Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State

Abstract

Anthracopoulos and Everard Asthma-What Is IT? "When I use a word, " Humpty Dumpty said in a rather scornful tone, "it means just what I choose it to mean-neither more nor less." Through the Looking Glass Lewis Carroll 1871 No disease was less understood by medical men, than asthma. Every difficulty of breathing, if fixed and continuous, was designated asthmatic; and the same indefinite application of the term still remains in vulgar use. This general application of the word caused it to be employed to denote a variety of morbid states of the lung, very different from one another. A practical treatise on the principal diseases of the lungs, GH Weatherhead. 1837 Homeostasis is the property of a system within an organism in which a variable is actively regulated to remain very nearly constant.

Time to Say Goodbye to Bronchiolitis, Viral Wheeze, Reactive Airways Disease, Wheeze Bronchitis and All That

“…Studies have clearly shown that infants are born with functional ASM which equals or exceeds the relative mass in adult airways (134). Given that the ASM has been active through most of infancy playing a critical role in airways development and branching this is not surprising (135,136). Studies undertaken more than 20 years ago showed (again unsurprisingly) the infant airway responds to agents such as histamine and methacholine and that short acting b-agonists can protect against this induced bronchoconstriction (137)(138)(139)(140)(141)(142).…”

“…An exacerbation is fundamentally different from poor control. An untreated or poorly adherent asthmatic generally responds well to a b-agonist when they have exercise induced or nocturnal symptoms but during an exacerbation the response to a b-agonist can be very poor (135,148) and require systemic steroids to restore b-agonist responsiveness and relieve the ASM spasm. If there were a good response, asthmatics would not be admitted to hospital nor require corticosteroids.…”

“…If there were a good response, asthmatics would not be admitted to hospital nor require corticosteroids. The mechanism that leads to loss of good b-agonist responsiveness is unclear but may be attributable to the impact of viral RNA (135,149).…”

“…Exacerbations of asthma and PBB require specific therapy, the majority of episodes require good supportive care appropriate to the severity of symptoms. recurrent viral infections and other conditions is beyond the scope of this review but has been discussed elsewhere (87, 88,135). However, a history can only help with a provisional diagnosis-possible or probable asthma or PBB for example but a definite diagnosis should only be made when a dramatic and unequivocal response to therapy is observed at a time point when such a response would be anticipated (e.g., 2 weeks of high dose antibiotics for PBB, 5 days of oral steroids or 5-8 weeks for inhaled corticosteroids for asthma).…”

“…Until we can develop a simple test for the diagnosis of asthma and other conditions such as PBB the significant on-going over and under diagnosis of asthma will persist particularly in pre-school children (135). We can in part reduce the inaccuracies in diagnosis by clarifying our terminology and thinking.…”