Asthma through history

Documented in ancient Egyptian hieroglyphics and first mentioned by Homer in the Iliad, asthma has proved to be a notable ailment throughout history. Inhaling something to treat the symptoms of asthma is a concept that caught on very early. Burning herbs of belladonna on bricks to inhale is listed among the 700 remedies described by the Ancient Egyptians. Another remedy appearing in the ancient Chinese medical text, Huang Ti ‘s Nei Ching (3,000-1,000 B.C.), suggests using the Ma Huang plant for this purpose. Ephedrine was extracted from the plant in the early 1900s and formulations of the chemical are still prescribed today. Similarly, in the early 20th century, Belladonna alkaloids derived from the thorn-apple plant also made it into the physician’s toolbox for asthma.

The use and discovery of ephedrine is an uncharacteristic highpoint in the long history of asthma treatment. Through the ages, those suffering asthma have endured a multitude of ill-conceived approaches to treating an inability to breath easily or, at times, an inability to breath at all.  Based on a number of gross misconceptions, many endured bloodletting and sucked down toxic asthma cigarettes. Proust once wrote of an attack “which obliged me to walk all doubled up and light anti-asthma cigarettes at every tobacconists I passed.” Up to less than half a century ago, the disease was dismissed as psychosomatic in some sufferers, an idea that dates back to the 17th century.

When first used systemically in the early 1950s, glucocorticoids provided an effective and useful way to manage asthma. Initially, pills or an injection were used. The first inhalers were introduced the late 1950s. They remain a part of standard care. Despite finding a way to manage asthma, blind spots in the understanding of the disease persisted into the 20th century. Why is it physicians and researchers have been in the dark for so long?   

An improved, however, rudimentary understanding of the disease did not emerge until 1968. That year, Andor Szentivanyi first described that blocking the beta-2 receptors causes constriction of pulmonary smooth muscle cells. Later years saw advances in an understanding of the altered immune system in people with asthma, such as the role of IgE and inflammatory cytokines. A more comprehensive understanding of the immune system’s role in asthma is fairly new to clinicians and researchers. This may be one explanation for why the search for a potential cure has remained elusive, until recently.