1900: The discovery of epinephrine

Epinephrine.  It was the first asthma rescue medicine and the greatest medical discovery ever, at least as far as we asthmatics are concerned.  This discovery spearheaded a quest that lead to the  inventions of the rescue inhaler, nebulizer, and albuterol.

By the turn of the 20th century there were many theories about asthma, and there were many remedies available, yet which one to use was a crapshoot, and the relief obtained was palliative at best.  Like in the ancient world, the best treatment for an asthma attack was the soothing hand upon your shoulder and reassuring words.

 Jockichi Takamine  (1854-1922)

Yet this all changed in 1900 when Jockichi Takamine discovered a hormone called epinephrine.  Three years later, in 1903, the medicine was injected into an asthmatic who, within only minutes, was breathing easy.  This was the first time ever that an asthmatic got instant relief by an asthma rescue medicine.

The medicine was originally marketed as Adrenaline.  Doctors were quick to start prescribing it for their asthmatics in distress.  Asthmatics, as you might imagine, quickly fell in love with the medicine.

Yet in order to get a shot an asthmatic had to seek out a doctor.  For this reason many asthmatics continued to stick with their usual asthma remedies, which mainly consisted of asthma cigarettes and insents.

At this time many asthma experts believed asthma was caused by dilation of the vessels in the lungs.  So it only made sense that the initial theory was that epinephrine made breathing easier because it constricted vessels in the lungs.

Yet another theory was that asthma caused the smooth muscles (bronchiolar muscles) that wrap around the lungs to spasm, and this caused the air passages to narrow. This was often referred to as the spasmotic theory of asthma.  We now refer to it as bronchospasm.

In 1907 it was discovered epinephrine was a bronchodilator; that it made breathing easier by dilating the air passages  -- known as bronchioles -- in the lungs It was therefore dubbed a bronchodilator.  (1)

Regardless of the cause, the medicine made breathing easier, and that's all asthmatics cared about.  Yet there were side effects.  The vasoconstricting quality of the medicine caused blood flow to speed up and this increased blood pressure, and increased the force and rate of the heart.  It also caused asthmatics to feel jittery, anxious and hyper.

And while it provided instant relief, this relief only lasted about an hour and a half to two hours.

So the quest was on to learn more about this medicine, to fine tune it to get rid of side effects, to make it last longer, and to discover better and faster modes of delivery.  The race was on.

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References:

1. Rau, Joseph L., "Inhaled Adrenergic Bronchodilators: Historical Development and Clinical Application," at AARC.org (American Association of Respiratory Care, July, 2000, Vol. 45, number 7), pages 854-62
2. Rau, ibid
3. Rau, ibid