Your car develops a rattle.
You are worried about the rattle and want to know what is causing it.
You take your car to your mechanic.
Your mechanic listens to what you say and hears your car’s rattle.
Your mechanic then tells you that the trouble with your car is a “rattle.”
He charges you $100.
You get a new mechanic.
Rattle is not a diagnosis. It is a symptom. Something is causing your car to rattle and that something needs to be identified (diagnosed) in order to fix it.
Asthma is no more of a diagnosis than “rattle” is a diagnosis. I would ask that you allow me to repeat that concept. Asthma is not a diagnosis.
The nearly universal mistake that is made in dealing with asthma is considering asthma to be a diagnosis. Your recognition that “asthma” is not a diagnosis is the key first step in improving how you can deal with your child’s asthma.
To help clarify, “the common cold” is a diagnosis. “Bacterial pneumonia” is a diagnosis. But in contrast, “cough” is not a diagnosis. Lots of different diseases can cause cough. We want to seek what causes the cough. And the cause we find for the cough is the diagnosis. And just like cough, “asthma” is not a diagnosis.
Asthma is a reason to go looking for a cause for the asthma. Whatever is causing the asthma is the real “diagnosis.”
If asthma is not a diagnosis, what is it?
Asthma is a physiologic disturbance.
With asthma, something isn’t working correctly in your child’s windpipes, and this leads to a symptom complex that people call asthma. I’ll discuss this more in the next chapter. The physiologic disturbance that leads to the symptoms people call asthma can result from very different pathologic processes (meaning very different diagnoses—indeed entirely different diseases). And these diseases, although they cause nearly identical symptoms, often require entirely different therapies.
The common symptoms found in a child with asthma are various combinations of
- Shortness of breath
- Gurgling in the chest from accumulation of airway mucus
- Coughing up of mucus
- Anxiety/fear (from being short of breath)
- Inability to exercise during episodes
- Sometimes vomiting with coughing
- Tickling in the airway, under the chin, or in the front of the neck
Wheezing is the whistling of airflow through airways that are narrowed from any cause. Coughing results from the tickling of nerves in the airway, from any cause. Shortness of breath is known in the medical dictionary as dyspnea, and occurs in association with any disorder that causes insufficient oxygen and carbon dioxide exchange. Mucus production in the airways is a response to many lung conditions and injuries and infections. I can keep going, but the point is that the symptoms that occur in children with asthma overlap with the symptoms of all sorts of lung diseases.
If your child has these sorts of symptoms, it may be asthma (or may not be), and in any event, we want to seek what underlies the symptoms of asthma. What is causing the asthma? What is the diagnosis?
Asthma may be caused by any one of the following, or combinations of them:
- Anatomic abnormalities of the airways
- Autoimmune disorders
- Immunologic disturbances
- Aspiration of stomach or mouth contents into lung
- Food intolerances
- Allergies to stuff inhaled into the lung
- Tumors or masses in the lung
- Foreign objects inhaled into the airway
There are all these different causes for asthma—all these very different potential diagnoses for the diseases that cause someone to have asthma. Clearly, the optimal treatments for asthma are also going to be very different, and depend on the underlying diagnosis (in addition to the special characteristics of each child).
The medical system is now disinclined to focus on individual health, and instead is focused on group data and statistical mumbo jumbo such as “quality metrics” and “best practices,” none of which have any bearing on what’s best for your child. If the system continues in this direction, children will be medically managed as if they were all clones.
But your child is special, his asthma is special, and you have every right to want special thought given to your individual child.
If your child receives a “diagnosis” of “asthma,” this should immediately raise in your mind the very next question: “What is the cause of my child’s asthma?”
Asthma is not a specific disease, and it is not a diagnosis. It is a reason to search for a diagnosis.
YOUR CHILD’S ASTHMA is your child’s asthma. It needs to be diagnosed and treated in your child, very specifically, with care, thought, and love.
By reading YOUR CHILD’S ASTHMA, which may take you as little as a few hours, you will learn more than by sitting in a doctor’s office and waiting room a hundred times. And reading the book will help you avoid having to do most of that anxious and frustrating sitting, too. The book is designed to help you help your doctor, and for your doctor to help you.
Thank you for your time.
John Hunt, MD