Friday, January 20, 2012

1960-2012: Evolution of asthma controller meds

Previously I described the history of steroids for the use of asthma, and how inhaled steroids became the preferred method of preventing asthma.  In this post I shall list the asthma controller medicines that have been used since the 1960s.

The following are asthma controller medicines past and present:

1.  Beclomethasone:   First marketed by Allen & Hanbury in 1960 and marketed as Becotide in 1972 overseas with a recommended frequency of two puffs four times 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.  Other oversease brand names are Becloforte, and Beconaise.  The initial inhalers were made with the chlorofluorocarbons (CFC) propellant and these have all been since phased out in favor of the HFA verions called Qvar (see below)

2.  Fenoterol:  It was a non-selective long acting beta agonist that asthma patients were allowed to use at home.  It was marketed as Barotek.  It was introduced to the market in New Zealand in 1976.  Shortly thereafter the asthma death rate soared in New Zealand to a rate significantly higher than other nations.  Fenoterol overuse was blamed for the deaths, however, this was never proven.  Some believe that poor education about asthma medicines encouraged some asthmatics to continue using the medicine instead of seeking help.  The New Zealant asthma death rate declined slightly after warnings were incorporated into the package in 1981, yet the death rate in New Zealand continued to be higher than other nations.  The death rate fell 50 percent in 1990.  Despite the warnings, sales of the product remained consistent and actually increased slightly in 1989-90.  (1)  Despite consistent sales, the product was taken off the market in the 1995 due to the scare. The product was also available in Japan and Canada.

Intal Spinhaler
3.  Chromolyn:  The Intal Spinhaler hit the market in the 1960s.  It was and was prescribed as an alternative to inhaled corticosteroids to treat inflammation in asthmatic airways.  It was popular in the 1980s and 90s.  You can read more about the Intal Spinhaler here.  The main problem with the spinhaler was the powder inhaled often precipitates coughing and asthma, plus the patient has to handle each dose.  The FDA approved an MDI (with the CFC propellent) in 1992 which ultimately replaced the spinhaler.  Due to decline in prescriptions of the medicine and the Montreal Protocol's ban on CFC inhalers, the medicine was phased out by December 31, 2010.

Azmacort inhaler
4  Triamcinolome:  It was introduced to the market by in the early 1980s as Azmacort and approved by the FDA in 1984.  It's formula was slightly stronger than beclomethasone and became another inhaled steroid option.  It was the first inhaler to come with its own built in spacer, which assured proper use of the inhaler, and increased compliance.  However, it was bulky and difficult to carry.  Sales started to decline in the late 1990s due to long acting inhaled steroids that required fewer puffs, such as fluticasone  After the declaration by the Montreal Protocol the  medicine was phased out by December 31, 2010.  However, in 2008 the FDA approved an HFA version which continues to be an option to this day. 

Tilade inhaler
5  Nedocromil Sodium:  It was approved by the FDA and introduced to the market in 1993 as an alternative to Tilade  It was an inhaler with the CFC propellant  Since sales of this product declined by the late 1990s due to better asthma controller medicines on the market. After the Montreal Protocol set a timetable to ban the use of the CFC propellant in asthma inhalers, the product was phased out by June 14, 2010.

6.  Flunisolide:  It was approved by the FDA in 1982 introduced to the U.S market as Aerobid.  This turned out to be perfect timing for entry into this market, because in 1989 the National Heart, Lung and Blood Instute's (NHLBI) Asthma Guidelines were created.  The guidelines recommended inhaled steroids as a top line asthma treatment, and sales of inhaled steroids skyrocketed, with Aerobid leading the way. Aerobid was the best selling inhaled steroid during the 1990s mainly because it had a stronger formula than triamcinolome and beclomethasone requiring fewer puffs to achieve the desired dose.

Aerobid inhaler
7.  Fluticasone: The Flovent CFC MDI was approved by the FDA and entered the market in 1996.  By 2000 the Flovent Diskus was approved as the DPI version of the medicine.  Soon thereafter the CFC MDI was taken off the market.  The Flovent HFA MDI was approved by the FDA in 2004.  The doses were:  44 mcg, 110 mcg, and 220 mcg.  The medicine is a stronger inhaled steroids than its predicessors and only needed to be taken twice daily.  One puff of the Diskus is equal to 2 puffs of the MDI.

8.  Salmeterol:  It was approved by the FDA in 1994, and became the latest long acting beta adrenergic (LABA) to enter the market.  The medicine attached to beta 2 adrenergic receptor sites in the lungs and continued to release the medicine for up to 12 hours.  All that was needed was two puffs twice a day. The Advair Diskus, a dry powdered inhaler, was approved by the FDA in 1997.  The diskus was green to distinguish it from the brown Flovent Diskus and eventually the Advair purple Diskus).  By 2008 some suspected the medicine was the cause of asthma related deaths and a black box warning was placed on the product.  The NHLBI Asthma Guidelines ultimately recommended the medicine not be used by itself in the treatment of asthma.  If asthma is bad enough that this medicine is needed, the guidelines recommended taking it with an inhaled steroid to control inflammation.  The product is still available as a treatment for other lung diseases such as COPD.

Advair Discus
9.  Advair:  This is a combination drug with both Fluticasone and Salmeterol that was introduced to the market in the 1990s, approved by the FDA in 2000 for ages 12 and up.  The recommended dose is 100/50 (Fluticasone/Salmeterol), 250/50, and 500/50.  It's recommended to start at the lower dose and increase as needed.  The 100/50 dose was approved for children ages 4 and up in 2003.  Some patients, especially younger ones and the very old, may have trouble generating enough flow to actuate the medicine.  For these patients an Advair HFA inhaler was approved by the FDA in 2006 that can be used with a spacer to improve coordination.  Source for above dates is FDA.gov.

The medicine was marketed as an asthma controller medicine to prevent bronchospasm and inflammation in asthmatic lungs to prevent asthma.  Because it combined the two medicines and the frequency is one puff twice daily, it greatly improves compliance with asthma medicine (I can personally attest to this).  Sales skyrocketed during the 2000s and it continues to be the top selling asthma controller medicine. Some fear salmeterol is related to asthma deaths and a black box warning was placed on the packaging in 2008.  I wrote about this in more detail here.The patent for Advair expired in the U.S. in 2010 and will expire by 2012 in most European countries.  It's expected that soon generic products will enter the market which would increase competition and lower the cost of the inhalers (currently priced at over $100).

Foradil Inhaler
10.  Formoterol:  Introduced to the market as an alternative to salmeterol.  The Foradil Aerolizer was approved by the FDA in 2001 and the product was marketed in the U.S.  Oxeze, Atock, Atimos and Performist were common names used overseas.  The Foradil Aerolizer was a dry powdered version of the medicine.  The Foradil Centihaler was approved by the FDA in 2006. The NHLBI Asthma Guidelines ultimately recommended the medicine not be used by itself in the treatment of asthma.  If asthma is bad enough that this medicine is needed, the guidelines recommended taking it with an inhaled steroid to control inflammation.   According to the FDA.com, as of 2007 there were no FDA approved formoterol products on the market in the U.S.  However, it's currently marketed by AstraZeneca in other countries as the Oxis Turbohaler.  The medicine is available, however, in the combination inhaler sold by AstraZeneca known as the Symbicort inhaler (see below).

11  Budesonide:  The inhaled steroid solution of Pulmicort was introduced to the market in the early 1980s as the only inhaled steroid available as a solution for home use.  Studies showed it was the safest and best corticosteroid solution.  It was mainly prescribed for kids, however it's recommended for any asthmatics who requires inhaled steroids and has trouble coordinationg an inhaler. From what I can tell it has the same potency as Flovent.  A Pulmicort Turbohaler hit the market in the late 1980s as the first corticosteroid as a dry powder inhaler.  In 1997 the Pulmicort Turbohaler  was approved by the FDA as the first DPI inhaled corticosteroid.  The inhaler never caught on and was later discontinued.  In 2000 Pulmicort Respules became the first corticosteroid nebulizer solution to be approved by the FDA.  However, due better inhaled steroids and the Monteral Protocol, the Pulmicort Turbohaler was phased out by June 30, 2011.  The Pulmicort Respules continue to be marketed as an inhaled corticosteroid option for children and adults with poor coordination skills with their corticosteroid MDIs.

Symbicort inhaler
12.  Symbicort:   Marketed by AstraZeneca and approved by the FDA in 2006. 
It basically works the same as Advair except the LABA (formoterol) is faster acting and appears to have a stronger cardiac effect.  The steroid in this inhaler is mometasone furoate (see below).  It's availabe as either a metered dose inhaler or dry powder inhaler via the Turbohaler.  Note:  Some countries have adopted the Symbicort Smart program whereby you can use your Symbicort as a rescue inhaler.  I wrote about this here

13.  Beclomethasone:  I'm mentioning this again because the older CFC versions of this inhaler were taken off the market and replaced by an HFA inhaler which has been rebranded as QVAR.  It was approved by the FDA in 2000.  The medicine is the same, yet some studies show the smaller particle size allows the medicine to penetrate deeper into the lungs as compared with other inhaled corticosteroids presently on the market.

Symbicort Twisthaler
14.  Mometasone furoate:  It's the latest long acting inhaled corticosteroid to enter the market.  It was approved by the FDA in 2008.  It's a once a day medicine, or twice a day if need be, that was introduced to the market as Azmanex.  It's a dry powder inhaler taken via the Azmanex Twisthaler.  I have never tried this medicne, although I had to teach myself how to use the inhaler so I could teach how to use it to patients. 

15.  Dulera:  It was approved by the FDA in June of 2010.  It hit the market as an alternative to Advair and Symbicort.  It containes Mometasone and Furosimide.  Other than that it works similar to Advair and Symbicort.  Whether one of these works better than the other is a matter of personal choice and physician preference.  I trialed this medicine once and it make my heart beat like a jackhammer and I went back on Advair. 

Singulair pills
16.  Montelukast sodium:  This product was introduced to the market in 1998 as Singulair.  It was the first leukotriene receptor antagonist.  What it does it it blocks the affects of leukotrienes and prevents them from causing inflammation and bronchospasm.  Leukotrienes are released from mast cells during the allergic response along with histamine.  While histamine causes inflammation of the respiratory tract, leukotrienes do this, but they mostly cause bronchospasm.  So Singulair was marketed as a product to help allergic asthmatics.  With insurance these pills cost about $1.00 each, or $30 for a month supply (as of this writing in January 2012). I took this medicine the past three years, but with my doctor's permission I just quit becasue I haven't noticed any results.  My doctor said he's recommending all his asthma patients quit taking it. 

17:  Zafirlucast:  This was another leukotriene receptor agonist admitted to the market as Accolate to compete with Singulair.   It was approved by the FDA in 1999.

18.  Zileuton:  This was another leukotriene receptor agonist marketed as Ziflo.  It was introduced to the market in 2007 and was discontinued in 2008 (you can read the discontinuation letter here).  It failed to take off becaue the other options only had to be taken once daily, while this one had to be taken four times daily. 

19.  Omalizumab:  This is the first medicine on the market to block the effects of IgE, an antibody that is responsible for the allergic response.  The medicine is marketed as Xolair and consists of a series of injections.  It costs $10,000 to $30,000 for an annual prescription, and for this reason it's only recommended for severe, persistent asthma (hardluck asthma) non responsive to other asthma remedies.  It was approved by the FDA in 2003.

Further reading:
References:

  1. Beasley, Richard, Sankei Nishima, Neil Pearce, Julian Crane, "Fenoterol and Asthma Mortality," The Lancet, August 8, 1998, volume 352, Issue 9126, page 486

Thursday, January 19, 2012

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.  

Tuesday, January 17, 2012

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.comhttp://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: