IS THERE AN INTRINSIC ASTHMA?

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Abstract
Asthma has been classified as extrinsic and intrinsic according to whether causative agents enter the system from without or arise within the organism. In addition, some have described a syndrome of intrinsic asthma characterized by such clinical features as age of onset at 40 or above, negative skin reactions, progressive course and intractability to therapy. To determine whether or not such a syndrome exists and whether a distinction between extrinsic and intrinsic asthma should be made on the above basis, 323 individuals were selected from a total of 1,442 asthmatic patients. They had perennial, continuous wheezing and had been under observation sufficiently long to permit a proper evaluation of their conditions. Among those excluded were cases with asthmatic wheezing which might easily have been interpreted as allergic asthma of the "intrinsic" type. In 7 of the 323 patients, the disease progressed and 5 additional ones died. In none of these could the above described syndrome be identified. In 3 cases, no clues as to the origin of the attacks could be detected. In each one the pattern of the attacks appeared different and it is impossible to group them under the common heading of "intrinsic asthma." Intrinsic causes were definitely responsible for attacks in a large number of the 323 patients. Among these the most important ones were sensitivity to cold, to endocrine products (premenstrual aggravation!) and bacterial infections. Psychogenic factors, products of digestion, or such physiological fluids as insulin, liver extract, colostrum may or may not play a part. In no case were such intrinsic factors found to be the only causes to the exclusion of those termed extrinsic. This evidence indicates that there is no justification for the diagnosis of intrinsic asthma as a symptom complex and that the concept of such a syndrome may lead to faulty diagnosis and to abandonment of treatment at a time when treatment is needed and may be most effective. The term "intrinsic asthma" based on the assumption that the disease is due to intrinsic causes is misleading since such causes are not present to the total exclusion of extrinsic causes.
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