The Journey of a Hardluck Asthmatic to Gallant Asthmatic
Now that I've been an RT for awhile, there's a question rolling around in my head: When I had severe asthma as a kid, was I a Goofus Asthmatic with a Goofus Doctor, or was I a legitimate Hardluck Asthmatic?
I say this because in 1984, when I was 14, my parents were forced to take me to the ER over 14 times for bad asthma attacks, and I was admitted 4 of these times. By January, 1985, my asthma was so bad that my doctor had me admitted to an asthma hospital in Denver for six months (that story is still to come).
Now that I've been an RT for 12 years, I've observed that we rarely have asthmatics as bad as I was. Further, due to modern asthma guidelines, when we do get asthmatics that severe, we often learn that they are Goofus Asthmatics or Poor Patient Asthmatics in need of a better doctor.
Fortunately for me, I have access to modern asthma wisdom that has confirmed that sereve asthma rates are declining. Likewise, I also work with 2 of the RTs who took care of me when I was a kid. I recently picked their brains.
Saharah was the first I approached. I asked point blankly: "Was I a Goofus Asthmatic with a Goofus Doctor?"
She said, "Absolutely not. When you were in the hospital we had several other asthma patients that were just as bad as you. Our knowledge of asthma was primitive compared to what we know now. We didn't educate parents. We didn't educate patients. Doctors weren't even educated. We didn't know much ourselves about asthma."
I followed-up, "So, do you agree with me then that even though the percentage of asthma patients increased by 75% between 1980 and 1995 that there are far fewer asthma patients admitted to the hospital than, say, 1984?"
"Oh, definitely. We educate everybody now about asthma. Every asthmatic should know how to never come back to the ER. Every asthmatic should know what medicines he should be on, and doctors know what meds to put patients on. Yes. And the new medicines available really help too."
"So, if you were my doctor instead of my RT in 1980," I asked Sahara, "would you tell me to stop taking my Vanceril?"
"Yes. Based on what I knew back then, yes I would have told you to stop taking your Vanceril."
"Good. So my doctors weren't Goofus doctors after all."
"Right. You had a good doctor. You were just a difficult asthmatic, as were many other asthmatic kids back then. And you are right, we don't see asthmatics as bad as you were anymore."
Then I posed the same question to Jane Sage: "Was I a Goofus with a Goofus Doctor?"
She said, ""Not only were you not a Goofus, but asthma was not treated as a disease of chronic inflammation back then either. So using corticosteroids as a top flight asthma therapy was not done. Likewise, doctors were ignorent of the side effects of corticosteroids, particularly in children."
"Today," she continued, "we know that a small amount of corticosteroids in your lungs all the time is relatively safe (so long as you rinse after each use). We are taught that it takes 2-3 weeks for inhaled corticosteroids to get into your system, and it will do little to prevent asthma if you are not on it continuously. Thus asthmatics are taught to never stop taking it even when they are feeling well. That wasn't the case in 1984."
It's funny she said that, because recently I found a note from my doctor written in 1980. It said, "I'm prescribing Vanceril, but do not have Rick use it unless he is having an asthma attack."
I also have my discharge papers after a two week stay in the hospital in January of 1984. On my medications list was written the following: "Vanceril inhaler prn (as needed)."
I remember my doctors back then discussing with me and my parents the systemic side effects of inhaled steroids. They said that like systemic corticosteroied, the inhaled ones might also stunt my growth and cause my bones to weaken.
Now we know, as Jane said, that inhaled steroids are relatively safe. That not using them and relying on your rescue inhaler to treat acute symptoms is far worse than using your Flovent or Advair or Pulmocort or Symbicort.
Sure, it's true my airways might have been "twitchy" whether I was on controller meds all the time or not. That I may never know. Yet I can say it's a pretty safe bet that because my asthma was treated with "primitive" wisdom, this resulted in lung scarring that led to me becoming an inhaler abuser, or bronchodilatoraholic.
So, I think the jury is out: I was a legitimate Hardluck Asthmatic.
Thankfully, modern wisdom and medicine cured me -- and others like me -- of my Hardluck Asthma and turned me into a Gallant Asthmatic instead. In a way, asthmatics like me who were born prior to the establishment of the asthma guidelines in 1991 were Poor Generation Asthmatics, asthma victims of the era we grew up in.
This is a perfect example of how far asthma wisdom has come just in my lifetime.
It is true that no asthmatic should ever have to suffer from asthma the way I did when I was a kid -- so long as you take your medicines exactly as prescribed by your doctor, have an asthma action plan, and continuously strive to be a Gallant Asthmatic.