Hippocrates (469-399BC) 'The Father of Medicine', mentioned asthma and skin diseases two and a half thousand years ago in his famous account of ‘Airs, Waters, Places’. He suggested that a humid area would induce certain diseases in the population:
Doctors had to wait over two thousand years before they could see an image of the animal that was probably the cause of these diseases: the tiny house dust mite.
Hope for Asthma
Approximately forty years ago three medical events came together to promise real benefits for people with asthma. First, house dust mite droppings were identified as a major cause of asthma with public education and mite avoidance recommended 1. Second, the invention of the modern measured-dose inhaler for drugs, including steroids, to ease symptoms 2. Third, the knowledge that there were two different types of asthma: steroid-responsive (mainly allergic) and steroid-resistant (chronic bronchitis) 3, 4. By combining these three events in asthma diagnosis and management the promise of real benefits could be realized, but this was not to be.
Hope for Asthma Dashed
In 1992, a group of 39 doctors and medical opinion leaders, many of whom had been researching house dust mite-related asthma, met and decided that the importance of the house dust mite’s role in asthma should be reduced or ignored 5, 6, 7, 8. Instead they recommended the use of medication, including steroids ‘as the drug of choice’ for all asthmatics.
In doing this the doctors failed steroid-resistant asthmatic patients who were getting little benefit from their medication and were probably ignorant to the cause of their symptoms. The doctors’ message went out as the newly created British Thoracic Society (BTS) Guidelines on the Management of Asthma and distributed to family doctors and nurses in the NHS 9. New drugs were vigorously promoted by an army of marketing representatives offering to educate practitioners regarding their company’s products 10. The consequence was that drug remedies were prioritized to the detriment of allergen education, recognition and avoidance 11.
The skewing of asthma management towards drug reliance is unacceptable and must be corrected by doctors and governments in the interest of public health. Excessive exposure to digestive enzymes packed into house dust mite droppings can be harmful for a large population of asthmatic patients. This is not new information 13.
Man has waited over two and a half thousand years to understand and avoid a major cause of asthma: the house dust mite. How much longer do we have to wait before medical opinion leaders place allergen education, recognition and avoidance before drug promotion?
What would Hippocrates say?
"Shame – not in my name"
Nell Nockles
July 1st 2019 ©