Asthma is a chronic illness. It’s described as treatable by doctors. Unfortunately, because of the advances in pharmaceuticals, the medical profession has stopped caring what factors exacerbate flare-ups or what causes it in the first place.

The only period of my life when I was able to go completely off the meds since they were released around the time I was 10, was when I was biking several miles a day and was in peak cardio-vascular condition. The regimen required that I exercise for long sessions, get out of breath, take short breaks to focus on exhalation, have albuterol handy for just in case, and that I not even take one day off. I was still smoking at the time, no shit. One albuterol inhaler would last 6 months.

Compare that to my current baseline which is one inhaler every month plus breathing treatments on top of that, multiple courses of prednisone each year, and doctors who guilt trip me for not having my asthma “well-controlled.” Every pulmonologist, every specialist say the same thing, use the inhaled steroids, there are no side effects and your flare-ups will disappear. I’m close to 40 years old, asmacort and flovent appear on my prescription history starting whenever they were released. My flare-ups didn’t disappear, I just got more colds, and the prednisone didn’t work as well when I needed it. Inhaled steroids depress the immune system, asthmatics have a nasty tendency to die from head colds that turn into bronchitis which then escalates to pneumonia, all because the immune system is compromised in the entire respiratory system. An attack of asthma is similar to a histamine response for example. The bronchial passages inflame, swell, clog, and spasm in response to changes in the body. Exercise or exertion can cause bronchial spasms so severe as cause sudden death.

I was warned that my asthma may get worse. No one could really offer a prognosis. I assume because the causes of asthma are not well understood so the course of the disease is similarly chalked up to the unknown as well. Children with asthma are assured that there is an excellent chance they will grow out of the disease by the time they become an adult. I imagine that excellent chance becomes smaller as asthma rates among children and adults continue to increase from year to year. So, if you don’t grow out of it, you have adult asthma until you die probably. It might get better, might get worse.

So after the hospital entubated me for 2 days when I was in my 20s, a specialist told me that I should be prepared for things to get worse. The only advice she could offer to go along with this vague warning, was don’t stop taking the meds, don’t run out of the meds, keep extras stashed around in case of emergency, and come to a doctor immediately when the meds stop working.

I find this dependence on pharmaceuticals distasteful. I also find it financially crippling, embarrassing, stigmatizing, and fucking debilitating. Why don’t doctors know more about asthma? Why don’t they bother to differentiate between the different types? And why doesn’t anyone in pulmonolgy put any thought or effort into diagnosing what’s causing the flare-ups?

I just had a bad couple of days from breathing diesel fumes down in West Oakland. I’m bummed that air pollution is so invisible to most people because it is such a silent killer. On the other hand, I would hate for asthma to become more widespread just so people would be aware of how serious and degenerative the effects of pollution have become.


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