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The treatment of asthma is occupying a critical role in minds of many scientific researchers. It is also creating the controversies among the researchers. In the ancient times asthma is treated by the traditional healers with the help of herbal wealth. They used the plant parts such as roots, stems, leaves, bark etc. for the preparation of medicines. People at that time also believe in that herbal drug as they are effective for their treatment of diseases. But now some researches are showing that the clinical and pharmaceutical data was unclear with the herbal remedies. Present day treatment of asthma is really changed alot when compared to ancient treatment. Complementary and alternative medicines (CAM) usage is wide spread worldwide. This trend has has commenced to draw in the pursuit of main stream healthcare providers and scientific researchers. There are many other therapies that led to arise, those are traditional Chinese medication (TCM), ding chaun tang (DCT), saiboku-to(TJ-96). Many researches are still going on the subject of treatment of asthma. Those researchers are mainly concentrating on the accurate cure of the asthma. Bronchial thermoblasty is the recently completed trial that showed the safety and efficacy on asthma. Bronchial thermoblasty provides longterm asthma control in patients with severe asthmatic attacks. A novel herbal medicament anti asthma herbal medicine intervention (ASHMI) is proved to be an effective therapy in treating allergic asthma.
Asthma is a chronic inflammatory lung disease that inflames and narrows the airways. This results in the obstruction of airflow. Asthma can also be called as bronchial asthma, which is very common disease observed all over the world in all age groups. But it is mostly seen in childhood.
What happens in asthma?
In asthma, there is a decrement in the volume of bronchioles and this results to a two-fold response to the allergens. The smooth muscles in the airways compressed and narrowed. These factors of inflammation cause a swelling of airways, this also causes increase of mucus secretion and thus causing wheezing, shortness of breath and cough.
"Asthma is one of the severe public health problem all over the world, especially in the western countries, and it is affected to an average of 20 million people annually in the US in recent years." (Moorman JE et al 2004). Asthma is mostly prevalent in children of age group 2-12 years. In females , this disease prevalence is more among young adults. Children with family history of allergy and asthma are more likely to have asthma. Among the adults boys are more prevalent to asthma when compared to the girls. But more cases are found in women than in men. It is estimated that 7-10% prevalence worldwide. (Lazarus SC et al.,2010).
The accurate cause of asthma is not known. It is a compound of facts like family genes and some environmental exposures. Some triggers cause an asthma attack if exposed to inflamed airways. Because it is better to prevent the inflammation of airways and keep off the triggers for better control of symptoms.
Characteristics of asthma:
Wheezing, cough, shortness of breath, mucus production, exhaustion are the major symptoms of the asthma that the patients experience. The intensity, duration and recurrence of symptoms alters from patient to patient. Sometimes symptoms may vary from episode to episode in the same patient.
Classification of asthma:
Based on the symptoms, asthma can be classified into four types.
Mild intermittent: In this , patient experience symptoms twice in a week or less. Between the symptoms , lung function is normal.
Mild persistent asthma: In this type of asthma patient experience asthmatic effects more than two times in a week. But not more than once in a single day. Some times it occurs in the night times also.
Moderate persistent asthma: In this the symptoms of asthma occur everyday.mainly those occur in the night times.
Severe persistent asthma: Here the symptoms are throughout the day on most days. The symptoms appear in the night times also.
Airway inflammation is the major problem in asthma. When the allergens, irritants etc. are exposed to the patient inflammatory mediators are triggered. The mediators are histamine, tryptase, prostaglandins and leukotrines. T-lymphocytes and bronchial mast cells releases these mediators. These mediators cause "early-phase asthmatic response". The activation of eosinophils and neutrophils occur due to these inflammatory mediators. Their movement to the airways and causes injury, which is called as the "late-phase asthmatic response". This results in the epithelial damage, mucus hyper secretion and hyper responsiveness and bronchial smooth muscle. This altering airflow blockage leads to recurrent episodes of wheezing, cough, breathlessness, chest tightness etc.
The asthma diagnosis is mostly clinical. "The diagnosis of asthma is usually based on the pattern of symptoms (airways obstruction and hyper responsiveness)and/or response to therapy (partial or complete reversibility) overtime".(Lemonske RF et al.,2010).
A detailed medical history of patient and physical examination is done to evaluate the presence or severity of the asthma symptoms. In children of age below 7 years diagnosis can be evaluated by the clinical response to the inhaled bronchodilators. But in children above 7 years diagnosis is done by the spirometry or other laboratory techniques.
Some laboratory tests are done to measure the lung function. Those are:
Peat flow meter
Complete blood count.
Spirometry is the authentic method to determine airway obstruction. Spirometry is used to test the lung function.
Herbal treatment of asthma :
Asthma is a chronic inflammatory disease and is a long-term disease. Treatment of asthma is altering in the day to day life of human being. There are different types of treatments using by the physicians changing according to the development of technology.
Past treatment of asthma;
In the ancient times asthma is treated with the many herbal remedies. These are prescribed by the traditional healers. "There is a strong faith and belief in the herbal health care system by the tribal people."(N.Savithramma et al.,2007). "Only local healers in their community having the knowledge on asthma drug plants"(N.Savithramma et al.,2007). There is no course study to become a traditional healer, it is done through spiritual endowment.(Dickinson, 1990). But according to the present regulations it is not acceptable by the government bodies of any country. Traditional healers used different type of herbal remedies such as Bhasmas, Churnas, Lehyas, Rasa's, Mula's, Amritha's for the treatment of asthma. A little or no pharmacological and clinical data is available for these herbal remedies. "The traditional healers used some plants for the ingredients in the preparation of ayurvedic medicines. Among those dashamulas, vesalehyam, tacisabi churnam, swasaritam are used in treatment of the asthma disease."(Murthy,1994). Combination of plants are given by the traditional healers. These are given according to the age, body nature, severity of disease and weight of the patient. Roots, stems, barks, leaves, seeds etc. are the different plant parts used for the preparation of ayurvedic medicines in the treatment of asthma. These are freshly prepared by the traditional healers when there is need like one day before use. The preparation of these herbal remedies is very risky and the accurate dose cannot be prepared. They collect the plant parts early in the morning and they prefer to give the medication with the empty stomach.(N.Savithramma et al.,2007).
"Adathoda vasica is extremely used by the ayurvedic physicians and the traditional healers due to its bronchodilatory activity either singly or in combinations." Shah et al., 1987 (Vedavathy et al., 1997). Other different medicinal plants are Acalypha indica, Achyranthes aspera, Cassia fistula, Citrus medica, Datura stramonium, Lactuca sativa, Papaver somniferum, Piccorrhiza kurroea etc. Datura stromonium is one of the majorly used medicinal plant as a ayurvedic medical remedy. Datura stramonium contains variety of alkaloids. It contains alkaloids such as atropine and scopolamine. Both these alkaloids acts on muscarinic receptors by blocking them on airway smooth muscle and sub-mucosal gland cells. Further more Datura stromonium plant , a herbal medicine is often prescribed to pregnant mothers with asthma symptoms. But if it is taken in larger amounts it may lead to the anti-cholinergic poisoning. "The large utilization of traditional medicine by a particular tribal African communities is assigned to its affordability and accessibility and thus the use of herbal medicine is becoming more popular worldwide."(Steenkamp,2003). E.Pretorius et al., (2006) confined that "The Datura stromonium used frequently by herbalists to treat asthma should be used with extreme care and discontinued immediately during pregnancy."
Now a days modern medical facilities attaining rapid penetration into the rural areas, and that may resulting in vanishing of herbal remedies.
Only very few herbal drugs having clinical data.
Little or no scientific evidence of herbal efficacy.
Insufficient information available regarding optimal preparation and dosages.
Different traditional healers uses different dosage of drugs and different duration of treatment.
Present day treatment:
Present day treatment of asthma is really changed a lot compared to the ancient treatment. Present days, physicians mainly concentrating in the prevention of long-term control of asthma attacks. "Corticosteroids are the most potent, non-specific anti-inflammatory produce improvement in lung function of patients and corner stone of asthma."(Ming-Chun wen et al., 2005). Many of the medications used now a days are bronchodilators, inhaled corticosteroids, leukotrine modifiers etc. Even Beta 2 agonists and corticosteroids are effective in controlling asthma, a healing therapy for asthma is missing. But also corticosteroids may also produce the severe adverse effects, they also develop immune suppression that decreases disease resistance and susceptible to other infections.
In asia traditional Chinese medicine (TCM) is used for a long time and it is starting to play a key role in the western health care as a complementary and alternative medicine. Scientific evidence is also increasing to support the use of traditional Chinese medicine for asthma. "Many patients with chronic illness, such as asthma, use complementary and alternative medication to treat their conditions and utilisation of complementary and alternative medication is increasingly wide spread in US."(Angkona Roy et al.,2010). But complementary and alternative medications have no clear data that they adhere with the inhaled corticosteroids and achieving the possible asthma control.
Some people do the self treatment that happening among adults with asthma. Self treatments such as taking coffee, black tea etc. during the time of asthma attacks. Those are non-prescriptional products and are little dangerous. This leads to reported hospitalization or other diseases. It interims the usage of more effective treatments.
"Most of the patients suffering from chronic allergic conditions get complementary and alternative medicine therapies including traditional Chinese medecines. This trend has commenced to draw in the pursuit of main stream healthcare providers and scientific researchers. This has stimulated the government agencies in the US to provide support and guidance for the scientific investigation of complementary and alternative medicines."(Xiu-Min Li,2007).
Hsu et al(2005) reported results of a clinical investigation of complementary traditional Chinese medicine (TCM) therapy for asthma. Chan et al(2006) stated that ding chaun tang (DCT), a Chinese herbal decoction, could reduce airway hyper responsiveness(AHR) in stabilized children with asthma.
The safety and efficacy of many herbal remedies are evaluated by many scientific researchers and those were now approved by many of the governments. "Japanese government approved herbal complexes Saiboku-to(TJ-96) is effective for the treatment of atopic asthma."(Y.Urata et al., 2002). But Saiboku-to(TJ-96) is tested only for its effect on bronchoconstriction and its eosinophilic precipitation was not assessed, thus it could not be expected for the accurate cure of asthma.
Now a days many people uses the pharmaceuticals and are not preferring the herbal remedies.
Most of the physicians also does not prescribe these herbal drugs. Thus these drugs are sold in the pharmacy without any prescription.
As the government showing less control over the herbal drugs, there is a chance of producing low quality products.
Some herbal remedies shows their side effects after a long time, thus patients doesn't dare to use these drugs for their treatment.
Future aspects of asthma treatment:
Many researches are still going on the subject of treatment of asthma. Those researchers are mainly concentrating on the accurate cure of the asthma.
"The recently completed randomized, multicentral, double-blind, shown controlled asthma intervention research2 (AIR2) trial evaluated the safety and efficacy of Bronchial thermoblasty. Bronchial thermoblasty significantly reduced severe exacerbations and emergency department visits for the respiratory symptoms at 1-year post treatment."(Mario castro et al., 2010). Bronchial thermoblasty provides longterm asthma control in patients with severe asthmatic attacks. To relieve from the asthmatic symptoms bronchial thermoblasty uses the radio frequency energy. But this therapy is not a perfect cure for asthma, because it does not remove the smooth muscles from the airways it just makes thinner.
"A novel herbal formula, anti-asthma herbal medicine intervention (ASHMI) has been shown to be an effective therapy in a murine model of allergic asthma. ASHMI is an extract of three herbs."(Kristin Kelly pieper et al.,2009).
Ling-zhi (Ganoderma lucidium)
Ku shen (Radix saphora)
Gan-cao (Radix glycyrrhiza uralensis)
ASHMI actually decreases the airway hyper activity and eosinophilic inflammation and thus shows the efficacy over the asthmatic symptoms.
As asthma is a chronic inflammatory diseases, inhaled corticosteroids (ICS) are given for the first line treatment, but some patients cannot achieve control of asthma even higher doses are used and also be given as the combination with beta2 agonists, leukotrine modifiers. Such patients require additional therapy.
Omalizumab is a new remedy that is currently going on clinical development. "Omalizumab, a recombinant humanized monoclonal antibody that specifically targets Ige and is indicated for patients with moderate to severe asthma caused by allergies."(Nicola A.Hanania,2010). Omalizumab is given as a subcutaneous injection once in a month or once in two weeks based on severity of disease. The cost of omalizumab is very high as it is about $10000 to $12000 per annual therapy. It is very much higher when compared to inhaled corticosteroids (Andrew F.Shorr .,2009).
"Patients with serious asthmatic symptoms have more psychotropic distress and trouble in facing with their disease emotionally and behaviourally, relative to patients with controlled asthma. (Kim L.Lavoie et al.,2009). Future treatments studies show focus on helping patients with severe asthma manage distress and cope more effectively with their illness, which may improve outcomes in this high risk patients."(Kim L.Lavoie et al.,2009).
Asthma is also treated by the herbal medicines other than the inhaled corticosteroids. In the ancient times herbal wealth is the only way of treating the diseases, but now a days many new drugs and techniques have araised. Those showed their more effectiveness when compared to herbal drugs whose clinical and pharmaceutical data is mostly unclear. Still many trials are going on for the efficient treatment of asthma.