Page 28 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 28
often mentioned as the Father of Modern selective β2- bronchodilators, were devel-
Medicine, made a more precise definition of oped for inhaled use. Long-acting beta-ago-
asthma connecting pathology, physiology, nists (LABAs - e.g., formoterol, salmeterol),
symptoms, and clinical findings, in the first introduced in middle ‘90s as an important
edition of his Textbook Principles and Prac- drug in asthma management. They demon-
tice of Medicine.6 Thus, it was in the 19th cen- strate a clear benefit in reducing asthma-re-
tury that asthma was described as a distinct lated symptoms and improving lung function
lung disease with specific etiology, clinical but only when used in combination with an
findings, and treatment. anti-inflammatory agent.17
28 Early Therapeutic Interventions The Introduction of Corticosteroids
on Asthma Management
severe asthma forum 1: severe asthma - basic and clinical views Therapeutic options for asthma were limited
until the middle of 20th century and asthma The story of corticosteroids in asthma be-
was treated largely as a disease of broncho- gins in the early 1950s, when cortisone was
spasm.7 Regimens containing anticholiner- first administered to treat asthma successfully.
gics were the first aetiologic treatment admin- Case series reporting the benefits of parenter-
istered for asthma. Paul Ehrlich proposed al administration of cortisone in patients with
black coffee for the treatment of broncho- allergic asthma were published: In 1950, Car-
spasm, as this beverage contains theophyl- ryer presented 3 patients with seasonal asth-
line and its derivative theobromine.8 Hen- ma and hay fever who received sequential-
ry Hyde Salter discusses “Asthma cigarettes” ly 100 mg cortisone or cholesterol suspension
containing dried leaves and flowering of D. daily over a 4-week period in a blinded man-
Stramonium as a treatment for asthma in his ner. All three patients experienced prompt re-
19th century work.9 Datura Stramonium con- lief from symptoms of asthma and hay fever,
tains alkaloids of belladonna which has anti- which lasted a few days post administration.18
cholinergic action. William Osler in his eight In 1953, Burrage W. presented 14 cases of se-
edition of his textbook in 1914 suggests hy- vere bronchial asthma treated with a mean
podermic injections of pilocarpine for asth- daily dose of 50mg cortisone for a prolonged
ma treatment.10 Adrenergic bronchodilators period. The author mentioned that “the use
were introduced as treatment for asthma in of cortisone in severe asthma involves a treat-
the beginning of 20th century. Initially both ment of an as yet imperfectly understood dis-
adrenaline and ephedrine were used subcu- ease with a potent hormone, whose mode of
taneously at repeated intervals during asth- action remains a mystery” and that “no pa-
ma attacks.11 In 1947, in Cecil’s Textbook of tient has remained asthma free on less than
Medicine, Rackemann presented the inhaled 25mg of cortisone daily”.19 Several other re-
administration of ephedrine to relieve asthma ports of parenteral administration of corti-
symptoms.12 Since then, inhalers were wide- sone in patients with asthma were published
ly available for asthma and bronchodilators over the following years.20-22
such as isoprenaline and orciprenaline.13,14
The widespread use of those nonselective The difficulties of parenteral adminis-
bronchodilators led to an increased ratio of tration and the relapse of symptoms follow-
deaths among asthmatics in England and ing discontinuation of treatment were extin-
Wales in the 1960s, possibly due to their car- guished with the initiation of oral therapy.
diovascular adverse effects or as a result of in- In January 1951, Scwartz E. reported 3 cas-
adequately treated asthma. In the 1970s, sal- es of “intractable” asthma successfully treat-
butamol15 and terbutaline16, relatively more ed with cortisone acetate tablets at initial
doses of 50-100mg with gradual tapering
Medicine, made a more precise definition of oped for inhaled use. Long-acting beta-ago-
asthma connecting pathology, physiology, nists (LABAs - e.g., formoterol, salmeterol),
symptoms, and clinical findings, in the first introduced in middle ‘90s as an important
edition of his Textbook Principles and Prac- drug in asthma management. They demon-
tice of Medicine.6 Thus, it was in the 19th cen- strate a clear benefit in reducing asthma-re-
tury that asthma was described as a distinct lated symptoms and improving lung function
lung disease with specific etiology, clinical but only when used in combination with an
findings, and treatment. anti-inflammatory agent.17
28 Early Therapeutic Interventions The Introduction of Corticosteroids
on Asthma Management
severe asthma forum 1: severe asthma - basic and clinical views Therapeutic options for asthma were limited
until the middle of 20th century and asthma The story of corticosteroids in asthma be-
was treated largely as a disease of broncho- gins in the early 1950s, when cortisone was
spasm.7 Regimens containing anticholiner- first administered to treat asthma successfully.
gics were the first aetiologic treatment admin- Case series reporting the benefits of parenter-
istered for asthma. Paul Ehrlich proposed al administration of cortisone in patients with
black coffee for the treatment of broncho- allergic asthma were published: In 1950, Car-
spasm, as this beverage contains theophyl- ryer presented 3 patients with seasonal asth-
line and its derivative theobromine.8 Hen- ma and hay fever who received sequential-
ry Hyde Salter discusses “Asthma cigarettes” ly 100 mg cortisone or cholesterol suspension
containing dried leaves and flowering of D. daily over a 4-week period in a blinded man-
Stramonium as a treatment for asthma in his ner. All three patients experienced prompt re-
19th century work.9 Datura Stramonium con- lief from symptoms of asthma and hay fever,
tains alkaloids of belladonna which has anti- which lasted a few days post administration.18
cholinergic action. William Osler in his eight In 1953, Burrage W. presented 14 cases of se-
edition of his textbook in 1914 suggests hy- vere bronchial asthma treated with a mean
podermic injections of pilocarpine for asth- daily dose of 50mg cortisone for a prolonged
ma treatment.10 Adrenergic bronchodilators period. The author mentioned that “the use
were introduced as treatment for asthma in of cortisone in severe asthma involves a treat-
the beginning of 20th century. Initially both ment of an as yet imperfectly understood dis-
adrenaline and ephedrine were used subcu- ease with a potent hormone, whose mode of
taneously at repeated intervals during asth- action remains a mystery” and that “no pa-
ma attacks.11 In 1947, in Cecil’s Textbook of tient has remained asthma free on less than
Medicine, Rackemann presented the inhaled 25mg of cortisone daily”.19 Several other re-
administration of ephedrine to relieve asthma ports of parenteral administration of corti-
symptoms.12 Since then, inhalers were wide- sone in patients with asthma were published
ly available for asthma and bronchodilators over the following years.20-22
such as isoprenaline and orciprenaline.13,14
The widespread use of those nonselective The difficulties of parenteral adminis-
bronchodilators led to an increased ratio of tration and the relapse of symptoms follow-
deaths among asthmatics in England and ing discontinuation of treatment were extin-
Wales in the 1960s, possibly due to their car- guished with the initiation of oral therapy.
diovascular adverse effects or as a result of in- In January 1951, Scwartz E. reported 3 cas-
adequately treated asthma. In the 1970s, sal- es of “intractable” asthma successfully treat-
butamol15 and terbutaline16, relatively more ed with cortisone acetate tablets at initial
doses of 50-100mg with gradual tapering
