TREATMENT OF ASTHMA – THE BOTANICAL APPROACH

Guided by: Submitted by:

Dr. Lincy Jaison Adersh S.U.

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INTRODUCTION
Asthma is an inflammatory disorder of the lung, characterised by narrowed air
tubules. It has a worldwide incidence of 155 million (Cokson 1999) and the prevalence has
been increasing since 1960 (Davanny A. et al., 2004). Many factors such as infections,
allergens, strain etc. causes inflammation to the airways. Asthma attack occurs when there is
a decreased air flow through the lung tissue, which is due to the constricted airways (Besty B.
et al., 2007). Most common symptoms associated with asthma are wheezing, coughing
particularly at night or in the early morning, breathlessness, chest tightness etc. (AMH 2006).
According to the frequency of symptoms and the spirometry and post-bronchodilator
responses, asthma can be classified as intermediate asthma, mild persistent asthma, moderate
persistent asthma and severe persistent asthma (AMH 2006).

There are many treatment options available for asthma. Most commonly used
treatment options are medication (control medications as well as attack prevention
medications), inhalers, spacers, nebulizers etc. However asthma treatment is believed to be
impossible. Anti-asthma drugs only mask the symptoms; do not cure the underlying cause
and they have the potential to cause many side effects as well. But it can be controlled by a
combination of good medication, adjustments in diet and a few precautions (ayurvediccare
2008). A natural remedy using herbs and herbal medicines is much effective in such
condition. The number of patients using complementary and alternative medicinal therapies
including herbal medicines (Ayurveda, Traditional Chinese Medicine etc.) is increasing
nowadays. Unlike conventional medicines herbal medicines are safe and have no or less side
effects.

Herbalism in the treatment of asthma – The History

Herbal medicines are one of the oldest and natural forms of medicines which provide
a complete system of healing and disease prevention. The use of herbs in medicine is an old
practise and has been followed from ancient time itself. Unlike the conventional medicines, it
considers the whole person, physically and physiologically, rather than just the disease part
(articlesbase 2005). Natural remedies that mainly include herbs and herbal medicines are
major mode of treatment for asthma in the olden days. Chinese herbal medicines, Japanese
kampo medicines and Indian ayurvedic medicines are those kinds of botanical medicines with
longest tradition and is still using in many places including developed countries (Borchers
A.T. et al. 1997).

According to early written records doctors in ancient China had used an herb called
Ma Huang, for treating people with asthma, as early as 3000 B.C. By 1900s scientists isolated
Ephedrine from Ma Huang, the active component of the herb which helped treating asthma.
Ephedrine still used in some of the asthma medications. According to one medical text from
ancient Egypt around 1500 B.C. a treatment for asthma required the sufferer to swallow
grapes, beer frankincense, a mixture of figs, and even crocodile or camel dung. The text also
describes about a treatment using the extract of a plant called Henbane which was heated on a
brick and the asthma sufferer would then have to inhale the vapours. The word asthma was
first used by the ancient Greeks to describe difficult or painful breathing. Medical texts from
this period recommend a number of things such as millipedes, ground up fox lungs, vinegar
etc. for the treatment of asthma (NIEHS 2004).

The treatment of asthma in the middle age was little complicated. Physicians in the
middle age treated asthma using ingredients like pearls, animal bones, goose dung etc.
Bleeding was another one treatment technique followed in this period. It is the intentional
cutting of a vein as a medical treatment. Modern era, during 18th and 19th centuries, has seen
a change in the ideas and approaches to asthma. Although diagnosis had improved,
treatments for asthma were still ineffective and harmful. Patients were asked often to drink
alcohol, eat garlic and even smoke tobacco by the doctors. Dangerous poisons like mercury
were also prescribed to them. Bleeding methods were also followed in this period (NIEHS
2004).

Traditional Chinese Medicines (TCM) is one of the major components in the

Complementary and Alternative Medicinal (CAM) therapies. CAM is the oldest form
prevention and treatment method for many diseases in China and many Asian countries and is
still followed in many part of the world. Investigations on the potential use of TCM started in
the past decade and it suggested the potential of these medicines to prevent or treat many
diseases including asthma (Bielory L. et al., 1999, Li X.M. et al., 2000). There are number of
studies which investigated the safety and efficacy of Chinese herbal products especially for
asthma. A double blinded, randomised placebo controlled trial compared ASHMI, a three
herb anti- asthma formulation, to oral prednisone therapy (Wen M.C. et al., 2005). The study
showed an improvement in the post-treatment lung function in both group, a slight more
improvement in prednisone group. There were no significant effect on body weight by
ASHMI. Also no significant side effects were observed. This study showed that ASHMI
treatment is effective and well tolerated without any adverse reactions. A randomised placebo
controlled study by Hsu C.H. and et al., evaluated the safety and efficacy of Mai Men Dong
Tan (mMMDT), a Chinese herbal formula, for its anti-asthmatic property. The study had
observed an improvement in the symptoms score for the mMMDT treated scores. Also no
drug-related adverse events were reported.

A systemic review of 17 randomised clinical trials, out of which six were based on
traditional Chinese botanical medicines and eight based on Indian ayurvedic medicines,
investigated the evidence for clinical efficacy of botanical medicines in the treatment of
asthma (Huntley A. Et al., 2000). The study showed that there is no ultimate evidence of any
of the herbal preparation which were included in the study. The study suggested an urgent
need for rigorously designed randomises clinical trials for the botanical preparations. Another
one systemic study reviewed 37 studies which included randomises controlled trials quasi
experimental designs (Singh B.B. et al., 2007). This study investigated the effectiveness and
safety profile of ayurvedic and collateral medicines. The study excluded traditional Chinese
Medicines. The results showed that most herbs which are either primary or adjuvant therapy
had beneficial effects. The study provided only little information regarding the safety.
According to the results some herbs had serious adverse effects. The study concluded that
herbs may be useful in treatment of asthma but there are very less evidence to make
recommendations (Singh B.B. et al., 2007).

Current Treatment for Asthma with Botanical Medicines

According to World Health Organization, 4.5 billion of world’s population use herbal
medicines as a primary health medication today. There is a huge demand for herbal
medicines and the popularity increases day by day. Herbal medicines are used in many
medical practises today because of its biomedical benefits and they have been used since
antiquity (Sane, 2002). According to a survey by Slader C.A. et al., on the use of
complementary and alternative medicines in asthma, the level of CAM use for adults ranged
from 4% to 79% and it was 33% to 89 % for children. The survey showed that herbal
medicines, breathing techniques, homoeopathy and acupuncture were the most commonly
used CAMs.

AK1 is an anti-asthmatic botanical medicine which significantly reduces the

frequency of attack, use of bronchodilators, use of corticosteroids and hospitalization rates. It
is in capsule form and contains a combination of botanical products such as Picrorrhiza
kurroa, apocynin, together with Picrorrhiza currora, Zingiber officinale and Ginkgo biloba
extract (Thomas M. et al., 2007). In a randomised controlled cross over study, effectiveness
of AKL1 have compared with placebo as in patients resistant to standard asthma therapy
(Thomas M, et al., 2007). The study consists of 32 adults asthmatic patients and it was a 36
week trial. The study consisted of 4 week single blind run in period, 12 week double blind
active phase, 8 week single blind washout period and a final 12 week cross-over phase. The
study had 95% confidence intervals (CI). The results showed that there were no significant
differences in lung functions either in placebo or active groups. However clinical
improvements were seen consistently in the patient related outcomes with AKL1 treatment.
No treatment related serious adverse reactions were reported. The study suggested that AKL1
treatment was well tolerated without significant adverse effects, but requires further studies.

Kampo, the Japanese herbal medicine, is one of the components of complementary

and alternative medicines. Kampo medicines are often used in many medical practises in
Japan (Motooabc Y. et al., 2009). The effectiveness of Saiboku-to (TJ-96), a Kampo drug
was investigated in a double-blinded, randomised, cross-over study (Urata Y., et al., 2002).
The study included 33 patients (15 males and 18 females). The study had a 4 week active or
placebo administrated period and a 4 week cross over alternative treatment period after the
washout period. The study results showed that there was a slight improvement in the general
symptoms by the patients. There were no significant adverse reactions reported during or
after the trial. There were significant decrease in blood eosinophils, serum ECP, sputum ECP
and sputum eosinophils by TJ-96. Serum ECP is a useful marker of eosinophilic
inflammation in bronchial asthma (Rouquet A. et al., 1996). This study suggested that TJ-96
has anti –asthmatic activity which is associated with the inhibition of eosinophilic infiltration.
Use of Botanical Medicines in the treatment of Asthma – The Future
There is a rise in the use and appreciation of botanical medicines throughout the
world, especially in Asia and Europe. Herbal medicines have got a rebirth throughout the
world, especially in developed countries, based on the renewed interest in the public and
scientific communities (Natural Herbal Remedies 2010). According to the BCC report of
2009, there is an expected increase in the global market for botanical and plant derived drugs,
from $19.5 million in 2008 to $32.9 million in 2013 with an 11.0% compound annual growth
rate (CAGR). In 2008 herbal medicines generated $127,000 and it is estimated that the
segment would reach $2.4 billion in 2013 for a CAGR of 651.7%. An estimated $30.5 billion
will be generated from all other plant derived drugs by the year 2013, for a CAGR of 9.4%
(BCC Research, 2010).

There is no question that plants will be continued in the future, either as a source of
therapeutic agent for many diseases including asthma or as a raw material for the extraction
of semi-synthetic chemical compounds like perfumes, cosmetics and food industries (Verma
S. et al., 2008). Recent trends show that there will be an increased demand for many
unconventional and alternative therapies for asthma, such as Traditional Chinese Medicines
(TCM), Ayurvedic medicines, traditional Arab Herbal Medicines etc. CAM especially
Chinese Medicines (CM) will focus mainly on combination therapies in future, which serves
both ancient and modern theories (Lee K.H., 2000). More consumers will be attracted to CM
in future because it has less severe side effects compared to single pure drugs. However
future research works would require modern analytical and chemical techniques to ensure
efficacy and safety (Lee K.H., 2000).

Limitations of herbal Treatment

Herbal remedies for asthma are as effective as conventional medicines or more than
that and many people are using these medicines today. However there is little evidence on the
effectiveness of herbal medicines to reduce the symptoms of asthma and researchers have
proved that (BBC News, 2000). Also there is a remarkable lack of safety of these medicines.
Since herbal medicines are regarded as nutritional supplements, they will not come under any
regulatory guidelines (Pat Bass, 2009). A study by a team from the University of Exeter,
examined the results of a number of clinical trials that tested the impact of herbs on asthma.
The data from the study showed that most of the results were of pure quality. The results also
showed that most of the herbal medicines used showed side effects. Many herbal medicines
do not cure the condition, but are useful for the management or hold up other natural
treatment therapies (all4naturalhealth, 2010). In general, herbal medicines have not been
researched scientifically as conventional medicines (BBC News, 2000)
Discussion and Conclusion
Several recent clinical trials have showed that some herbs have the potential of
improving the lung functions as well as reducing the symptoms in the treatment of asthma.
Studies shows that many unconventional alternative therapies such as TCM, Ayurvedic
medicines etc. are beneficial in treating asthma, but requires further researches to prove the
efficacy. The safety data available for these medicines are not encouraging; there is a need for
randomised clinical trials to prove the safety of these medicines. The safety profile for the
herb and the study quality must be balanced with established effectiveness. The recent use of
herbal medicines by asthmatics is estimated between 6% and 10% (Singh B.B., 2007)

Since asthma is a subjective problem, asthma treatment needs to be approached in an

individual manner. What is more important in asthma natural remedy is making people
familiar with the triggers of the asthma reactions. A good asthma can be defined with
minimal need for reliever medication, minimum symptoms during day and night, no
exacerbations, normal lung function and no limitation of physical activity (AMH, 2006). An
herbal medicine can said to be effective, if it meets all these criteria. An effective asthma
management system would require a good medication which includes conventional as well as
alternative therapies with cleaner environment, food, diet and nutrition.
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