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RI FED: Asthma - John C. Kirk

Dec. 3rd, 2010

11:25 pm - RI FED: Asthma

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Each year, the Royal Institution do a set of Christmas lectures: these are presented to a live audience, then broadcast on TV later. They're aimed at children, but I've found some of them quite interesting as an adult, and I've felt a bit jealous of some of the bored kids who are squandering the opportunity to be there in person.

The RI also run several other events during the year, and most of these are open to the general public. Back in 2006, I went along to a lecture about consciousness and anaesthesia. I enjoyed it, but it was the only event I attended that year, so I let my membership lapse.

Last week I went along to a lecture about Treatment of asthma through the ages. This was one of their Friday Evening Discourses, which are only open to members and their guests, so I had to rejoin in order to attend, but it was definitely worthwhile.

According to the website: "If you haven't been before, you should bear in mind that FEDs are by tradition formal occasions, and while evening dress is not obligatory, it is customary. Smart dress is acceptable." This was a bit ambiguous, and I wondered whether black tie (DJ) would be smart enough, or whether they expected white tie (tails). However, since I don't have white tie stuff, I just wore black tie and hoped for the best.

When I was younger, I was quite vigorously opposed to any kind of dress codes, particularly the idea of wearing a suit and tie to work. As an undergrad in Durham, most people wore jeans, which makes sense: they're cheap, comfortable, tough, and easy to clean (none of which can be said for a suit). This applied to lecturers as well as students, and people still took them seriously because we respected their knowledge. Having said all that, I also have to admit that it's quite fun to dress up every now and then. Besides which, I am reliably informed that bow ties are cool! I have a real bow tie, but it's been a couple of years since I last tied it, and 5 minutes in front of a computer didn't yield brilliant results; fortunately one of my work colleagues took pity on me, and retied it for me so that it actually resembled a bow.

As it turned out, about half of the men in the audience (and the speaker) were wearing black tie. Other men either wore suits or "smart casual" clothes (and a few youngsters wore school uniform), so the RI didn't have bouncers enforcing a rigorous dress code. As for the women, I didn't see any ballgowns; a few wore dresses, but most wore stuff that would suit an office environment. I think that as long as you don't turn up in jeans/T-shirt and trainers, you'll be fine.

The lecture started at 20:00, but they asked everyone to be seated by 19:45. While we were waiting, they had projectors showing the speaker's name and university. This led to an interesting effect (apparently traditional): the speaker came in just before 20:00, then started speaking on the dot, without any introduction. That makes a nice change from some other events I've been to, where people waffle on for ages at the start. The talk lasted an hour, then he took questions from the audience, and I was impressed by the calibre of these. At the Turing lectures, for instance, lots of people ask long rambling questions which mainly seem phrased to show off how smart the questioner is. Not all the questions are like that, but I can see why some people make a swift exit as soon as the main event is over. By contrast, most of the questions at the RI talk were short and relevant.

After the talk, I filled out a short survey form. This included one question about my background, i.e. why I'd attended the event:



A couple of my friends have asthma, but it doesn't directly affect me. I'm also not doing any research in this field; my professional interest only extends as far as St John Ambulance (I'm teaching a class night on asthma next week). So, this left an interesting question: am I a scientist? There is some debate about whether computer science is a science at all, but I think it is. So, I have science degrees, and I work for a research organisation, but I don't really think of myself as a scientist, so I ticked the "General interest" box. I did try some garage band science a few years ago, but I haven't spent much time on that. (Also, as susannahf pointed out yesterday, I don't always adhere rigorously to scientific standards.)

More generally, this makes me think about my academic aspirations. I really enjoyed my time at university, and I always intended to do a PhD in due course, although that seems less likely as time passes. In my BSc and MSc I did far better with the exams than the projects, so I'm not sure whether I'm suited to a research degree. My main problem was that I got distracted too much. Part of this was "real life" stuff, e.g. working part-time and sorting out the building work in my flat. However, another issue was that I'd study irrelevant stuff, e.g. I read the "Science of Discworld" books during my MSc and thought "Wow, I'm learning all this new stuff, so that counts as work." The learning is what I enjoyed the most about both degrees, and I was taught by people who literally "wrote the book" on some of the topics (e.g. algorithmic graph theory). So, this comes back to the RI: I can go along and learn about new topics, and since it's my free time I don't have to justify the relevance (or cost) to anyone else.

Mind you, I think relevance can be a trap. The speaker mentioned that he was talking to someone at a wedding 10 years ago who is mainly famous for discovering 7 different species of starfish. However, it turned out that they were both working on the same molecules, and the stuff that's on the outside of starfish (to stop barnacles sticking to them) could also be useful to treat asthma (to stop mucus sticking to the lining of the airway). That was a chance meeting that led to them doing a joint research project at work, and if I'm aware of developments in other fields then it may help me in IT. It also fits in with the "renaissance man" ideal, and it avoids the embarrassment of a medical researcher reinventing calculus (thanks to shuripentu for the link).

Coming back to the asthma talk, the topic was "treatment through the ages", so he started out with some bizarre treatments from Ye Olde Days (e.g. crocodile poo). This was amusing, and a nice hook to advertise the talk, but not particularly substantial. So, he mainly focussed on treatments from the past 100 years. For instance, an early treatment involved injecting people with epinephrine (aka adrenaline), in order to ease constriction of the air passages. However, this had the side-effect of raising the patient's pulse and blood pressure, which isn't desirable when they're already panicking about not being able to breathe properly. Since then, researchers have been trying to get more specific about the effects of their drugs, e.g. beta antagonists. As a side note, apparently the person who's made the major breakthroughs in asthma medication (whose name I've forgotten) has also been working on migraine treatments, so some people should be double grateful to him.

The most interesting thing I learnt is that there are two main symptoms of asthma. I'm familiar with airways constricting, but the other issue (new to me) is that mucus builds up on the lining of the airways. He showed a photo of a cross-section of a lung (from someone who died of an asthma attack), and the spaces that should have been storing air were almost completely full of mucus.

The speaker also mentioned the "hygiene hypothesis" - this means that you can strengthen your immune system by exposure to dirt, rather than staying in a sterile environment. As a related issue, he said that people used to dry their clothes outside, whereas nowadays most people use tumble-dryers: this means that the clothes get charged with static electricity, so they act as dust magnets when they come out of the dryer, which can then trigger an asthma attack. (I drip-dry my clothes inside, and I assume that's as good as leaving them outside.)

In general, I think that the RI lectures are aimed at a lay audience, i.e. you don't need to know much about the particular subject already. That said, I think that I benefitted from my past experience (SJA and clinical drug trials).

Anyway, all in all it was a good evening, and I'm glad I went. The RI haven't posted their event calendar for next year yet, but I think it should be out very soon, so let me know if you'd like a guest pass to any of the other FEDs.

Comments:

[User Picture]
From:sammoore
Date:December 7th, 2010 11:41 am (UTC)
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The most interesting thing I learnt is that there are two main symptoms of asthma. I'm familiar with airways constricting, but the other issue (new to me) is that mucus builds up on the lining of the airways

Just a thought, as a first aider, mucus building up on the lung is not a symptom. You cannot observe it directly (and if you are I'd say they Asthma was the least of their problems).

I don't do anywhere near much first as you but I strongly believe that of I can't do anything about a problem, I don't really need to know about it.

Sam
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[User Picture]
From:johnckirk
Date:December 7th, 2010 12:40 pm (UTC)
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Within SJA, we refer to "signs and symptoms", which are related but distinct. Signs are things that I can detect myself, e.g. bleeding or high blood pressure. Symptoms are things that the casualty needs to tell me about, e.g. a headache. The mucus doesn't really fall into either category, but I'm not sure about the best term to describe it.

As for first aid treatment, you're right that this is basically irrelevant to me, but I'm interested to know what's going on inside. Also, when you read through the first aid manual, it can be tricky to remember whether Condition X gives a fast or slow pulse. If I understand why the body reacts that way, it's easier to remember.
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[User Picture]
From:sammoore
Date:December 7th, 2010 01:13 pm (UTC)
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>Signs are things that I can detect myself, e.g. bleeding
>or high blood pressure. Symptoms are things that the
>casualty needs to tell me about,

That's a pretty useful distinction. Noted for future reference.

>If I understand why the body reacts that way, it's easier to remember.

I totally agree with this. I've just spent the last two days on a Rescue and Emergency Care course (1st aid when help is 8 hours not 8 minutes away is how it's sold). I have now got a handful of laminated cards in my 1st aid kit with reminders of the things that I might not need instantly (ABC, etc) but things that might be possible over a longer time (DE and SAMPLE, etc). You can read a lot of stuff in 8 hours if you need too :-)

Sam
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From:susannahf
Date:December 7th, 2010 04:55 pm (UTC)
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Laminated cards are very useful. Some things may not be practical to remember, but very useful in certain circumstances (e.g. normal heart/breathing rates in kiddies). Looking stuff up can also a) make you look competent/professional, and b) give you thinking time ;)

The best thing about primary and secondary surveys, and using a stethoscope, is that people shut up and leave you alone, giving you time to figure out what the hell to do next ;)
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From:susannahf
Date:December 7th, 2010 04:52 pm (UTC)
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There are some things you can do about both (and they are different).

Airways constricting: remove things that will cause further constriction (stress, very tight collars, cold air, allergens), provide things that will reverse constriction (bronchodilators FTW! - blue inhalers for the non-techies)

Mucus build-up: postural drainage (although I wouldn't advise this in an acute attack, it can be useful in long-term treatment), physiotherapy (ditto), encourage (maybe? certainly don't discourage) coughing, suction, humidification (doesn't remove mucus per se but can "soften" it, making it easier for the natural cough reflex and cillae to remove)

Realistically, most of these are long-term treatments, or only suitable for use in severe cases or in hospital, but it's worth thinking about. E.g. if you have a choice of cold dry air, or warm wet air, warm and wet is likely to be more asthma-friendly, although sharp transitions can lead to bronchoconstriction...
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From:sammoore
Date:December 8th, 2010 02:01 pm (UTC)
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Interesting stuff.

Mu approach to first aid (and although I train every two years or so, I use it only every few months and 'serious' issues every few years) is that I have a limited amount of brain space to remember stuff and that it will fade unless it is very simple.

So the stuff I try and remember is the really important stuff, or systemic stuff I can work out from first principles (DR ABCDE, etc). I can look up SAMPLE or the meanings of different pulses at my leisure, along with radio protocol or what various flares mean, etc
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