Asthma History Lexicon

The following are the basic medical terms used throughout this history.  Many of these terms are no longer used.  The terms are not in any particular order.

Basic terms by Hippocrates:

1. Dyspnea:  Shortness of breath
2. Asthma: More severe shortness of breath (gasping, panting)
3. Orthopnea: Shortness of breath that requires  the person to sit up to breathe. 

Basic Medical/ Historical Definitions:

• Magico-religious:  Treatment for diseases that involves either incantation (magic) or prayer religious). 
• Emperico-rational:  Treatment based on experience and observation.  
• Rational (civilized):  A word that means physical, dietic, and pharmacological treatments that are not mystical in themselves.  They are generally treatments used by physicians, although they can work their way into the magico-religious.  For example, common ailments such as colds, asthma, stomach aches may be treated with herbs, but the unexplained diseases may be treated with magic.  We must be careful when using the term rational, as we must put it into the perspective of the beliefs of the people we are referring to.  While magic may not appear to be rational to us, it is to the ancient Egyptians, for example.  Usually, rational is used from our perspective, and in which case magic is considered not rational (irrational), and in this sense the term rational is equivalent to the term civilized.
• Civilized:  Empirical medicine. It's what we would see as rational in the modern world.  For example, treating asthma with an incantation is not civilized, and treating asthma with inhalation of herbs on stones is rational because it would actually work.  
• Natural:  These are diseases that are normally occurring , such as your common colds, aches and pains, pneumonia, pleurisy, etc.  They are generally treated with herbs, massage, broths, salves, etc.
• Herbs:  Herbs were available to ancient people.  They may have known of their effects, yet not the why or how.  Such herbs were used to treat naturally occurring ailments such as aches and pains and colds.  Common herbs were opium, coca, cinchona, ephedrine, caffeine, carcara, sagrada, chaulmoogra, digitalis, ipacacuanha, podophyllum,, pyrethrum, squill, belladonna, and strammonium.  The modern medical profession may recognize these as many have been synthesized into many of the modern medicines we use today.  
• Amulet:  An object that possesses magic properties to ward off evil spirits.  Generally it can be anything from a bone from prey, a chip of human bone (as from trepidation), an animal, an object such as an ax, knives, etc.  They meet and destroy evil spirits.  They catch and neutralize black magic directed toward the owner of the amulet.  These are often the chief means of preventative medicine in many ancient societies.
• Black Magic:  Spells with the intention to do harm. 
• White Magic:  Spells with the intention to do good. 
• Fetish:  An object that  is the seat of magic power.  It may be the abode of a spirit or may have been charged by the medicine man with the mystic power, mana, or manitou, or whatever it may have been called.  It may be an object of worship.  The owner of a fetish expects it to act according to his intentions.
• Omen:  A message believed to tell the future.  It was very common for ancient societies to see temples and priests, and even to dissect organs of humans and animals, for signs as to what will happen in the future.  It was important to medicine in that it could give the people hope and faith that good things are to come, such as victory in battle.  Of course it could also predict gloom, and in this case the person would be wary and careful.  
• Totem:  An object reminding a group of their ancestry.  It could either be an object or an animal.  
• Charm:  Stating of a magic spell
• Talisman:  An object that possesses magic properties and brings good luck
• Mascot:  An animated talisman, a person or animal that brings good luck
• Incantation:  A magic spell used as medicine.  It's generally said to rid the body of black magic or evil spirits.
• Prayer:  Petition to a deity, such as God or a specific god in the pagan world, for something good.  We don't think of it this way, but prayer is a form of medicine.
• Pagan:  Polytheistic medicine; many gods; a follow of polytheistic medicine; 
• Polytheistic:  Many gods
• Monotheistic:  One god
• Literati:  The educated.  In the ancient world few are educated, so it was special to be a member of the literati. 
• Scribe:  A person who understands language and can read and write.  It was a very prominent position in the ancient world, and usually such individuals held high status.  
• Physician:  A person who uses rational or emperico-rational treatment to treat the sick.  The first physicians by this definition were seen during the Ancient Egyptian era of about 3,000 B.C. They relied less on religion and magic and more on reality.
• Priest:  These are people who treat diseases with incantations and prayers.
• Sorcerer: See witch and magician; They diagnose what demon is in you, or what god is mad at you. Cures are based on the diagnosis, and generally are incantations, fetishes, amulets, etc.  They perform rituals, dances, touches, massages or whatever their society has decided is necessary to drive the demon out or satiate the angry god.
• Fetish:  An object thought to have magical powers to protect and aid its owner.  
• Magic:  Sorcery; the use of made up charms and spells to cure diseases; see white magic and black magic.  
• Spell:  Incantation
• Superstition:  Trust in magic; belief that what you do or say will effect your health; examples include: if you walk in front of a black cat you will have bad luck; if you toss salt over your shoulder you will have good luck.  It's also belief that incantations will actually work.  
• Shaman:  A better term for medicine man.  Inspirational type of medicine man who is voluntarily possessed, through whom the spirit speaks, who exorcises and prophesies.
• Seer:  The non-inspirational type of medicine man who is not possessed but has a guardian spirit that speaks to him not through him, who does not exorcise and is not a prophet.
• Medicine man:  A person who embraces the totality of transcendental forces.  He is concerned not only with the people's health but with their general welfare, ranging from crops to victory in war.  It is his function to avert evil that may threaten the individual or tribe in any form to propitiate the spirits for the benefit of his people, and also to destroy the enemy.  He is, therefore, priest, sorcerer, and physician in one.  He is often the chief of the tribe, the king who rules over the people.  He often knows the stories and songs that tell of the origin of the world and the deeds of the tribe and it's heroes in a far remote age.  This secondary role is very important in a script less society.  For specific medicine men see Shaman and Seer. 
• Humor (Humour):  Bodily fluids.  Throughout most of the ancient world it was believed there were four humors: blood, phlegm, black bile and yellow bile.
• Blood:  Sanguine; if you have too much or too little you had a sanguine personality, or a specific ailment.  Curing it is to render the opposite humor.  If a person is believed to be sick due to too much blood, bleeding is the obvious remedy.
• Phlegm:  A humor considered to be copld and moist. 
• Black bile:  Not a normally occurring humor unless the person has been obsessed or cursed with some form of black magic.  An excess results in a melancholy personality.
• Yellow bile:  Humor secreted by liver and causes the skin to be yellow.  
• Primitive man:  man who lived pre-civilization, out in the wilderness, and daily in search of food and shelter.  In the modern world it means men who live outside civilization, such as the aboriginies of Australia.  They may participate in non rational or uncivilized medicine.
• Serfs:  People who were bound to the soil or to the shop
• Diathesis:  Hereditary predisposition to get a disease, such as asthma or allergies
• Naturalistic:   Health and healing involving the use of preparations of the various plants and natural products.  
• Supernaturalistic:   Health and healing involving incantations, prayers and exorcisms.  
• Synthetic:  A chemical composition of a medicine that is similar in effect and cause as the original medicine.  It is the medicine made in a factory as opposed to grown on a farm or extracted from animals.  For example, atropine is a natural component of the thorn-apple plant, although atrovent is a synthetic form of atropine made in a factory (atrovent is synthetic).  Epinephrine is drawn from the thyroid of animals, whereas Iseotharene was synthesized as the first successful modification of epinephrine.  Epinephrine is natural, Iseotharene is synthetic. 
• Physic/ physick:  Medicine; the art of medicine
• Pharmacology: The making of medicines; this was a component of the Egyptian "black art," or chemistry.  It was originally to be an evil art, mainly because most of the solutions made were poisonous.  When solutions were mixed in adequate doses and given at adequate frequencies, these potions worked as remedies.  However, the potions must have been trialed on unwitting slaves or prisoners to learn what the results would be.  For a person who was severely ill, it may have been worth the risk of trying such a preparation.  
• Chemistry:  Some think it comes from the Egyptian term khemia, which means "black land." Egypt was called the black land as opposed to the dessert being called the red land.  It was called chemistry because the Egyptians were thought to be the first to mix various liquids together.  This is also believed to be how pharmacology got its start.
• Black Art:  Chemistry; comes from the Egyptian art of chemistry; pharmacology
• Alchemy:  Art of mixing chemicals in search of the combination of chemicals that make gold or the ultimate cure.  This was the method of making many of the proprietary remedies. 
• Proprietary Preparations:  Medicines made by combining a variety of chemicals and herbs and sold on the market under the guise that it is the ultimate cure for a specific ailment, or as a panacea or preventative for all ailments; folk medicine. The medicine usually involved solutions (mostly alcohol) that were bottled and sold to a naive or ignorant populace
• Patent Medicine:  Proprietary preparations that were patented, bottled and sold under colorful names and labels.  This was a popular fad of the 17th, 18th and 19th centuries.  Most proprietary preparations of the 19th century were called patent medicines even though most were not patented.  Even the products not patented came under that claim that they were, indeed, patented.  
• Folk Medicine:  Medicine practiced by people not associated with the medical profession; medicine practiced based on myth, theories, and lies. 
• Proprietary Medicine:  See proprietary preparations or patent medicine
• Nostrum Remedium:  Medicines that were sold but not tested (Latin).  In the middle ages such preparations were referred to as proprietary preparations; In the 19th century they were called patent mediicne. 
• Morbidity:  Causes disease or distress
• Mortality:  Causes death

Anatomy/ or Anatomy Related Terms: 

• Circular muscles of the bronchial tubes:  A 19th century description of the muscles that wrap around the bronchial tubes or passages; bronchial muscles; see bronchiole muscles
• Bronchioles:  The are the air passages in your lungs. The air you inhale moves through these tubes. They are often referred to as the bronchiolar passages or simply air passages.
• Bronchiole muscles:  These are muscles that wrap around the bronchioles. They are often referred to as bronchiolar muscles.  In the older days, they may have been referred to as: "circular fibres of the branchiae."
• Bronchoconstriction:  This is when bronchiolar muscles spasm and squeeze the air passages causing them to become narrow.  This makes it so air has trouble moving past the constriction.  This is the main component of an asthma attack.
• Bronchodilation:  This is when the air passages open up, or when broncoconstriction is reversed.  This is what's necessary to reverse an asthma attack. 
• Beta 2 Adrenergic Receptors (B2):  These are receptors that line bronchiolar muscles. Stimulation of these causes bronchodilation. They are often referred to as B2 receptors.  The ideal bronchodilator is specific to these receptors.
• Beta 1 Adrenergic Receptors (B1):  Line heart muscle and, when stimulated, cause vasodilation, increase blood pressure, and speed up rate and strength of heart rate.  The ideal bronchodilator will not be selective to these receptors to limit side effects.
• Alpha 1 Adrenergic Receptors (A1):  Line heart muscle and, when stimulated, cause vasodilation, increase blood pressure, and speed up rate and strength of heart rate.   The ideal bronchodilator will not be selective to these receptors to limit side effects.  
• Beta 2 adrenergics:  This is medicine that sits on B2 receptors and cause bronchodilation.  These are sometimes referred to as beta agonists, B2 agonists, front door bronchodilators, asthma rescue medicine, or rescue medicine.  I prefer the term rescue medicine.  Examples include epinephrine, metaproterenol , albuterol, and levalbuterol.
• Acytylcholine:  This is a neurotransmitter that sits on receptor sites on bronchiole muscles and cause bronchoconstriction.  

Diagnosis/ Symptoms (symptoms often were the diagnosis): 

• Paroxysm:  Convulsion; A sudden attack of a disease; asthma symptoms; acute symptom
• Exacerbation:  Acute worsening of a disease process, i.e., asthma exacerbation; exacerbation of asthma
• Hypertrophy:  Enlarged, bigger.  An example is when you workout your muscles become hypertrophied; an overworked heart becomes hypertrophied
• Spasms:  Involuntary contraction or convulsions of muscle or group of muscles; i.e., bronchospasm
• Convulsions:  Spasms; 
• Exciting cause:  Trigger; it causes a paroxysm
• Asthma:  It was first defined as a disease entity by Hippocrates around 400 B.C., although he pretty much defined it as dyapnea, or short, gasping breaths.  Asthma wasn't separated from the umbrella of dyspnea and defined as a disease of its own until around 1700 by John Cullen.  Through the 17th century it was believed to be caused mainly by sputum, and in 1840 Dr. Charles J.B. Williams proved the spasmotic theory of asthma.  Through most of history asthma was also believed to be a nervous disorder, and this wasn't disproved until around 1950.  For a more thorough definition of asthma, read through this asthma history.  
• Dyspnea:  Shoreness of breath; short, gasping breaths; air hunger. We now use it to describe air hunger, although it's used by its generic for as simply shortness of breath. The term comes from Greek terms dysp for "ill" or "hard" and pnoe from the term pnein which means "breathing" or "to breathe." (from Dictionary.com)
• Orthopnea:  Shortness of breath so severe that it requires a person to sit up in order to breath.  John Fuller defined it as more severe than asthma.  We now use it to describe the requirement to breath due to heart failure and foaming pulmonary edema (fluid in the lungs). 
• Pulmonary edema:  It's actually blood that backs into the lungs when the heart fails as a pump.  It generally presents as pink and frothy.  I like to refer to it as foaming pulmonary edema.   
• Catarrh:  This is an old term that means swelling or inflammation of the respiratory tract that causes increased secretions.  It's usually used to refer to swelling and drainage in the nose. It's an old way to describe a cold, although "catarrh" can also exist due to other ailments, such catarrh of the lungs is bronchitis.  It may also refer to a symptoms of influenza or asthma.  . 
• Ordinary Catarrh:  An old term used to describe the common cold.  It was probably also used early on to describe hay fever until hay fever was defined by John Bostock in 1819.
• Dry Catarrh:  Described by Rene Laennec as catarrh that is not associated with increased sputum production.  It was more associated with asthma as compared with chronic bronchitis.  Laennec defines it as dyspnea associated with narrowing of the bronchi by swelling of the mucus membrane. 
• Coryza:  Common cold. Acute inflammation of the upper respiratory tract.  It's an old term that is not used anymore now that we have more specific disease processes such as colds, allergies, bronchitis, and asthma.
• Pleurisy:  Pain in chest with each breath.
• Perepneumony (peripneumonia): Pneumonia
• Pericarditis:  Inflammation or swelling of the heart
• Hydrops pectoris:  Pleural effusion; fluid in the pericardial sac surrouding the lungs
• Ascites:  Fluid in the abdominal cavity
• Nephrosis:  edema
• Hydrothorax:  Dropsy of the chest; fluid in the lungs
• Edema:  Nephrosis; Increased fluid in tissue or organ; inflammation
• Edema of lungs:  Pulmonary edema or foaming pulmonary edema caused by heart or kidney failure
• Pulmonary Edema:  Fluid in lungs; see foaming pulmonary edema
• Foaming Pulmonary Edema:  Fluid in lungs that foams; pink frothy secretions that seep from the nose and mouth during severe, end stage heart or kidney failure; symptom with it include severe orthopnea and dyspnea
• Dropsy:  An old term for edema. It's an accumulation of fluid in a body cavity; a greater than normal quantity of water in a body cavity.  It generally presents with tightening of the skin due to fluid under the skin, and usually presents in the lower extremities, such as the ankles.  There are various forms of dropsy, which general are diagnosed by using the word dropsy coupled with the body part involved.  For example, fluid in the lungs was referred to it as dropsy of the lungs.  Water on the brain was referred to as cerebral dropsy. Other examples include dropsy of the eye, dropsy of the tongue, and dropsy of a joint.  Dropsy is the English version of the Greek term for water. 
• Hydro:  Another Greek term for water.  It may be used in place of dropsy.  For instance, if a patient has dropsy of the brain, it may be referred to as hydrocephalus.  If a person has dropsy of the eye it may be referred to as hydrothalmia.  Dropsy in the paricardial sac around the heart was hydrocardia.  
• Hydrops:  Another term for water.  For example, hydrops ascites is water in the belly. 
• Hydropsy: Full name for dropsy 
• Cor Pulmonale:  When your heart is overworked due to forcing blood through stiff lungs, the right heart eventually becomes hypertrophied.  As the disease progresses, this often results in left heart hypertrophy by default.  This is generally not a concern with pure asthma, although it is with other chronic lung diseases such as cystic fibrosis, chronic bronchitis, emphysema, farmer's lung, etc. However, it may be linked to asthma in older texts where one or more of these diseases was thought to be asthma due to the symptoms that present.  
• Heart Failure:  Also referred to as Congested Heaart Failure.  This is when your left heart becomes weak and becomes an inefficient pump.  The result in blood gets backed up into the lungs and this results in pulmonary edema.
• Winter Catarrh:  Common cold
• Summer catarrh:  Hay fever 
• Catarrhus aestivus:  Hay fever
• Hay asthma:  Dyspnea caused by hay fever, or during the hay fever season
• Summer Catarrh:  Hay fever 
• Autumnal Catarrh:  Hay fever
• Hay Fever:  An old term for allergies; sneezing, stuffy nose, nasal drainage, wheezes, itchy eyes and nose, and the like that were linked with the hay fever season; rhinitis
• Rose Fever:  An old term for allergies; sneezing, stuffy nose, nasal drainage, wheezes, itchy eyes and nose, and the like that were linked with the rose blooming season
• Fever:  Modern definition is a temperature of the human body that exceeds 98.7 degrees Farenheit; hyperthermia.  The old definition is any malady of the human body.  
• Laryngo-bronchio-catarrh:  A term used by Dr. Philip Phoebus in the 19th century to describe inflammation of the respiratory passages due to contact with pollen.  
• Aniphylactic shock:  A sudden and severe allergic reaction that results in drop in blood pressure and inability to breathe; pharynx and larynx and bronchioles swell so much it's impossible to get air in or out of lungs.  
• Inflammation:  Swelling and redness; edema
• Turguscence:  Swelling and redness, inflammation; edema
• Lung Fever:  Pneumonia
• Lung Sickness:  Tuberculosis
• Gripp (Grippe):  Tuberculosis
• La Grippe:  Tuberculosis
• Pthisis:  Tuberculosis of the lungs; chronic wasting away
• Pott's Disease:  Tuberculosis of the spine
• Consumption:  Tuberculosis
• King's Evil:  Tuberculosis of neck and lymph nodes
• White Plague:  Tuberculosis
• Plague:  Any disease with a high morbidity and mortality rate
• Marasmus:  Chronic wasting away (malnutrition); often used in referring to tuberculosis
• Long Sickness:  Tuberculosis
• Galloping Consumption:  Pulmonary tuberculosis
• Potter's Asthma:  Tuberculosis
• Polio Potter's Asthma:  Poliomyelitis
• Poliomyelitis (polio):  Disease that causes infantile paralysis
• Neuralgia:  General discomfort (i.e., neuralgia of the head is a headache)
• Costiveness:  Constipation
• Croup:  Inflammed (swollen) larynx; laryngitis, diptheria, strep throat
• Cyanosis:  Darkened skin, bluish discoloration of skin, due to lack of oxygen in blood to that part of body
• Debility:  Lack of movement; not able to get out of bed
• Diptheria:  Contageous disease of throat
• Dysury:  Difficult urination
• Dropsy of lungs:  Edema of lungs; water in lungs; hydrothorax
• Epitaxis:  Nose bleed
• Quinsy:  Tonsillitis
• Rose Cold:  Hay Fever; seasonal coriza, seasonal catarrh
• Hay Fever:  Seasonal allergy, summer catarrh; winter catarrh, spring catarrh, etc.; Rhinitis
• Suffocative Catarrh:  Croup
• Epidemic Catarrh:  Influenza, coryza (common cold or flu)
• Chronic Bronchitis:  Inflammation of the bronchi
• Melancholia:  Depression; severe depression
• Dysentery:  Disease of intestine causing fever, pain and diarrhea
• Flux:  Dysentry
• Flu of humor:  Circulation
• Dysphasia:  Difficulty of speech
• Frogg:  Croup (voice/ breathing sounds frog-like)
• Kink:  Fit of coughing; fit of choking
• Lumbago:  Back pain
• Mania:  Insanity
• Horrors:  Delerium tremons
• Infantile Paralysis:  Polio
• Membranous Croup:  Diptheria
• Pertussis:  Whooping coug
• Turgescence:  swollen, inflamed; buildup of fluid inside a tissue
• Congestion:  Accumulation of fluid in one area, as in the lungs. 
• Melancholy:  Gloomy, depressed, pessimistic; caused by an accumulation of black bile (see Spleen)
• Spleen:  The ancient Greeks believed the spleen produced the humor black bile.  With an increased supply of black bile in the system, the person had a tendency to be melancholy (depressed) in nature.  Due to this belief, a depressed, gloomy person person was generally diagnosed with Spleen or Melancholy.  
• Splenetic:  Melancholy, spleen, depressed; caused by an accumulation of black bile in spleen
• Choleric:  The ancient Greeks believed a person with an increased supply of yellow bile had a tendency to become overly organized and controlling.  
• Phlegmatic:  The ancient Greeks believed a person with an increased supply of phlegm had a tendency to become overly relaxed, easy going, friendly, peaceful (and also stubborn and pessimistic) 
• Sanguine:  The ancient Greeks believed a person with an increased supply of blood had a tendency to be overly jovial and social.  
• Cachexia (cachectic): Loss of appetite and weight due to chronic disease; chronic wasting away
• Palsy:  An old term for paralysis or uncontrolled movement (shaking) of a body part.  It may be specific to a body part, such as the face (cerebral palsy), face, hands, legs, feet.  It may be specific to the heart, lungs, or body in general, which is generally associated with high mortality.
• Torpor:  A state of sluggishness, lassitude, languor, lethargy, apathy, indifference.  
• Lethargy:  A state of being sleepy; barely awake; awakens, although quickly falls back to sleep 
• Apoplexy:  Old term meaning to become crippled or paralyzed (palsied) due to a stroke
• Pituitous:  Full of phlegm

Allergy/ Asthma: 

• Chronic:  It's always there
• Acute:  It's going on right nowAtopic:  A predisposition to an over reactive immune system that results in hay fever, asthma, allergies and eczema. It's from the Greek word atopia which means out of the way or uncommon (an abnormal response)
• Allergy:  A hypersensitivity to an an antegen that causes the immune system to over react and this results in symptoms of inflammation of the respiratory tract and eyes, that results in congested nose, sneezing, runny nose, itchy eyes, eczema, hives, and etc. The immune system over reacts to an allergen
• Allergen:  Something that causes an allergic reaction, such as dust mites, cockroach urine, trees, grass, pollen, etc. 
• Asthma:  The definition has changed over time.  The latest definition is chronic underlying airway inflammation that makes the bronchial muscles hypersensitive to asthma triggers. When exposed to an asthma trigger the inflammation becomes worse and bronchospasm occurs.  
• Chronic asthma:  Inflammation of the airways that is always there.  All asthma is essentially chronic.
• Acute asthma:  Asthma that is acting up right now; asthma exacerbation; bronchospasm
• Asthma exacerbation:  Asthma that is acting up right ow; bronchospasm
• Hypersensitive:  Over sensitive
• Hypersensitivity:  A predisposition to over react to a trigger, such as an asthma trigger or allergen allergen; i.e. asthmatic lungs are hypersensitive to asthma triggers, eczema patients have skin that is hypersensitive to certain allergens

Remedies: 

• Prophylaxis:  a protein entered into the body to offer it protection; to prevent the spread of disease
• Anaphylaxis:  Hypersensitivity to causative agent such as an allergen; a protein entered into the body that does not protect it; a severe allergic reaction can result in anaphylaxis or anaphylactic attack that can become severe and life threatening (i.e. inflammation of the air passages that can inhibit your ability to breathe. 
• Trepaning (trepination):  Process of opening up the skull for medicinal or spiritual purposes
• Bleeding:  Allowing some blood to escape by cutting a vein; usually done to balance the humors to cure diseases, such as pneumonia and sometimes asthma; also called phlebodomy or venesection
• Venesection:  Bleeding, phlebodomy; the drawing of blood from a vein
• Phlebotomy:  Bleding, venesection; the drawing of blood from a vein
• Fumigation:  Inhalation of fumes of smoke or steam for medicinal purposes.  It could involve smoke from a fire or steam from bath houses or other. 
• Cleansing:  Various primitive and ancient cultures believed that a good cleansing of the body would either cure diseases or prevent them; it was also a means to expectorate poisons from the body.  The means of doing this would be by causing sweating, vomiting, bowel movement, urination, removal of sputum, etc. (diaphoresis, emetic, purge, diuretic, expectoration, etc.) 
• Expectorate:  Cough up sputum; to spit
• Emetic:  Substance that makes patient vomit (ipacec); expel poisons by mouth; treatment for dysentry
• Diuretic:  Makes patient pee (lasix)
• Enema:  Substance that makes a person have a bowel movement; cleanse out the bowels.
• Purgative:  A remedy that cleanses the system by causing evacuation of the bowels; stimulates the bowels; laxative; cathartic
• Purging:  To remove impurities from the body; to cleanse the body, by evacuation of the bowels.  Methods used were enemas and laxatives. 
• Cathartic:  Substance that accelerates defacation (makes you poop); Stimulates the bowel; acts as a purgative or laxative; expels poisons by rectum
• Laxative:  Substance that softens defacation to make passage of bowel easier
• Diaphoresis:  Sweating; medicine that induces sweat; remedy such as steam baths, steam rooms, showers, or any other means of inducing a sweat
• Diuretic:  Causes urination
• Diuresis:  Process of urination
• Astringent:  Constricts body tissues to stop flow of blood or secretions
• Narcotic:  Anything that dulls the mind or blunts the senses, and causes euphoria, such as opium, morphine, belladonna, strammonium, marijuana, alcohol, etc.
• Opium:  Juice of poppy that has a narcotic effect; causes relaxation; soporific; analgesic; dulls the mind
• Analgesic:  Reduces pain
• Soporific:  Induces sleep
• Sedative:  Induces relaxation
• Hallucinogenic:  Relaxes the mind; causes mind to wander so you forget you're short of breath; dulls the mind
• Solanaceae (Nightshades):  A variety of plants that contain alkaloids that have poisonous or healing effects on the human body, such as Datura Strammonium and Atropa Belladonna.
• Strammonium (Datura Stramonium, Thornapple, Jimsonweed, jamestown weed, etc.):  It's a member of the  Solanaceae family of medicinal plants.  Used as a herbal remedy to make breathing easier and as a hallucinogenic; any part of the plant could be dried and crushed.  It was then burned and inhaled (inhaled, sniffed, snorted, smoked, etc.) It also thins secretions, so it can make breathing easier that way. 
• Belladonna (Atropa Belladonna, Deadly Nightshade):  It's a member of the Solanaceae family of medicinal plants.  Used as a herbal remedy to make breathing easier and as a hallucinogenic; any part of the plant could be dried and crushed.  It was then burned and inhaled (inhaled, sniffed, snorted, smoked, etc.)  It also thins secretions, so it can make breathing easier that way. 
• Cannabis (Marijuana):  The plant is dried and inhaled to produce a hallucinogenic effect, and also it makes breathing easier. 
• Indian Hemp (Apocynum cannabinum, Hemp dogbane): Similar to Cannabis, and grows mostly in America.  Inhaling various forms of the plant can ease the mind to take the edge off dyspnea.  Appocynum means "poisonous to dogs."  It must have been observed that dogs ingesting it died (probably of heart failure). 
• Atropine:  It's the active component of the members of the Solanaceae family (such as Belladonna, Stramonium, Indian Hemp, Canibis, etc. It causes the bronchial muscles to relax, and in this way opens up the air passages to make breathing easier.  It also dries secretions, which may help both breathing.  It can also benefit some stomach ailments, as it dries secretions there too. 
• Ipacac (ipacacuanha): It's used to induce vomiting 
• Clysters:  Enema inserted into rectum

Inhalers/ nebulizers: 

• Atomization:  Nebulized; made into tiny particles that can be inhaled
• Purvurization:  Pulverizing the particles so they can be inhaled.  An example is when water from a waterfall smashes into the rock turning the water into a mist.  The first mist nebulizers worked in this manner.  
• Pulverizer:  A device that uses pulverization to create a mist to be inhaled 
• Atomizer:  A device that creates a mist to be inhaled, although the particles vary in size from large to small.  Some of the first nebulizers were atomizers, although by the 1920s atomizers were reserved for sprays, such as perfume sprays.
• Nebulizer:  A device that creates a fine mist (usually by using the Bernoulli Principle) to produce a mist small enough to penetrate the air passages of the lungs. 
• Inhaler:  A device that allows for the inhalation of medicine, such as herbs.  Primitive use involved smoke and steam.  Modern use involves a small, pocket sized device that allows for the inhalation of aerosolized medication that is small enough to penetrate the air passages of the lungs.  
• Anticholinergic medicine:  This is medicine that sits on receptor sites and prevent acetylcholine from causing bronchoconstriction.  In this way, this type of medicine is a bronchodilator, or a back door bronchodilator.  I prefer to refer to them as back door bronchodilators.  Examples include Atropine, Ipatropium Bromide, and Tiatropium Bromide

Lung sounds: 

• Stethoscope:  A device used to listen to lung sounds.
• Auscultation:  Using a stethoscope to hear lung sounds.
• Rhonchi:  This is an old term that originally referred to any continuous high or low pitch sounds heard in the lungs.  Today this lung sound is still used, and mainly refers to coarse or low pitch wheezes (sonorous wheezes).  However, some use it to describe secretions in the air passages (see rhales). In many old text, rhonchi is used instead of wheeze, and rhonchi is broken down into two types: sibilant and sonorous (see below).
• Rhales (Rales):  This is an old term used to describe wet lung sounds.  The wet sound may be produced from excessive secretions (as with chronic bronchitis) or frothy blood (as with heart failure).  When Rene Laennec came up with this term, heart failure and chronic bronchitis were often looped under the umbrella term of asthma, and therefore you may see it used in relation to asthma.  Today the term is generally no longer used, and coarse crackles is used instead.  Rhales are generally heard on inspiration and expiration, and generally compose at least 3/4 of the lung fields. 
• Rales Vibrants:  Same as Rales (see above).  It basically refers to the rapid, vibrating, sound of fluid moving around in the lungs as the patient inhales and exhales.  
• Sibilant Rhonchi:  This is a constant high pitch sound of air moving through narrowed air passages in the lungs, and we now refer to it as a sibilant wheeze, or simply a wheeze.
• Sonorous Rhonchi:  This is the constant low pitch sound of secretions moving through the air passages.  It's generally a coarse sound and is now simply referred to as rhonchi (see above). 
• Sibilant Wheeze:  This is a constant high pitch sound of air moving through narrowed air passages.  It is generally associated with bronchospasm.  This sound is almost always inaudible and can only be heard on auscultation.  
• Sonorous Wheeze:  This is a constant low pitch sound of air moving through secretion filled air passages, as in chronic bronchitis or pneumonia.  It is not associated with bronchospasm.  This sound can be audible or inaudible, and can sometimes be heard with or without auscultation. 
• Wheeze: This is the same as sibilant wheeze.  However, many simply refer to any respiratory high pitch or low pitch sound as a wheeze.  
• Crackle:  This is a modern used in an attempt to be more specific than rhales.  It's a fine "crack" of the lungs popping open, or it can be the sound of fluid (either mucus or blood) moving around in the lungfields on inspiration and expiration.  This term is nonspecific, and is ideally broken down into fine crackles and coarse crackles.
• Fine Crackles:  This generally refers to the sound of the air sace (alveoli) popping open on inspiration.  This sound is generally isolated to certain lung fields.  For example, chronic bronchitis patients are unable to take in a deep breath, and therefore these may be heard in the bases upon a deep inspiration. When heard in only one or two lobes (such as left lower lobe and left upper lobe) it can be an early sign of pneumonia.
• Coarse Crackles:  This generally refers to the sound of fluid in the lungs.  This sound is generally gravity driven, whereas when a person with fluid in his lungs lies on his left side, coarse crackles will be heard on the left lung fields.  When the person is sitting or standing, they will be heard in the bases. This lungsound, therefore, is not specific to one or two lobes.  
• Stridor:  This generally refers to the sound of air moving through large airways (such as the throat) that are inflamed or filled with secretions.  This sound is generally harsh and it can be audible.  

Medical theories: 

• Spasmotic theory of asthma:  The belief that contraction or spasms of the muscles that line the bronchioles is a main component of asthma
• Nervous theory of asthma:  The belief that asthma is nervous in origin, or caused by things that influence the mind, such as strong emotions (laughter, crying), stress, excessive happiness, excessive sadness, a yearning for the mother, etc. 
• Pneumatic asthma:  A term used by Thomas Willis (1621-1675) to refer to all descriptions of asthma before his time.  It is when the lungs are "obstructed or not open enough."  Samuel Gee  (1839-1911) wrote that the ancients regarded all asthma as "pneumatic and dependent on bronchial obstruction."
• Psychosomatic theory of asthma:  Another name for the Nervous theory of asthma.  It's a term that  was sometimes used by the medical community during the 20th century.  
• Bronchitic theory of asthma:  Wheezing and dyspnea depend on obstruction of the air tubes by the inflammatory products of bronchitis. 
• Convulsive theory of asthma:  That asthma is caused by convulsions or spasms of the bronchioles, also see spasmotic theory of asthma and brochospasm theory of asthma
• Spasmotic theory of asthma:  That asthma is caused by convulsions or spasms of the bronchioles, also see convulsive theory of asthma and bronchospasm theory of asthma
  Bronchospasm theory of asthma:  That asthma is caused by convulsions or spasms of the brochioles, also see convulsive theory of asthma and spasmotic theory of asthma

Other: 

• Chlorofluorocarbon (CFC):  A liquified gas propellant used in used in asthma inhalers until the Montreal Protocol was signed in the late 1990s and a goal was set to ban the propellant to protect the ozone. 
• Hydroflouroalkane (HFA):  A new propellant used in inhalers that is safe for the environment.  Most inhalers on the market now use this propellant or are propellant free.
• Montreal Protocol:  A pact by various countries to ban CFC propellants and replace them by something else.
• Papyri (papyrus):  Paper-like material made from the papyri tree.  It was the material used for writing in ancient Egypt and was usually rolled into scrolls.  
• Georg Eber Papyri:  A papyri found between the legs of an Egyptian mummy believed to be the oldest medical document in recorded history.  It was purchased in 1873 by George Eber, and is believed to be dated back to 1550 B.C.  It's s 110 page scroll and 20 meters long. It is believed to contain copies of older texts.  It contains descriptions of internal diseases and treatments, which generally involve magic.  It is written in hieroglyphics.  
• Edwin Smith Papyri:  It's the oldest known surgical text dating back to 1500 BC.  It does not involve as much magic as the Eber Papyri because most of the ailments described are actual and seen, such as broken bones and cuts.  It's considered to be the first document of rational medicine.  It's a 17 page scroll and 4.6 meters in length.  It's believed to be copies of older medical texts.  

1800-1985: Asthma Cigarettes

Elliot's Asthma Cigarettes*

So as you probably know by now by hanging out on this blog I had pretty bad asthma as a kid.  When I was 18 I walked into my doctor's office and he said, "Look, if you ever decide to smoke cigarettes, just let me know and I'll put you out of your misery myself."

The irony was a few days later I visited the Manistee County Historical Museum in Manistee, Michigan.  The museum is housed in the old A.H. Lyman Company building, which was a pharmacy.  In the back the old pharmacy shelves classic medicines.  On the box of one of these boxes was written: "Elliotts Asthma Cigarettes.."  What I saw was similar to what you see in the picture to the right.

Potter's Asthma Remedy*

If smoking was supposed to be so bad for asthma, I thought, why would doctors prescribe smoking cigarettes?  And what was in them anyway?  

What's in 'em?

Recently I set off on a quest to learn more about this interesting "medicine."  I learned the following about asthma cigarettes:

• They didn't contain tobacco, but crushed and dried herbs from the nightshade family of plants called solanaceae, which included datura strammonium, atropa belladonna, the hyoscyamus niger, Lobelia inflata and similar plants.  Indian Hemp and Cannabis are similar herbs also included in some brands.
• Such plants contained an alkaloid called Atropine that causes mild bronchodilation, and made breathing easier. 
• Smoking wasn't considered hazardous; it was actually seen as beneficial. 

Who first inhaled 'em?

It's difficult, if not impossible, to know when people first inhaled fumes of herbs to provide breathing relief or hallucinogenic effects.  In all likelihood it occurred by chance as the herbs were tossed onto hot coals and incidental inhalation resulted in hallucinogenic effects.  Later on an asthmatic inhaled these fumes, and he felt relief.  The herbs were probably believed to be a gift from the spirits or gods.

The first recordings of inhaling the herbs was around 4,000 B.C., which marked the dawn of the bronze age.  Ancient city states of Sumeria and the empire of Egypt were in their infancy, and the discovery of papyrus and cuneiform soon allowed societies the ability to communicate from one generation to the next by writing, perhaps with a reed stick.

Kinsman's Asthma Cigarettes*

The Ancient Egyptians had plentiful access to  atropa belladonna.  It was a pungent smelling herb that grew to be about three feet high with oval shaped, pointed leaves that grew about three to six inches long with reddish or purplish flowers.   (1)

Folks experimented with this herb and discovered its poisonous effect.  When too much was inhaled the person died.  This gave the plant the reputation as the "deadly nightshade."  Egyptians soon learned the best recipe involved picking the leaves, stems and roots, drying them under the hot sun, crushing what was left, and using the byproduct in a variety of ways.

Encyclopedia.com describes how Egyptian women squirted drops in their eyes "for the allure given by large, black pupils: hence the name belladonna — ‘fine lady'."  It made pretty eyes prettier and helped beautiful Egyptian women woo men. (1)

Ad for Schiffmann's Asthma Cure (1899)*

Physicians used it as a remedy for just about any respiratory ailment.  The dried and crushed herbs were tossed on bricks preheated on hot coals, and the smoke was inhaled to provide temporary breathing relief.  Over time a funnel was sometimes added to channel the smoke toward the patient's airway.

Inhaling the herb also provided a hallucinogenic effect, especially if enough was inhaled.  This may have been beneficial to the asthmatic as well, considering it helped take their minds of their trouble. Inhaling the smoke may have been beneficial to anyone suffering from a chronic illness, and was probably smoked regularly simply for recreational hallucinations.

However, there were risks, such as dry mouth, increased heart rate, dilated pupils, nausea and headache. If ingested or inhaled in high enough quantities, it may even cause death, hence the name deadly nightshade.

Kellogg's Asthma Cigarettes*

Who smoked the first pipes?

Again, it's impossible to know who carved out, let alone smoked the first pipes.  It's also impossible to know for whom the first pipe was carved for, nor what herbs were stuffed inside it.

It's possible the idea of using a sharp tool to hollow out a piece of wood for smoking herbs may have occurred to various inventors in various societies at different times.  The component smoked depended on what herbs were available.

For example, in India the incentive to carve out pipes was to smoke strammonium, belladonna, or Indian hemp for it's hallucinogenic effect. The fact the herb had other medicinal properties may have been learned later, or earlier.  Who knows?

Yet what we do know is the first medicinal use of pipes to smoke a medicine for asthma-like symptoms was recorded in ancient India around 100 A.D.  There were many herbs the Indians had access to, and one such was datura strammonium.  The herb produces an unpleasant smell and grows to be about five feet tall with a pale green stem with spreading branches and puplish leaves coarsely sedated along the edges.  Its flowers are white or purple.  (2)

By empirical means its entertaining effect was learned, as well as its poisonous qualities when too much was inhaled or ingested, which mainly included hallucinogenic effects.  At times it must have been observed the medicine made you mad, which may explain the name.

Datura comes from the ancient Hindu word for plant, dhatura.  Stramonium is a New Latin word meaning thornapple.  Strammonium originally came from the Greek word strychnos which means nighshade and mankos meaning "mad."  (3)

Other than thornapple, common names I've found during my research that refer to strammonium are jimsonweed, Jamestown weed, drowny thornapple, Devil's trumpet, angel's trumpet, mad apple, stink weed and tolguacha.  It was obvious by these names the side effects of inhaling too much was well known

Like belladonna, the leaves, stems and roots were dried and crushed into a fine powder the Indians stuffed into their pipes and smoked it.  The benefits obtained must have been of higher quality than simply inhaling fumes from igniting the herbs on bricks.  Although either technique may have been used, depending on what the patient had access to.

Obviously the herb may have been used for entertainment, although medicine men and physicians ultimately learned of the medicinal benefits.  By 100 A.D. Indian physicians recommended smoking  strammonium for diseases of the lungs and throat, or simply for its hallucinogenic effect.  Again, the hallucinogenic effect may be desired when no other remedy was applicable

The famous Greek physician Hippocrates wrote about stramonium and belladonna, so we know Greek physicians had access to such wisdom.  With the fall of Cordova Greek medicine made its way to Rome, so we know the Romans had access to it too.   With the fall of Rome all such knowledge was lost for over a thousand years.

So how did such wisdom come to us?

A long time passed before British physician and asthmatic James Anderson visited India and enjoyed the mild breathing relief he obtained after smoking a cigarette containing datura strammonium.  The year was 1802.  (4)

Anderson returned to England and reported his find to his friend Dr. Sims in Edinbergh.  Sims trialed it, noted the benefits, and published a report in the Edinbrugh Medical and Surgican Journal.  After this report asthma cigarettes were entered into British and American pharmacopoeia, and ultimately became popular for the treatment of asthma in these western nations.  (5, 12 page 55)

Of course it also should be noted here that there were no standards or regulations regarding dosing in those days, and no recommendations as to how much of a medicine should be consumed, or in this case inhaled.  Dr Sims reportedly died a year after his report from an apparent overdosing of Belladonna.  (5, page 55)

So American Indians smoked pipes too?

Yes, American Indians smoked dried herbs stuffed into pipes too.  Now, did they get this wisdom from travelers from far off lands, or did they come up with the idea on their own.  No one knows for sure, and either theory is a possibility.

Either way, American Indians had access to another member of the nightshade family called lobelia inflata.  Various folks experimented and observed it's effects when ingested and inhaled, and soon it was learned of the hallucinogenic effect.  At first it must have been tossed into fires, later on heated bricks or in pots, and ultimately the herbs were stuffed into pipes and smoked.

Now did they come up with this on their own, or did they get the idea from others.  Your guess is as good as the best historians.  Either way, they smoked it for relief of asthma symptoms and for other benefits too, and it's for this reason many refer to it as Indian Tobacco or Asthma Weed.

American physicians were introduced to lobelia and used it for asthma releif, yet they also used it to make some patients vomit.  The idea here was that along with vomit toxins would be removed from the body to balance the humors and cure the ailment.  For this reason it was often referred to as pukeweed and vomitwort.  (6)

What was the secret ingredient?

Well, there had to be something in the nightshade family of plants that produced the medicinal effect, and this component was the alkaloid Atropine.

Atropine was first derived from the belladonna plant in 1833.    By 1867 Atropine was isolated by von Bezold.  It was then determined to be a component alkaloid of the various nightshade plants found in India, including the datura strammonium, atropa belladonna, and the hyoscyamus niger (black henbane), and Lobelia inflata (7)

Early studies showed atropine was the potent component in the plant, the same component that dried secretions, increased heart rate, opened air passages, and produced a hallucinogenic effect.  It was the ingredient that that made the nightshade family of plants so sought after.

What started the Asthma Cigarette craze?

By the mid 19th century the market for inhaling ingredients and powders grew steadily.  Some pharmacists gathered the ingredients and sold them to individuals.  Some folks placed some powder on plates, igniting it and inhaling the fumes.  Some stuffed it into homemade pipes, inhaling it that way.  Others rolled it into cigarettes, inhaling it that way. 

Some pharmacists gathered the ingredients and further prepared them into powders to be further prepared by the patient.  Some pharmacists went a step further and rolled the powder into cigarettes that could be purchased in packs.  So there were a variety of options.

Potter's Patient Inhaler (funnel device)*

By 1879 an asthma cigarette craze struck America and Europe.  (8)  More and more companies entered the market in an attempt to benefit off the plight of asthmatics.  Belladonna, stramonium, lobelia, henbane, atropine, and even cannabis were packaged in cans and placed on shelves in pharmacies.

The products were marketed for just about any respiratory condition, including asthma, chronic bronchitis, whooping cough, cholera, croup, catarrh, and hay fever.  By the 1880s technology progressed so some companies pre-rolled cigarettes, packaged them, and sold their product at pharmacies.

Asthma cigarettes from a variety of companies could be found on pharmacy shelves like the A.H. Lyman Company.  According the Inhalatorium, the most famous brands were:

Potter's Asthma Cigarettes*

• Schiffmann’s Asthmador
• Blosser’s
• Potter’s 
• Marshall’s
• Kinsman’ 
• Dr Guild’s green Mountain
• Kellogg’s  
• Page’s
• Regesan’s

In my studies the brand I've come across most often was Potter's Asthma Cigarettes, which you can see in the picture to the right or by clicking over to inhalatorium.com.  This was among the most popular brands in Britain.

The main ingredient in Potter's cigarettes were stramonium, belladonna and atropine.  Mark Sanders over at Inhalatorium.com notes that Potter's also had a variety of asthma remedies that included cigarettes, incense, pills and powders to be inhaled by Potter's funnel device

Potter's Asthma Pills*

An asthmatic patient of mine who grew up in 1950s America said she remembered her dad smoking cigarettes from a green package.  We later figured the produce was Dr. Schiffmann's Asthmador Cigarettes.

When did the craze end?

The end of asthma cigarettes was slow. Even as better products were introduced to the market, asthmatics didn't want to give up something that worked for them. It's no different than today's asthmatics fussing over the end of popular medicines like Chromolyn, epinephrine and theophylline.

Asthma cigarettes continued to be popular even after the discovery of epinephrine in 1900 and as the solutions of epinephrine and atropine became options for home use with the invention of the mass-producible electric nebulizer in the 1930s, asthmatics still lit up the powders.

Sales of asthma cigarettes and powders stayed consistent because they provided breathing relief, were less expensive than those other options, and were available without a prescription.  Plus the nebulizers available were bulky and fragile, as well as expensive.

Yet while asthma cigarettes were the preferred choice due to convenience and cost, that all changed in 1957 with the invention of the inhaler, and the release of the Medihaler-Iso and the Medihaler Epi.  These inhalers provided instant relief, were relatively inexpensive, and easily carried in pockets and purses.

Easy to use & fast acting Medihaler (1957)

As sales of asthma inhalers sales went north, asthma cigarette sales went south.  Yet despite the decline in sales, the cigarettes were still a viable over the counter option until the early 1980s.

The end came due to growing concerns teenagers were purchasing asthma cigarettes not for asthma relief but for their hallucinogenic effects. (9)  So studies were conducted to confirm whether or not asthma cigarettes really worked, and whether they should be taken off the shelves.

By this time there were many other options for asthmatics, which included safer asthma rescue medicine such as Ventolin and Alupent, theophylline, and a refined and safer version of Atropine called Ipatropium Bromide (Atrovent).  These medicines could also be delivered in preset doses via inhalers and solutions to be nebulized.

H.L. Elliot and J.L. Reid described in a 1980 article published in the British Journal of Clinical Pharmacy a study that concluded asthma cigarettes made of "herbal preparations containing Atropine-like alkaloids" were just as effective as using ipatropium bromide (Atrovent).

Dr. R. Schiffman's Asthma powder*

The researchers concluded that "an overdose of of asthma cigarettes is manifestly capable of producing pharmacological effects (hallucinations, delerium, tachycardia)." They also concluded that the dose of medication getting to the lungs is "variable and unpredictable."

Likewise, they noted that "In view of increasing evidence of abuse, there appears to be good reason to restrict availability of these preparations. Although a herbal cigarette might possibly be recommended for the asthmatic who insists on continuing to smoke," a majority of asthmatics would get just as much benefit with fewer side effects by using thier Atrovent inhaler. (10)

By 1985 asthma cigarettes were removed from the shelves of all U.S. Stores.  Yet while being generally extinct in western nations, they are still available in some third world nations.

I will leave you today with a recipe for asthma cigarettes from the National Druggist, Volume 30, 1900:

---

Asthma Cigarettes------

(W.B.C. Cleveland Ohio)  The following formula is one that the writer has used for several years occasionally, and has found effective and not unpleasant, provided that the cigarettes are used not to frequently, or to excess:

• Strammonium leaves.....................8 parts
• Green tea leaves............................8 parts
• Lobella Leaves..............................6 parts
• Plantain leaves.............................2 parts

Mince the leaves to a condition suitable to rolling in cigarette form, and moisten the mixture with cold saturated solution of potassium nitrate in water, dry thoroughly, and pack in air tight cans or jars.  Lavel "Asthma Cigarette" mixure.  Directions:  When an attack of asthma is imminent take sufficient of the mixture to make one or two cigarettes of the ordinary size, roll in cigarette paper, and smoke slowly, inhaling the smoke as deeply as possible.  If relief is not afforded by the first, a second cigarette should be used.

---

So there you have it, the history of asthma cigarettes.  It was an options that provided hope and some relief for many asthmatics for a long time.  

eferences:

1.  "Belladonna," Encyclopedia.com,  http://www.encyclopedia.com/topic/belladonna.aspx
2. "Plants poisonous to livestock," Cornell University's Department of Animal Science,  http://www.ansci.cornell.edu/plants/jimsonweed/jimsonweed.html
3. "Plants poisonous to livestock," ibid
4. Sneader, Walter, "Drug discovery: a history, 2005, England, page 96\
5. Sneader, ibid
6.  University of Maryland Medical Center, "Lobelia,"  http://www.umm.edu/altmed/articles/lobelia-000264.ht
7.  Encyclopecia.com
8. "The Scarcity of Cubebs," The Chemist and Druggist," 1887, Feb. 26, page 268 of  Chemist and Druggist: A Weekly Trade Journal, 1887, Vol. XXX, January to June 1887
9. Jackson, op cit, page
10. H.L. Elliot and J.L. Reid, "The Clinical Pharmacology of a Herbal Asthma Cigarette"British Journal of Clinical Pharmacy (1980, 10, 480-490) 
11. *  Picture used with permission from Inhalatorium.com.  Check out the site for more picutures, ads and descriptions of asthma cigarettes and other asthma remedies.
12. Smyth, Hugh D.C, Anthony J. Hickey, "Controlled Pulmonary Drug Delivery," 2100, Springer New York Dordrecht Heidelberg London

Further reading:  

• Jackson, Mark, "'Divine Stramonium': The Rise and Fall of Smoking for Asthma,"  Med Hist., 2010 April; 54(2): 171–194.

1900-2012: History of steroid use for asthma x

So now in our quest through the anals of asthma history we come to corticosteroids.  If we consider the discovery of Epinepherine to be the most important discovery as far as asthmatics are concerned, the discovery of cortisone must be considered the second greatest discovery of all time.

The discovery of cortisone occured the same year epinepherine was discovered in 1900.  According to Barry E. Brenner in his history of asthma, "at that time Solis-Cohen prepared a crude extract of the adrenal gland and used it in the treatment of acute asthma." (1)

In the late 1930s it was isolated, and it was used successfully for the first time in 1944, according to Meriam-Webster dictionary.  It was initially used to reduce inflammation for patients with rheumatoid arthritis, yet it was ultimately discovered that it would help reduce inflammation in the air passages of asthmatics. (2)

According to Answers.com, "Schering-Plough," cortisone was synthesized in 1949 by Merck & Co, yet through a series of legal loops Schering obtained access to cortisone information.  This made it possible to make cortisone, and made it easily available to physicians.  (3)

What you have to realize, however, is at this time asthma was believed to result in inflammation only during an asthma attack.  Brenner explained that several studies were completed in the 1940s and 50s, and in 1955 prednisone was discovered as the first synthetic corticosteroid and marketed as an effective treatment for acute asthma symptoms. (4)  Medicine.net reports that it was approved by the FDA in 1955. 

Medrol Steroid Pack

Schering marketed prednisone as Metricorton in 1957.  Paracort and Deltasone are other generic options on the market. 

Another similar product is prednisolone which was also approved by the FDA in 1955.  It was marketed as either Sterane or Delta-cortef, although is available under as variety of products such as Pediapred and Orapred as well as generic names.

Dexamethasone also entered the market in the 1950s as Decadron.  Some believe this is a more potent steroid that lasts anywhere from 1-3 days in your system, making it ideal for kids who won't reliably take yucky tasting pills or solutions. 

Dexamethasone was actually the first corticosteroid to be marketed as a solution to be nebulized, and this was shown to benefit asthmatics in studies done in the 1960s.  (5) 

Methylprednisolone was later marketed as a varient and marketed as Medrol and Solu-medrol.  Medrol is the pill form and comes in what is referred to as a Medrol Steroid pack, or simply a steroid pack.  If you're an asthmatic chances are you've been prescribed a steroid pack at one point or another. 

The pack comes with five rows of 4 mg pills:  7 in the top row, 5 in the second row, 4 in the third row, 3 in the fourth row, 2 in the fifth row, and 1 in the sixth row.  You take the top row on day one, the second row on day two and so forth.  The idea is you take fewer pills each day to wean yourself off. 

I often get asked what's the difference is between prednisone, prednisolone, and methylprednisolone.  The answer is that they are simply the same or simlar products made by different companies.  Some say that methylprednisolone has fewer side effects, yet that's like saying Albuterol is better than Xopenex, or snow is better than rain.  In other words, which one a doctor prescribes is based on personal preference.

To treat acute episodes of asthma the medicine could be given as an injection, or the pill or liquid version could be taken at home.

Yet once you start taking steroids you had to slowly be weaned off.  Your body produces corticosteroids, and if you take the pill form your body will think you have enough and stop production.  For this reason, if you're given a high dose of corticosteroid medicine and then you stop cold turkey you leave your body with no corticosteroids and you'll die.  So you must wean, and that was one of the nice things about the steroid pack.  A doctor gave you a shot of Solu-medrol at the office and sends you home with a pack to wean you off.   

Sales of systemic corticosteroids boomed during the late 1950s and 60s.  It didn't take long for doctors to note a major problem with this medicine.  There were certain individuals who had persistent or chronic arthritis or asthma who required steroids on a daily basis.  Since there was little data on ideal dosing, some physicians prescribed high doses long-term for some patients.  It soon became evident there were some severe consequences to such long term, and high dose use of systemic corticosteroids.

Beclovent Inhaler

Noting the success of the Medihaler-epi and Medihaler-iso, pharmaceuticals hoped to take take advantage of the booming inhaler market.  In 1960 beclomethasone was introduced as the first inhaled corticosteroid by Allen & Hanbury, the makers of the Albuterol inhaler.  (7)  The product was marketed as Becotide in 1972, and the recommended dose was four puffs daily. 

GlaxoSmithKline's version of beclomethasone was Vanceril, and Schering-Plough's version was Beclovent, and both were approved by the FDA for sale in the U.S. in 1982. 

I was prescribed Vanceril from the late 1970s until 1985, yet from time to time other generic forms entered my home.  (You can see a 1979 ad for Beclovent and Ventolin here.) 

After the CFC propellants were set to be phased out in 1989, the hunt was on to find an environmentally friendly inhaler.  3M Pharmaceuticals developed an HFA version of beclomethasone called Qvar, and it was approved by the FDA in 2000.  By 2001 GSK stopped production of Vanceril, and soon thereafter Schering-Plough ceased production of Beclovent.

Studies actually show that (aside from the spike in cost), this changeover might have worked to the advantage of asthmatics as the new version has been proven to get deeper into the lungs providing better distribution of the medicine (I wrote about this in more detail in this post). 

However, according to Dr. H. Morrow Brown at Allergiesexplained.com, beclomethasone was almost written off as a useless medicine.  Many doctors preferred to treat asthma by desensitization with allergy shots, and this was done with me. 

I have the medical records to prove it. I remember getting allergy shots through the 1970s all the way until 1985.  As some point you'd have thought my doctors would have caught on they weren't working, considering my asthma continued to get worse and worse instead of better.

So desensitization was a top line therapy for athma and inhaled steroids were relatively ignored by physicians until a study was reported in The British Medical Journal in 1971 and 1972 showing beclomethasone was effective in controlling asthma. (8)

Becotide Inhaler

This turned out to be a great achievement because the inhaled medicine is absorbed in the lungs where it's needed and very little gets in the system, as opposed to oral or injected steroids which cause systemic effects. 

From the 1970s until the early 1990s systemic steroids were prescribed for severe episodes of asthma, and other than that acute episodes were managed by rescue medicine and inhaled corticosteroids like Becotide because side effect (although still expected), were believed to be far less than systemic steroids. 

Perhaps as a result of this, between 1957 and 1985 the market for asthma inhalers (which also included bronchodilators) skyrocketed so that in 1985 asthma inhaler sales were 25 percent of the asthma prescription market (theophylline was also at 25 percent of this market). 

The problem that remained until the early 1990 -- perhaps due to the 1950s scare -- was that doctors were still afraid that inhaled steroids used long term would produce the same side effects as systemic steroids.  For this reason they were leary of prescribing them as an every day medicine, and recommended them for use only during an acute attack to limit side effects. 

A second problem was that scientists had yet to discover that inflammation in the lungs wasn't just there during an acute attack, that it was chronic (always there).  For both these reasons, corticosteroids -- either systemic or inhaled, were only prescribed for moderate and severe asthma, and rarely mild asthma. 

Vanceril Inhaler

In the 1960s triamcinolone entered the market as Azmacort.  In 1975  Schering-Plough introduced its version of beclomethasone as Vanceril.  In the early 1980s Budesonide was introduced to the market as Pulmicort. 

Studies showed Pulmicort was the safest and most effecteve nebulized corticosteroid.  Decadron is sometimes given by aerosol in hospitals in the emergency rooms, but rarely, and usually not for asthma but inflammation of the throat.  Pulmicort has earned the respect of physicians, and it's basically the only nebulized corticosteroid available for home use. 

Perhaps my doctor had me trial all these at some point, yet the one I remember becoming friends with was the Vanceril inhaler.   It was a little pink inhaler designed the same as the Ventolin inhaler.  I have a note from my doctor following a 1981discharge from a local hospital after an asthma admission that says:  "Use your Vanceril for two weeks, then use only when you have trouble breathing."

By 1985 my asthma continued to be high risk, and I was using my asthma rescue medicine several times daily.  Sometimes I'd use my Ventolin inhaler in less than a week, and made several unscheduled doctor visits and emergency room for uncontrolled asthma.  I survived this, yet many asthmatics did not. 

My local doctor decided he couldn't help me, so I was shipped to National Jewish Hospital/ National Asthma Center (Now National Jewish Health).  Doctors there were up to date on the latest asthma wisdom and weren't afraid to prescribe inhaled steroids. 

The Azmacort inhaler with built-in spacer

Knowing my asthma was high risk, my doctor at NJH put me on Azmacort, and instructed me to take four puffs four times every day to control my asthma.  I was not to stop taking it no matter what, even if I felt good. 

The neat thing about this inhaler was it was the first inhaled steroid with a pleasant taste (at least I thought so).  The only problem was you needed four puffs four times a day to equal two daily puffs of our modern inhaled corticosteroids. 

This many puffs was a pain in the butt, but when I was compliant it worked like a charm.  So long as I took my inhaled steroid every day there would be just enough steroid in my system to prevent an asthma attack. 

By 1989 there were enough studies to confirm the approach NJH doctors used on me was the best way to treat asthma.

The results of the research showed that NJH was on the right track in treating asthmatic children with a daily dose of inhaled corticosteroids.  That experts now had to come up with a way to educate regional doctors of this approach so that other asthmatic children could benefit.

Thus, in 1989 the NHBLI's asthma guidelines were created. The guidelines highlighted the following:

• Asthma is often underdiagnosed
• All asthmatics have some degree of chronic inflammation
• A small amount of steroids in asthmatic lungs obtained from inhaled corticosteroids is often all that's needed to control this inflammation and prevent asthma symptoms.
• The amount of steroid inhaled from an inhaler is very small compared to systemic steroids, and therefore side effects are rare and minimal at worse.  Thus, the benefits far outweighed the risks for many asthmatics with uncontrolled asthma.
• Thus, the emphasis for asthma treatment was changed from focusing on controlling acute asthma symptoms to preventing asthma from occurring by treating the underlying inflammation and preventing bronchospasm.
• Inhaled steroids should be used daily to prevent asthma, and rescue inhalers should only be used when needed to treat acute asthma episodes. 
• Inhaled steroids are safe to use for mild asthma to prevent airway remodeling that may cause asthma to become moderate to severe. 

In 1992 A National Heart, Blood and Lung Institute-sponsored Childhood Asthma Management Program (CAMP) was created to study the impact of long-term inhaled steroid use in children.  The pediatric department at NJH conducted a landmark study of 1,041 children between the ages of 5 and 12 for 20 years.  The results confirmed the idea that daily inhaled corticosteroid use for asthma was effective and safe.

The inhaled steroid used in the study was Budesonide.  The results showed that Budesonide (inhaled corticosteroid use) for asthmatic children:

1. Reduced hospitalizations by 43%
2. Reduced Urgent Care visits by 45%
3. Reduced Prednisone use by 43%
4. Reduced use of Albuterol
5. Increased episode free days (10)

Loaded with this new wisdom, physicians started prescribing inhaled corticosteroids more often.  This helped many asthmatics better control their asthma, and use of rescue medicine declined.  Now asthma experts refer to uncontrolled asthma as using rescue medicine more than twice in a two week period.

Greg Minton, in his book "Breathing Space" explained that after the release of the asthma guidelines sales of inhaled steroids soared, and flunisolide, marketed as Aerobid, lead the charge.  Minton described that "in the first three months of 1991, prescriptions of Aerobid doubled those of the entire previous year. Aerobid was the fastest growing inhaled steroid on the market." (9)

In 1992 the National Heart Blood and Lung Institute sponsored Childhood Asthma Management program (CAMP) provided research

At one point my regional doctor decided Azmacort wasn't good enough for me and he prescribed Aerobid as a replacement.  I took two puffs of it -- just once -- and rejected it on the grounds the mist tasted like rotten mints.  Surely Aerobid required fewer puffs, but I decided I'd rather puff away at the better tasting Azmacort.

By the late 1980s Pulmicort became the first dry powder inhaler on the market when the Pulmicort Turbohaler was introduced.  I never used this inhaler on myself, although I have instructed it to patients from time to time.  Considering the horibble taste, I can't fathom that Aerobid sold so well. 

The market for inhaled corticosteroids proved to greatly benefit asthmatics not simply by controlling and preventing asthma, but by reducing unscheduled doctor visits, emergency room visits, hospital admissions, and the cost of treating the disease. 

Other pharmaceuticals rushed to enter this market, and this brought about the longer lasting and more potent inhaled corticosteroids we use today. Fluticasone was introduced as Flovent in the 1990s and Mometasone furoate in the 2000s. 

Interesting to note that each new inhaled steroid was a little more selective than the previous, and lasted a little longer. This is the main reason some of the older inhaled steroids have been phased out in favor of fluticasone, mometasone furoate, and other new ones on the market or in the oven. (11)

Advair entered the market in the late 1990s ad the first combination inhaler with a long acting beta adrenergic (rescue medicine) and an inhaled steroid.  It was a combination of fluticasone and salmeterol.  It quickly became the best selling asthma product because it controlled asthma and only required two puffs a day.

Symbicort and Dulera are similar products to enter the market.  Since the patent for Advair expired in 2010 generic versions are expected to hit the market soon, and hopefully lower the price.

So you can see we have come a long way since cortisone was discovered at the turn of the century, since prednisone was discovered in the 1950s, and beclomethasone hit the market in 1972.  While physicians were once hesitent to prescribe a daily dose of inhaled corticosteroids to control asthma, steroid inhalers have since become a top line therapy for preventing and controlling asthma. 

Click here for more asthma history.

References:

1. Brenner, Barry E, ed., "Emergency Medicine," 1998, from chapter one "Where have we been?  A history of acute asthma," page 18
2. Meriam-Webster dictionary, "Corticosteroid," http://www.merriam-webster.com/dictionary/corticosteroid
3. "Schering-Plough: Information," Answers.com, http://www.answers.com/topic/schering-plough-corp
4. Brenner, op cit, page 18
5. Schleimer, Robert P., et el, "Inhaled Steroids in Asthma," vol. 163, 2005, New York, page 5
6. "Schering-Plough: Information," op cit
7. Primary Care Respiratory Journal,"A brief history of inhaled asthma therapy over the last fifty years," Volume 15, Issue 6, December 2006, Pages 326-331
8. Dr. H. Morrow Brown at Allergiesexplained.com,  http://allergiesexplained.com/
9. "Mitmann, Gregg, "Breathing Space:  How allergies shape our lives and landscape, 2007,  page 247 (a great read if you want to learn more about the history of asthma/ allergies
10. Werner, Alison, "Taking a Long-Term Look at Childhood Asthma Treatment," RT: For Decision Makers in Respiratory Care," January, 2012, www.rtmagazine.com, page 18-21
11. Schleimer, op cit, page 45

1957: The invention of the rescue inhaler x

When Americans unite and put their minds and imaginations together in a quest to obtain a united goal, anything can be accomplished.  This was what occurred during WWII.  While war is bad, it can bring about many good things.  In this way, the metered dose inhaler -- the rescue inhaler you have in your pocket right now -- is a byproduct of war.

A 1957 ad for the Riker inhaler (a)

Allied troops fighting in the fields of Europe were often infested with bugs that caused Malaria.  This was impeding the war effort.

To remedy this problem the U.S. Government hired researchers to come up with a bug repellent that would help allied soldiers attack bugs.

Lyle Goodhue and William Sullivans must have first looked to the past to find a solution.  They would have learned that in 1790 pressurized aerosols were introduced in France to create carbonated beverages.

They would have learned that in 1837 the first spray can was made of heavy steal in Perpigna.  The can had a valve in it that allowed it to create the spray.  Several prototypes were tested in 1862, although nothing ever came of it. (1)

They would have learned that in 1927 a Norwegian man named Erik Rotheim patented the first spray can that was capable of holding pressurized contents and spraying them.  It's now considered the forerunner of modern spray cans.

Goodhue and Sullivans then took these old ideas and combined them with ideas of their own and came up with a design capable of carrying a pressurized propellant called flurocarbon.  The bug spray was added to the propellent and the spray can allowed for the bugs to be sprayed and killed.

So while the first spray cans were used to hold bug sprays during the war, the concept soon evolved to other products, such as paint and perfume.  It was the perfume market that Riker Laboratories (a subsidiary of what is now 3M Pharmaceuticals) was thinking of when it started tinkering with this product.  They wanted to create a spray perfume. (2)

Yet Riker researchers soon realized there was a demand by asthmatics for a convenient to use and portable spray can for asthma medicine.  This was how the first inhaler came to fruition.  In 1956 Riker inventors created the asthma inhaler market with a Medihaler-Epi that contained epinepherine and medihaler Iso that contained Isophrenaline.

The Riker inhaler was a major breakthrough.  This product was incorporated with the first ever actuator with a one-way valve that allowed for the medicine and propellant to be sprayed in a uniform dose (a metered dose), and soon became known as the metered dose inhaler (MDI).  The Medi-Iso delivered a metered dose of 0.15 mg and the Medi-Epi delivered a dose of 0.06 mg.  The inhalers were  easy to use, provided fast relief, and were easy to lug around. (2)

The design of this original inhaler was very similar to many of the inhalers we lug around today, such as the Ventolin inhaler.  It could easily fit into a boy's front pocket or a mom's purse, and using it was as as easy as squeezing the actuator.

Electric nebulizers in the 1950s were large, bulky and made of glass.  They were also expensive, so many asthmatics had less expensive nebulizers that required them to squeeze a bulb to aerosolize the medicine.  Many asthmatics continued to smoke asthma cigarettes, insents, or other palliative asthma remedies.

So getting asthma relief was inconvenient when the medihaler was introduuced, and the relief given wasn't very good. So this was the market advertisers for Riker Laboratories aimed for when they started their first advertising campaign.

1956 ad for the Medihaler (b)

An old advertisement for the Medihaler (see image) used the inconvenience of these other devices as a marketing ploy:

Medihaler with your favorite bronchodilator:

• No rubber bulbs to deteriorate
• No breakage of costly glass nebulizers
• No spilling of solution in pocket or purse

The Medihaler became an instant hit.  It, coupled with the discovery of theophylline, caused the market for asthma medicines to boom.

Gregg Mitman, in his book "Breathing Space: How allergies shape our lives and landscapes," explained that between 1972 and 1985 prescription drugs in the United States showed a modest 7 percent increase in the number of prescriptions filled.

During the same period, prescriptions for asthma drugs increased 200 percent."  The market for asthma inhalers was so bullish that other pharmaceutical companies raced to make their asthma remedies available as an inhaler.  (3)

Mitman further explained that the sale of asthma inhalers alone (both beta adrenergics and others), accounted for "25 percent of all prescriptions dispensed for the treatment of asthma in 1985."

So it didn't take long at all for pharmaceuticals, doctors and asthmatics to catch on to the convenience of the rescue inhaler.  Life for asthmatics changed forever, and for the better.


Click here for more asthma history.

References:

1.  About.com, "History of spray cans,"  http://inventors.about.com/od/astartinventions/a/aerosol.htm (provides a good history of the spray can)
2. Brenner, Barry E, ed., "Emergency Medicine," 1998, from chapter one "Where have we been?  A history of acute asthma," page 23
3.  Mitmann, Gregg, "Breathing Space:  How allergies shape our lives and landscape, 2007,  page 237 (a great read if you want to learn more about the history of asthma/ allergies)

Pictures:

1. (a)  Deco Dog, http://www.decodog.com/inven/medical2.html, you can purchase or check out old asthma inhaler ads here 
2. (b)  Deco Dog, ibid