Asthma therapy :
from cigarettes to inhalers
FAWZIA ABO ALI
AIN SHAMS FACULTY OF MEDICINE
Inhalation has been employed as a
method of delivering medication to
the lung for centuries, in forms
ranging from smoke to vapour.
Ancient man discovered medicinal
plants by observation and experience.
Inhaling the smoke or odours of some
plants was tried to get pleasure and
relief of lung troubles .
Inhalation in ancient Egypt.
The first recordings of inhaling the herbs
was around 4,000 B.C.
The Ancient Egyptians had plentiful
access to atropa belladonna plant.
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.
• Physicians used belladonna as a remedy for just
about any respiratory illness. The dried and crushed
herbs were heated, and the smoke was inhaled to
provide breathing relief.
• However, there were risks, such as dry mouth,
increased heart rate, dilated pupils, nausea and
In ancient India around 100
A.D. There were many herbs
the Indians had access to ,such
as datura strammonium.
Like belladonna, the leaves,
stems and roots were dried and
crushed into a fine powder
the Indians stuffed into their
pipes and smoked it.
A long time passed before British physician and
asthmatic James Anderson visited India and
enjoyed breathing relief after smoking a cigarette
containing datura strammonium.
The year was 1802.
Dr. Sims a friend of Anderson in Edinbergh, noted
the benefits, and published a report in
the Edinbrugh Medical and Surgical Journal.
After this report ,asthma cigarettes were entered
into British and American pharmacopoeia, and
became popular for the treatment of asthma in
these western nations.
Sneader, Walter, "Drug discovery: a history, 2005, England, page 96
Atropine (secret ingredient the cigarettes) was first
derived from the belladonna plant in 1833.
By 1867 Atropine was isolated. 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).
Early studies showed that atropine :dried secretions,
increased heart rate, opened air passages, and
produced a hallucinogenic effect.
Asthma Cigarette craze!!
By the mid 19th century the market for inhaling
ingredients grew steadily. Belladonna,
stramonium, henbane, atropine, and even cannabis
were widely sold to patients.
Some inhaled powder on plates, others stuffed it
into pipes, or rolled it into cigarettes.
The products were marketed for any respiratory
condition, including asthma, chronic bronchitis,
whooping cough, catarrh, and hay fever.
By the 1880s technology progressed so some
companies pre-rolled cigarettes and sold them at
Asthma cigarettes brands
• Asthma cigarettes from a
variety of companies could be
found on pharmacy shelves.
According the Inhalatorium,
the most famous brands were:
• Potter's Asthma Cigarettes
• Dr Guild’s green Mountain
• Charles Dickens suffered severe
recurrent attacks of asthma.
• He found relief from his "chest
troubles" only with asthma
cigarettes, the popular asthma
remedy of that time.
Invention of nebulizers:
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 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),
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, inexpensive, and easily
carried in pockets and purses.
The end of asthma cigarettes
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.
H.L. Elliot and J.L. Reid described in a 1980 article published in
the British Journal of Clinical Pharmacy a study that concluded;
1. “Asthma cigarettes made of "herbal preparations
containing Atropinelike alkaloids" were just as
effective as using ipatropium bromide (Atrovent)”.
2. "an overdose of of asthma cigarettes is capable of
producing (hallucinations, delerium, tachycardia."
3. “the dose of medication getting to the lungs is
"variable and unpredictable.“
4. "In view of increasing evidence of abuse, there
appears to be good reason to restrict availability of
these preparations. “
The end of asthma cigarettes
• By 1985 asthma cigarettes were
removed from the shelves of all
U.S. Stores. By this time there
were many other options of
inhalers which have taken over
since the introduction of the first
modern -the pressurised metered-
dose inhaler (pMDI).
The pMDI was initially used for the administration
of the non-selective beta-agonists adrenaline and
However, the epidemic of asthma deaths which
occurred in the 1960s led to these drugs being
outdated by the selective short-acting beta-agonist
salbutamol, and the first inhaled corticosteroid
At the same time, sodium cromoglycate was
introduced, to be administered via the first dry-
powder inhaler--the Spinhaler--but owing to its
relatively weak anti-inflammatory action, its use is
now very limited.
Over the last 10
years, the long-acting
become an important
add-on therapy for
the management of
asthma, and they are
now often used with
ICS either separate
or in a single
2. "Sneader, Walter, "Drug discovery: a history, 2005, England, page
3. "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
4. H.L. Elliot and J.L. Reid, "
The Clinical Pharmacology of a Herbal Asthma Cigarette"British
Journal of Clinical Pharmacy (1980, 10, 480-490)
5. Smyth, Hugh D.C, Anthony J. Hickey, "Controlled Pulmonary Drug
Delivery," 2100, Springer New York Dordrecht Heidelberg London
6. www.hardluck asthma.com
8. Crompton G, A brief history of inhaled asthma therapy over the
last fifty years.Prim Care Respir J. 2006 Dec;15(6):326-31. Epub
2006 Nov 7.