to be missing. on the characteristies of variable bronchodilator dose regularly inthe meantime, the environmental airflow obstruction that happen over does not improve asthma theorists may be able to make a short periods of time.”? All of these difference to the outcome of the things make it difficult to diagnose management. condition, but they frequently disagree accurately. not only with the geneticists but also Typically, three things occur in an with each other. "asthma attack", which is defined for For example, we are told that asthma this article as the situation where the is a condition that is primarily found in asthmatic finds it difficult to breathe and requires a short-acting Western societies, and that the more affluent the society then the bronchodilator medication to overcome the symptoms:'* more prevalent is the problem.” We are also told that washing * spasm of the bands of smooth muscle wrapped around the air- clothes in cold water could be a primary cause of asthma.’ It is ways; unlikely, however, that people living in impoverished countries * swelling of the inner lining of the airways; with virtually no asthma are using hot water when they wash their * production of an excessive amount of mucus in the airways. clothes. These factors narrow the airspace in the tiny tubes, leading to Other examples of these disagreements include: increased airway resistance’ and making it especially difficult to ¢ Immunisation encourages asthma.” exhale. Being unable to breathe out freely causes hyperinflation ¢ Immunisation prevents asthma.* of the lungs because air is trapped inside them. This compounds * Gas stoves cause asthma.™ the difficulty because the person wants to breathe in again before * Ga they have finished exhaling.'* As resistance in the airways + Not having infections cau: increases, the person naturally breathes harder to overcome the + Having infections, particularly as a toddler, is a causal factor.” restriction and, paradoxically, this overbreathing increases resis- tance, making the problem worse.'° However, there are some things that most asthma researchers that taking a short-acting bronchodilator dose regularly does not improve asthma management. However, there are some things that most asthma researchers do agree on: 1. The underlying cause of asthma is airway inflammation, and the chemicals involved in this process damage the airways, causing "remodelling". So even though the symptoms may be episodic, the airway change is permanent.* 2. Bronchodilators open up narrowed airways by relaxing smooth muscle.” 3. The overuse of beta-2 agonist bronchodilator medications makes asthma get worse.” 4. The use of anti-inflammatory inhaled corticosteroids reduces airway inflammation and the need for bronchodilators. It is con- sidered the cornerstone of good asthma management." The Cause of Asthma It was originally thought that asthma was caused by "nerves",'” and then it was thought to be primarily caused by spasm of the smooth muscle wrapping the airways.'” It must have seemed logical, therefore, that taking a short-acting bronchodilator regularly would stop the spasm and lessen asthma symptoms. However, it has been known since at least 1990'” that taking a short-acting bronchodilator dose regularly does not improve asthma management," and it is estimated that this practice, based on faulty theory, has caused asthma to get worse in thousands of cases"*° and has caused the deaths of thousands more.”””! 34 = NEXUS It has been known since 1990 www.nexusmagazine.com DECEMBER 2005 — JANUARY 2006