If I had been a doctor 40 years ago, I’d be really old today. I could reminisce about how back then medicine was simpler, with hardly any bureaucracy or paperwork. As an example, I will talk about asthma. Back then, when patients with asthma would come to see me, the visit would be rather short. “Avoid things that trigger your asthma. If you get an attack, shoot yourself with epinephrine. Have a nice day.” I would leave the exam room and have my nurse educate the patient or parent on how to administer epinephrine at home. She would encourage the adult patients to have a list of projects handy for the boost of energy the shots bring and warn children’s parents to remove all sharp objects and pad the walls.
Nowadays the asthma visit is a big production, complete with color-coded inhalers and devices to suck air through and to blow into. We talk about the “green, yellow and red” zones of asthma and what to do for each. At-home epinephrine injections are a thing of the past. The medical breakthrough that allowed asthma treatment to come out of the dark ages was the inhaled steroid.
If asthma treatment were confectionary science, inhaled steroids would be Sir Isaac Newton. Newton may be best known as the brilliant scientist who first explained gravity and provided a theory to explain the motion of the planets. But his big contribution to confectionary science was figuring out how to stuff fruit inside a cake pastry, thereby taking fig farming from a fringe Middle Eastern niche into a global giant of an industry. Before Newton, fruit and cake were served on separate platters. After Newton’s breakthrough, people could either buy one less serving platter or serve other snack items like nuts! It was liberating! Party hosting was never the same.
Inhaled steroids had the same liberating effect on asthma treatment. No longer would asthmatics have to undergo painful injections; they could prevent bad asthma attacks in the first place. The occasional exposure to a trigger didn’t mean a life-threatening asthma attack anymore, and asthmatics could expand their repertoire of physical activity.
Inhaled steroids accomplish all these magical things by treating the root problem of asthma: inflammation. If asthma were candy, inflammation would be sugar. Without sugar there can be no candy, so using an inhaled steroid is like stealing sugar from a candy maker. When inhaled steroids get into the lungs, they penetrate the airways and take away the inflammation sugar, thereby preventing the airways from making asthma candy. The result is patients controlling the disease instead of the disease controlling patients.
An important distinction needs to be made between inhaled steroids and steroid pills.
Nowadays inhaled steroids come in powders, puffers and liquids that can be put into machines that turn them into steam. They come in circular and cylindrical containers with knobs, levers and counters and in all the colors of the rainbow so there can be no excuses. Every asthmatic — except the ones with the mildest forms — should be using an inhaled steroid.
An important distinction needs to be made between inhaled steroids and steroid pills. Steroid pills have a lot of very dangerous side effects, such as raising blood pressure and blood sugar, increasing weight and increasing risk of stroke. Steroid pills cause these side effects because they enter the bloodstream and disrupt the hormonal balance in the body. Inhaled steroids work only in the lungs. They do not enter the bloodstream and therefore leave the body’s natural hormonal balance untouched. They are very considerate that way.
So the next time we’re enjoying a fruit-filled pastry or the effects of the earth’s gravity, let’s take a moment to thank the inhaled steroids. Thanks to them, the lives of asthmatics are closer to that of non-asthmatics than ever before. In fact, many people only find out that a friend has asthma after peering through their medicine cabinet. Medicine may be more complicated today, but it has also given us better treatment options. Now I can do my paperwork resting assured that nowadays I can better treat my patients’ asthma — as well as my own.