Asthma is a chronic inflammatory disorder associated with airway hyper-responsiveness of tracheobronchial tree to various stimuli and manifested by acute, recurrent or chronic attacks of bronchial narrowing, variable in severity and usually of brief duration.

The episodes are usually associated with widespread but variable airflow obstruction within the lung that is often reversible.

It is believed that airway reactivity is major feature of asthma and this is induced by inflammation and that inflammmation is basic abnormality present in asthma.

PATHOGENESIS OF ASTHMA

The narrowing of the airways in asthma is due to inflammation of the lining mucosa and contraction of bronchial smooth muscle.

The common denominator underlying the asthmatic diathesis is non specific hyper irritability of tracheobronchial tree.

This phenomenon is cardinal feature of asthma and is thought to be primary pathogenic event in the disease.

The pathological, physiological and clinical manifestations of asthma have their origin in complex interaction of environmental stimuli with locally resident cells including the epithelial lining and those migrating from the blood stream.

The interaction involves several mediators and cytokines that amplify the response and perpetuate it tp maintain continous disease activity.

PREDISPOSING FACTORS OR TRIGGERS FOR ASTHMA

Asthma exacerbations can be triggered by variious factors. Most of the patients have more than one precipitating factors and various triggers can cause exacerbations at different times.

ALLERGENS

Allergic asthma is dependant upon an IgE response controlled by T and B lymphocytes and activated by interaction of antigen with mast cell bound IgE molecules. Most of the allergens that provoke asthma are air borne. In allergic asthma, sensitisation to allergens occur when the macrophages and dendritic cells process the inhaled allergens and present it to T lymphocytes.
Allergic asthama is frequently seasonal and it is most often observed in children and young adults. A non seasonal form may result from allergy to various allergens in the environment.

Infections

Respiratory infections are most common of the stimuli that evoke acute exacerbations of asthma. Respiratory viruses are the major etiologic factor. In young children, the most important infectious agents are respiratory virus and parainfluenza virus. In adults and older children, rhino virus and influenza virus predominate.

ENVIRONMENTAL POLLUTION

Environmental causes of asthma are usually related to climatic conditions that promote the concentration of atmospheric pollutants and antigens. These conditions develop in densely populated urban areas.

OCCUPATIONAL FACTOR

Occupation related asthma is a significant health problem, acute and chronic airway obstruction has been reported to follow exposure to large number of compounds used in many types of industrial processes. Exposure to metal salts, industrial chemicals, biologic enzymes, various gases oxides of nitrogen,sulphur etc trigger asthma.

EMOTIONAL STRESS

Psychological factor can interact with the asthamatic diathesis to worsen the disease process. The extent to which the psychologic factor plays a role in acute exacerbation is unknown but probably varies from patient to patient.

EXERCISE

Asthma can be made worse by physical exertion. Provocation of bronchospasm by excercise is probably operative to some extent on every asthmatic patient and in some it may be only trigger mechanism that will produce symptoms.

SYMPTOMATIC PRESENTATION OF ASTHMA.

The cardinal symptoms of asthma consists of a triad of dyspnoea, cough and wheezing.
In its most typical form asthma is an episodic disease and all three symptoms co-exist.
It is seen that the attacks often occur at night, may be due to fluctuations in airway receptor thresholds that may result from circadian variations in the circulating levels of endogenous catecholamines and histamine.
Attacks may also abruptly follow exposure to a specific allergen, physical exertion, a viral respiratory infection or emotional excitement.

At the onset patient experiences a sense of constriction in chest, often with a non productive cough.
In practice we see that the frequency and severity of symptoms and exacerbations varies from patient to patient.
It is seen that the respiration becomes audibly harsh and wheezing in both phases of respiration becomes prominent, expiration usually becomes prolonged and patient presents with tachypnoea, tachycardia and mild systolic hypertension.
If the attack is severe or prolonged, the accesory muscles become visibly active and frequently a paradoxical pulse will develop. These two signs are valuable in indicating the severity of obstruction.
Termination of the episode is frequently marked by a cough producing thick stringy mucus which often takes the form of casts of the distal airways and when examined microscopically eosinophils and charcot leyden crystals are seen.
In extreme situations, wheezing may markedly lessen or even disappear completely, as exhaustion sets in the level of conciousness may decline and chest may be silent which is an omnious sign of impending respiratory arrest.

A BRIEF NOTE ON ASTHMATIC ATTACK.

Premonitory symptoms

Patient presents with Asthmatic aura, sometimes sneezing, dry irritant cough, irritability, restlessness may precede or accompany attacks of wheezing breathlessness.

Paroxysms

Paroxysms usually occurs middle of night with sense of oppression in chest, leading to respiratory distress. Patient sits up and leans forward fighting for breath or rushes for fresh air to relieve sense of suffocation.
Asoociated with anxiety, cyanosis, perspiration and cold extremities.
Wheezing is loud and audible from a distance.
On auscultation inspiration is short and high pitched, expiration is prolonged with ronchi.
Rales may be heard at the base towards end of attack. In severe airway obstruction airflow may be so reduced that the chest is almost silent.

Termination

Termination occurs spontaneously. As bronchial spasm gets less, the patient is able to cough and bring out viscid mucofibrin expectoration.

Duration of Attack

Varies from few minutes to several hours. Sometimes the paroxysms are continous leading to status asthamaticus.

HOMOEOPATHIC MEDICINES FOR ASTHMA WITH INDICATIONS

Arsenicum Album

Its the first and foremost drug that comes to my mind when it comes to respiratory allergies and asthma. Since centuries Arsenic is being used by mountaineers and people living on high altitude to combat complaints of dyspnoea due to low pressure and oxygen. Recent toxicological study in real world chornic exposure to Arsenic contaminated ground water from wells and other sources  in West Bengal Chile Argentina shows that non malignant respiratory effect of arsenic is more pronounced in persons already having skin lesions; which shows that there is more susceptibility of person with skin lesions towards arsenic compared to others. So if we apply it homoeopthically in treating patients with atopic dermatitis with respiratory allergies and asthma then it will yield good results. the organism as a whole shows following keynote signs that calls for arsenicum album; Night aggravation ; aggravation on lying down especially on back; after drinking; burning relieved by heat ; very sensitive to cold; very restless keeps changing position and sensitive to touch and external impressions ; great thirst  desire for small quantity of cold water in short interval of time. dry cough aggravates after midnight with scanty frothy cough with constrictive suffocation breathlessness with wheezing aggravates at midnight with darting pain in upperlobe of rt lung (indicated in Primary tuberculosis Gohn’s Focus) causing heamoptysis accompanying with burning pain between shoulder blades.

Blatta Orientalis

This medicines was first proven accidentally and has an interesting story so thought to share it with you all, once upon a time back in 18th century there was an old man who used to stay alone and was suffering from asthma since many years, he used to get many asthmatic attack throughout the day, one morning he was having severe asthmatic attack and he boiled the tea and consumed it after which his asthma got relieved to great extent after drinking a cup of tea prepared by him, it was the same tea that he used to drink on daily basis, so what was so different that day that his asthma got relieved so much?? Last night he was suffering very bad episodes of breathlessness which kept him awake that night so at night he had prepared black tea for himself after which he slept and next morning boiled the same tea again that had been prepared last night and consumed again . But again what a great difference can it make to boil the same old tea again and how can it produce medicinal properties so great so that it can relieve asthma, and if it was so easy then how did not others find this curative property of that tea till date, On emptying the tea pot he had seen a dead cockroach at the bottom of the tea pot that day , he was wise enough to recollect it after few days that he had seen a cockroach in the tea pot, and attributed the reason behind the cure to the cockroach, then he started consuming that tea boiled along with the same Indian cockroach  water whenever he got the asthmatic attack, and after few days he found that it not only gave relief in acute exacerbation of asthma but also reduced the frequency and intensity of episodes. he the started giving the same to other asthma sufferers around him for free then gradually people from far off started to flock around him for the medicine and soon he was famous, he then used to prepare in large quantity and add alcohol to preserve it for longer period, gradually after it came to notice to homoeopaths that the same indian cockroack if given to healthy humans in very large quantity then it used to produce asthma in that subject , soon they realised that the cure of asthma with Blatta Orientalis was based on homoeopathic principle of “similia similibus curentur” so they incorporated it into Homoeopathic Materia Medica. IT has peculiar asthmatic symptoms Heaviness of chest as if some weight was put on chest pt feels that he is breathing in the air only till trachea and not till lungs ; short fast breaths feels lungs are not expanding completely; sensation as if shoulders were dragged downwards towards feet. general sensation of heat in whole body.

Aralea Racemosa

A very good remedy for nocturnal cough of asthmatic aggravating by lying down and at midnight after first sleep with profuse perspiration, sensation as if foreign body stuck in throat,raw and sore feeling behind the sternum,  Good remedy for hay fever, respiratory complaints aggravates in spring and during draughts,copious, watery excoriating, acrid salty nasal discharge with extreme sneezing on least irritation to nose even by air.

Antimonium Tartaricum

Lots of rattling of mucous in chest but with very small quantity of expectaration with drowziness trembling prostrating debility and sweating desires cold water in small quantity frequently, Sailors asthma and asthma due to damp cellars and damp monsoon weather, velvety sensation in chest due to cough with much burning ascending upwards to throat, dyspnoea shortness of breath with rapid breathing relieved by sitting upright or lying on rt side and on eructation, Relieves asthma and respiratory allergies aggravated due to parasitic infections by expelling parasites from body especially bilharziasis. good remedy for breathing difficulty due to paralysis of respiratory muscles. typically acts on pneumogastric nerve so it proves to be very good remedy for hiccups nausea and vomitting due to coughing or other gastric complaints or daiphragm irritation.

Balsum Peru 

It is a very good remedy for catarrahal conditions in asthmatic patients with loud ronchi, rales copious thin muco-purulent discharge.

Dulcamara

Especially suited in affections during damp cold weather, patient has sensation of tickling in throat with hoarse barking cough with rattling of mucous which is expelled only after coughing for long time which is thick yellow in character, cough aggravates after exertion. spasmodic cough with difficulty in breathing in asthmatic patients, good remedy for hay fever and whooping cough.

Justicia Adhatoda

In low potency it acts as a good expectorant in tenacious productive cough and in high potency its used for dry spasmodic cough with dyspnoea and tightness in chest dryness with pain in throat with difficulty in swallowing , aggravated in close warm room.

Drosera Rotundifolia

Crumbs-like sensation in throat feather-like sensation in larynx, asthma triggers while talking ; dry spasmodic deep hoarse cough in spells repeating in very short intervals “MASTER HAHNEMANN TERMED THIS REMEDY AS PRINCIPAL REMEDY FOR WHOOPING COUGH”. haorse cracked voice.

Aspidosperma / Quebracho 

Also known as DIGITALIS of LUNGS, stimulates respiratory centers and increase oxygenation. Indicated in Cardiac Asthma Dyspnoea on Exertion is a keynote guiding symptom of this medicine, also helpful in pulmonary thrombasis and stenosis. usually prefered in mother tincture or first decimal potency.

Eucalyptus Globulus

Moist Asthma with paplitation, white thick expectoration well indicated in mucopurulent offensive expectoration as well as it combats infections efficiently, ulcers on tonsil mouth and pharynx with supurative conditions. Enlarge ment of nodes and glands like lymphomegaly , tonsilomegaly adenoiditis etc.