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Medical Forum / Diseases and Disorders / Asthma / February 2004Why asthma drug treatment must always fail.
There is the saying that "hard cases make bad law, that is to say when a party to an action is under psychological stress the resulting decision and precedent will be bad. It would seem reasonably obvious that this will apply in medicine as well. Normally a doctor with a patient traumatized by his disease or a psychologist treating a person traumatized by something like physical violence will make allowances and maybe embark on debriefing. That asthmatics are traumatized seems to be proved that the topic never normally crops up. If the psychological side of asthma is discussed, then it is usually on the point that an asthmatic may have a personality defect causing his disease in the first place and not that he has a trauma as a result of it. It is assumed that his views on asthma treatment will be free of any trauma effect and quite level-headed One writer on asthma (Prof. Deane Hillsman of UCLA) stated however: "Recurring acute dyspnea attacks are painful experiences, and it is understandable that patients frequently live in fear of these attacks. Fear of dyspnea attacks, and of the unknown, leads to a Loss of Control. The loss of control involves loss of the means to control the attack itself. Perhaps even more profound is the loss of control of "self," and the very basic qualities of what comprises the human experience. The ability to control acute dyspnea attacks restores patient confidence over the most distressing component of the COPD disease process, which in turn can restore the loss of control of "self." Restoring "self" can have a profoundly positive effect on the patient's general outlook and well being." (http://www.ohiou.edu/isarp/conf_00/papr_19.htm) If, as must be the case, we accept that asthmatics are either directly traumatized by attacks or by warnings following an asthma diagnosis that they may be suffocated more or less without warning (unless they embark on medication) at any time, then their opinions are not to be taken at face value. In particular it is really hard to see why if they are told that diaphragmatic breathing turns off a wheeze or if they experience it themselves (see Dr. Erik Peper http://www.i-breathe.com/thb12/Incentiv.htm), they still stick to drugs which either weaken and paralyze muscles in the chest and/or symptomatically treat (suppress) inflammation in the bronchi. There must be "something psychological" about this preference, as is in fact borne out by the great increase in asthma with modern medication. See for example: " Especially intriguing is the recent theory that the very drugs that revolutionized asthma care are partly responsible for the increase in overall incidence, and especially for the growing mortality rate. This hypothesis is particularly compelling since the current epidemic indeed began at about the same time modern asthma drugs went on the market." (Barbara Benagh, an authority on yoga and herself a recovered asthmatic http://www.yogastudio.org/asthma_article/main_story.htm) If, as seems likely, diaphragmatic breathing is a powerful treatment or even (as I suspect) a cure for asthma, then it is hard to see why anybody without having had asthma and without the inevitable medication bias of most doctors, should not come to the conclusion that drug treatment of asthma with the "preventers" and "relievers" is not the worst possible concept and doomed to failure. At any rate it would seem normal and reasonable not to exclusively stick to medication, especially when there are heavy side effects. Medication is not commonsense and axiomatic. Richard Friedel >That asthmatics are traumatized seems to be proved that the topic >never normally crops up. If the psychological side of asthma is [quoted text clipped - 3 lines] >on asthma treatment will be free of any trauma effect and quite >level-headed In other words, just suck it up? Oh, the horror of it all... "This is not limited to the United States by any means, Sadock said, noting that in Japan there is a condition known as koro, in which a man suffers from delusions that his penis is actually shrinking back into his stomach." http://www.msnbc.msn.com/id/3979636/ > >That asthmatics are traumatized seems to be proved that the topic > >never normally crops up. If the psychological side of asthma is [quoted text clipped - 11 lines] > into his stomach." > http://www.msnbc.msn.com/id/3979636/ Thought it was chiefly in China, but no matter. Since the idea appeals to your goodself, just apply for a patent using Viagra instead of chopsticks and paper weights usually employed and sell him the patent rights to some budding asthma drug maker as a second line of business. Then after retiring on a fortune you will have more time for the likes of us. See also http://www.usu.edu/psycho101/lectures/chp16mental/mentaldisorders.htm " Cultures produce different kinds of psychological distress. Cultures affect the ways in which distress is expressed. Culture affects the way others respond to a distressed person. Culture-bound syndromes: expressions of mental distress that are almost completely limited to specific cultural groups. (Example) Koro: fear that the penis will withdraw into the abdomen and cause death (exclusive to Southwest Asia). (Example) Anorexia nervosa: most prevalent in North America and Western Europe, adolescent women of mid to upper SES." If the proverbially so intrepid Kung-Fu types in Japan get attacks of koro, why shouldn't westerners get asthma the same way? Curious, Richard Friedel >See also http://www.usu.edu/psycho101/lectures/chp16mental/mentaldisorders.htm > [quoted text clipped - 13 lines] >koro, why shouldn't westerners get asthma the same way? Curious, >Richard Friedel Ahhh, Grasshopper, you are embracing the desire to learn amid life's Confuciunisms! Curious yes, that koro attacks are perceived as a "retraction" of sorts. More likely, however, at least in western experience, is the fear that the abdomen will grow to engulf the tadger, with similar results and fears. Yesterday, Americans were shown repetitive television advertisements during the football playoffs for Viagra-like medicines, with the attendant message that these meds will help one to "stay in the game." There were also ads for the asthma medicine Singulair, showing a woman off on a rough-water rafting vacation, helping her as well to "stay in the game," so to speak. Curious too, was beer commercial that made light of a football player whose oversized ego was "deflated" because the crowd booed him for dropping the ball. Leon didn't think he could play anymore that day and told the coach that he wanted to have some time out to reflect (Leon time). The coach suggested he have some herbal tea to help him cope with his (feigned) sense of failure and rejection. IMO, there are psychological effects on and of any dis-ease. To embrace and learn from them, not to deny them, is healthy and empowers one to better cope. However, this aspect of health does not come in a pill... >That asthmatics are traumatized seems to be proved that the topic >never normally crops up. So if I don't talk about cancer - this means I must have cancer? Note the flaw in your reasoning? Isn't it more likely that the reason the subject has not come up is because it is not an issue? "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >That asthmatics are traumatized seems to be proved that the topic > >never normally crops up. [quoted text clipped - 5 lines] > Isn't it more likely that the reason the subject has not come up is > because it is not an issue? Every possible detail of asthma is normally researched. The more or less obvious modern psychological approach of Dr. Peper (http://www.i-breathe.com/thb12/Incentiv.htm) with conditioned reflexes is avoided, probably because it would debrief patients, give them peace of mind and spoil asthma drug sales. You don't have to be a conspiracy theory addict to realize this.. Specifically Colin, one point is that wheeze occurs in asthma. As plausibly shown by the admirable Dr. Peper, it can be stopped by a little brainpower. Recommending relievers to stop it weakens breathing muscles and thwarts any self-healing tendency (pharma reps take note), just like alcohol-containing patent medicines a century ago furthered addiction they were supposed to cure. You only seem to have rhetoric to defend your belief that muscle weakening drugs and cortisone are a good idea for treating asthma, no scientific reasoning. Could present asthma treatment be the very quackery you are always finding in unorthodox approaches by psychological projection? > "It's not American foreign policy, to promote narcotics trafficking Just guess why. Respectfully submitted, Richard Friedel >Every possible detail of asthma is normally researched. The more or >less obvious modern psychological approach of Dr. Peper >(http://www.i-breathe.com/thb12/Incentiv.htm) with conditioned >reflexes is avoided, probably because it would debrief patients, give >them peace of mind and spoil asthma drug sales. You don't have to be a >conspiracy theory addict to realize this.. Yes, every possible detail of asthma is researched. However only positive results (ie discoveries) are published. Negative results tend not to be published. A hypothesis without actual evidence is nothing. "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >Every possible detail of asthma is normally researched. The more or > >less obvious modern psychological approach of Dr. Peper [quoted text clipped - 8 lines] > > A hypothesis without actual evidence is nothing. Colin my point, which you keep on ignoring, is that asthma attacks not only produce fear so that sufferers are anxious to avoid them, but that the attacks modify thinking and judgment. If you look at texts on the psychological side of asthma, you will find that this point is missed. Dr. Erik Peper (http://www.i-breathe.com/thb12/Incentiv.htm) seems to have the only study on the critical role of conditioned reflexes, one of the basic themes of modern psychology, which modify thinking - by brainwashing if you like. In fact the usual texts on the psychological aspects of asthma seem to be by people who have never had an attack, or dismiss asthmatics' being programmed by attacks as delusions, like delirium, and without any rational bearing or significance. The result is a mystification and an unnecessary blaming of patients for not being right in the head (f. i. shocked by Sept.-11), see the following: Asthma Reality http://www.asthme-reality.com/asthme2A.htm "Let's take the example of asthma as a consequence to effort The logical response of the central system (broncho-constriction) trying in the first place to solve an erroneous cause (chondro-costal articular message wrongly perceived, as coming from the pulmonary plexus) will be reinforced as it tries to prepare the respiratory system to give the effort necessary to respond to the situation requiring resolution. The emotions that follow will start hormonal responses which will not place the subject in a state of increased vigilance in responding to the situation, but in a state of panic, the central system noting that the "Me" will not be able to correctly respond to the request because of a defective vital element." --------------------------- The Curious 2000-Year Case of Asthma http://www.psychosomaticmedicine.org/cgi/content/abstract/62/6/816 "This historical review reveals the progress and missteps that have been made in the study and treatment of asthma by comparing the general medicine approach with the major research findings on asthma published over 60 years in Psychosomatic Medicine. Research has identified antecedent, collateral, and subsequent factors to scientifically describe and control this disease in terms of diagnosis, management, and treatment. Paradoxically and regrettably, the prognosis for those with asthma is worse than ever. Curious also that a noninfectious disease should spread so rapidly and mostly for specific groups identified by variables like age, gender, ethnicity, and socioeconomic status. Furthermore, partial, not full, family concordance indicates merely genetic influence, not determination. General medicine now focuses on enumerating the range of environmental and situational triggers, or stimuli, producing asthma and describing the pathophysiology of bronchial inflammation. With a more comprehensive multifactorial approach, psychosomatic medicine seems well suited to investigate further the physiological, psychological, social, and environmental factors implicated in this medical conundrum. A future challenge for psychosomatic medicine is to stem the tide of rising prevalence and cure the disease of asthma." --------------------------- Relationship of Self-Reported Asthma Severity and Urgent Health CareRelationship of Self-Reported Asthma Severity and Urgent Health http://www.psychosomaticmedicine.org/cgi/content/abstract/65/6/993 "OBJECTIVE: Posttraumatic psychological stress may be associated with increases in somatic illness, including asthma, but the impact of the psychological sequelae of the September 11, 2001 terrorist attacks on physical illness has not been well documented. The authors assessed the relationship between the psychological sequelae of the attacks and asthma symptom severity and the utilization of urgent health care services for asthma since September 11." --------------------------- http://www.med-psych.net/modules/news/article.php?storyid=579 Mental Disorders and Asthma in the Community "Conclusions To our knowledge, these findings are consistent with and extend the findings of previous reports by providing the first available information on the association between physician-diagnosed asthma and DSM-IV mental disorders in a representative population sample of adults. Our results suggest an association between asthma and a range of mental disorders." --------------------------- http://www.lungusa.org/asthma/astasthage.html IS ASTHMA "PSYCHOSOMATIC"? IS IT ALL IN THE HEAD? (American Lung Association) "No. People used to think asthma was a psychological problem. It is not. Asthma is a real medical problem, but too much stress can make asthma worse". --------------------------- http://www.bodysoulandspirit.net/resources/news_articles/2000/news-journaling.htm Writing for therapy helps erase effects of trauma "A new study, published in the April 14, 1999, issue of the "Journal of the American Medical Association," shows that expressive writing can even ease the symptoms of asthma and rheumatoid arthritis. Joshua Smyth, Ph.D., an assistant professor of psychology at North Dakota State University, and colleagues asked 70 people with either asthma or rheumatoid arthritis to write about the most stressful event in their lives. The study participants wrote about their emotional pain for 20 minutes straight on three consecutive days. Another group of 37 patients wrote about their plans for the day. Four months later, 47 percent of the group that wrote about past traumas showed significant improvement -- less pain and greater range of motion for the arthritis patients, increased lung capacity for the asthmatics -- while only 24 percent of the group that wrote about their daily activities showed such progress. " Regards, Richard Friedel "Recurring acute dyspnea attacks are painful experiences, and it is understandable that patients frequently live in fear of these attacks. Fear of dyspnea attacks, and of the unknown, leads to a Loss of Control. The loss of control involves loss of the means to control the attack itself. Perhaps even more profound is the loss of control of "self," and the very basic qualities of what comprises the human experience. The ability to control acute dyspnea attacks restores patient confidence over the most distressing component of the COPD disease process, which in turn can restore the loss of control of "self." Restoring "self" can have a profoundly positive effect on the patient's general outlook and well being." (http://www.ohiou.edu/isarp/conf_00/papr_19.htm) >> A hypothesis without actual evidence is nothing. > >Colin my point, which you keep on ignoring, is that asthma attacks not >only produce fear so that sufferers are anxious to avoid them, but >that the attacks modify thinking and judgment. Are you certain they produce fear in most people? I know that my own reaction is more annoyance than fear. >If you look at texts on the psychological side of asthma, you will >find that this point is missed. Dr. Erik Peper >(http://www.i-breathe.com/thb12/Incentiv.htm) seems to have the only >study on the critical role of conditioned reflexes, one of the basic >themes of modern psychology, which modify thinking - by brainwashing >if you like. Where was this paper published? I could find no reference to it being accepted for publication. Besides, one paper does not a conclusion make. "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > > >> A hypothesis without actual evidence is nothing. [quoted text clipped - 5 lines] > Are you certain they produce fear in most people? I know that my own > reaction is more annoyance than fear. Then why are you taking asthma meds? Why don't you stop attacks with pursed lips breathing or breathing from the diaphragm? > >If you look at texts on the psychological side of asthma, you will > >find that this point is missed. Dr. Erik Peper [quoted text clipped - 5 lines] > Where was this paper published? I could find no reference to it being > accepted for publication. Its content is probably thought to be too obvious to be published. > Besides, one paper does not a conclusion make. > [quoted text clipped - 4 lines] > want, eventally, to exterminate us." > 'Christian Century' magazine And just what did Thomas Jefferson say about ignorance and not being free? www.newgenevacenter.org/ portrait/jefferson.jpg Do you need lessons in being a good American from a European? Richard Friedel >> >Colin my point, which you keep on ignoring, is that asthma attacks not >> >only produce fear so that sufferers are anxious to avoid them, but [quoted text clipped - 7 lines] >Why don't you stop attacks with pursed lips breathing or breathing >from the diaphragm? Because I have reviewed your evidence and am not convinced. -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine >Colin my point, which you keep on ignoring, is that asthma attacks not >only produce fear so that sufferers are anxious to avoid them, but >that the attacks modify thinking and judgment. You are generalizing people. I have had asthma since I was 2, and I don't get frightened, I tend to get frustrated more than anything else. Even as a child, it was just something I had to go through. There was no fear about my next attack, nor is there now. I live my life and do what I can. I know that when I have to go to the ER I bring a book with me so I have something to do while I'm sitting there. A couple of doctors remarked on it, that I was wheezing so badly and reading. I said "what else would you like me to do?" Don't put everyone in the same box. Never a good idea. Life is uncertain - eat dessert first. Nancy 8=: ) > >Colin my point, which you keep on ignoring, is that asthma attacks not > >only produce fear so that sufferers are anxious to avoid them, but [quoted text clipped - 11 lines] > > Life is uncertain - eat dessert first. > Nancy > 8=: ) You seem almost trying to make asthma seem generally acceptable, almost a way of life. What I can never understand is why you do not use pursed lips breathing to curb an attack. Is taking a medication such a good idea, specially in the long run? With pursed lips breathing you only have to prolong about 8 breaths in an attack. Takes some doing but it is surely worth it. Then you don't have to get medication into your system. Guess medication is a timebomb. See on plb "The rescue breathing pattern.. http://www.ohiou.edu/isarp/conf_00/papr_19.htm by Prof. Deane Hillsman of UCLA. On stopping wheezing naturally see http://www.i-breathe.com/thb12/Incentiv.htm. Highly motivating, not style cramping, I hope. Regards, Richard Friedel Hi Nancy > >Colin my point, which you keep on ignoring, is that asthma attacks not > >only produce fear so that sufferers are anxious to avoid them, but [quoted text clipped - 7 lines] > sitting there. A couple of doctors remarked on it, that I was wheezing so > badly and reading. I said "what else would you like me to do?" This was also my experience as a child. I was diagnosed with asthma at the age of 4. Hardly had a day when I didn't wheeze. Often had blue lips. But for me all this seemed normal and when I had a bad attack would try to bury myself in a book. A good book would distract me enough so that I no longer noticed the attack. > Don't put everyone in the same box. Never a good idea. I agree. > Life is uncertain - eat dessert first. > Nancy > 8=: ) Regards Norman Back > Hi Nancy > [quoted text clipped - 32 lines] > Regards > Norman Back Well, asthmatics seem to be in the same box to a great extent. There may be other causes than something directly affecting the respiratory system of a more or less healthy person. According to Peper (http://www.i-breathe.com/thb12/Incentiv.htm) and others asthma is something like driving with the brake on. Owing to lack of diaphragm activity the bronchi are not held open. This can be controlled voluntarily as well as by asthma drugs. Furthermore the patient does not in an attack understand the sinister effect of airtrapping and blows up his lungs ("can't breathe out"). He must prolong his exhales (http://www.ohiou.edu/isarp/conf_00/papr_19.htm ). It is hard to see why otherwise robust people do not take pursed lips breathing more seriously in order to get out of the mess once and for all (while still carrying a reliever around just in case). After about 8 rigorously prolonged breaths an attack can be curbed according to the second link (Prof. Deane Hillsman of UCLA). Then breathing from the diaphragm is learnt, see Peper. All the same it would be best to talk this over with a doc. Regards, Richard Friedel. >Well, asthmatics seem to be in the same box to a great extent. There >may be other causes than something directly affecting the respiratory >system of a more or less healthy person. And the world could be flat and the moon could be made of cheese. Just not very likely. >According to Peper (http://www.i-breathe.com/thb12/Incentiv.htm) and >others asthma is something like driving with the brake on. Owing to [quoted text clipped - 3 lines] >airtrapping and blows up his lungs ("can't breathe out"). He must >prolong his exhales Sounds like this guy is clueless. There is over 30 years of research into the nature of asthma. Why should we ignore all of this for a crank theory? -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >Well, asthmatics seem to be in the same box to a great extent. There > >may be other causes than something directly affecting the respiratory [quoted text clipped - 3 lines] > > Just not very likely. Don't get you. Don't asthmatics have anything in common? Orthodox treatment seems to believe they do. > >According to Peper (http://www.i-breathe.com/thb12/Incentiv.htm) and > >others asthma is something like driving with the brake on. Owing to [quoted text clipped - 5 lines] > > Sounds like this guy is clueless. Peper shows that the bronchi are held open in this way (wheeze turned off). Just where is your proof to the contrary? > There is over 30 years of research into the nature of asthma. Why > should we ignore all of this for a crank theory? Read a bit of Carl Sagan, Revolutions are the life blood of science. Richard Friedel >> Sounds like this guy is clueless. > >Peper shows that the bronchi are held open in this way (wheeze turned >off). Just where is your proof to the contrary? Wrong. You _know_ that the standard of proof is on the proponent of a theory. Until his theory is actually tested and shown to be true - it is nothing. -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >> Sounds like this guy is clueless. Colin, to get to common ground: We all learn at school that the lungs are like balloons in a bottle and are inflated and allowed to deflate by reducing and restoring the pressure in the bottle around them. (Google search with "lungs" + "ballon"). See f. i. http://www.cyfernet.org/integrate/iowa/sresp.html http://biology.about.com/c/ht/00/07/How_Working_Model_Lungs0962932482.htm http://www.raft.net/resources/ideas/Balloon%20in%20a%20Bottle.pdf The last item states quite emphatically: "Science behind the Activity Initially, the air in the balloon is at the same pressure as outside air and as the air in the bottle. As you blow into the balloon, air moves into the balloon (the pressure in your lungs as you blow is greater than the air pressure in the balloon) and the balloon begins to expand." This notion seems all the more attractive because when the chest wall is punctured a lung simply collapses (pneumothorax) This model or notion is imported into or exported from pulmonary mechanics. The pleural space is absurdly exaggerated in size in the above texts ("lung" hanging in a bottle) and could not in nature lead to a pressure equalization all over the lungs. But the pulmonologists tell us that breathing in a diaphragmatic or non-diaphragmatic manner would be irrelevant ("alternative or complementary") for the cross section of the bronchi because the suction effect for lung inflation would be acting all over the lungs' outer face in the pleural space. But see Peper for the contrary view (diaphragmatic breathing turns off wheeze). In reality, on allowing for excessive reductionism (theory) in the school syllabuses, breathing with the thorax muscles or with the diaphragm does have different effects on different regions of the lungs. Since in asthma the regional distribution of air (ventilation) and blood (perfusion) is impaired it is obvious for asthma to give up the balloon model and to emphasize studies (are there any?) showing that air distribution is dependent on "breathing techniques", like zazen breathing with the diaphragm being moved down relative to some (for us) mystical point (tanden or hara).just below the navel. I just can't figure out why you stick to the medicine only stuff for asthma. It is irrational.Where's the science? Richard Friedel Common sense is the collection of prejudices acquired by age eighteen. (A. Einstein) >I just can't figure out why you stick to the medicine only stuff for >asthma. It is irrational.Where's the science? Richard Friedel I stick to it because of the massive amount of source scientific research that demonstrates the current model to be the best explanation of what asthma is and how it works. All you have is a belief. -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > We all learn at school that the lungs are like balloons in a bottle > and are inflated and allowed to deflate by reducing and restoring the > pressure in the bottle around them. (Google search with "lungs" + > "ballon"). See f. i. <snip links> > The last item states quite emphatically: > [quoted text clipped - 7 lines] > This notion seems all the more attractive because when the chest wall > is punctured a lung simply collapses (pneumothorax) Once again we see the common tactic of starting with fact and then gradually taking things off course. The ballow example is a little confusing since int he lungs things work exactly the opposite. The chest cavity expands on inspiration; either through the ribs seperating, the diaphragm dropping, or both; producing a lower pressure inside than out and net airflow in. On expiration the reverse happens. I think what Richard is trying to get at is that the lungs are not hoolw balloons, but rather, spongy material. The larger airways are held open by cartilage support structures but the mediaum and small airways are tethered open by the spongy network of lung tissue. As the chest wall expands, the spongy material thatis the lung is pulled, and this pulling opens the airways. This becomes especially important in COPD (smoking related emphysema) where lung tissue, i.e. tethers, are lost to the point where the airways collapse on expiration due to a loss of the tethering effect and wheezing is produced. In asthma the lung tissue is fine and the tetheirng mechanism is intact so this whole thing is thought to be less important. The obstruction is not due to unsupported airways collapsing, but rather, by active constriction of smooth muscle, the production of mucus, and the swelling of the lining of the airway. Anyway - what he says above is true, albeit poorly stated. > This model or notion is imported into or exported from pulmonary > mechanics. > > The pleural space is absurdly exaggerated in size in the above texts > ("lung" hanging in a bottle) and could not in nature lead to a > pressure equalization all over the lungs. Pressure will equalize as long as air can flow. > But the pulmonologists tell us that breathing in a diaphragmatic or > non-diaphragmatic manner would be irrelevant ("alternative or > complementary") for the cross section of the bronchi because the > suction effect for lung inflation would be acting all over the lungs' > outer face in the pleural space. See this is one place where he starts to drift. I'm not really sure "pulmonologists" currently say this. Many conventional sources do discuss different methods of breathing. It is just not the center of active research discussion. > But see Peper for the contrary view > (diaphragmatic breathing turns off wheeze). And this is where we take the plunge into completeley unsupported specualtion. It may well turn out that diaphgragmatic breathig has some advantages. I doubt it will be anythign so dramatic as "turning off the wheeze". Not even Peper goes that far. Anyway, time will tell and in the mean time Colin is right - it is up to the proponent to prove his theory right - not everyone else to prove it wrong. > Since in asthma the regional distribution of air (ventilation) > and blood (perfusion) is impaired it is obvious for asthma to give up > the balloon model and to emphasize studies (are there any?) showing > that air distribution is dependent on "breathing techniques" Thatis a good question for you. let us know when there are. > I just can't figure out why you stick to the medicine only stuff for > asthma. It is irrational. Again - one way to spot an unsupported thoery is that its proponents need to set up straw men to knock down. No one "sticks to a medication only" model of asthma therapy. > Where's the science? Richard Friedel Good question.  SignatureCBI, MD ..... (Cancelled because of extreme length). Well, to find common ground, like everybody is saying, "thank God for doctors". But on the other hand a little informed feedback is part of good doc-patient teamwork. However one does not need to be a patient, and still less a doctor, to see that any claim to comprehensiveness (this is what is in Colin's and other peoples' minds) of standard asthma literature is bogus. For instance older and other healthy people may find it difficult to breathe in cold weather without medication They should be given tips about breathing to avoid airway constriction in this case and there are masses of other examples where natural (but nevertheless scientific) remedies are possible. (Get back to W. James' pragmatism and what he said about the waste of time with being overly academic.) To be comprehensive asthma books should OBVIOUSLY at least provide a basis for such tips. The existence of this one more or less serious omission obviously leads on to a suspicion that asthma books are irresponsibly one-sided in other respects. The hint behind phrase "what the doctor never tells you" is not disingenuous but a real piece of wisdom here. Maybe the asthma books are dedicated to being clueless about actual breathing. If Dr. Erik Peper (he has a Ph.D, not an MD) proves that diaphragmatic breathing turns off wheeze, a symptom often seen as a reason for starting a course of asthma drugs with all their likely side effects, why is Peper's work on this not understood as legitimate, intelligent scientific input by the asthma establishment? Have you forgotten that P. has (co)authored around 20 Medlined studies? The effect behind the breath holding stunt of the B u t e y k o e a n s could for that matter be studied scientifically. Let us hope that it is somewhere in the research pipeline. To repeat myself, half an hour looking at the weighty, two-tome standard, professional works on asthma in a library will show that breathing habits (i. e. techniques) which people may well be thinking about a lot of the time get no attention. A doc would have to gain experience on this from his patients before being any help here. In particular in the small town where I live there are many old men typically (and as far as possible discretely) making faces indicating that they are short of breath or trying to convince themselves that the are not short of it. They could be given some tips, without the asthma establishment (ALA etc.) objecting to this being CAM and decidedly inferior to taking patented or recently patented meds. What I meant about the didactic trick of thinking of the lungs as balloons in a bottle and drawing off air from it for inflation was that: a) like the one-time didactic method with railroad rail spacing (to prevent the rails squirming around in hot weather), the intention is now misunderstood. It was just to tell people about thermal expansion, not to dictate how tracks should be laid for coming ages. Pity really, think of jingles with the rail rhythm in them. b) Specifically, the balloon example is highly misleading about (i) the internal lung structures not being tethered (air filled balloon with no possibility of this) as you explain and (ii) such structures necessarily leading to non-isometric internal changes obviously relevant for the defective distribution of air in the lungs in asthma. Non-isometric changes in lung shape are produced by some breathing exercises, often involving diaphragmatic breathing. For Carl Sagan this would have meant a scientific uprating of exercises and a downrating of the apparently ideological belief in relievers and preventers which either by being symptomatics directly weaken breathing muscles or enable such atrophy to take place by permitting dysfunctional breathing with abrasion of the bronchi linings. Isn't obvious that this follows from Peper's finding (which you as a less qualified scientist - but possibly better qualified clinician - than P must accept) on diaphragmatic breathing stopping wheeze? You surmise that "Pressure will equalize as long as air can flow" would prohibit the possibility of airtrapping, and that . "No one sticks to a medication only model of asthma therapy" sounds encouraging. Proof? While I've gotten you on the line, I may drift off a bit: What do you think of bhastrika (my posting on yoga)? It seems to do just what is claimed for it. You breathe as forcefully and as quickly as possible thru the nose with maximum lung volume. Probably diaphragmatic breathing is necessary. Owing hyperventilation this would be unsuitable for brittle asthma. The assistance and objectivity of a doc would be necessaary. How about trying it out yourself? It more effective than a breath-hold and 100 times more healthy. What do you think of using exercise (latex) band around the waist to improve diaphragm strength? What do you think of stepsynchronized breathing (or "walking yoga") for an asthmatic to learn to keep breathing regular with longer exhales (like pursed lips breathing)? There is an entrainment effect making breathing control easier. Breathing is in any case dependent not only on the amount but also the type of exertion. Again, how about trying it out yourself (4 breaths inhale, a little more for an exhale)? Thanks for the trouble you are taking here, but all the same how about a little less rhetoric?. Regards, Richard Friedel > If Dr. Erik Peper (he has a Ph.D, not an MD) proves that diaphragmatic > breathing turns off wheeze, a symptom often seen as a reason for > starting a course of asthma drugs with all their likely side effects, > why is Peper's work on this not understood as legitimate, intelligent > scientific input by the asthma establishment? If he does prove it then it will be. > > If Dr. Erik Peper (he has a Ph.D, not an MD) proves that > diaphragmatic [quoted text clipped - 7 lines] > > If he does prove it then it will be. Very unlikely considering asthma medicine's record to date. Failing initial plausibility for "peers", to get started, a new approach will not be taken up and methodically tested in a way that also has to be peer approved., (see http://www.the-scientist.com/images/yr2001/oct29/peer.gif). This conservatism may be due to the attraction asthma has for quacks like "Doe" with his blood letting fantasies and B u t e y k o's dreams with CO2 as a panacea. How about giving a good example as a doc and trying out bhastrika? See posting on No. 1 yoga. For folks without cardiac disease or hypertension, it seems to be an extremely powerful way of getting rid of mucus and of opening up the bronchi like a spray. You breathe as energetically and rapidly as possible in and out thru the nose. In a way it resembles an attack of asthma but has a good effect, which is sort of logical for those who believe that nature is basically benevolent, i. e. an attack is a natural tactic which has somehow gone awry. You would then make it clear that medicine is not simply a narrow minded cult with sacred beliefs and taboos, but considers and scientifically comments on things like yoga which are often considered by the public. (I meant to imply that Peper has reasonalby made out his case.) Richard Friedel >Very unlikely considering asthma medicine's record to date. Failing >initial plausibility for "peers", to get started, a new approach [quoted text clipped - 4 lines] >"Doe" with his blood letting fantasies and B u t e y k o's dreams with >CO2 as a panacea. It is only unlikely because of the sheer amount of scientific data that supports the current model. The scientific model used to define asthma is changed with every new discovery made about its nature. If actual scientific evidence showing that your theory is a superior model for asthma is discovered then your model will be considered. -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >Very unlikely considering asthma medicine's record to date. Failing > >initial plausibility for "peers", to get started, a new approach [quoted text clipped - 11 lines] > If actual scientific evidence showing that your theory is a superior > model for asthma is discovered then your model will be considered. Well, I seem to be a bit more broad minded than you do. You stick to the primacy of preventers and relievers - in principle. The bubonic plague, black death, would be still with us or would have taken much longer to tackle if people had stuck to pure pharmacology. It was the fleas and rats that had to be discoverd as the culprits in spreading the disease. Richard Friedel >The bubonic plague, black death, would be still with us or would have >taken much longer to tackle if people had stuck to pure pharmacology. Actually it was the scientific method and the abandonment of pet medical theories in preference for ones that were proven that did this. -- "It's not American foreign policy, or the plight of the Palestinians, or America's longstanding support for Israel. A group of people with money and weaponry have simply decided that we, as a civilization, are unfit to live, and want, eventally, to exterminate us." 'Christian Century' magazine > >The bubonic plague, black death, would be still with us or would have > >taken much longer to tackle if people had stuck to pure pharmacology. > > Actually it was the scientific method ..... And more especially the proper assessment of medicines. Although masses of medicines were used in the past the first effective one was apparently quinine. The others used at the time quinine was discovered were, by present day standards, worse than useless. Their reputations were spurious and unscientific. You'd probably agree with me that many modern medicines also profit undeservedly from a spurious reputation, although they have passed scientific tests and thus kept to a minimum standard. The important thing is to see that long term outcomes are satisfactory (scientific), for exámple via this ng. BTW, how about your trying out bhastrika (yoga) as a a reasonably healthy asthmatic? See posting on it. It seems safe enough and is logical. Mucus is cleared and the peakflow value improves. Richard Friedel |
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