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Asthma is an Environmental Disease

I am having an asthma attack and I am thinking through my breathing.
Cynthia Hoffman

Issue #29, November 1996

It is 2:00 in the morning and I am awake. I am sitting in front of my computer, clicking the mouse on a red card and putting it onto a black card. I am playing solitaire and I am almost falling asleep sitting up and I am counting: one, two, three inhale; one, two, three, exhale; one, two, three inhale; one, two, three exhale.

I am having an asthma attack and I am thinking through my breathing.

I have had asthma all my life. No one knows why. I was born prematurely, but wasn't incubated so that might be the cause, but it might not. I have allergies to all things green, but that's only maybe the reason, although it certainly doesn't help. Whatever the true reason, my lungs do not work efficiently and every once in a while, that inefficiency keeps me up nights, thinking through my breathing.

And sometimes I wonder: in the time when I was born, doctors were delivering babies without arms because of thalidomide. I have cousins who are dealing with the second generation effects of DES on their own offspring, and I wonder. What difference does it make that my mother believed the advertising and didn't breast feed me? I mean, one thing they do know about asthma is that it's a disorder related to the immune system and the first liquid from breast milk is full of good stuff to bolster a child's immune system. Of course, I'm actually so allergic to milk that a doctor once joked that I probably would have been allergic to my mother's milk as well.

It is 2:15 in the morning and I am playing solitaire. I am bored and I am yawning, but I am still counting: one, two, three inhale; one, two, three exhale; one, two, three inhale; one, two, three exhale. Maybe I'll switch to Chip's Challenge.

When I was a child, there were few drugs available that prevented asthma attacks. If I had an asthma problem, it was usually fixed after it had appeared rather than beforehand. I'm lucky I don't have a problem with needles.

Allergy shots, twice a week and the occasional adrenaline shot in the ass kept me breathing through childhood. That's 4 shots, twice a week and the occasional adrenaline shot to get my lungs going again. Adrenaline is an interesting drug and one I rather like the feeling of when I get it because my body produces it naturally. When I get shot full of artificial adrenaline, though, I have a tendency to pass out cold just because I stand up too quickly.

Then, along came Marax, the asthma wonder drug of the 1970s. No wonder I have an aversion to throwing up.

It is 2:30 in the morning and I am reading email and yawning and forcing myself to stay awake. I have taken Proventil and Theo-dur and I have upped my dosage of both for the evening. I am tired, but I am jittery; I am coughing and I am debating getting a rush of adrenaline by forcing myself to throw up. I am playing more solitaire, this time it's King's in the Corners and I am counting: one, two, three inhale COUGH; one, two, three exhale, WHEEZE. But I am breathing and I am shaking and I am crying, but I am breathing.

My partner is lying quietly in bed, but I rather doubt she's sleeping through this. I hate living this way. But at least I am breathing.

I was a child in the Central Valley of California and I was allergic to everything. When other kids went camping, I stayed home; when other kids ran track, I watched. My life was proscribed by Dimetane, Dimetapp and Benadryl. I knew my allergist by name and I knew I was allergic to cats, dogs, grass, trees and dust. I was allergic to detergent and hand lotions and milk and strawberries.

When I was a teenager, I discovered winter sports and I learned how to ski. It was an amazing gift: nature that was safe for me to interact with because it was so cold there was no pollen or spore danger. I skied in the California Sierras every weekend I could for years and years and years. I loved the rush and I loved the speed and I loved the snow.

I looked forward to the first snow of the season and I have wonderful memories of skiing Mammoth on July 4 one year. I followed the trail of Greyhound busses up the Donner Summit; I saw Lake Tahoe and Yosemite Valley for the first times and I fell in love. I kept the new inhaler in my jacket pocket, but I don't recall ever needing it when I was in playing in the snow. I felt free.

It is 2:45 in the morning and I am counting and I am breathing and I am playing Chip's Challenge. Chip is running and sliding and swimming and playing and picking up computer chips and solving puzzles and generally doing all of the things I can't. But I am counting as he picks up chips: one, two, three inhale; one, two, three exhale; one, two, three inhale; one, two, three exhale. Chip has reached level 27, and I am still breathing.

When I was sixteen years old, I spent months in Israel working on a kibbutz, climbing hills and camping in the Sinai. I was in great shape, could hike for miles and one day, with a group of friends, I climbed Masada to watch the sun rise over the Dead Sea. And I had an asthma attack.

I reached the top and passed out. Because of where I was, I had no recourse to technology and had to figure out how to breathe on my own, without an adrenaline shot or one of those newly invented inhalers I'd left back at camp. I counted and I breathed; and I watched the sun rise and I swore I'd never have another asthma attack again as long as I lived.

I didn't have another one for almost 15 years.

It is 3:00 in the morning and Chip has reached level 42 and I am still counting and breathing and yawning. I am tired of Chip, however, and return to solitaire and reading the occasional e-mail. At least in Australia, it's tomorrow.

One, two, three inhale; one, two, three exhale. I am still breathing.

I keep remembering all those romantic poets who died romantic deaths of TB. I'm here to tell you that there's nothing romantic about losing lung capacity. All those poets and artists moved to the desert or to a spa to take a cure. I moved to the Bay Area from the Central Valley of California.

For the first time in my life, my life wasn't proscribed by antihistamines, decongestants and my proximity to an emergency room. That was 1978 and the air here was clear, a little moist and I was alive again. I went hiking and camping for the first time since Israel and I loved the Berkeley Hills in the rain.

It is 3:15 in the morning. I am playing solitaire and I am counting and I am breathing. I have avoided throwing up, but I am still wheezing, and I am playing Klondike and I am cheating because Windows lets me. When I count to three, I can inhale and when I count to three again, I can exhale. But I am wheezing and I cannot let myself fall asleep.

I switch games and I am now playing La Nivernaise. I want to go to sleep. I go to the phone and call the office answering machine and tell them I am sick.

In 1989, after a few years back in the Central Valley, where I have been introduced to Alupent and nebulizers because a friend needed them on a daily basis, I returned to the Bay Area. The air is no longer clean and moist. California is in the midst of a drought and the pollen level has increased. I am no longer safe. The earth moves and I have other concerns for a while. I get two kittens.

It is 3:30 in the morning and I am starting to relax. I am breathing better and I am pleased with that. The drugs have kicked in, and I am no longer shaking and wheezing. I begin to consider sleeping, but return to Chip's Challenge instead. Chip has reached level 47 and is sliding on ice wearing ice skates. I continue to count, but I am concentrating less hard.

Inhaling is no longer a matter of thinking it through.

In 1991, after years of colds that became bronchitis because my lungs just weren't up to snuff, I came down with pneumonia. The asthma, which had been gone since that 1976 trip up Masada, returned with a vengeance. Technology, which has created a polluted and almost unlivable world in a place that used to be safe, has also created new drugs: inhalable steroids and super drugs that have replaced Marax and nebulizers that pump drugs directly into my lung sacs and open them for me when I can't talk them into opening themselves.

I hate steroids because they make my skin erupt, but I take them when they're prescribed because they help make my lungs work.

The kittens have become cats and I keep them against doctor's orders. I have, however, quit smoking.

And I begin taking drugs on a daily basis again. And I discover that they still don't know much about asthma. Each time I see another doctor, I get told something new.

I keep the drugs to a minimum and I live my life as best I can.

It is 4:00 in the morning, and I am breathing almost normally. I am playing Tetris, and my wrists are aching. I consider turning off the computer and going to bed.

I am no longer counting and I am no longer wheezing. The shapes on the computer screen are melting into one another.

I have stopped taking antihistamines and I have weaned myself off all but the most emergency of steroids. Even though I can still hike sometimes, and I can walk for miles, I discovered last year that I can no longer ski because I can't breathe in the cold anymore. I am angry and I am sad, but I am alive.

I understand that I make environmental choices every day. I choose to drive a car and therefore must accept that in a very tangible way, I contribute to the pollution in the air that I breathe. But as I look out my office window toward the Oakland Hills, I see a green haze that wasn't there 15 years ago and I wonder about my lungs and what it will take to keep them working through the next 15 years.

When I was a child in the 1960s, my parents believed in technology and they raised me to believe in it too. As I have grown up, I have debated what believing in technology means and I refused to be a slave to it. But I am connected to it by my lungs, which periodically refuse to operate without help, in a world where that help is intimately tied to the very things which create the problem.

It is 4:15 in the morning. I am breathing without thinking for the first time in 6 hours. I turn off the computer and I prepare for bed.

I crawl into bed and my partner rolls over and goes to sleep. She has never been through this with me before, although she has been warned. I know that this is just one more night among many in the past, and many more to come.

But I am breathing easily again. So I fall asleep.

Cynthia Hoffman was once told by her doctor that it was the cigarettes or the cats. The cats are fine, thank you very much. But she still misses smoking. She can be reached via the internet at