Asthma therapy :from cigarettes to inhalersFAWZIA ABO ALIAIN SHAMS FACULTY OF MEDICINE
Inhalation therapyInhalation has been employed as amethod of delivering medication tothe lung for centuries, in formsranging from smoke to vapour.Ancient man discovered medicinalplants by observation and experience.Inhaling the smoke or odours of someplants was tried to get pleasure andrelief of lung troubles .Incense Inhalation
Inhalation in ancient Egypt.The first recordings of inhaling the herbswas around 4,000 B.C.The Ancient Egyptians had plentifulaccess to atropa belladonna plant.Encyclopedia.com describes howEgyptian women squirted drops in theireyes "for the allure given by large,black pupils: hence the namebelladonna — ‘fine lady.“It made pretty eyes prettier and helpedbeautiful Egyptian women woo men.www.encyclopedia.com
• Physicians used belladonna as a remedy for justabout any respiratory illness. The dried and crushedherbs were heated, and the smoke was inhaled toprovide breathing relief.• However, there were risks, such as dry mouth,increased heart rate, dilated pupils, nausea andexcitation.
Ancient IndiaIn ancient India around 100A.D. There were many herbsthe Indians had access to ,suchas datura strammonium. Like belladonna, the leaves,stems and roots were dried andcrushed into a fine powderthe Indians stuffed into theirpipes and smoked it.
Asthma Cigarettes1800-1985:A long time passed before British physician andasthmatic James Anderson visited India andenjoyed breathing relief after smoking a cigarettecontaining datura strammonium.The year was 1802.Dr. Sims a friend of Anderson in Edinbergh, notedthe benefits, and published a report inthe Edinbrugh Medical and Surgical Journal.After this report ,asthma cigarettes were enteredinto British and American pharmacopoeia, andbecame popular for the treatment of asthma inthese western nations.Sneader, Walter, "Drug discovery: a history, 2005, England, page 96
AtropineAtropine (secret ingredient the cigarettes) was firstderived from the belladonna plant in 1833.By 1867 Atropine was isolated. It was thendetermined to be a component alkaloid of the variousnightshade plants found in India, including the datura strammonium, atropa belladonna, and the hyoscyamus niger (black henbane).Early studies showed that atropine :dried secretions,increased heart rate, opened air passages, andproduced a hallucinogenic effect.www.encyclopedia.com
Asthma Cigarette craze!!By the mid 19th century the market for inhalingingredients grew steadily. Belladonna,stramonium, henbane, atropine, and even cannabiswere widely sold to patients.Some inhaled powder on plates, others stuffed itinto pipes, or rolled it into cigarettes.The products were marketed for any respiratorycondition, including asthma, chronic bronchitis,whooping cough, catarrh, and hay fever.By the 1880s technology progressed so somecompanies pre-rolled cigarettes and sold them atpharmacies.
Asthma cigarettes brands• Asthma cigarettes from avariety of companies could befound on pharmacy shelves.According the Inhalatorium,the most famous brands were:• Potters Asthma Cigarettes• Blosser’s• Marshall’s• Kinsman’• Dr Guild’s green Mountain• Kellogg’s• Page’s• Regesan’swww.inhalatorium.com
Charles Dickens(18121870)• Charles Dickens suffered severerecurrent attacks of asthma.• He found relief from his "chesttroubles" only with asthmacigarettes, the popular asthmaremedy of that time.
Invention of nebulizers:Asthma cigarettes continued to bepopular even after the discovery ofepinephrine in 1900 and as thesolutions of epinephrine and atropinebecame options for home use with theinvention of bulb syringe nebulizers.Rau, Joseph L., "Inhaled Adrenergic Bronchodilators: Historical Development and Clinical Application," at AARC.org(American Association of Respiratory Care, July, 2000, Vol. 45, number 7),
First inhalerwhile asthma cigarettes werethe preferred choice due toconvenience and cost, that allchanged in 1957 with theinvention of the inhaler, and therelease of the Medihaler-Isoand the Medihaler Epi.These inhalers provided instantrelief, inexpensive, and easilycarried in pockets and purses.
The end of asthma cigarettesthe cigarettes were still a viable over the counteroption until the early 1980s.The end came due to growing concerns teenagerswere purchasing asthma cigarettes not forasthma relief but for their hallucinogenic effects.
H.L. Elliot and J.L. Reid described in a 1980 article published inthe British Journal of Clinical Pharmacy a study that concluded;
1. “Asthma cigarettes made of "herbal preparationscontaining Atropinelike alkaloids" were just aseffective as using ipatropium bromide (Atrovent)”.2. "an overdose of of asthma cigarettes is capable ofproducing (hallucinations, delerium, tachycardia."3. “the dose of medication getting to the lungs is"variable and unpredictable.“4. "In view of increasing evidence of abuse, thereappears to be good reason to restrict availability ofthese preparations. “
The end of asthma cigarettes• By 1985 asthma cigarettes wereremoved from the shelves of allU.S. Stores. By this time therewere many other options ofinhalers which have taken oversince the introduction of the firstmodern -the pressurised metered-dose inhaler (pMDI).
The pMDI was initially used for the administrationof the non-selective beta-agonists adrenaline andisoprenaline.However, the epidemic of asthma deaths whichoccurred in the 1960s led to these drugs beingoutdated by the selective short-acting beta-agonistsalbutamol, and the first inhaled corticosteroid(ICS) beclomethasone.At the same time, sodium cromoglycate wasintroduced, to be administered via the first dry-powder inhaler--the Spinhaler--but owing to itsrelatively weak anti-inflammatory action, its use isnow very limited.
Lastly,Over the last 10years, the long-actingbeta-agonists(LABAs) havebecome an importantadd-on therapy forthe management ofasthma, and they arenow often used withICS either separateor in a singlecombination inhaler.
References:1. Encyclopecia.com2. "Sneader, Walter, "Drug discovery: a history, 2005, England, page963. "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 18874. H.L. Elliot and J.L. Reid, "The Clinical Pharmacology of a Herbal Asthma Cigarette"BritishJournal of Clinical Pharmacy (1980, 10, 480-490)5. Smyth, Hugh D.C, Anthony J. Hickey, "Controlled Pulmonary DrugDelivery," 2100, Springer New York Dordrecht Heidelberg London6. www.hardluck asthma.com7. www.Inhalatorium.com.8. Crompton G, A brief history of inhaled asthma therapy over thelast fifty years.Prim Care Respir J. 2006 Dec;15(6):326-31. Epub2006 Nov 7.