THE ROLE OF EMOTIONS IN CHILDREN WITH INTRACTABLE BRONCHIAL ASTHMA.

Abstract

Asthma in children is certainly broadly recognized as being immunologic in origin. However, despite the immunological origin of asthma, the treatment of the total child must include the feelings of the child. The feelings of the child are inextricably bound with the attitude of the parents toward the child’s disease and the child himself. Our research in the past ten years has disclosed that our original classification of asthmatic children into two groups-those responding and those not responding to specific hyposensitization therapy-is still valid. Our concern is with the children of the latter group, who are popularly referred to as having refractory or intractable asthma. The solution of problems connected with the treatment of the intractably asthmatic child has occupied me personally in one way or another for many years. A program of rehabilitation begun in 1930, and expanded in 1940, was found to be insufficient to meet the needs of the large population of asthmatic children. Continuous study of the intractably asthmatic child helped to assemble incontrovertible clinical facts, and thus some knowledge was accumulated; but knowledge alone, or even in association with clinical experience based upon the use of corticosteroids, has not given us the basic reasons for intractability of the affliction. However, the cloak of fiction that asthma was purely or initially psychogenic was removed. It was recognized that intractability was essentially a secondary or superimposed psychogenic application of a primary immunologic process. A child crippled with intractable asthma is defined as one who, living for at least one year in his own home environment, fails to respond to adequate and expertly administered conventional medical therapy which relieves 90 per cent of all children suffering from allergic bronchial asthma. Thus, about 10 per cent of all asthmatic children suffer from intractable asthma. Careful observations over a period of more than thirty years showed clearly that when a child with intractable asthma is removed from his own home environment, even during the pollen season, and placed in a residential convalescent asthma home, his asthma either disappears miraculously or is ameliorated for the duration of his separation from his own home. After varying periods of time of such separation, the child may often be returned to his own home without the recurrence of intractable asthma. Rehabilitation programs for such a child are real and rapid methods of therapy. This procedure has proven its value.