TREATMENT OF BRONCHIAL ASTHMA WITH SIMILIMUM

DR. S. GOPINADHAN ASSISTANT DIRECTOR C.R.I.H., KOTTAYAM

INTRODUCTION
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Bronchial Asthma is a chronic inflammatory disorder of the airways. This airway inflammation underlies disease chronicity and contributes to airway hyper-responsiveness, air flow limitation and respiratory symptoms such as recurrent episodes of wheezing, breathlessness, chest tightness and cough particularly during the night time and early morning hours.
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Introduction contd.
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Patient may develop symptoms immediately or 4-6 hours after their exposure to allergens. Common aeroallergens include house dust mites (often found in pillows, mattresses, carpets etc.), cockroaches, cats and seasonal pollens. Non specific precipitants of asthma include exercise, URTI, rhinitis, sinusitis, postnasal drip, aspiartion, gastro-oesophageal reflux, changes in weather, and stress.
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Introduction contd.
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Some individuals develop asthma due to certain medication such as aspirin, NSAID, analgesics etc. Occupational asthma is triggered years after exposure. Women may experience asthma at predictable time during menstrual cycle.
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Introduction contd.
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Severity of asthma: Mild Breathless with activity Speech sentences Body position able to recline Respiratory rate increased Use of accessory muscles Usually not Breath sounds moderate wheeze Mental status - may be agitated
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Introduction contd.
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Severity of asthma: Moderate Breathless with talking Speech phrases Body position prefers sitting Respiratory rate increased Use of accessory muscles commonly Breath sounds loud wheeze during expiration Mental status - usually agitated
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Introduction contd.
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Severity of asthma: Severe Breathless at rest Speech words Body position unable to recline Respiratory rate > 30/minute Use of accessory muscles usually Breath sounds loud wheeze during expiration & inspiration Mental status - usually agitated
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Introduction contd.
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Severity of asthma:

Impending respiratory failure Breathless at rest Speech mute Body position unable to recline Respiratory rate > 30/minute Use of accessory muscles always Breath sounds little air movement without wheeze Mental status - confused and drowsy
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HOMOEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA

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If the law of similars is true, medicines prescribed according to this principle will act as true bronchodilators in bronchial asthma. The advantage of a homoeopathic bronchodilator over other bronchodilator is that it produces a continuous dilatation of the bronchial tubes even after the withdrawal of the drug. This can be done only by a systematic approach to the patient without compromising the basic principles of homoeopathy
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HOMOEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA

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Systematic approach includes: - to find out totality-several methods - to select apt potency - to administer the remedy in proper dosage - proper repetition - accessory management - diet and regimen - educating the patient
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HOMOEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA

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Different methods to select the similimum in bronchial asthma: - Aetiology - Modalities - Physical generals - Mental symptoms - Physical findings - Severity of episodes
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HOMOEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA

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Management of acute episodes: Strictly speaking we can not make a definite distinction between drugs which are useful for acute episodes and those for inter-episodic state. However, there are certain drugs which are very effective in acute episodes such as Ant.tart., Ars., Ipec., Kalibich., Kali carb, Bry, Spong, Cina etc. These drugs are usually selected on the basis of modalities, aetiology and physical findings.
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HOMOEOPATHIC MANAGEMENT OF BRONCHIAL ASTHMA

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Management of inter-episodic phase: This can be done by the drugs selected on physical general, mental generals, constitution, repertorial totality etc. In some occasions the drug used to control acute episodes itself will found continuously indicated I during inter-episodic state.
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CLINICAL TIPS FOR PRESCRIPTION

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Dust mites Kali bich Cockraoches, cats, other animal hairs Nat. ars House dust - Kali bich Wooden dust - Ipec. Any dust - Ars., Kali carb., Calc., Hep. Seasonal pollens Lach, Hep. Sulph, Spongia Exercise induced Lyco., Ars URTI Ars., Bry Sinusitis Bry, Rhust., Kalibich, Sil. Alcohol - Ars., Nux v.
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CLINICAL TIPS FOR PRESCRIPTION

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Postnasal drip Kali bich Gastro-oesophageal reflux Nux v., Ars., Kali bich. Changes in weather Ars., Hep sulph., Bry, Rhust. Wet weather - Ars., Nat. s. Warm season - Kali bich., Sulph Stress Ign., Ars., Nat.m., Cham. Aspirin, NSAID, analgesics - Nux v. Occupational causes - Ars., Ipec., Nat.a., During menstrual cycle - Kali carb. Vaccination from - Ant tart., Sil., Thuja
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CLINICAL TIPS FOR PRESCRIPTION

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Depending on severity: Mild cases

Breathless Speech Body position Respiratory rate Use of accessory muscles Breath sounds Mental status with activity sentences able to recline increased Usually not moderate wheeze - may be agitated

- Lyco., Phos., Ars., Bry., Nux v., Psor.

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CLINICAL TIPS FOR PRESCRIPTION

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Depending on severity: Moderate cases

Breathless Speech Body position Respiratory rate Use of accessory muscles Breath sounds Mental status with talking phrases prefers sitting increased commonly loud wheeze during expiration - usually agitated

- Dros., Ars., Phos., Spong., Kali carb., Ant.t., Ipec., Igna., Lach., Lyco.
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CLINICAL TIPS FOR PRESCRIPTION

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Depending on severity: Severe cases

Breathless Speech Body position Respiratory rate Use of accessory muscles Breath sounds Mental status at rest words unable to recline > 30/minute usually loud wheeze during expiration & inspiration - usually agitated

- Dros., Ars., Phos., Spong., Kali carb., Ant.t., Ipec., Igna., Lach., Lyco., Bry.
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CLINICAL TIPS FOR PRESCRIPTION

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Depending on severity: Impending respiratory failure

Breathless at rest Speech mute Body position unable to recline Respiratory rate > 30/minute Use of accessory muscles always Breath sounds little air movement without wheeze Mental status - confused and drowsy

Ars., Ant.t., Ipec., Lach., Carb v.

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CLINICAL TIPS FOR PRESCRIPTION

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Depending on physical findings:

Cynotic features Lach., Carb v., Ant.t Blue blotter Lyco., Ars Pink puffer Ant.t Flapping alae Ant.t., Lyco. Accessory muscle into action Ars., Ant.t Bilateral rhonchi - Ars Fine crepitus Ant.t Coarse crepitus Ipecac Dryness of lips Ars. Air entry poor Lyco
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CLINICAL TIPS FOR PRESCRIPTION

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Depending on the position of the patient:

Lying on back Psor Lying on left side Ars Lying on abdomen Ars., Cina Sitting upright Kali carb Sitting and supporting on bed with hand Kali carb Sitting and supporting face with hand Kali carb Knee elbow or knee face position Ars Sitting and bending forward Ars., Lach. Standing near window and arm raised above head - Sulph Sitting in open air Sulph Walking slowly Kali carb Carried Ars
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CLINICAL TIPS FOR PRESCRIPTION

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Mental symptoms:
Acute emotional excitement Ign., Ars., Long continued grief - Nat m Overanxious patient - Ars Anger, scolding Cham Fright Ars., Ign., Lyco Indignation Igna Guilty of conscience Igna., Ars.
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CLINICAL TIPS FOR PRESCRIPTION

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Dietary errors:
Cold food Ars, Hep, Nux v Cold drinks Rhust, Phos Curd Ars Egg Sulph Meat Ars., Puls., Chicken Ferr Flatulent food Lyc., Nux v. Fish Ars., Puls Shell fish and Oyesters Lyc Fruits Ars., Lyc Milk Ars, Calc., Nit.ac Sour Ant.t., Ant.c., Ars Vegetables Bry, Ars., Nat.s
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OPEN CLINICAL TRIAL ON BRONCHIAL ASTHMA

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CCRH has conducted an open clinical trial on Bronchial Asthma at CRIH, Kottayam during the period 1985 1990 Aims and objectives: To evolve a group of most effective drug to control acute episodes To find out the reliable indications of the effective drugs To find out the most useful potencies To find out the reliable frequency of repetition
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OPEN CLINICAL TRIAL ON BRONCHIAL ASTHMA

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MATERIALS: 1934 cases of bronchial asthma treated in the OPD, IPD and MCRU of CRIH, Kottayam. Patients with age up to 60 were included in this study All cases of bronchial asthma except status asthmaticus, cases with other systemic disorders and those with severe withdrawal symptoms were included.
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OPEN CLINICAL TRIAL ON BRONCHIAL ASTHMA

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METHODS: Diagnosis:

Clinical history Radiological findings Laboratory findings Basis of selection of remedies: -Aetiology -Modalities -Physical generals -Mental symptoms -Physical findings -Severity of episodes Outcome measure : Improvement in symptoms and signs Follow up: Once in 14 days for period of 2 years
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OPEN CLINICAL TRIAL ON BRONCHIAL ASTHMA

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RESULTS: 973 cases had marked to moderate improvement 262 cases had only mild improvement 131 cases did not show any improvement 54 cases became worse 514 cases were dropped out Medicines found most useful: Ant.t, Ars, Bry, Cina, Carb.v, Ipec, Kali b, Kali c, Lach, Lyc, Nat.s, Nux v, Phos, Psor, Sulph. General management: Dietary management Most useful potencies: 30 and 200
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