TREATMENT OF BRONCHIAL ASTHMA WITH SIMILIMUM

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TREATMENT OF BRONCHIAL ASTHMA WITH SIMILIMUM

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

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INTRODUCTION

• 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.

• 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.

• 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.

• 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.

• 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.

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

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Introduction contd.

• Severity of asthma Impending respiratory
• failure
• Breathless at rest
• Speech mute
• Body position unable to recline
• Respiratory rate gt 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• Depending on severity
• Mild cases
• 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
• - Lyco., Phos., Ars., Bry., Nux v., Psor.

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CLINICAL TIPS FOR PRESCRIPTION

• Depending on severity
• Moderate cases
• 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
• - Dros., Ars., Phos., Spong., Kali carb.,
  Ant.t., Ipec., Igna.,
• Lach., Lyco.

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CLINICAL TIPS FOR PRESCRIPTION

• Depending on severity
• Severe cases
• Breathless at rest
• Speech words
• Body position unable to recline
• Respiratory rate gt 30/minute
• Use of accessory muscles usually
• Breath sounds loud wheeze during
• expiration inspiration
• Mental status - usually agitated
• - Dros., Ars., Phos., Spong., Kali carb.,
  Ant.t., Ipec., Igna.,
• Lach., Lyco., Bry.

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CLINICAL TIPS FOR PRESCRIPTION

• Depending on severity
• Impending respiratory
• failure
• Breathless at rest
• Speech mute
• Body position unable to recline
• Respiratory rate gt 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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

• 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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THANK YOU