Asthma has a precious treatment long back from centuries. Around 1900, it was clearly built that asthma could be caused due to the allergens in the external conditions and mentioned some general approaches for treatment and causes of asthma by Sir Thomas Granger Stewart and George Alexander Gibson. (past pdf)
From the past century treatment has been using for asthma are non-anti cholinergic bronchodilator stimulation, anti cholinergic belladonna-related alkaloids, corticosteroids, cromones, antileukotrienes and anti-IgE medications. (past pdf)
Anticholinergic asthma treatment:
Asthma Cigarettes were the primary treatment for sudden attack of asthma, the cigarettes contains tobacco with Stramonium tobacco, Stramonium is the dried part of flowering or fruiting part of Datura stramonium which contains alkaloids of belladonna as a pro-drug.
In 1910-1914 pilocarpine injections and anti cholinergic in the form of injections and inhalers were started using for treatment of asthma which became a first line therapies.
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In 1970â€™s it was considered to be belladonna-alkaloids were not important in effect in treatment of asthma. After a decade they have started using of non adrenergic bronchodilators like ipratropium bromide and atropine which is effectively used for treatment in mild intermittent asthma. (past pdf)
The bronchodilators Aminophylline was dissolved in water and injected intravenously showed good results, after that many water soluble injections like methyl xanthenes, theophylline, aminophylline were found to be more effective in asthma treatment, these drugs have other mechanism of action in asthma treatment. Among these drug Theophylline is more effective and it also have many adverse effect. Some asthma patients respond to adrenaline and ephedrine but this ephedrine was a traditional Chinese medicine. Adrenalin chloride was found to be very effective treatment given by subcutaneously can control the serious attack from minutes to hours.
Around in mid 1950 metered dose inhalers came in to the marked, that made a wide use by the asthma patients, beta-adrenergic agonist like epinephrine and isoproterenol were used in inhaler medication. Later other beta-adrenergic agonists like albuterol, metaproterenol, terbutline, isoetherine were developed as new meter-dose inhalers. In the middle of 20th century more deaths were found in the asthma patients due the usage of isoproterenol inhaler that was controlled by removing of those inhalers from the market. Formoterol, fenoterol and salmeterol are the beta2 agonist which is modified in such way to provide long duration of bronchodilator activity.
Corticosteroids reduce the inflammation in air tubes, which can be used daily or in alternate days. The corticosteroids have been used in asthma treatment from past 30 years. Inhaler corticosteroids have less adverse effects compare to other administration methods. Compare to bronchodilators corticosteroids have slow mechanism of action on air ways, but the corticosteroids are safer than the bronchodilator.
They have occupied a central place in asthma treatment by its rapid relief from asthma symptoms, reducing hospitalization and deaths, balancing the lung function. AeroBid, Advair, Azmacort and Pumicort are the main inhaled corticosteroids.
Corticosteroid treatment is more effective later in to course of asthma than in early it was clearly showed in the randomized, double blind, cross-over study.(NEJM)
Disodium cromoglycate was the first specific targeted drug in asthma treatment. This drug was targeted towards the allergens. Antileukotriene can block the branchocostriction with inhibitors like zileuton. IgE showing a good resulst in clinical trial that it is effectively treat the moderate asthmatic patients.
Bronchodilators like Beta2 adrenergic agonist used in inhalers have chances of developing residual branchoconstriction after some hours of treatment. (589 pdf)
Inhaled corticosteroid have some worse imbalance in asthmatic adults, there are chances of addiction to these medications and also have many side effects.(editorial)
Apart from these medications there are many complementary and alternative therapies are available for asthma. Many people are showing interest towards the complementary and alter native therapies as chemical drugs shows many side effects.
Complementary and alternative therapies available for asthma treatment are:
Acupuncture: In this a very fine needles will insert into parts of body where treatment requires, there will be some temporary relief in symptoms of asthma.
Buteyko method: It is a kind of breathing exercise in which more carbon dioxide will be send out of the body which made many patients decreased in their medication.
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Chiropractic:A method of treatment in which the manipulation of spine will be done. It has shown that some effective treatment in asthma more research is required in this area.
Homeopathy: In this a drug is prepare with allergic substances and is administered in to the patient which alter the immune system to recognise the allergen without any side-effects. This treatment is useful for asthma patients. But the major problem is it can recognise exact allergen but the patient will have more than one.
Hypnosis: In this the patient will concentrate on one thing which makes stress free.
Supplements: supplements like vitamin C, magnesium and fish oil minerals are helpful in asthma patients.
Yoga : this is a practice by movement of body parts slowly and postures called asana. Pranayama is a very effective exercise in asthma.
Some of the complementary and alternative therapies are not scientifically proved. The major problem is these therapies could not help in serious emergency conditions. And some of the treatments are effective but they take a lot time to cure asthma.
Herbal medicines are the plant extracts. Herbal drug formulations are more effective and safe without any adverse effects that made reasechers and pharmacy companies more focus towards the herbal drugs. Traditional Chinese have precious and miracle herbal drug drug formulations for asthma treatment. This ultimately leads to more preclinical and clinical studies on herbal drugs. The patients also showing more interest towards the herbal medicines comparing to other complementary and alternate therapies.
About 40% of asthma patients are using herbal remedies for asthma treatment as many of the asthma patients are reporting a good outcome with herbal drug therapies. (Akl1)
Many traditional herbal drug formulations like UNANI, AKL1, ASHMI and other have shown successful results in preclinical studies and these are moving in to human clinical trial to check how effectively they are working. These the novel drugs in treatment of asthma.
AKL1 formulation is a mixture of standardized extracts of Picrorrhiza, Apocynin, Zingiber officinale and Ginkgo biloba. The capsules of AKL1 were prepared based on in-vitro study data.
Human studies of AKL1 showed a good improvement in quality of life like cough related health status and asthma control. But there are some adverse events due to this drug. Further research is required for this novel drug on preparation and standardisation. It may show significant results in future as it was showed excellent tolerability.(akl1)
UNANI formulation consists of piper longum, Adhatoda vasica, Picrorhoza kuroa, Hyssopusofficinalis in to 500mg drug. UNANI formulation have showed a good result in improvement of peak exploratory flow rate and forced expiratory volume in one second. The patients also feel relief from this treatment with few side effects. In UNANI the formulation is based on bronchodilator, antiinflammation, antihistamine, leukotrien inhibitor.