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In the first edition of his classic text, Osler (1) listed several theories concerning the cause of asthma, which included (7) spasm of the bronchial muscles,(2) swelling of the bronchial mucous membrane, and (5) inflammation of the smaller bronchioles. He pointed out the similarities between the changes that occurred in the nasal mucous membranes in an attack of hay fever and those found in bronchi in asthmatics. He suggested that the exudation from a hyperemic swollen bronchial mucosa could explain the hindrance to respiration. He thought that those changes could either be by direct irritation of the bronchial mucosa or be induced by reflexes following stimulation of the nasal mucosa and other sites.

The excessive airway narrowing that occurs in asthmatic subjects in relation to both specific and nonspecific stimuli seems to have been clearly understood by Osler. Since then, much has been written about the …