Scope of repertories in the management of bronchial asthma

Dr Likhitha A P

ABSTRACT:
Bronchial asthma, a chronic inflammatory condition of the airways is seeing a rise in cases globally due to various modern factors such as urbanization, industrial pollution, sedentary lifestyles and changes in diet. This condition is marked by recurring episodes of wheezing, breathlessness, chest tightness and coughing, especially at night or early morning. Despite advancements in knowledge and treatment options, asthma continues to be a major global health issue due to its widespread prevalence, impact on quality of life and associated healthcare costs. This article aims to correlate the rubrics from various repertories with the symptoms of bronchial asthma, providing insights that can be directly applied in clinical practice.

KEYWORDS:  Bronchial asthma, Rubrics, Repertory, Homoeopathy

INTRODUCTION:
Asthma classified under ICD-11 code CA23, is a chronic inflammatory disease of the airways characterized by episodes of wheezing, shortness of breath, chest tightness and coughing. These symptoms which can range in severity are often triggered by allergens, exercise, cold air or respiratory infections.

Historically, asthma-like symptoms have been documented since ancient times, with early medical observations by Hippocrates in Greece. Over the centuries, the understanding of asthma has shifted from being seen as a psychological condition to recognizing its complex nature involving airway inflammation and hyperresponsiveness. The inflammation leads to airway narrowing and excessive mucus production, making breathing difficult. Asthma management typically involves using inhalers to reduce inflammation and relax airway muscles, along with identifying and avoiding specific triggers. Despite advances in treatment, asthma continues to be a major health concern due to its significant impact on daily life and the potential for severe attacks.

EPIDEMIOLOGY/PREVALENCE
Bronchial asthma is a prevalent chronic respiratory condition worldwide. According to epidemiological studies, its prevalence varies significantly across different populations and regions. Globally, it affects approximately 300 million people. The prevalence of asthma has been on the rise in recent decades, particularly in urban areas and developed countries. It is estimated that around 10% of children and 5-7% of adults suffer from asthma in various parts of the world. According to global burden of disease total burden of bronchial asthma in India is 34.3million which account for 13.9% of global burden.

ETIOLOGY

Etiological factors for Bronchial asthma have been shown to include

• Genetic Factors: Family history can increase susceptibility.
• Environmental Allergens: Exposure to triggers like pollen, dust mites and pet dander.
• Respiratory Infections: Viral infections can provoke asthma episodes.
• Air Pollution: Both outdoor pollutants and indoor irritants like smoke.
• Occupational Exposures: Chemicals, fumes and dust in certain work settings.
• Physical Activity: Exercise-induced asthma triggered by exertion.
• Medications: Some drugs especially aspirin and NSAIDs can worsen symptoms.
• Emotional Factors: Stress and intense emotions may exacerbate asthma attacks.
• Obesity: Being overweight or obese can increase asthma risk and severity.

These factors interact in complex ways, influencing the onset and aggravation of Bronchial asthma.

SYMPTOMS

• Wheezing: A whistling or squeaky sound during breathing.
• Shortness of Breath: Difficulty breathing, especially during physical activity or at night.
• Chest Tightness: A sensation of pressure or discomfort in the chest.
• Coughing: Often worse at night or early in the morning and can be persistent.
• Increased Mucus Production: Thick mucus in the airways.
• Difficulty Sleeping: Due to coughing, wheezing or shortness of breath disrupting sleep.
• Fatigue: Feeling tired or lacking energy often due to sleep disturbances or inadequate oxygen intake.

These symptoms can vary in intensity and frequency triggered by factors such as allergens, exercise or respiratory infections.

DIAGNOSTIC CRITERIA:

• Symptoms: Presence of recurrent episodes of wheezing, shortness of breath, chest tightness and coughing, especially at night or early morning. (GINA diagnostic criteria)
• Medical History: Detailed discussion focusing on symptom patterns, triggers and family history of asthma or allergies.
• Physical Examination: Examination may reveal wheezing, prolonged expiration and signs of respiratory distress.
• Lung Function Tests: Spirometry to measure airflow obstruction and assess reversibility with bronchodilator use (criteria include FEV1/FVC < 0.70 and ≥12% improvement in FEV1 post-bronchodilator).
• Peak Flow Measurement: Monitoring peak expiratory flow rates to track variability.
• Allergy Testing: Identifying allergens that may trigger asthma symptoms, often through skin prick tests.
• Exclusion of Other Conditions: Ruling out alternative diagnoses like COPD or congestive heart failure that can present similarly.

REPERTORIAL APPROACH

1. Some of the rubrics related to Bronchial asthma fromBoenninghausen’s Therapeutic Pocket Book (BTPB) are as follows:

SECTION	CHAPTER	SUB RUBRIC	PAGE NUMBER
Parts of the body and organs	Respiration	Arrested	112
Parts of the body and organs	Respiration	Oppressed	113
Parts of the body and organs	Respiration	Suffocative attacks	114
Parts of the body and organs	Cough	With expectoration	115
Parts of the body and organs	Cough	tenacious	117
Parts of the body and organs	Cough	hardened	118
Parts of the body and organs	Air passages	Interrupted	122
Parts of the body and organs	Chest	Internal	124
Sensations and complaints	Sensation	Constriction	149
Sensations and complaints	Sensation	Heaviness -internally	162
Sensations and complaints	Sensation	Inflammation -internally	163
Sensations and complaints	Sensation	Inflammation -mucous membrane	164
Sensations and complaints	Sensations	Motion – difficult	167

2. Some of the rubrics related to Bronchial asthma from Kent’s “Repertory of the Homoeopathic Materia Medica” are as follows:

CHAPTER	RUBRIC	SUB RUBRIC	PAGE NUMBER
Respiration	Accelerated		762
Respiration	Arrested		762
Respiration	Asthmatic		764
Respiration	Difficult		766
Respiration	Gasping		772
Respiration	Wheezing		776
Cough	Asthmatic		782
Cough	Constriction	chest	784
Cough	Expectoration	Amel	790
Cough	Expiration	Eating after	790
Cough	Irritation	Bronchia	794
Cough	Mucus	Chest in	798
Expectoration	Difficult		814
Expectoration	Stringy viscid		818
Expectoration	White		820
Expectoration	Thick		820
Chest	Constriction		826
Chest	Inflammation	Bronchial tubes	834
Chest	Oppression	Expiration during	840
Chest	Weakness	Respiration deep	882

3. Some of the rubrics related to Bronchial asthma from “Boger Boenninghausen’s characteristics and repertory”are as follows:

CHAPTER	RUBRIC	SUBRUBRIC	PAGE NUMBER
Respiration	Asthma	Bronchial	690
Respiration	Difficult		691
Respiration	Expiration	Difficult	691
Respiration	Suffocative attack	At night	694
Respiration	Tight	Wheezing	694
Respiration	Tightness	Of chest	694
Respiration	Impeded	By	695
Respiration – time			698
Respiration – aggravation			699
Respiration – amelioration			704
Respiration – Concomitant			705
Cough	Asthmatic	wheezy	705
Cough	Expectoration		727
Chest	Inner	Constriction	754
Chest	Heaviness Fullness Narrow as if too Secretion increased		758 760

4. Some of the rubrics related to Bronchial asthma from“Murphy’s Homoeopathic Medical Repertory”are as follows:

CHAPTER	RUBRIC	SUB RUBRIC	PAGE NUMBER
CLINICAL	Asthma		386
CLINICAL	Asthma	Children	386
LUNG	Asthma	General	1430
LUNG	Asthma	Allergic hay fever with	1430
LUNG	Asthma	Alternating with eruption	1431
LUNG	Asthma	Anxiety with	1431
LUNG		Chronic	1431
LUNG	Asthma	Coughing asthmatic	1431
LUNG	Asthma	Eruption after suppressed	1432
LUNG	Asthma	Wheezing Weather change of Vaccination after Suppression from	1434
LUNG	Asthma	Dust from inhaling Eruption with Elderly people in Hysterical	1432
LUNG	Asthma	Winter attacks	1435
LUNG	Asthmatic	Constitutions	1435

5. Some of the rubrics related to Bronchial asthma from “Synthesis 1.3 Android application” created by Archibel SA based on synthesis repertory version 2009,

Editor: Dr.Frederick Schroyens.

• RESPIRATION – ASTHMATIC
• RESPIRATION – ASTHMATIC – allergic
• RESPIRATION – ASTHMATIC – bronchial
• RESPIRATION – ASTHMATIC – bronchial – children; in
• RESPIRATION – ASTHMATIC – cold; after taking a
• RESPIRATION – ASTHMATIC – coryza; after
• RESPIRATION – ASTHMATIC – dust; from inspiration of
• RESPIRATION – ASTHMATIC – eczema; after suppressed
• RESPIRATION – ASTHMATIC – expectoration – amel.
• RESPIRATION – ASTHMATIC – hysterical
• RESPIRATION – LYING DOWN agg.; after
• RESPIRATION – DIFFICULT – ascending – agg.
• RESPIRATION – WHEEZING
• RESPIRATION – COUGH – after – amel.
• RESPIRATION – EXPIRATION – during – agg.
• RESPIRATION – ASTHMATIC – winter attacks
• RESPIRATION – ASTHMATIC – violent
• RESPIRATION – ASTHMATIC – temperature; from a slight change of
• RESPIRATION – ASTHMATIC – sudden attacks
• RESPIRATION – ASTHMATIC – status asthmaticus
• RESPIRATION – ASTHMATIC – summer; in
• RESPIRATION – ASTHMATIC – recurrent
• RESPIRATION – ASTHMATIC – periodical
• RESPIRATION – ASTHMATIC – position knee-elbow – amel.
• RESPIRATION – ASTHMATIC – odors agg.
• RESPIRATION – ASTHMATIC – old people; in
• RESPIRATION – ASTHMATIC – night
• RESPIRATION – ASTHMATIC – morning
• RESPIRATION – ASTHMATIC – mental exertion agg.
• RESPIRATION – ASTHMATIC – miner’s asthma, from coal dust
• COUGH – ASTHMATIC
• COUGH – PAROXYSMAL
• COUGH – COLD; AFTER TAKING A
• COUGH – DUST, as from
• COUGH – MUCUS – Chest; in – Upper; in
• COUGH – MUCUS – Trachea
• COUGH – CONSTRICTION; from – Chest; in
• COUGH – CONSTRICTION; from – Larynx; in
• COUGH – CONSTRICTION; from – Trachea; in
• COUGH – OPPRESSION; from – Chest; in
• CHEST – CONSTRICTION
• CHEST – CONSTRICTION – asthmatic
• EXPECTORATION – THICK
• EXPECTORATION – VISCID
• GENERALS – COLD – agg.

6. Some of the rubrics related to Bronchial asthma taken from S.R Phatak’s “A concise repertory of homoeopathic medicines”are as follows:

• A – Asthma; bronchial
• A – Asthma; bronchial – cold, preceded by
• A – Asthma; bronchial – constitutionally
• A – Asthma; bronchial – coryza – after
• A – Asthma; bronchial – dust, inhalation of
• A – Asthma; bronchial – eruptions, alternating with
• A – Asthma; bronchial – expectoration amel
• A – Asthma; bronchial – foot sweat, suppressed, from
• A – Asthma; bronchial – full moon
• A – Asthma; bronchial – hay fever, of
• A – Asthma; bronchial – infantile
• A – Asthma; bronchial – miners’s
• A – Asthma; bronchial – old people, in
• A – Asthma; bronchial – sailors, on shore
• A – Asthma; bronchial – overheated, being, after
• A – Asthma; bronchial – winter agg
• C – Cough – warmth amel.
• R – Respiration – exertion – agg
• R – Respiration – humid air agg
• R – Respiration – heavy

7. Some of the rubrics related to Bronchial asthma taken from “Pocket manual of Homoeopathic Materia Medica and Repertory” by William Boericke, are as follows:

Respiratory system

Bronchial tubes- Asthma: remedies in general

Concomitants –with bronchial catarrh

• -with burning in throat and chest
• -with constriction of throat
• -with cyanosis
• -with every fresh cold

Modalities -AGGRAVATION

• –After sleep
• –At night, lying down
• -From cold, damp weather
• -From inhaling
• -In spring
• -In summer

AMELIORATION-

• -At sea-
• -From bending forward, rocking-
• -From eructation-.
• -From expectoration-
• -From lying down, keeping arms spread apart-

1. Cough
2. Expectoration
3. Respiration arrested
4. Dyspnoea
5. Wheezing

CONCLUSION:

• The scope of Kent’s repertory of homeopathic materia medica lies in the availability of general symptoms.
• BTPB is based upon the concept of complete symptom. It can be used when physical symptoms are available.
• BBCR is the latest among the 3 well known repertories in use. The accessing of complete symptom as regards Location, Symptom, Modalities & Concomitant is made to a large extend within each of the chapters.
• Boericke repertory is a clinical repertory which contains clinical symptoms & corresponding group of medicines. They facilitate the selection of remedies based on pathological similarity, Causation, modality & concomitant.
• Phatak’s repertory – one of the reliable alphabetical repertories which is concise, handy & useful for ready reference. General modality represented in the capitals AGG or AMEL & modality related to a particular part is represented by small letters Agg or Amel.
• Murphy’s Repertory has vast clinical information significant to modern homeopathic practice. This is a unique repertory which helps a practitioner to find out the similimum based on clinical as well as classical symptoms.

Thus, various repertories like Boenninghausen’s Therapeutic Pocket Book (BTPB), Boger Boenninghausen’s characteristics and repertory (BBCR), Murphy’s repertory, Kent’s repertory, Boericke’s repertory, Phatak’s repertory contains numerous rubrics related to Bronchial asthma. The above-mentioned rubrics emphasizes the role and scope of repertories in managing Bronchial asthma.

REFERENCES:

1. Global Initiate for Asthma. Pocket Guide for Asthma Management and Prevention.2023: 20-23. Available from 14 https://ginasthma.org/pocket-guide-for-asthma-management-and-prevention/ [Accessed on 3rd july 2024]
2. Roberts, H.A., Wilson, A.C. and von, B.C.M.F. (1999) The principles and practicability of Boenninghausen’s therapeutic pocketbook for Homoeopathic physicians: To use at the beside and in the study of the Materia Medica. B. Jain Publishers (P) LTD, New Delhi.
3. Kent JT. Repertory of the Homoeopathic Materia Medica. Enriched Indian ed. New Delhi. B Jain Publishers; 2017
4. Boger CM. Boger Boenninghausen’s Characteristics Repertory with corrected Abbreviations and word index. USA. B. Jain publication; 2015.
5. Murphy R. Homeopathic medical repertory.3/e. B. Jain Publishers; New Delhi:
6. Archibel SA. Synthesis 1.3 Android app based on Synthesis Repertory Dr Frederick Schroyens; 2009.
7. Phatak S. Materia Medica of Homoeopathic Medicines: Revised Edition: 2/e. B. Jain Publishers, New Delhi, 2018.
8. Boericke William, Pocket manual of Homoeopathic Materia Medica and repertory, 9/e, B. Jain Publishers, New Delhi, 2012.

Dr. Likhitha A P
PG Scholar, MD(HOM) Part 1
Department of Case Taking and Repertory
Government homoeopathic medical college and hospital, Bengaluru.

UNDER THE GUIDANCE OF: Dr. Anusuya M Akareddy(Hom)
HOD and PG guide
Department of Case Taking and Repertory
Government homoeopathic medical college and hospital, Bengaluru.