Asthma

 A friend of mine was rushed to the emergency room after being in the vicinity of an open jar of peanut butter; a relative of my husband’s nearly died after a sudden allergic reaction to the family cat. In an asthma attack, the airways narrow and the sufferer struggles to get air in or out. In the US, between 1980 and 2000, asthma rates doubled, but hospitalization rates tripled, suggesting that asthma is now not only more common but more severe.

Scientists don’t know what causes asthma. For a while it was thought to be a neurological disease—the nervous system sending the wrong signals to the lungs. Later, scientists believed it was an allergic reaction. Now, as one researcher notes, “It’s clear now that it is considerably more complicated than that. We now know that half the cases in the world involve allergies, but half are due to something else altogether—to nonallergic mechanisms. We don’t know what those are. I have spent thirty years studying asthma, and the main thing I have achieved is to show that almost none of the things people think cause asthma actually do. They can provoke attacks if you have asthma already, but they don’t cause it. We can do nothing to prevent it. All we can really say about asthma is that it is primarily a Western disease. There is something about having a Western lifestyle that sets up your immune system in a say that makes you more susceptible. We don’t really understand why.”

Some scientists suggest asthma is caused by the absence of certain gut microbes; others are suggesting viruses. The dogma has been that both the allergic and nonallergic asthmas involve inflammation in the lungs, but with some asthmatics if you put their feet in a bucket of ice water, they begin to wheeze immediately. That can’t be due to inflammation because it happens too fast. Maybe the cause is neurological after all. I think what we can say is that where asthma is concerned, no one knows much of anything.

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