The Philip Ellman lecture the carcadian rhythm of asthma
1985; Elsevier BV; Volume: 79; Linguagem: Inglês
10.1016/0007-0971(85)90020-8
ISSN1878-2426
Autores Tópico(s)Child and Adolescent Health
ResumoI am very honoured to deliver this named lecture and would like to pay particular tribute to Dr Philip Ellman. He was a remarkable man who managed to be master of two specialties as well as being an excellent physician. He was also a superb editor of the British Journal of Diseases of the Chest and this is one tenuous link I have with him as I have served for a number of years on the Editorial Board where his memory is still revered. My other link provides the basis for this lecture as one connection between joint and pulmonary diseases is a circadian rhythm of symptoms. I am sure Dr Ellman noted that many of his patients with rheumatoid arthritis complained of early morning joint stiffness and would have compared this with the early morning chest tightness of asthma. The purpose of this lecture is to discuss likely factors causing the early morning chest symptoms of asthma as they provide valuable information about asthma itself as well as useful information about both prognosis and therapy. Asthma has been known to be particularly troublesome at night for a very long time. One of the earliest references to it was by Moses Maimonides who was body physician to Saladin and looked after his son who had asthma. His recommendations for treatment were unfortunately rather punitive as he suggested that patients should sleep as little as possible and in addition he also advocated celibacy. Much of our more recent understanding of asthma stems from the work of Sir Thomas Willis who recognized and described nocturnal asthma which he attributed to the heat of the bed making the blood boil. He suggested avoiding the bed and sleeping in a chair. Sir John Floyer who was also active in the seventeenth century and himself suffered from asthma, gives a vivid account of nocturnal attacks; indeed he pointed out that his asthma was mainly manifest at night. He gave no helpful hints about treatment but did enjoy 12 years’ remission when he moved to the ‘clear air of Oxford’. Nearly two centuries later, a great Victorian physician, Salter, drew attention to asthma being most frequent between 2 and 6 a.m. and pointed out that pollen asthma ‘often affects a sort of diurnal rhythm being generally worse at night’. He also averred that asthma never kills, stating that he had never seen a case in which a paroxysm proved fatal: more of this later. Thus the circadian nature of asthma has been well known to clinicians for centuries but it is only comparatively recently that this important clinical
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