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A long and winding road
A Long and Winding Road Asthma Through the Years Suzanne Rutkowski
Plagued by the effects of the London smog in the early 1900s, inventor Sir Hiram Maxim developed his own inhaler that delivered menthol and pine essence.
Numerous brands of asthma cigarettes were available in the late 1800s. Typically they contained stramonium and belladonna, but no tobacco. All photos courtesy of Inhalatorium.com
ASTHMA MAGAZINE
Asthma has been the focus of a lot of media attention in recent years. These reports include news about the increase in its prevalence and the new medications to treat it. Although so much attention may be new, asthma is not a new disease. In fact, symptoms of breathlessness, chest tightness, cough, and mucus production have been documented for thousands of years. Have you ever wondered about the history of asthma? You may be amazed at some of the treatments that were used in the past. When were our modern medicines discovered? Today’s medicines aren’t a cure, but you will marvel at how far we have come in controlling this condition. Asthma symptoms were first recorded about 3500 years ago in an Egyptian manuscript called “Ebers Papyrus.” Reference to the word “asthma” also appeared in Homer’s Iliad. The word was derived from a Greek word meaning “labored breathing.” Hippocrates, a famous Greek physician born in 460 BC, believed that asthma was caused by a disturbance in the balance of humors (various body fluids). He blamed the humor, phlegm, for flowing from the brain down through the nose to clog the lungs. The remedies during this time included everything from herbs to animal feces, with the treatments often steamed over hot stones so they could be inhaled. Around 100 ad, another Greek physician, Aretaeus, recognized that asthma was a chronic
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7
who had died from a severe asthma attack. During this period scientists developed a better understanding of the mechanisms of asthma. Tools to Diagnose and Assess Asthma
Dr. Guild’s Green Mountain asthma compound contained stramonium and belladonna, along with potassium nitrate, anise and anethol. It was to be put on a plate and lit so the patient could inhale the fumes.
breathing condition. He noticed that it came and went spontaneously and that breathing was affected by exercise, and he was also the first to describe an acute attack. Greek and Roman physicians at that time believed that breathlessness, like other illnesses, resulted from an internal imbalance and that diet, plant and animal remedies, lifestyle changes, and prayer were the remedies of choice. Much later, in 1190, the Spanish physician Moses Maimonides wrote a book on asthma. Asthma treatments had not improved much during that millennium, as the treatments he recommended included a modest lifestyle of sleep, food, drink, avoidance of the pollution from the city, and large amounts of chicken soup. 8
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ASTHMA MAGAZINE
First Discoveries of Asthma Triggers
Such holistic approaches to asthma continued for many more centuries until physicians began to better understand some of the things that triggered asthma. In 1660, Konrad Schneider identified dust and other irritants as causes of asthma. At the end of the 17th century, Sir John Floyer associated the disease with respiratory infections, laughter, and exercise. He also noticed that it was frequently worse at night, as he himself was asthmatic and would awaken from sleep having difficulty breathing. At the turn of the 18th century, Giovanni Morgagni, a professor of anatomy, discovered thick secretions plugging the air passages of people
January/February 2004
With the lack of instruments to diagnose asthma, physicians were unable to examine the interior of patient’s bodies until 2 important discoveries were made. In 1761, an Austrian physician, Leopold Auenbrugger, discovered a new method of examining a patient’s lungs by using percussion—the practice of tapping on the chest to hear differences in sounds. Later, in 1816, the French physician René Laennec designed the first stethoscope to listen to a patient’s heart and breathing. This exciting discovery allowed physicians to distinguish the typical wheezing sound of asthma from the sounds produced by other respiratory ailments. Laennec was also the first to describe the muscles around the bronchial tubes tightening and squeezing the tubes shut during an asthma episode. In the 1840s, a British surgeon, John Hutchinson, invented the first spirometer to help diagnose and further understand airway obstruction. This device measured a person’s lung function. Today, the spirometer remains the primary tool for assessing the severity of a person’s asthma condition. Understanding the Nature of Asthma
During the 17th and 18th centuries, physicians continued to enhance their understanding of the nature and causes of asthma. In the 1600s, the physician Van Helmont, who himself had asthma, referred to it as the “epilepsy of the lungs.” He was referring to the unpredictability and suddenness of asthma attacks. He also thought that asthma symptoms increased with changes in climate or emotional stress. Through the work of various scientists at this time, it was discovered that asthma could be trig-
gered by such factors as chemical odors, animal dander, exercise, and cold air. During the 1800s, John Hutchinson (mentioned previously for inventing the spirometer) noted that asthma was an inflammatory disease and recognized that asthma could be triggered by things in the environment, which he called allergens. Another theory that attracted attention during this period was the idea that asthma could be caused by emotions. William Osler, a Canadian physician, talked about asthma as a “neurotic disorder.” This helped create a lasting impression of asthma being a psychological condition rather than a physical one. Over the years, the pendulum has swung to both extremes on this issue. Today we understand that asthma is a physical condition with physiological causes. However, it is also accepted that it can have emotional triggers, such as stress. Asthma Treatments Over the Years
By the 19th century, physicians and pharmacists were introducing various new treatments and medicines for asthma. People were sometimes advised to attend health spas offering special features, such as clean water, clean air, and sunshine. Often these centers were located at high altitudes or in dry climates, making them relatively free of allergens. From the 19th century until the early 20th century, smoking cigarettes and pipes were common ways of introducing medications directly into a person’s bronchial tubes. People with asthma smoked different medicinal substances, including tobacco and stramonium. Smoking tobacco was a common practice, as it was reported that it could quickly relax the constricted airways. As a child, President Teddy Roosevelt smoked cigars to relieve his asthma episodes, which were often severe. Stramonium was derived from smoking the leaves of the thorn-apple tree. It had a bronchodilating effect and, in fact, was an early version of an anticholinergic drug, such as today’s medication
Atrovent. Maxim’s Pipe of Peace delivered a combination of menthol and pine essence. In addition to smoking, people with asthma took tablets and powders made from various substances, such as herbs. Inhaled remedies were also delivered by a number of devices, such as the bronchial kettle or Benzoinol inhaler. Injections of morphine (or morphine combined with cocaine) were also an accepted treatment. In 1864, Newton’s inhaler was patented in the United Kingdom. It was a dry powder inhaler consisting of a box with rotating veins that would blow a fine powder into a cloud. The person with asthma would put his mouth on the opening, crank the handle, and inhale. By the turn of the 20th century, newer and more effective medications began to appear. Scientists extracted and purified the hormone from the adrenal glands. By 1900, physicians were prescribing injections of adrenaline, also known as epinephrine, for patients with asthma. This remained a mainstay of therapy until around 1930 and is still used today to treat acute asthma episodes and severe allergic reactions. In the 1930s, the medication theophylline was introduced as a medication to relieve asthma attacks. It had been known since the 1800s that drinking strong coffee improved asthma. Theophylline is related to caffeine, the active ingredient in coffee. Theophylline remained an important medication in the treatment of asthma until recent years. Although, for the most part, the newer medications we use today have supplanted it, it is still used occasionally to treat asthma. In the 1940s, epinephrine was altered to produce a medication called isoproterenol. Isoproterenol was an effective bronchodilator when it was given by inhaler and offered quick relief from asthma symptoms. It was the first fast-acting brochodilator that could be inhaled rather than given through injection. This medication works by stimulating “beta-receptors,” which then relax the muscles around the air ASTHMA MAGAZINE
passages. In the 1960s, it was found that beta-receptors affecting the lungs were different from those affecting the heart. Research discovered selective beta agonists that worked especially on the airways, causing fewer side effects such as rapid heartbeat. They are called beta2-agonists and include salbutamol, albuterol, terbutaline, and pirbuterol. These medications are still used today to provide quick relief from the symptoms of asthma. In the last 30 years, much has been learned about the mechanisms of asthma. The important role of inflammation in asthma has been studied and, as a result, the antiinflammatory medications—corticosteroids, cromolyn sodium, and antileukotriene—have been introduced. These medications have greatly changed the management and treatment of asthma. With our quickly evolving understanding of asthma and the development of new, effective medications, asthma is now a much more manageable disease. It is no longer a disease for which only relief of symptoms is provided; the symptoms are now preventable and controllable. Asthma is a disease that has been recognized for more than 3000 years, yet only in the last 30 years has it been effectively treated. With this in mind, think about how far the treatment of asthma may evolve over the next 20 to 30 years. Perhaps we can even look forward to a cure. Sources www:nlm.hih.gov/hnd/breath_exhibit www.asthma-help.co.uk/historypda.htm www.inhalatorium.com Newhouse MT, Barnes PJ. Conquering asthma, Ontario: BC Decker Periodicals Inc; 1991. Hannaway, Paul. Asthma—an emerging epidemic. Marblehead (MA): Lighthouse Press; 2002.
Suzanne Rutkowski, CMA, works as a patient educator, advocate, and consultant in the field of asthma and allergy. Reprint orders: Elsevier Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350. doi 10.1016/j.asthmamag.2003.11.00
to subscribe call 1.800.654.2452
|
9
Plagued by the effects of the London smog in the early 1900s, inventor Sir Hiram Maxim developed his own inhaler that delivered menthol and pine essence.
Numerous brands of asthma cigarettes were available in the late 1800s. Typically they contained stramonium and belladonna, but no tobacco. All photos courtesy of Inhalatorium.com
ASTHMA MAGAZINE
Asthma has been the focus of a lot of media attention in recent years. These reports include news about the increase in its prevalence and the new medications to treat it. Although so much attention may be new, asthma is not a new disease. In fact, symptoms of breathlessness, chest tightness, cough, and mucus production have been documented for thousands of years. Have you ever wondered about the history of asthma? You may be amazed at some of the treatments that were used in the past. When were our modern medicines discovered? Today’s medicines aren’t a cure, but you will marvel at how far we have come in controlling this condition. Asthma symptoms were first recorded about 3500 years ago in an Egyptian manuscript called “Ebers Papyrus.” Reference to the word “asthma” also appeared in Homer’s Iliad. The word was derived from a Greek word meaning “labored breathing.” Hippocrates, a famous Greek physician born in 460 BC, believed that asthma was caused by a disturbance in the balance of humors (various body fluids). He blamed the humor, phlegm, for flowing from the brain down through the nose to clog the lungs. The remedies during this time included everything from herbs to animal feces, with the treatments often steamed over hot stones so they could be inhaled. Around 100 ad, another Greek physician, Aretaeus, recognized that asthma was a chronic
to subscribe call 1.800.654.2452
|
7
who had died from a severe asthma attack. During this period scientists developed a better understanding of the mechanisms of asthma. Tools to Diagnose and Assess Asthma
Dr. Guild’s Green Mountain asthma compound contained stramonium and belladonna, along with potassium nitrate, anise and anethol. It was to be put on a plate and lit so the patient could inhale the fumes.
breathing condition. He noticed that it came and went spontaneously and that breathing was affected by exercise, and he was also the first to describe an acute attack. Greek and Roman physicians at that time believed that breathlessness, like other illnesses, resulted from an internal imbalance and that diet, plant and animal remedies, lifestyle changes, and prayer were the remedies of choice. Much later, in 1190, the Spanish physician Moses Maimonides wrote a book on asthma. Asthma treatments had not improved much during that millennium, as the treatments he recommended included a modest lifestyle of sleep, food, drink, avoidance of the pollution from the city, and large amounts of chicken soup. 8
|
ASTHMA MAGAZINE
First Discoveries of Asthma Triggers
Such holistic approaches to asthma continued for many more centuries until physicians began to better understand some of the things that triggered asthma. In 1660, Konrad Schneider identified dust and other irritants as causes of asthma. At the end of the 17th century, Sir John Floyer associated the disease with respiratory infections, laughter, and exercise. He also noticed that it was frequently worse at night, as he himself was asthmatic and would awaken from sleep having difficulty breathing. At the turn of the 18th century, Giovanni Morgagni, a professor of anatomy, discovered thick secretions plugging the air passages of people
January/February 2004
With the lack of instruments to diagnose asthma, physicians were unable to examine the interior of patient’s bodies until 2 important discoveries were made. In 1761, an Austrian physician, Leopold Auenbrugger, discovered a new method of examining a patient’s lungs by using percussion—the practice of tapping on the chest to hear differences in sounds. Later, in 1816, the French physician René Laennec designed the first stethoscope to listen to a patient’s heart and breathing. This exciting discovery allowed physicians to distinguish the typical wheezing sound of asthma from the sounds produced by other respiratory ailments. Laennec was also the first to describe the muscles around the bronchial tubes tightening and squeezing the tubes shut during an asthma episode. In the 1840s, a British surgeon, John Hutchinson, invented the first spirometer to help diagnose and further understand airway obstruction. This device measured a person’s lung function. Today, the spirometer remains the primary tool for assessing the severity of a person’s asthma condition. Understanding the Nature of Asthma
During the 17th and 18th centuries, physicians continued to enhance their understanding of the nature and causes of asthma. In the 1600s, the physician Van Helmont, who himself had asthma, referred to it as the “epilepsy of the lungs.” He was referring to the unpredictability and suddenness of asthma attacks. He also thought that asthma symptoms increased with changes in climate or emotional stress. Through the work of various scientists at this time, it was discovered that asthma could be trig-
gered by such factors as chemical odors, animal dander, exercise, and cold air. During the 1800s, John Hutchinson (mentioned previously for inventing the spirometer) noted that asthma was an inflammatory disease and recognized that asthma could be triggered by things in the environment, which he called allergens. Another theory that attracted attention during this period was the idea that asthma could be caused by emotions. William Osler, a Canadian physician, talked about asthma as a “neurotic disorder.” This helped create a lasting impression of asthma being a psychological condition rather than a physical one. Over the years, the pendulum has swung to both extremes on this issue. Today we understand that asthma is a physical condition with physiological causes. However, it is also accepted that it can have emotional triggers, such as stress. Asthma Treatments Over the Years
By the 19th century, physicians and pharmacists were introducing various new treatments and medicines for asthma. People were sometimes advised to attend health spas offering special features, such as clean water, clean air, and sunshine. Often these centers were located at high altitudes or in dry climates, making them relatively free of allergens. From the 19th century until the early 20th century, smoking cigarettes and pipes were common ways of introducing medications directly into a person’s bronchial tubes. People with asthma smoked different medicinal substances, including tobacco and stramonium. Smoking tobacco was a common practice, as it was reported that it could quickly relax the constricted airways. As a child, President Teddy Roosevelt smoked cigars to relieve his asthma episodes, which were often severe. Stramonium was derived from smoking the leaves of the thorn-apple tree. It had a bronchodilating effect and, in fact, was an early version of an anticholinergic drug, such as today’s medication
Atrovent. Maxim’s Pipe of Peace delivered a combination of menthol and pine essence. In addition to smoking, people with asthma took tablets and powders made from various substances, such as herbs. Inhaled remedies were also delivered by a number of devices, such as the bronchial kettle or Benzoinol inhaler. Injections of morphine (or morphine combined with cocaine) were also an accepted treatment. In 1864, Newton’s inhaler was patented in the United Kingdom. It was a dry powder inhaler consisting of a box with rotating veins that would blow a fine powder into a cloud. The person with asthma would put his mouth on the opening, crank the handle, and inhale. By the turn of the 20th century, newer and more effective medications began to appear. Scientists extracted and purified the hormone from the adrenal glands. By 1900, physicians were prescribing injections of adrenaline, also known as epinephrine, for patients with asthma. This remained a mainstay of therapy until around 1930 and is still used today to treat acute asthma episodes and severe allergic reactions. In the 1930s, the medication theophylline was introduced as a medication to relieve asthma attacks. It had been known since the 1800s that drinking strong coffee improved asthma. Theophylline is related to caffeine, the active ingredient in coffee. Theophylline remained an important medication in the treatment of asthma until recent years. Although, for the most part, the newer medications we use today have supplanted it, it is still used occasionally to treat asthma. In the 1940s, epinephrine was altered to produce a medication called isoproterenol. Isoproterenol was an effective bronchodilator when it was given by inhaler and offered quick relief from asthma symptoms. It was the first fast-acting brochodilator that could be inhaled rather than given through injection. This medication works by stimulating “beta-receptors,” which then relax the muscles around the air ASTHMA MAGAZINE
passages. In the 1960s, it was found that beta-receptors affecting the lungs were different from those affecting the heart. Research discovered selective beta agonists that worked especially on the airways, causing fewer side effects such as rapid heartbeat. They are called beta2-agonists and include salbutamol, albuterol, terbutaline, and pirbuterol. These medications are still used today to provide quick relief from the symptoms of asthma. In the last 30 years, much has been learned about the mechanisms of asthma. The important role of inflammation in asthma has been studied and, as a result, the antiinflammatory medications—corticosteroids, cromolyn sodium, and antileukotriene—have been introduced. These medications have greatly changed the management and treatment of asthma. With our quickly evolving understanding of asthma and the development of new, effective medications, asthma is now a much more manageable disease. It is no longer a disease for which only relief of symptoms is provided; the symptoms are now preventable and controllable. Asthma is a disease that has been recognized for more than 3000 years, yet only in the last 30 years has it been effectively treated. With this in mind, think about how far the treatment of asthma may evolve over the next 20 to 30 years. Perhaps we can even look forward to a cure. Sources www:nlm.hih.gov/hnd/breath_exhibit www.asthma-help.co.uk/historypda.htm www.inhalatorium.com Newhouse MT, Barnes PJ. Conquering asthma, Ontario: BC Decker Periodicals Inc; 1991. Hannaway, Paul. Asthma—an emerging epidemic. Marblehead (MA): Lighthouse Press; 2002.
Suzanne Rutkowski, CMA, works as a patient educator, advocate, and consultant in the field of asthma and allergy. Reprint orders: Elsevier Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone (314) 453-4350. doi 10.1016/j.asthmamag.2003.11.00
to subscribe call 1.800.654.2452
|
9