Breathing Lessons
Reviewed by LM Asta, MD
CONSUMER HEALTH INTERACTIVETaking Charge of Asthma: A Lifetime Strategy
By Betty B. Wray, MD
John Wiley and Sons Inc.
231 pp $14.94 
Asthma is often triggered by the most obscure of elements. This chronic disease can be set off by the pollen blowing around the yard, the dust that settles in the corners of your house, even the food that you consume. Now, patients and parents of children with asthma have the opportunity to uncover what brings on their symptoms in Taking Charge of Asthma: A Lifetime Strategy, by physician Betty B. Wray. Wray, a former president of the American College of Allergy, Asthma, and Immunology, has written this book to help the rising number of patients diagnosed with asthma control their symptoms and lead essentially normal lives. Breathing through a straw
It's a welcome book, because asthma can be a scary disease. People say that an asthma attack feels a lot like trying to breathe through a straw. During the attack, the muscles that surround the breathing tubes in the lung tighten, keeping air from getting in and out of the lungs. In addition, there's an alarming rate of severe and fatal cases of asthma, federal health officials report. According to the National Center for Health Statistics, in 2006 over 16 million adults and almost 7 million children had asthma. Children under 5 are especially vulnerable. But this book doesn't bury the reader in statistics and jargon. Wray encourages readers to take charge, and she shows them how to work with their doctors and find solutions on their own. Wray says identifying the allergens around you is critical. After making an appointment with a doctor, she advises patients and parents to keep an asthma journal to document the circumstances surrounding their breathing problems. She includes a thought-provoking list of questions to help readers pinpoint the time of day, the location, and the season when their breathing is most difficult. Wray writes about ferreting out the foods, plants, and other agents in your environment that could provoke an asthma attack. Guide to allergens
She makes it easier to write your journal by providing a guide to the regional flora and their peak pollen seasons, as well as an explanation of indoor allergens. People who suspect that certain foods aggravate their symptoms will find a sensible discussion on food allergies and a clear explanation of how to eliminate the dishes that trigger them. Wray also touches on the controversial theories (like the advent of insulated houses and children spending more time indoors) that attempt to explain the asthma epidemic. Insulated houses may save on heating bills, but they can also trap dust, mold, and other allergic triggers, and children who are cooped up inside them face continuous exposure. For example, some of my patients find themselves wheezing around substances like tobacco smoke, pollen, and animal dander at home, so I teach them how to reduce their exposure to these common triggers. In some cases, they can do so simply by not sleeping with the family pet or banishing smokers to the outdoors. If these new arrangements keep them well and out of the office, that suits me just fine. When you do see your or your child's doctor, bring along information gleaned from your asthma journal, notes on medications and instructions, and a list of questions to ask. The chapter called Working With Your Doctor will help readers compile these questions if they don't have them already. Wray also documents holistic approaches to asthma, as well as the emotional consequences of a condition that affects every waking breath. The chapter, Nourishing Your Mind, Body, and Spirit, takes a holistic approach to asthma management, advising patients to write about their feelings and experiences living with asthma. She urges readers to take responsibility for their own well-being by being aware of their emotions and nutrition. This chapter also covers complementary therapies for asthma, such as herbs, acupuncture, biofeedback, and chiropractic, but finds little research to support their complete effectiveness. Missing pieces
Despite its sound advice, this book has shortcomings. There are no illustrations that might clarify the difficult material in the anatomy and physiology of asthma and the disease's immunologic principles. A few simple line drawings, like those in One Minute Asthma by Thomas F. Plaut, MD (Pedipress, 1998), would help. And while Wray goes out of her way to include both drug and complementary therapies, she doesn't address the National Asthma Education and Prevention Program's (NAEPP) recommendations in its Guidelines for the Diagnosis and Management of Asthma. These guidelines, released in 1997 and updated in 2007, stress the importance of a step-by-step approach to managing asthma symptoms. This is a serious oversight. Asthma symptoms are classified as mild to severe and intermittent to persistent. Different medications are prescribed at each step as the symptoms become more frequent and severe. The author reproduces these steps in a table, but she fails to comment on the importance that the NAEPP placed on the appropriate use of anti-inflammatory medications to reduce symptoms. Indeed, her chapter on anti-inflammatory medications cautions, "Many of us remember all too well the successive waves of 'fashionable' medications that are at first greeted with enthusiasm and then prove to cause unforeseen problems." Here her clinical advice seems at odds with the NAEPP guidelines. Medical books, unfortunately, are out of date before they're even published, and this book is no exception. Since 1998, research has hinted at irreversible lung damage from underutilized anti-inflammatory medications, while other reports have provided reassuring data on the long-term use of inhaled steroids. Still, Taking Charge of Asthma provides a wealth of information for patients interested in understanding and pinpointing the causes of this condition, and managing them. Ideally, with this guide, they may need less medication. These are goals towards which both patient and doctor should work. -- LM Asta, MD, a board-certified pediatrician and a fellow of the American Academy of Pediatrics, is an assistant clinical professor of pediatrics at the University of California San Francisco School of Medicine. She practices in Walnut Creek, California.
Further Resources The National Asthma Education and Prevention Program (NAEPP) Guidelines for the Diagnosis and Management of Asthma http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.htm Asthma: Epidemic of a Chronic Disease, report from Donna E. Shalala, former secretary of the Department of Health and Human Services http://www.aspe.hhs.gov/sp/asthma/overview.htm#epidemic
Reviewed by C.E. McLaughlin, MD, a professor of sports medicine at the University of California at Berkeley.
Our reviewers are members of Consumer Health Interactive's medical advisory board.
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First published January 23, 2001
Last updated October 8, 2008
Copyright © 2001 Consumer Health Interactive
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