My conviction and I guess my experience is that asthma is in the
head.   If you happen to believe that the respiratory system works
like a ventilating or pneumatic power system subject to the laws of
fluid mechanics, you may, if you have an asthmatic tendency, develop
asthma. You speak of social attitudes, but this would not exclude the
culture bound disease aspect.

Breathing is by all accounts an art and breathing has powerful
physiological effects.  There can be no denying that breathing
reactions of a person to unpleasant or pleasant breathing sensations
are important for health.

Dr. Greenfield Sluder's JAMA paper of 1919 stated that asthma was a
symptom of a nose condition and by implication not primarily a lung
condition as presently believed. As a corollary steps to improve the
physiological condition of the nose and, it seems, to "tune" the
movement of air through it should influence asthma/no asthma.

The powerful effect of the nose on lung expansion may be shown by a
healthy person's trying to breathe as deeply as possible (i. e. with
maximum inhaled volume) through the mouth.  When the nose is held, the
inhaled volume is less. This is what one would expect if Sluder was
right.

1)    Ongoing asthma research pinpoints an inability to take a deep
inspiration as a key symptom of asthma (a non-asthmatic reacts like
and asthmatic to a provocation test for asthma diagnosis, if he is
prevented from deeply inspiring).
2)    Cutting out the reflex action of the nose by holding it instead of
afflicting it with chemicals (Sluder) should be and is equivalent as
regards impairing taking a deep, asthma thwarting breath.

Is it really responsible for your organization to consolidate the
standard asthma concept when the etiology is still obscure?  Is not
the fluid mechanics stuff unscientific and a mystical belief?  Why not
basically consider that in an attack an asthmatic's body is doiing its
best to take a deep lung expanding breath, but is failing to do so
because of some minor defect in the respiratory system like a nose
trouble.  This might be a more humane approach in the long run.

Why not, just as an example, treat yoga breathing exercises
(pranayama) empirically if they have a good reputation instead of
saying they are unscientific and beyond the pale?  For example
alternate nostril breathing might be good for asthma because it
somehow tunes air flow in the nose and teaches feeling the effect of
adjustments in nose airflow on grip strength etc. Regards, Richard
Friedel