Keynote Prescription in Asthma

Hippocrates first used the word asthma as a medical term. As asthma is believed to be genetic in origin, the first question that arises is, “What is the triggering factor behind it?” How do the symptoms appear? There are many triggering factors that vary from person to person and according to the type of asthma, whether it is allergic or non allergic. For example, allergens, irritants in the air, weather – dry, windy, or cold, respiratory infections, exercise – sometimes vigorous exercise can trigger difficult breathing, strong emotions, and  some patients show asthmatic symptoms in reaction to certain drugs.

Types of Asthma à

(1) Childhood Asthma – The reason is genetic hypersensitivity to the environment so they becomes allergic frequently.

(2) Adult Asthma –  Occurs after the age of 20 yrs. More common in females. The ratio is less than the childhood asthma. It is triggered mostly due to an allergy.

(3)Asthma induced by cough – It is very difficult to recognize as it is misdisgnosed as chronic bronchitis or sinusitis. There is complete absence of any other symptom of asthma.

(4) Asthma due to Occupation – It is triggered at the workplace from chemicals, dust, paint, gases, smoke, fumes etc.

(5) Nocturnal Asthma – Here the patient gets aggravation during the night especially between 2 – 4 Am. Two major types of asthma which we get in day to day practice is bronchial and cardiac.

Pathogenesis à

When any allergen enters the air passage and travels to the inner airways, it is ingested by antigen cells. These cells forward them to other immune cells. On normal people these immune cells (THO) check and usally ignore the allergen molecule. In asthma patients however these cells transfer into a different type of cell (TH2).

Our immunity produces antibodies against this inhaled allergen. The next time the patient inhales the same allergen, the antibodies ‘recognise’ it and activate a response cycle. Inflammation occurs and released chemicals cause cell wall thickness. The cells produced for proliferation incite the mucus producing cells to grow larger and to produce more and thicker mucus. The inflamed airways are more hyperactive and they are more prone to bronchospasm.

Signs and symptoms à

Couging, wheezing, chest tightness, shortness of breath. These are few common symptoms but the severity of disease varies person to person.

Diagnosis of Asthma à It can be done by physical examination, lung function test, spirometry, blood gas analysis and few other investigation.

Role of Homoeopathy in Asthma

The treatment is given in two parts; one is in acute episode and the other is in inter-episodic states.  The homoeopathic bronchodilators produce continuous dilatation of bronchial tubes even after the withdrawl of the drug because they are very well selected constitutional remedies prescribed on the unique way the person experiences his/her disease.

Remedies:   Here are some keynotes which are helpful for quickly prescribing in acutes. Always consider the type of expectoration, pulse and time modality to distinguish the remedy.

1] Ammonium Carb: Chilly patient. Respiratory distress usually comes after midnight. Cough worse lying on bed. Dyspnoea agg ascending, during sleep, cold air, motion and in a warm room, but still better in open air. Severe obstruction of nose, must breathe through mouth. Thirst unquenchable. Expectoration copious, visid,white. Concomitant: Oppressive fullness near the bridge of nose as if everything inside would burst; Great burning is felt in esophagus as from alcohol. Pulse frequent, strong or small.

2] Antim Tart: Difficult respiration in night, better by sitting erect and in open air. Patient wants to be fanned. There is gasping for breath during cough, patient has to bend forward to get some relief. Breathing arrested from mucus in trachea better by expectoration. Respiration is stertorous and limbs cold. Concomitant cough. Sleepiness and cold sweats. Twitching of face during cough.

3] Cuprum Met: Oppressed breathing with severe apnoea, patient cannot speak or swallow a few drops of water. Prostration with cold sweating. Patient cannot breathe if mouth or nose covered with oxygen mask. Constriction in region of xiphisternum.  Respiration deep, interrupted, arrested and rattling respiration agg after 3am. Long  uninterrupted cough worse between 11pm to 1 am..Gurgling sound in cough. Hippocratic sunken face with icy coldness of lips; patient takes long pause before replying. Swallowing creates noise. Respiration difficult after fright. Pulse weak, soft or small.

4] Arsenic Album: Restless, anxious, worse midnight, must jump out of bed.  Expectoration is frothy, bloody and copious. Respiration worse by cold food, exertion better by sitting erect. Concomitant- thirst and fainting with attack, offensive odour from mouth.  Pulse-Feeble, imperceptible,slow and sometimes thready.

5] Laurocerasus:  Hard, constant and rough cough. Worse by lying and sitting upright causes congestion in chest, hence patient must be in semi-recumbent position. Extremely chilly and wants warm covering. First, sudden gasping for breath then 2-3 long breaths, then a pause followed by 2-3 gasps is the typical breathing pattern. Concomitant- Clubbed fingers, bluish red complexion and blue lips is the triad of this remedy. Thirst for small quantity and scanty urine. Pulse full and irregular.

6] Lobelia inflata: Severe dry, exhausting cough accompanied by nausea. Any motion aggravates. Respiration arrested during cough, agg cold air and amel by warm food, warm room and from open air. There is severe air hunger. Concomitant- Discomfort of sacral bone. Coldness of teeth and white tongue. Pulse  fast, thready, intermittent.

7] Lachesis-Asthma when weather gets hot after winter. Difficult respiration after jealousy. Severe coughing, Violent headache and suffocation as soon as they lie down. They want doors and windows open.

8] Carbo Veg – Very good remedy for asthma in old people. Difficult respiration; aggravation in warm room; amelioration by fanning, open air and by sitting erect. Chest constriction. Respiration arrested, sighing and wheezing. Concomitant symptom is external coldness.

9] Sambucus Nigra -Loud  and fast respiration. Difficult respiration after midnight at 3 or 4 am. Expectoration is copious and tenacious. Cough day and night better by sitting erect.

10]  Opium -Spasm of larynx causes cough. Respiration is moaning, gasping, fast and deep. Patient must be awakened to avoid suffocation. Coldness of hands and feet. Loosening of clothes ameliorates.

11] Hydrocyanic acid -Difficulty in respiration is accompanied by constriction in the throat. Face discoloration is blue or pale. Expectoration bloody, mucus and yellow.