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Sudden epidemics and sex-linked prevalence? One illustration

December 18, 2010

Spending the morning wheezing and coughing reminded me of this topic.

I have asthma, which is also considered an epidemic. I’ve been wheezy and prone to horrible coughing fits pretty much all my life. It’s not the more easily missed cough variant asthma, since I do get obvious wheezing and shortness of breath. This is a problem at other times, but it’s really evident when I get colds or flu. I’ve been lucky so far this winter with that. *crosses fingers*

Pretty much every time I come down with a cold, I spend several weeks sounding like I’ve got a cross between croup and whooping cough, with serious trouble sleeping and eating. It turns into a vicious circle, with postnasal drip starting me coughing, then the airways constricting from that irritation and causing more wheezing and coughing and gasping for air; that inflammation and irritation, in turn, seems to create a lot more snottiness–probably going overboard trying to wash away irritants–to the point that it’s hard to clear the airways and I start gagging and coughing more to avoid drowning. And so on. Yeah, it’s rather nasty-sounding! When that pattern sets in, I have to try to sleep sitting up, end up with head-to-toe pain from strained muscles, used to be afraid I’d broken ribs–and have passed out many times from just not being able to breathe. These days I’ve figured out ways of getting in more food (eating cold stuff helps), but I used to lose a lot of weight every time this happened. Cough suppressants have never worked well for it, at all. This was a problem through most of the winter, every year, when I was in school (and was frequently treated as purposely disruptive there *headdesk*). It’s hard to do much in that state, besides its just being pretty miserable.

Unlike a friend who kept getting real chest infections put off on asthma/who knows what and left untreated, doctors kept assuming that the only way I could possibly have such a hellacious cough was if I had some kind of chest infection. (A huge rib cage and about twice the average lung capacity probably helps it sound scarier to people who aren’t used to that, too. People not-so-subtly edge away from me when I get started in public here in mostly-more-gracile Greater London, maybe concerned about treatment-resistant TB!) And if you’re getting more postnasal deluge than drip, the cough can look productive when it’s really dry. At least a couple of winters, I’m sure in retrospect that my sinuses developed their own strains of antibiotic-resistant infections, from staying on escalating series of antibiotics pretty much all winter. I’ve been a lot healthier since I just stopped going to the doctor unless I’m pretty sure I’ve got a real chest infection, which has only happened twice in better than ten years.

Still, even with all the whooping and gasping and wheezing, nobody thought asthma–much less tried giving me a rescue inhaler–until I was 14 or 15, ca. 1990, and a relatively young new doctor had taken over the practice we were using. Even though a huge fuss was made over my allergies years before that, and I kept getting “asthmatic bronchitis” written on my chart, it apparently never occurred to anyone that this might be asthma. Apparently it was perceived as a rarer condition, which mostly showed up through wheezing and inability to get enough air–rather than whooping and gasping to get more–with the same symptom profile all the time, in everyone. Also, it was perceived as mostly affecting boys.

My mom didn’t get diagnosed until a couple of months before I did, at past 40. She did the exact same thing; most of that allergy-prone side of the family did/does spend the winter hacking and wheezing, for as long as anyone can remember. (Which makes it less distressing when another kid does it.) Through a combination of getting dismissed at home and doctors assuming that it was a boy’s condition which always manifested in the same ways, my uncle kept getting put in the hospital with asthma attacks while she got told to stop being such a drama queen. Finally, that doctor thought “gee, that doesn’t sound good; let’s see if a rescue inhaler helps, here and now”–and it did, remarkably so.

I’ve also noticed that my asthma has gotten taken a lot more seriously the past ten years or so. (It’s untreated other than antihistamines now for other reasons; my last inhaler is empty.) They’re recognizing more now that the straightforward cough-variant asthma (and other symptom profiles) is, indeed, asthma, and a serious problem benefiting from treatment. The last time my mom insisted I go in to the doctor’s with cold-related “bronchitis” when I was back in the US a few years ago, they got concerned at the way I was sounding, so decided to check my blood oxygenation and peak flow rate for the first time ever. I wasn’t actually feeling any worse than usual with that–didn’t even think I was that sick to begin with–and thought it was a bit unnecessary, but the results made them freak to the point that they wouldn’t let me leave and climb behind the wheel of a car until I had an albuterol nebulizer treatment. Which did, indeed, leave me far better able to breathe! They also sent me home with two different kinds of inhalers (rescue and anti-inflammatory) and some Singulair–which I wish I had more of now for regular use, as much as it helped. Always, before that, I’d just gotten “take some antihistamines and decongestants, and use the rescue inhaler as needed”.

Then there are some of the points I made about diagnostic concerns with celiac and other forms of gluten sensitivity a while back. My own “just ate four bags of Olestra-fried chips” symptoms kept getting put off on (a) generic allergies, which was at least close to the truth, and (b) our nebulous old friends, Stress, Anxiety, and Depression. (Though, indeed, that can create some anxiety, when you have no idea when those symptoms will kick in while you’re trying to go about your business! Very much like hardly being able to sleep or eat for weeks at a time from asthma can make you pretty depressed.)

The point here? Not to whine about my asthma, but that what looks like an epidemic–not to mention reported prevalence rates among different groups of people–can depend very much on what you’re thinking to look for in the first place, and how people’s symptoms get interpreted and treated. I would suspect that increasing pollution, chronic stress, etc. might really be causing more cases of asthma which need more aggressive treatment, but it’s really hard to tell what’s going on. The benefit of fewer assumptions starting in doesn’t just apply to asthma. In some other cases, it’s really not clear that increases in recognition and diagnosis aren’t creating the whole “epidemic”.

I am reminded of a few recent posts from Left Brain/Right Brain: Health inequity in children and youth with chronic health conditions (could also apply to gender), Another example of misdiagnosed autistic adults (from an ethnic minority, to boot), and Girls less likely to be diagnosed with autism than boys. There’s a lot more on similar themes elsewhere (just try searching on something like “diagnosis girls autism asperger”, for the gender component), but I read those recently and they popped into mind.

See also Stephen Dufrechou’s recent How Our Brains Threaten Democracy: The Logic Behind Self-Delusion–which does not just apply to politics. Humans are remarkably good at cognitive bias, in general.

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