History of Asthma (Part 2): Modern History
As time moved from ancient history toward modern history, asthma treatment and knowledge began to evolve.
In the 1500s in Europe, tobacco was introduced as a treatment for asthma, as it was used to induce coughing and expectorate mucus.
Jean Baptiste Van Helmont (1579-1644), who was a chemist and physician from Belgium stated that asthma “originated in the pipes of the lungs.”
Bernardino Ramazzini (1633-1714) was the first to recognize exercise induced asthma. He discovered a link between asthma & organic dust.
Sir William Osler (1849-1919) was a Canadian physician is known as the “father of modern medicine”. He was one of the three founders of the John Hopkins Medical School. Osler first wrote of Asthma in his textbook “Principals and Practice of Medicine” that asthma was a spasm of the bronchial tubes, swelling of the bronchial mucus membranes, being closely related to hay fever, often beginning in childhood, and often times runs in families. He found that both direct and psychogenic nervous system stimulation could cause an asthma attack. His writings ultimately led to the thought that asthma was a psychosomatic disease. He focused on pharmacological treatment of anxiety until almost a decade later when the impact of stress on lung function was realized.
In 1873, a doctor from Manchester England by the name of Charles Blackley showed that pollen was the cause of hay fever and what was once known as “hay asthma”. He collected pollen and would rub it on various parts of his body to reproduce his symptoms.
In the early 1900s asthma was treated with selective b2-adrenoceptor agonists (which causes dilation of the bronchial passages) which were very effective in treating asthma. However, this led to unrestricted access and over the counter availability which increased the number of asthma related deaths due to overuse which peaked in the 1960s.
In 1916 Francis Rackemann found that not all asthma was as a result of allergies. He categorized asthma as being either “intrinsic” (non-allergic) or “extrinsic” (allergic).
Since the 1920s, deaths from asthma were known to be associated with structural changes of the airways and extensive inflammation but not much was known as to why this happened and exactly how it created bronchospasm. For decades, asthma was treated as episodic exacerbations. It wasn't until 1921 when Küstner and Prausnitz discovered that a serum substance that could passively transfer allergens which led to the identification of IgE. They realized that most asthmatics had allergy symptoms to both indoor and outdoor irritants.
In the 1960s & 1970s peak flow meters were quite the technological advancement and were used to measure the amount of airway obstruction as well as measuring arterial blood gasses.
After years of clinical trials in the 1970s, inhaled corticosteroids were highly effective controller medications to prevent asthma symptoms. In the 1980s, there was a clear understanding of how an exposure to an allergen causes a chemical mediator release from airway mast cells, which causes the allergic asthma response.
It has been pretty fun for me to really go back in time and research all about how the understanding of asthma has evolved over time. I'm very glad to live in this day & age!
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