Bronchial Asthma and Homoeopathy

Bronchial Asthma and Homoeopathy

Abstract :-

Asthma is a chronic inflammatory disorder of the airways (Bronchial tree) in which breathing is periodically rendered difficult by widespread narrowing of the bronchi (reversible bronchoconstriction).

It is clinically, characterized by recurrent episodes (paroxysms) of wheezing, breathlessness (dyspnea), tightness of the chest and cough.

• Global Initiative for Asthma (GINA) – 2015 – ‟Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by the history of respiratory symptoms such as wheeze, shortness of breath, chest tightness and cough that vary over time and in intensity, together with variable expiratory airflow limitation.” These episodes are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment.⁽¹⁾

Epidemiology :-

• Prevalence of asthma varies considerably within countries and between countries.
• It is more prevalent in developed countries than developing ones, more in children (15%) than adult (10% to 12%), more in urban than rural areas, reasons of which are not fully understood.
• Nearly 8% to 10% of the total population suffers from it.
• The disease can start at any age, but in a majority it starts before 10 years of age. 
• It is twice as common among boys than girls, whereas in adults the male to female ratio is usually equal.⁽²⁾

Risk Factors :-

• Endogenous factors :-

• Genetic predisposition
• Atopy
• Airway hyperresponsiveness
• Gender and Age
• Ethnicity
• Obesity
• Early viral infections
• Environmental factors :-

• Allergens (indoor / outdoor)
• Occupational sensitizers
• Respiratory infections

Trigger Factors :-

• Inhaled allergens
• Upper respiratory tract viral infections
• Air pollution (e.g. sulfur dioxide, irritant gases)
• Passive smoking (tobacco smoke)
• Drugs ( ꞵ-blockers, aspirin)
• Physical factors : Exercise, Cold air and hyperventilation
• Emotional stress
• Irritants (household sprays paint fumes) 

Pathogenesis :-

Environmental factors

                                                    ↓

AllergensSensitizers

                                                    ↓

Inflammatory cellsMast cells, Eosinophils, TH2 cells

                                                    ↓

Mediators

Histamine and serotonin, leukotrienes, prostaglandins, thromboxane, platelet activating factors (PAF), bradykinin, adenosine, nitric oxide etc.

                                                    ↓

Bronchial inflammation

                                                    ↓

Bronchial hypersensitivity + Triggering factors

                                                    ↓

EdemaBronchoconstrictionMucus production

                                                    ↓

Airway narrowing

                                                                            ↓

CoughWheezeBreathlessnessChest tightness

Clinical Features :-

1. EPISODIC ASTHMA :-

• Occurs as episodes with asymptomatic between asthmatic attacks.
• Frequency and duration of attacks vary.
• Present with relatively sudden onset of paroxysm of wheezing and dyspnea.
• May develop spontaneously or triggered by allergens, exercise or viral infections.
• It may be mild too severe and may last for hours, days or even weeks.

2. SEVER ACUTE ASTHMA (STATUS ASTHMATICU) :-

• It is the most severe form of asthma in which the severe acute paroxysm persists for days and even weeks.
• Presents with severe dyspnea and unproductive cough.
• During this attack, patients prefer an upright position fixing the shoulder girdle to assist the accessory muscles of respiration.
• Physical signs included sweating, central cyanosis, tachycardia and pulsus paradoxus.
• The bronchoconstriction and asthmatic symptoms does not respond despite the initial administration of standard acute asthma therapy.
• It may cause severe airflow obstruction leading to severe cyanosis and even death.

3. CHRONIC ASTHMA :-

• Chronic persistent symptoms include chest tightness, wheeze and breathlessness on exertion.
• Characterized by episodes of spontaneous cough and wheeze worst during the night.
• Chronic productive cough with mucoid sputum, punctuated by recurrent attacks of purulent expectoration from frank infection. They are prone to repeated attacks of  ‟severe acute asthma.” Features sometimes resemble those of chronic bronchitis.

Physical Signs :-

• During an attack –

• Inspection – increased respiratory rate with use of accessory muscles of respiration.
• Percussion – Hyperresonant percussion note over the lungs.
• Auscultation – 

1. Breath sounds are vesicular with prolonged expiration.
2. High – pitched polyphonic expiratory and inspiratory rhonchi.
3. Very severe attacks may result in a silent chest which is an ominous sign.

• In between the attacks –
• The chest may not reveal any abnormal physical signs.
• Chronic asthmatics –
• Usually reveal a few scattered rhonchi.

Investigations :-

• The diagnosis is mainly clinical and based on a characteristic history.
• Lung function tests –

• Spirometry
• Peak expiratory flow rate (PEFR)
• Lung volumes and Diffusing Capacity
• Carbon monoxide (CO) transfer test
• Exercise tests – it used in the diagnosis of asthma in children.
• Airway Responsivenss (AHR)
• Indirect challenge tests
• Imaging –

• Chest X – ray
• High resolution computed tomography (CT)
• Measurement of allergic status –

• Skin prick tests (SPT)
• Elevated serum I_gE levels

• Blood and Sputum tests
• Exhaled Nitric oxide (FENO)
• Trial of Corticosteroids
• Arterial Blood Gas Analysis

Complications :-

• Pneumonia
• Collapse of part or all of the lung
• Respiratory failure
• Status asthmaticus⁽¹⁾

Homoeopathic Approach :-

• Antimonium tartaricum
• Blatta orientalis
• Arsenicum album
• Natrum sulphuricum
• Eriodictyon
• Ipecacuanha
• Kali carbonicum

1. Antimonium Tartaricum :-

• Unequal breathing; abdominal breathing; Suffocative shortness of breath; before cough or alternating with cough.
• Must sit up to breath or cough⁽³⁾
• Great rattling of mucus, but very little is expectorated.
• Bronchial tubes overloaded with mucus⁽⁴⁾
• Difficult respiration  > BY EXPECTORATION⁽⁵⁾

2. Blatta Orientalis :-

• Cough with dyspnea in bronchitis and phthisis.
• Much pus like mucus.⁽⁴⁾
• Asthma with great wheezing, < from exertion, damp⁽⁵⁾

3. Arsenicum Album :-

• It cured some long standing case of asthma of a nervous character. (jtkent)
• Shortness of breath, unable to lie down, must sit up
• < odours, laughing, ascending, turning in bed or receding eruption
• > coffee, sweet water
• Whistling, wheezing breathing
• Asthma < taking cold, in mid summer
• Cough alternating dry and loose, dry at night  > sitting up 
• Expectoration scanty, frothy⁽³⁾
• Unable to lie down; fear of suffocation
• Air passage constricted⁽⁴⁾
• Asthma worse at 12 AM to 2 AM⁽⁵⁾

4. Natrum Sulphuricum :-

• Loose but violent cough > sitting; must hold chest or sides
• Every fresh cold or any unusual exertion brings on an attack of asthma
• Breathing short while walking; constant desire to take deep, long breath
• Asthma with early morning diarrhea
• Expectoration greenish and copious⁽³⁾
• Humid asthma; rattling in chest, at 4 and 5 AM
• Cough with thick, ropy, greenish expectoration; chest feels all gone.⁽⁴⁾
• Asthma after grief
• Asthma may stop at puberty and recur in the thirties or later⁽⁵⁾

5. Eriodictyon :-

• Wheezing; asthma with coryza and mucous secretions
• Dull pain in the right lung.
• Breathing in fauces⁽⁴⁾

6. Ipecacuanha :-

• Painless hoarsness at the end of a cold
• Constant constriction in the chest and larynx < least motion
• Gasps for breath
• Cough incessant and violent, with every breath
• Paroxysms of suffocative cough, with ratching; child stiffens out, becomes red or blue in face and finally nauseated gags and vomits >stepping into open air, warmth
• Whooping cough with bleeding from the nose and from the mouth
• Asthma accompanied with skin disease. ⁽³⁾

7. Kali Carbonicum :-

• Catarrhal aphonia; with violent sneezing
• Breathing difficult, asthmatic < least motion , walking; alternating with diarrhea; with vertigo.
• Incessant, hard retching or choking, futile cough; then vomiting.
• Whooping cough
• Expectoration difficult or small round balls come flying from the mouth without effort; salty, thick, bloody, yellowish, greenish, offensive and profuse; taste sour or pungent.⁽³⁾
• Cough with relaxed uvula⁽⁴⁾
• Asthma worse 2 to 4 AM or at 3 AM⁽⁵⁾

• Bibliography :-

1. Boloor archith,Nayak ramadas,Bronchial asthma,3^rd ed,new delhi,jaypee brothers medical publishers (p) ltd,2023
2. Munjal yashpal,Bronchial asthma,9^th ed,Mumbai,jaypee brothers medical publishers (p) ltd,2012
3. Phatak S.R., reprint ed, new delhi,Indian books & periodicals publishers,2011
4. Boericke William,9^th ed,new delhi,Indian books & periodicals publishers
5. Morrison Roger,Mumbai,homoeopathic medical publishers,1993
6. Kent J.T, A Lectures on homeopathic material medica

About the Author:

Vruti Mungalpara – Intern – L.R Shah Homoeopathy College, Rajkot

Co-Author:

MANALI KAMALIYA