As far as life-long, high-maintenance medical conditions are concerned, I suppose that asthma isn’t the worst possible one to have. Jennifer and I watched ER last night and we both felt very sorry for the young boy who had had two heart transplants already and was facing a third, and who had been taking so many drugs throughout his life to treat his condition that his body was permanently altered by the side effects. He was essentially trapped within his own body, and I personally didn’t blame him at all for not wanting yet another heart transplant.

When I was younger, I was told that I was growing to grow out of my asthma. Most kids do. Adult-onset asthma is relatively rare in and of itself, and the number of people who don’t grow out of their asthma is relatively small. Obviously, I did not grow out of my asthma; throughout high school and college and into real life, asthma has been part of my existence. I suppose that even until recently, I had harbored the hope that my asthma would eventually go away, that I’d be able to live without the daily medications or the monthly visits to my pulmonologist or the occasional hospital stay. I had figured that a decent diet, along with some exercise, would help put it behind me.

But this week in the hospital, I realized that it simply isn’t going to be the case.

Sure, over time, my asthma may get better. But I will never be free of the medication. I will probably be taking something for my asthma every single day for the rest of my life, and probably more than once per day. There will always be pills, inhalers, nebulizers. At one point during the week, the respiratory therapist who delivered my breathing treatments told me that they may decide to send me home with portable oxygen.

It was that last part that really scared me, and really drove it home for me. I have nightmares about becoming one of those really old men who has to carry an oxygen tank wherever he goes… and apparently there is a possibility that it might come true. Even though my blood O2 levels never fell below 95%, which is excellent, I suppose there is always the possibility that my lungs — already scarred and damaged by over thirty years of asthmatic behavior — will someday lose their efficiency as oxygen derivers, and I’ll be forced to that step.

Asthma is kind of a scary disease. When you’re very young, and you don’t really understand what’s happening, it’s easy to panic and get scared when all you know is that you can’t breathe. And when you’re 33, it’s still easy to get scared when you’re trying hard to breathe but just can’t get the air to move. A really bad attack can be like breathing through one of those tiny straws that you use to stir coffee; one of those tiny straws that’s been bent so there’s even less flow. The tiny airways in your lungs get clogged; mucous builds up, tiny muscles contract, tissue swells. When you breathe, if you can, you hear wheezing, rasping, possibly gurgling. If you’re having a really bad attack, you turn cyanotic — you get so little oxygen flowing through your blood that your extremities, like your lips and your fingernails, turn blue. That’s only happened to me once that I can recall, and I was very young at the time. But it’s one of the questions that I am regularly asked when I go to a doctor with an asthma attack: are you cyanotic, are you turning blue?

So the medicines which they give you to control asthma if you’re a severe asthmatic basically treat the three effects of an asthma attack: beta-antagonist adrenalin derivatives (such as Albuterol) to control the muscle spasms (this makes sense; with more adrenalin in your body, your smooth muscles, like the ones which line your lungs, relax, allowing you to get more air into your body so that you can run faster from that lion); corticosteroids such as Pulmi-Cort or Azma-Cort to control the tissue swelling (mostly inhaled, sometimes orally administered, such as Prednisone — sometimes injected, like Salumedrol); and a host of other medications to control the mucous. Atrovent, I think, is supposed to help with that. And then there are a whole bunch of drugs that work, without any real good reason: Theophylline, for some reason, is a very effective medication for long-term treatment of asthma. The last time I asked my doctor how it works, he said something about adeno-triphosphate and how Theophylline seems to improve its efficacy in respiratory processes. I knew more or less what he was talking about; on the other hand, I also got the sense that he didn’t know much more than I did.

So now I’m on a whole new host of medications: more Prednisone than I’ve taken in nearly fifteen years, and heavy antibiotics — since an asthmatic’s lungs are prone to getting worse infections if one happens to settle in. What bothers me the most are, of course, the side effects: Prednisone has some well documented emotional side effects, and I’m finding myself irritable, cranky, and short-tempered. Combine that with the light-headedness that one of the antibiotics is causing, and you have yourself a Richard who’s pretty much useless right now (though I suppose some would argue that there really isn’t much of a difference). The only thing that’s good is that I know why it is I’m feeling cranky and irritable right now and so I can keep it in check.
And so here I am. With asthma. For the rest of my life. Asthma is on the rise, and the number of deaths due to asthma is increasing year by year (although I think that it ironically has to do with the increasing efficiency of the short-term medications that some asthmatics come to rely on instead of the long-term care that they really need). While my asthma isn’t nearly as bad as it was twenty years ago, it’s certainly not good. I would like it to be gone, of course. But it’s not going to. Like it or not, I’m stuck with it.