Role of homoeopathy in bronchial asthma

Dr Rajisha Ramachandran

 “When you can’t breathe, nothing else matters”   – Lewis

Asthma is a disease of respiratory system in which respiratory passages in the lungs becomes over reactive and over responsive. Because of this increased sensitivity, lungs become inflamed when exposed to some irritants such as cold air, smoke, pollen etc. Asthma causes inflammation of the lungs and causes and results in narrowing of the respiratory passages.

Bronchial Asthma is a chronic inflammatory disorder characterized by episodes of breathlessness, wheezing, cough, chest tightness etc caused due to bronchial hyper-responsiveness and variable air flow obstruction which is reversible spontaneously or with treatment.¹ Asthmatics harbour a special type of inflammation in the airways that makes them more responsive than nonasthmatics to a wide range of triggers, leading to excessive narrowing with consequent reduced airflow and symptomatic wheezing and dyspnoea. Narrowing of the airways is usually reversible, but in some patients with chronic asthma there may be an element of irreversible airflow obstruction.²

EPIDEMIOLOGY
Bronchial asthma is recognized as major health problem by the World Health Organization.³According to latest Global Burden of Diseases (GBD) study, 339.4 million people in the world have high burden of asthma. Globally asthma is ranked 16^th among the leading causes of years lived with disability and 28^th among the leading causes of burden of diseases.⁴ Prevalence of asthma is high in developed countries compared to developing countries.⁵ In India, about 15-20 million were estimated to be asthmatic. In India, its prevalence is about 2 percent.⁶ It is one of the cause of impaired quality of life with decreased ability to complete daily activities (85%), physical activity limitation (69%), loss in productivity at work (73%) or study (64%), and limits in leisure and lifestyle (78%).⁷

AETIOLOGY AND RISK FACTORS
Asthma is a heterogeneous disease with interplay between genetic and environmental factors. Several risk factors that predispose to asthma have been identified. These should be distinguishes from triggers, which are environmental factors that worsen asthma in a patient with established disease.² Endogenous risk factors include genetic predisposition, gender, atopy, ethnicity and exogenous risk factors are allergens, occupational sensitizers, smoking, infection, obesity, dietary factors etc.

1.Genetic Predisposition: The familial association of asthma and a high degree of concordance for asthma in identical twins indicate a genetic predisposition to the disease. The most consistent findings have been associations with polymorphisms of genes on chromosome 5q, including the T helper 2 (TH2) cells interleukin (IL)-4, IL-5, IL-9, and IL-13, which are associated with atopy. Novel genes that have been associated with asthma, including ADAM-33, and DPP-10, have also been identified by positional cloning.²

2. Atopy: The genetic predisposition to IgE mediated response to common allergens is the strongest identifiable factor predisposing factor for the development of asthma.⁸ About 80% of asthmatic patients suffer from other allergic diseases like allergic rhinitis and atopic dermatitis. The allergens that lead to sensitization are usually proteins that have protease activity, and the most common allergens are derived from house dust mites, cat and dog fur, cockroaches (in inner cities), grass and tree pollens, and rodents (in laboratory workers).²

3. Respiratory tract Infections: viral infections (especially rhinovirus) are common triggers of asthma exacerbations. There is some association between respiratory syncytial virus infection in infancy and the development of asthma. Atypical bacteria such as mycoplasma pneumonia and Chlamydia pneumonia involved in asthma. 

4. Diet: Diets low in antioxidants such as vitamin C and vitamin A, magnesium, selenium, and omega 3 polyunsaturated fats (fish oil) or high in sodium and omega-6 polyunsaturated fats are associated with an increased risk of asthma.²

5. Occupational asthma: Has become common work-related respiratory disease in the world and common among adults of working age.⁹

6. Exercise: Exercise is a common trigger of asthma, particularly in children. The mechanism is linked to hyperventilation, which results in increased osmolality in airway lining fluid and triggers mast cell mediator release, resulting in bronchoconstriction. Exercise-induced asthma (EIA) typically begins after exercise has ended and resolves spontaneously within about 30 min.²

7. Hormones: Some women show premenstrual worsening of asthma. They are related to progesterone and in severe cases may be improved by treatment with high doses of progesterone or gonadotropin-releasing factors. Thyrotoxicosis and hypothyroidism can both worsen asthma, although the mechanisms are uncertain.

8. Gastroesophageal reflux: Gastroesophageal reflux is common in asthmatic patients because it is increased by bronchodilators. Although acid reflux might trigger reflex bronchoconstriction, it rarely causes asthma symptoms.

9. Obesity: Asthma occurs more frequently in obese people (body mass index >30 kg/m2) and is often more difficult to control.

10. Air pollution: Air pollutants, such as sulphur dioxide, ozone, and diesel particulates, may trigger asthma symptoms. Indoor air pollution may be more important with exposure to nitrogen oxides from cooking stoves and exposure to passive cigarette smoke. There is some evidence that maternal smoking is a risk factor for asthma.

11. Stress:  Many asthmatics report worsening of symptoms with stress.

12. Allergens: Inhaled allergens are common triggers of asthma. Domestic pets, particularly cats, have also been associated with allergic sensitization, but early exposure to cats in the home may be protective through the induction of tolerance. In thunderstorms the pollen grains are disrupted, and the particles that may be released can trigger severe asthma exacerbations (thunderstorm asthma).

13. Air pollution: Air pollutants, such as sulphur dioxide, ozone, and diesel particulates, may trigger asthma symptoms. Indoor air pollution may be more important with exposure to nitrogen oxides from cooking stoves and exposure to passive cigarette smoke. There is some evidence that maternal smoking is a risk factor for asthma.

14. Other factors: Lower maternal age, prematurity and low birth weight.

PATHOPHYSIOLOGY
T-lymphocytes play a key role in asthmatic airway inflammation and sensitisation. There are two types of T-lymphocyte helper (Th) cells. Th1 controls synthesis of Ig such as IgA and IgM whereas Th 2 controls IgE production. Usually, there is a balance between Th1/Th 2 switch. Exposure to an inducing factor sensitises T cells of a person with genetic susceptibility with bronchial asthma, and it shifts the Th1/Th 2 switch in favour of Th 2 dominance. Once sensitised, these Th 2 cells get into airway mucosa and governs IgE mediated responses of allergic reaction. In a normal individual, when a noxious allergic substance enters the airway, IgA is released. However, in a sensitised person IgE is released. Once sensitised, the dose of the noxious agent that provoke asthma on subsequent exposure is much less.¹⁰

Genetic disposition and exogenous factors trigger mainly three patho-physiological changes which characterize bronchial asthma. They are bronchial hyper-reactivity, bronchial inflammation and endo-bronchial obstruction.¹¹

Airway inflammation leads to airflow limitation by bronchospasms, mucosal oedema and formation of mucus plug. This inflammation persists for several years.  Endo-bronchial obstruction, especially small and medium sized airway is the end product of these patho-physiological phenomena. Severity of asthma depends on the severity of pathology. Eventually this results in reduction of forced expiratory volume in 1s, forced vital capacity, peak expiratory flow and increase in airway resistance.²

CLINICAL FEATURES

• Typical asthmatic symptoms are recurrent episodes of dyspnoea [sometimes at rest], expiratory wheeze, cough and chest tightness usually having an abrupt onset. Asthmatic symptoms are usually brought by coughing or sneezing on allergen exposure. Asthma shows diurnal pattern with aggravation of symptoms and PEF in the morning. Attacks may occur seasonally or during all times of year.¹
• It may lead to disrupted sleep due to cough and wheeze. There is an increased mucous production, which is thick, mucoid and difficult to expectorate. History of recurrent episodes of asthma caused by one or more trigger factors is important for the diagnosis of bronchial asthma. However, between episodes, patients usually remain symptom-free.¹⁰Inadequate symptom control, smoking, allergic rhinitis, chronic sinusitis, psychological factors, improper medication, viral infections of upper respiratory tract, gastro-oesophageal reflux, occupational factors, climatic variations and disturbed sleep etc. contributes to severe asthmatic exacerbations.¹²

Physical Examination
Rhonchi are heard as the most prominent sign of asthma, especially during expiration. At the time of asthma exacerbation signs such as increased respiratory rate, flaring of alae nasi, use of accessory muscles of respiration, and pulsus paradoxus may be detected.¹⁰

CLASSIFICATION OF ASTHMA
Bronchial asthma is classified into extrinsic [atopic] and intrinsic [cryptogenic] asthma.

Intrinsic Asthma 

• In intrinsic variety, external precipitating factors are known and are usually associated with atopic eczema etc.
• Family history of bronchial asthma can be observed in many cases and has raised level of IgE in serum.
• Intrinsic asthma occurs by the age 30 and here precipitating causes and raised antibody levels are not seen, but they have tendency to eosinophilia.¹

Extrinsic asthma

• Extrinsic variety has better prognosis and usually sets by the age 10-15years.¹
• Have other atopic manifestation like urticaria, eczema, allergic rhinitis
• Family history of asthma
• Better prognosis

COMPLICATIONS
Even though rate of mortality is low, severe asthma can cause respiratory failure and death. Tendency to frequent respiratory infections, pulmonary collapse caused by mucus collection, pneumothorax, mediastinal emphysema and rib fractures due to violent cough etc. Children who have taken cortical steroids for control of asthma may show growth retardation. Frequent infections can lead to emphysema or chronic cor pulmonale.¹

DIAGNOSIS AND INVESTIGATION OF ASTHMA

Blood Examination
Usually, patients have an eosinophil count in the range of 5% to 15%, or the absolute eosinophil count is more than 400. Total serum IgE and specific IgE are elevated in bronchial asthma.

Sputum Induction
Sputum examination can provide a useful clue about the severity of airway inflammation. Sputum is induced after administration of hypertonic saline with a nebuliser. In patients with asthma, the number of eosinophils are increased in the induced sputum. Estimation of eosinophilic cationic protein in sputum or urine is also found to be a useful test for assessment of the severity of airway inflammation.

Measurement of Lung Functions
Various types of lung function tests are available, but measurements of peak expiratory flow rate (PEFR) by a peak flow meter and forced expiratory volume in one second (FEV1)by a spirometer are most useful in a making diagnosis and assessing the severity of asthma.

Peak airflow meter- helps in the objective assessment of airflow obstruction and monitoring progression of disease and treatment. It measures peak expiratory flow rate [PEFR]; maximum expiratory flow rate over the first 10 milliseconds during a forced expiration. It is done by blowing out as hard as possible after a maximum inspiration to move the pointer on the calibrated dial of instrument. Normal range is 450-700L/min in men and 300-500L/min in women. Serial PEFR measurement helps in diagnosis of asthma. A diurnal variation of >20% is considered as diagnostic.

Pulmonary function tests
These are non-invasive tests to know how lungs are functioning. It also helps to diagnosis, identify the severity of pulmonary impairment and monitor the treatment and progress of disease. It measures the lung volumes, capacities, rate of flow, gas exchange etc and compares with normal values adjusted for age, gender, height and ethnicity. It can be assessed using a spirometer.¹³

Spirometry
Asthma is diagnosed by demonstration of reversible airway obstruction in spirometry. A ratio of FEV1 and forced vital capacity (FVC) less than 0.7 is diagnostic of airway obstruction. After bronchodilator administration, FEV1 increases by more than 12% and 200 mL in asthmatic patients. It is called reversibility of airway obstruction which is characteristic of asthma.¹⁰

It is the simplest test for all respiratory functions. Spirometry begins with a full inspiration followed by a forceful expiration which empties the lungs rapidly and expiration is continued as long as possible [preferably 6 seconds], followed by full inhalation. It generates pneumotachographs- plots volume and flow of air during each respiration. The flow-volume curves are produced with a positive expiratory limb and a negative inspiratory limb.¹³

Estimated FEV1 and FVC are the important parameters to assess the ventilatory capacity. By assessing the breathing patterns, it can detect the conditions like bronchial asthma, COPD, pulmonary fibrosis etc. thus it helps to diagnose of disease at the earliest, prognosis, assess effect of therapy, monitor lung growth, delineate risk factors etc.¹

FEV1 [Forced Expiratory Volume in One Second] is the volume of air expelled in the first one second of a forcible expiration after a full inspiration. Normally it is more than 75%. It depends on the effort made by the patient, elastic recoil of lungs and positive thoracic pressure applied by the expiratory muscles. Airway obstruction is indicated by value less than 70%.

FEV1/ FVC measurement (Tiffeneau – Pinelli index) helps to detect obstructive and restrictive lung disease. It is the proportion of a person’s vital capacity that they are able to expire in the first second of forced expiration to full forced capacity, represented as FEV1%. FEV1/FVC > 70%, means restrictive defect as FVC is reduced more than FEV1, seen in interstitial lung diseases like pulmonary fibrosis and chest wall deformities. FEV1/FVC < 70%, indicate obstructive defect as FEV1 is reduced more than FVC, seen in bronchial asthma and chronic obstructive pulmonary disease. Bronchodilator challenge testing is done to differentiate patients with reversible airway obstruction like asthma. A bronchodilator is given and spirometry is repeated after several minutes, increase of FEV1 by 12% and FVC by at least 200ml considered to be positive. Obstructive defects in patients with asthma have reversibility, where as those with COPD typically are not. The average forced expiratory flow rate over middle 50% of the FVC is called mid-expiratory rate [FEF25-75%]. Its reduction of less than 60% of predicted value with normal or low FEV1/FVC ratio confirms airway obstruction.¹⁴

Chest Radiograph

Radiograph of the chest may show hyperinflation in a patient with asthma. It may also reveal complications of severe asthma such as rib fracture, pneumothorax, and pneumomediastinum.

High Resolution Computerised Tomography of Chest

High resolution computerised tomography shows areas of thickening of the bronchial wall in patient with severe asthma.

Exhaled nitric oxide [FeNO] levels

FeNO levels are elevated in asthma patients due to increased levels of nitric oxide synthase in the respiratory mucosa. This test is done to measure airway inflammation. It is raised due to eosinophilic inflammation seen in acute airway inflammation, sputum eosinophilia and viral infections of respiratory tract.¹²

DIFFERENTIAL DIAGNOSIS

1. Congestive heart failure
2. Mechanical obstruction to airway
3. Pulmonary embolism
4. Vocal cord dysfunction
5. Tracheal and bronchial lesions
6. Eosinophilic pneumonias
7. Systemic vasculitis
8. In children, other upper airway diseases such as allergic rhinitis and sinusitis should be considered as well as other causes of airway obstruction including foreign body aspiration, tracheal stenosis, laryngo- tracheomalacia, vascular rings, enlarged lymph nodes or neck masses. Bronchiolitis and other viral infections may also produce wheezing

MANAGEMENT

• Patient Education: It is aimed to enable asthmatic patient to treat himself under guidance of his doctor. It is achieved by proper education of the patient.  Every patient with asthma should learn to take medicines regularly, correctly and understand the difference between relieving and preventive medicines. Identification and avoidance of risk factors and triggers involved in asthma are also important components of patient education.
• Identify and reduce exposure to risk factors: Asthma exacerbation can be caused by a variety of trigger factors. Early identification of a trigger factor and preventing its exposure improves asthma control and reduces requirement of medicines.

• Assess, monitor and treat asthma: Asthma control is assessed and then patient is treated to achieve the control. Once adequate control is achieved, the patient is monitored regularly to maintain the control.

• Avoiding the aggravating factors and allergens◊ especially in case of occupational and atopic asthma. Avoidance of sensitizing agents in few instances cured or substantially improved asthma patients. Maintain optimal humidity, prevent mould spores, cleaning house regularly to avoid dusts.

• Maintain healthy weight; overweight can worsen asthma symptoms.¹⁵

• Cognitive behavioural therapy improves the quality of life, anxiety levels and asthma control especially in adults.¹⁶

Regular exercising can strengthen the lungs and there by relieve symptoms. But exercise induced asthma typically develop clinical features with exercise. Swimming causes increased pulmonary function and lowers the risk of asthma related symptoms.¹⁷

• Cessation of smoking

• Breathing exercises and Yoga known to be helpful in management of allaying paroxysms.¹ It improves asthma specific health status but not asthma Patho -physiology. The mean FEV₁, PEFR are improved with yoga breathing exercises. This also reduced the use of inhalers.⁸

• Bronchodilators act primarily on airway smooth muscle to reverse the bronchoconstriction of asthma. There are three classes of bronchodilator in current use: b₂-adrenergic agonists, anticholinergics, and theophylline; of these, b₂-agonists are by far the most effective.

HOMOEOPATHIC APPROACH

Homeopathy is a science based on laws of similar, which means it treats the disease with medicines producing similar symptoms when given in healthy individuals. Homeopathy treats the person as a whole.

There are medicines given to treat the acute attacks of asthma as well as to prevent the recurrence of it, also to treat the allergies which may trigger the attack of asthma.

Homoeopathic system evolved a drug regimen of using acute remedies for acute attack and constitutional deep acting remedies to prevent recurrence.

Among the disease classification of Hahnemann, asthma comes under true natural chronic disease caused by the chronic miasm. It also excited by a number of precipitating and maintaining factors and influenced by genetic family history. Asthma can be considered as intermittent disease as it recurs at regular intervals in some patients. Similarly, it can be regarded as alternating disease as they sometimes alternate with skin diseases.

Asthma can be caused by psora, syphilis, sycosis or the combinations of these. In 80^th aphorism, Hahnemann says ‘the monstrous internal chronic miasm – the psora, the real fundamental cause and producer of all other numerous diseases including asthma and ulceration of lungs etc.

RELATED STUDIES IN HOMOEOPATHY

A study conducted at 5 units / institutes of Gudivada, Andra pradesh, Shimla, Udupi and Delhi on 2641 subjects – an observational study to conduct a review on clinical research work of the council in the field of asthma. The results of which showed Arsenicum album as most effective in treating bronchial asthma- it was prescribed to 1042 subjects in which 933 were better. Other remedies used were Kali carbonicum, Hepar sulphuricum, phosphorous, Carbo vegetabilis and Bryonia. Conclusion showed that there was positive outcome in controlling acute episodes of asthma, reducing the frequency, intensity of subsequent episodes and weaning off of bronchodilators.¹⁸

In a study conducted at west Bengal, India comprising of 140 samples using spirometry in a double blind randomized, placebo controlled clinical trial, the primary objective was to determine the action of homoeopathic medicines over placebo. The result obtained was group differences over 3 and 6 months showed significant differences in improvement in UC+IH  compared to UC+P (p<0.01) with moderate to large effect sizes. Conclusion showed that homoeopathy seemed superior to placebo in the treatment of bronchial asthma in adults^.19

The study on the efficacy of homoeopathic treatment in modulation of immunoglobulin E (IgE) levels in bronchial asthma demonstrated the reduction in the IgE and Absolute Eosinophil Count level and improvement in pulmonary functions along with clinical improvement in bronchial asthma under homoeopathic treatment. Sulphur, Arsenicum album and Pulsatilla were found to be more effective in reducing IgE in this study.²⁰

A retrospective evaluation of the study on the results of homoeopathic treatment of 62 patients suffering from bronchial asthma showed a very significant statistical improvement in the condition.²¹

A study conducted by Dr. Parth Aphale in 2018, concluded that the medicines Ars.alb, Spongia, Pulsatilla are effective in the managing the acute attacks and recurrent exacerbations of asthma. Among them Arsenicum album was most effective remedy.²²

RUBRICS IN REPERTORY:

KENT’S REPERTORY²³

RESPIRATION – ASTHMATIC

Acon. Agar. all-c. aloe alum. AMBR. Am-c. anac. ant-c. Ant-t. Apis ARG N. arn. ARS. ARS-I. arum-t. Asaf. asar. Aur. Bar-c. bar-m. Bell. Blatta a. Bov. Brom. Bry. Cact. Calad. Calc. camph. Cann-s. Caps. carb-an. carbn-s. Carb-v. card m. caust. cham. chel. Chin. Chinin-ar. Chlol. Cic. cina cist. cocc. coc-c. Coff. Colch. coloc. Con. croc. Crot-h. crot-t. CUPR. daph. Dig. Dros. Dulc. eup-per. Euph. Ferr. Ferr-ar. ferr-i. ferr-p. Gels. Graph. grat. grin. Hep. Hippoz. hydr-ac. hyos. Ign. Iod. IP. KALI-AR. Kali-br. KALI-C. Kali-chl. Kali-i. KALI-N. Kali-p. Kali-s. lac-d. Lach. lact. Laur. Led. LOB. Lyc. manc. Med. meny. Meph. merc. mez. Mosch. Naja nat-act. nat-c. Nat-m. nat-p. Nat-s. Nit-ac. nux-m. Nux-v. ol-an. Op. par. petr. phel. Phos. Phyt. plat. plb. podo. Psor. PULS. ran-s. raph. rhod. rumx. Ruta sabin. SAMB. Sang. sars. sec. sel. Seneg. Sep. SIL. sin-n.    spig. SPONG. squil. Stann. Still. STRAM. stront-c. SULPH. Sul-ac. Thuj. Verat. verat-v. viol-o. viol-t. zinc.

RESPIRATION – ASTHMATIC – morning

Aur. Calc. carb-an. Carb-v. Coff. Con. dig. KALI-C. Meph. phos. Verat. zing.

RESPIRATION – ASTHMATIC – evening

bell. Cist. ferr. nux-v. Phos. PULS. stann. Sulph. Zinc.

RESPIRATION – ASTHMATIC – night

am-m. Ant-c. ARS. aur. Brom. bry. Carb-v. CHEL. Chlol. Cist. coff. coloc. daph. Dig. Ferr. ferr-ar. Ip. kali-ar. Kali-c. lach. Meph. nux-v. Op. phos. PULS. sang. Sep. Sulph. Syph. Thuj. zinc.

RESPIRATION – ASTHMATIC – midnight,after

ARS. calc-ar. Carb-v. Ferr. ferr-ar. Graph. Lach. SAMB.

RESPIRATION – ASTHMATIC – change of weather

Ars. chel. dulc.

RESPIRATION – ASTHMATIC – cold,from taking

acon. dulc. Lob. Podo. Puls. sil. SPONG. Stann.

RESPIRATION – ASTHMATIC – emotions,after

Acon. ambr. cham. Coff. cupr. Gels. Ign. nux-v. pall. verat.

RESPIRATION – ASTHMATIC – eruptions,after suppressed

Apis Ars. Carb-v. Dulc. Ferr. hep. Ip. Psor. PULS. sec. Sulph.

RESPIRATION – ASTHMATIC – hay asthma

Ambro. Ars. Ars-i. Bad. Carb-v. Dulc. Euphr. IOD. Kali-i. Lach. Naja Nat-s. Nux-v. Op. Sabad. Sil.

Sin-n. Stict.

RESPIRATION – ASTHMATIC – hysterical

MOSCH. NUX-M. Nux-v. phos. PULS. stann. stram. sulph.

RESPIRATION – ASTHMATIC – periodic

all-s. Alum. ant-t. ARS. Asaf. Carb-v. Chel. Hydr-ac. nux-v. Phos. Plb. Seneg. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – spasmodic

am-c. Ant-t. arg-n. ARS. Asaf. Bell. Cact. caust. Cocc. coff. con. Cupr. Dros. Ferr. ferr-p. Gels. Graph. Hydr-ac. Hyos. IP. Kali-br. Kali-c. Lach. laur. led. LOB. Mag-p. Meph. merc. Mez. Mosch. Nux-v. Op. ph-ac. phos. Plb. Puls. raph. samb. Sars. Sep. SPONG. Stram. sulph. Sumb. Tab. VALER. zinc.

HOMOEOPATHIC MEDICAL REPERTORY – MURPHY ²⁴

Lungs – ASTHMA, general

Carb-v. CARC. card-m. caust. cham. chel. Chin. Chinin-ar. Chlol. chlor. Cic. cina cist. coc-c. Coca cocain. cocc. Coff. Colch. coloc. Con. croc. Crot-h. crot-t. CUPR. Cupr-act. cupr-ar. daph. Dig. Dros. Dulc. eup-per. Euph. Ferr. Ferr-ar. ferr-i. ferr-p. gal-ac. Gels. glon. Graph. grat. grin. Hep. Hippoz. hydr-ac. hyos. ictod. Ign. ille. Iod. IP. KALI-AR. Kali-bi. Kali-br. KALI-C. Kali-chl. Kali-i. KALI-N. Kali-p. Kali-s. Kola lac-d. Lach. lact. Laur. Led. lem-m. LOB. Lyc. magn-gr. manc. Med. meny. Meph. merc. merc-i-r. mez. morph. Mosch. Naja Naphtin. nat-act. nat-c. Nat-m. nat-p. NAT-S. Nit-ac. nux-m. Nux-v. ol-an. Op. par. petr. phel. Phos. Phyt. plat. plb. podo. Psor. ptel. PULS. queb. ran-s. raph. rhod. rumx. Ruta sabad. sabin. SAMB. Sang. sars. scroph-n. sec. sel. Seneg. Sep. SIL. sin-n. spig. SPONG. squil. Stann. Still. STRAM. stront-c. stry. Sul-ac. SULPH. syc. syph. tab. tela ter. Thuj. tub. vario. Verat. verat-v. viol-o. viol-t. VISC. xan. zinc. zinc-m. Zing.

Lungs – ASTHMA, general – allergic, hay fever, with

ALL-C. Ambr. apis aral. ARS. Ars-i. arum-t. Bad. Carb-v. CARC. chinin-ar. chlor. Dulc. Euphr. IOD. Ip. Kali-i. Lach. linu-u. Lob. Med. Naja naphtin. Nat-s. Nux-v. ol-an. Op. phle. Sabad. sang. sep. Sil. Sin-n. Stict. sul-i. sulph. THUJ. tub.

Lungs – ASTHMA, general – allergic, hay fever, with – sneezing, with

ALL-C. Ars. Carb-v. Dulc. Euphr. lach. Naja Nat-s. Nux-v. sin-n. stict.

Lungs – ASTHMA, general – alternating, with – eruptions

Ars. Calad. caust. Crot-t. dulc. graph. Hep. Kalm. lach. mez. mut. Psor. rat. rhus-t. Sulph.

Lungs – ASTHMA, general – anxiety, with

Arg-n. ARS. Dig. Kali-ar.

Lungs – ASTHMA, general – coughing, asthmatic

Acon. Alum. Am-c. am-m. ambr. anac. ANT-T. aral. arg-n. arn. ARS. Ars-i. asaf. aspar. bar-c. bar-m. Bell. Brom. bry. calad. calc. calc-s. carb-an. Carb-v. carbn-s. caust. cham. Chin. chinin-ar. chlor. cic. CINA coc-c. cocc. con. cor-r. croc. Crot-t. CUPR. dig. dol. DROS. dulc. Euph. euphr. ferr. ferr-ar. ferr-i. ferr-p. guaj. Hep. hyos. ign. iod. IP. Kali-ar. Kali-bi. Kali-c. kali-chl. kali-n. kali-p. Kreos. Lach. lact. laur. Led. lob. lyc. merc. mez. mosch. mur-ac. nat-m. nat-s. nicc. nit-ac. Nux-m. NUX-V. op. petr. phel. Phos. prun. psor. Puls. rhus-t. sabad. Samb. Sang. Sep. Sil. spig. Spong. squil. stann. Stram. sul-ac. sulph. verat. viol-o. zinc. zing.

Lungs – ASTHMA, general – eruptions, after suppressed

Apis Ars. calad. Carb-v. Dulc. Ferr. hep. Ip. Psor. PULS. sec. Sulph.

Lungs – ASTHMA, general – wet, weather, in

Aur. carc. Chin. con. DULC. NAT-S. sil. Thuj. verat.

Lungs – ASTHMA, general – wheezing

ail. all-c. aloe Alum. am-c. Ambr. Ant-t. Apoc. aral. arg-n. ARS. Ars-i. Brom. calad. calc. calc-s. Cann-s. Caps. CARB-V. carbn-s. card-m. Cham. Chin. Chinin-ar. chlol. Cina crot-t. Cupr. dol. Dros. erio. ferr. ferr-i. Fl-ac. graph. Grin. hep. hydr-ac. Iod. iodof. IP. just. Kali-ar. Kali-bi. KALI-C. Kali-s. Lach. LOB. Lyc. Lycps-v. manc. merc. murx. naja Nat-m. Nat-s. Nit-ac. Nux-m. nux-v. ox-ac. phos. prun. sabad. Samb. sang. sanic. seneg. sep. spong. squil. stann. sulph. Syph.

Lungs – ASTHMA, general – dust, from inhaling

Blatta-o. brom. ictod. Ip. kali-c. pot-a. Sil.

COMPLETE REPERTORY²⁵

RESPIRATION – ASTHMATIC

RESPIRATION – WHEEZING

RESPIRATION – ASTHMATIC – night

am-m. ANT-T. aral. ARG-N. ARS. ars-i. ars-s-f. arum-d. aur. aur-ar. BROM. bry. CARB-V. carc. cham. CHEL. CHLOL. CIST. coff. coloc. con. daph. DIG. FERR. ferr-act. ferr-ar. grin. IP. kali-ar. KALI-C. lach. limen-b-c. MEPH. merc-pr-r. naja nux-v. OP. pect. phos. pitu-a. PULS. samb. sang. SEP. stict. stram. SULPH. SYPH. THUJ. zinc. zinc-phic.

RESPIRATION – ASTHMATIC – periodic

all-s. ALUM. ant-t. ARS. ASAF. CARB-V. CHEL. CHIN. chinin-ar. cist. HYDR-AC. ign. ip. nux-v. parth. PHOS. PLB. SENEG. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – eruptions – suppressed, after

acon. AMMC. APIS ARS. calc. CARB-V. cupr. DULC. elmen FERR. hep. IP. med. mez. PSOR. ptel. PULS. sec. SULPH. verat.

RESPIRATION – ASTHMATIC – sitting – up amel.

ant-t. aral. ars. ARS-I. bar-m. BROM. crot-t. FERR. ferr-act. HEP. ip. kali-bi. kali-c. KALI-N. lach. lact-v. meph. parth.

RESPIRATION – ASTHMATIC – sleep – during, coming on

ACON. am-c. ARS. CARB-V. GRIN. HEP. KALI-C. lac-c. LACH. meph. merc-pr-r. nat-s. op. samb. sep. SULPH.

RESPIRATION – ASTHMATIC – hay asthma

ail. all-c. ambro. ARAL. ARS. ARS-I. arum-t. BAD. bomb-pr. camph. CARB-V. carc. caust. chinin-ar. chlor. cycl. DULC. eucal. euph. euph-pi. EUPHR. gal-ac. GELS. GLYCYR-G. grin. hydr-ac. IOD. IP. kali-bi. kali-fcy. KALI-I. KALI-P. kali-s-chr. LACH. LOB. lob-p. med. moni. mosch. NAJA napht. naphtin. nat-m. NAT-S. nuph. NUX-V. ol-an. OP. phle. plb. psor. PULS. SABAD. sang. sep. SIL. SIN-N. STICT. sul-i. ter. tub.

RESPIRATION – ASTHMATIC – recurrent

am-c. ANT-C. ARS. CALC. carb-v. caust. cupr. ferr. graph. KALI-C. lach. lyc. MED. NAT-S. NIT-AC. NUX-V. phos. sep. sil. stann. SULPH. zinc.

SYNTHESIS REPERTORY²⁶

RESPIRATION – ASTHMATIC

RESPIRATION – ASTHMATIC – morniAur. Calc. carb-an. Carb-v. carc. Cassia-s. Coff. Con. dig. KALI-C. Meph. nux-v. phos. Verat. zing.

RESPIRATION – ASTHMATIC – evening

bell. bit-ar. Cist. ferr. Kali-s. nat-m. nat-p. nux-v. petr. Phos. PULS. stann. Sulph. Zinc.

RESPIRATION – ASTHMATIC – night

am-m. Ant-t. Arg-n. ARS. ars-s-f. arum-d. aur. aur-ar. bit-ar. Brom. bry. calc-ar. Carb-v. carc. cham. CHEL. Chlol. Cist. coff. coloc. daph. des-ac. Dig. Ferr. ferr-ar. Ip. kali-ar. Kali-c. Kali-s. lach. limen-b-c. meph. naja nux-v. Op. phos. PULS. Samb. sang. Sep. spong. Sulph. Syph. Thuj. Tub. zinc. zinc-p.

RESPIRATION – ASTHMATIC – bronchial

ant-t. arist-cl. ARS. bar-c. bell. Bry. Calc. Camph. CHIN. con. cortiso. Cupr. cupr-ar. DULC. Ferr. Graph. hed. hep. hippoz. Influ. ip. Lach. merc. nux-v. Phos. PULS. SENEG. SEP. sil. STANN. Sulph. zinc.

RESPIRATION – ASTHMATIC – eruptions, after suppressed

ant-c. Apis Ars. calc. Carb-v. cupr. Dulc. Ferr. graph. hep. Ip. mez. Psor. PULS. rhus-t. sec. Sulph.

RESPIRATION – ASTHMATIC – flatulence, from

Carb-v. Cham. Chel. Chin. Lyc. mag-p. Nux-v. op. phos. Sulph. zinc.

RESPIRATION – ASTHMATIC – hay; from

Ambr. Ars. Ars-i. arum-t. Bad. Carb-v. Dulc. Euphr. IOD. Kali-i. kali-s-chr. Lach. lob. Naja Naphtin. Nat-s. Nux-v. Op. phle. Sabad. sang. Sil. Sin-n. Stict. sul-i.

RESPIRATION – ASTHMATIC – hysterical

acon. ambr. asaf. aur. bell. caul. caust. cham. cocc. coff. con. cupr. ign. ip. Lach. MOSCH. NUX-M. nux-v. phos. PULS. stann. stram. sulph.

RESPIRATION – ASTHMATIC – periodical

all-s. Alum. ant-t. ARS. Asaf. Carb-v. Chel. chin. chinin-ar. Hydr-ac. ip. nux-v. Phos. Plb. Seneg. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – sitting upright amel.

Ars. kali-c.

RESPIRATION – ASTHMATIC – smoking – after

asc-t. NAT-AR.

RESPIRATION – ASTHMATIC – sudden attacks

Acon. Ant-t. Ars. bell. bry. CAMPH. Cham. chin. cupr. ip. Lach. MOSCH. nux-m. nux-v. OP. pitu-a. puls. Samb.

RESPIRATION – ASTHMATIC – weather – change of

Ars. Cassia-s. chel. dulc. hyper. pitu-a.

RESPIRATION – ASTHMATIC – weather – cold

Hep.

RESPIRATION – ASTHMATIC – weather – cold – wet

ant-t. aur. DULC. Med. Nat-s. thuj. verat.

BOENNINGHAUSEN’S CHARACTERISTICS AND REPERTORY BY BOGER²⁷

RESPIRATION – Asthma

ACON. Am-c. Ambr. ant-c. Ant-t. ARS. Aur. BELL. BRY. Calc. CAMPH. CARB-V. caust. Cham. CHIN. Cocc. coff. CUPR. Dulc. FERR. HYOS. ign. IP. KALI-C. LACH. lyc. merc. Mosch. Nit-ac. nux-m. NUX-V. Op. PHOS. PULS. SAMB. sep. Sil. stann. STRAM. SULPH. Verat. ZINC.

RESPIRATION – Asthma – attack, during

ACON. ANT-T. ARS. bell. bry. CAMPH. CHAM. chin. IP. LACH. MOSCH. nux-m. Nux-v. OP. Puls. SAMB.

RESPIRATION – Asthma – bronchial

Ant-t. ARS. bar-c. bell. BRY. CALC. CAMPH. CHIN. con. CUPR. DULC. FERR. GRAPH. Hep. Ip. LACH. merc. nux-v. PHOS. PULS. SENEG. SEP. Sil. STANN. SULPH. zinc.

RESPIRATION – Asthma – recurrence against

Am-c. ANT-C. ARS. CALC. carb-v. Caust. Cupr. ferr. graph. KALI-C. Lach. lyc. NIT-AC. NUX-V. Phos. sep. Sil. Stann. SULPH. zinc.

RESPIRATION – Asthma – spasmodic

ant-c. ANT-T. arg-n. Ars. BELL. bry. camph. Caust. COCC. CUPR. ferr. HYOS. KALI-C. LACH. lyc. MOSCH. NUX-V. op. SAMB. Sep. Stann. STRAM. SULPH. ZINC.

RESPIRATION – Asthma – thymic

ACON. Am-c. ambr. ANT-T. asaf. aur. BELL. CON. cupr. ferr. HEP. ign. IP. Lach. MERC. Phos. SENEG. SPONG. VERAT. Zinc.

RESPIRATION – Expiration – difficult

Chlor. IP. meph. Viol-o.

BOERICKES REPERTORY²⁸

RESPIRATORY SYSTEM – Respiration – Wheezing

alum. am-c. ant-i. Ant-t. aral. Ars. cann-s. carb-v. card-m. erio. Grin. Hep. iod. iodof. Ip. just. kali-bi. Kali-c. lob. lycps-v. nux-v. prun. Samb. seneg. Spong.

THERAPEUTICS

NATRUM SULPHURICUM
Constant desire to take deep long breath. Constitutional remedy in asthma. Every fresh cold brings on attack of asthma.²⁸Dyspnoea desire to take a long breath during damp cloudy weather. Humid asthma in children; with every change to wet weather; worse in damp rainy weather; sputa green and copious. Lower lobe of left lung is affected. Great soreness of chest, during cough, has to sit up in bed and the chest with both hands.²⁹ Dyspnoea; desire to take a deep breath during damp, cloudy weather. Humid asthma in children; with every change to wet weather; with every fresh cold; always worse in damp, rainy weather; sputa green, greenish, copious.³⁰

ARSENICUM ALBUM                                                                                             Expectoration scanty, frothy. Darting pain through upper third of right lung. Wheezing respiration. Haemoptysis. Pain between shoulders; burning heat all over. Cough dry, as from sulphur fumes; after drinking.²⁸ Unable to lie down; fears suffocation. Air-passages constricted, burning as if coals of fire were in chest, suffocative catarrh.²⁹ Breathing: asthmatic causes patient to sit or bend forward, Asthma with constriction of chest and anguish.³¹

BRYONIA
Cough dry at night; must sit up; worse after eating or drinking with vomiting and stitches in chest. Rusty coloured sputa. Frequent desire to take a long breath to expand the lungs. Coming into warm room excites cough.²⁸ Irritable, angry and vehement people. Complaints < by motion, inspiration, coughing; > absolute rest and lying on painful side. Cough dry hard racking with scanty expectoration. Complaints when warm weather sets in after cold days; from cold drinks; after taking cold or getting hot in summer; from chilling when overheated; suppressed discharges.²⁹

KALI CARBONICUM
Dry hard cough with stitches in chest. Pain in chest, worse lying on right side. Whole chest is over sensitive. Scanty tenacious expectoration. Coldness of chest. Better in warm climate.²⁸ Asthma relieved by sitting up or bending forward or by rocking; worse from 2-4am.²⁹

IPECAC
Asthma, yearly attacks of difficult shortness of breathing. Cough incessant and violent, with every breath. Suffocative cough which causes the child becomes stiff and blue in the face. Dyspnoea with constant constriction in chest. Continued sneezing, coryza; wheezing cough.²⁸ Cough dry, spasmodic, asthmatic, constricted. Difficulty in breathing from least exercise with violent dyspnoea, wheezing and anxiety about the stomach. < winter and dry weather; slightest motion. ²⁹

ANTIMONIUM TARTARICUM                                                                                        Every time the patient coughs there appears to be a large collection of mucus in the bronchial tubes and that, volumes would be expectorated but nothing or little comes up.²⁹Great rattling of mucous, but very little is expectorated. Coughing and gaping consecutively. Dyspnoea relieved by eructation. Cough and dyspnoea better lying on right side.²⁸

PHOSPHORUS
Cough due to tickling in throat, which is worse from cold air, reading, laughing, talking and going from warm room in to cold air. Sweetish taste while coughing. Hard dry tight racking cough. Congestion of lungs. Burning pains, heat and oppression of chest. Tightness across chest; great weight on chest. Respiration quickened oppressed. Much heat in chest, worse lying on left side. Sputa rusty blood coloured or purulent.³²

PULSATILLA
Dry cough in the evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucus expectoration. Pressure upon chest and soreness. Urine emitted with cough. Expectoration bland, thick, bitter, greenish. Shortness of breath, anxiety and palpitation when lying on left side. Smothering sensation when lying down.²⁸

LYCOPODIUM
Cough worse when going downhill. Gray thick bloody purulent salty expectoration. Night cough as from sulphur fumes. Better by warm food and drinks, on getting cold, from being uncovered.²⁸ Deep seated progressive chronic diseases. Affects right side. Ailments from fright, anger, mortification, vexation with reserved displeasure. Cough deep and hollow even raising mucus in large quantities which affords little relief.²⁹

HEPAR SULPH                                                                                                                                                          Loses voice and coughs when exposed to dry, cold wind. Cough troublesome when walking. Dry, hoarse cough. Cough excited whenever any part of the body gets cold or uncovered, or from eating anything cold. Croup with loose, rattling cough; worse in morning. Rattling, croaking cough; suffocative attacks; has to rise up and bend head backwards. Anxious, wheezing, moist breathing, asthma worse in dry cold air; better in damp.²⁸

SPONGIA                                                                                                                                                                      Great dryness of all air-passages. Cough, dry, barking, croupy, no mucus rales Croup; worse, during inspiration and before midnight. Every mental excitement< or increase cough. Respiration short, panting, difficult; feeling of a plug-in larynx. Cough abates after eating or drinking, especially warm drinks. Worse after sleep or sleep into< Bronchial catarrh, with wheezing, asthmatic cough, worse cold air, with profuse expectoration and suffocation; worse, lying with head low and in hot room.²⁸

KALI NITRICUM                                                                                                                                                        Dry, morning cough, with pain in chest and bloody expectoration. Asthma, with excessive dyspnoea, nausea, dull stitches, and burning in chest. Dyspnoea so great that breath cannot be held long enough to drink, though thirsty. Oppression worse in morning. Sour-smelling expectoration.²⁸

SULPHUR
Suffocative attacks, wants the doors and windows open; becomes suddenly wide awake at night and drowsy in afternoon after sunset followed by wakefulness the whole night. Complaints that are continually relapsing; patient seems to get almost well when the disease returns again and again.  Oppression as of a load on chest with burning sensation in chest, heat throughout chest. Loose cough with much rattling of mucus < talking, morning. Greenish purulent or sweetish expectoration. Chest feels heavy; stitches, with heart feeling too large and palpitating. Stitching pains shooting through to the back, <lying on back or breathing deeply.  Dyspnoea appears in middle of night, relieved by sitting up.²⁸

SILICEA
Sputum persistently muco-purulent and profuse. Slow recovery after pneumonia. Cough and sore throat, with expectoration of little granules like shot, smells offensive. Cough with expectoration in day, bloody or purulent. Stitches in chest through back. Violent cough especially when lying down, with thick yellow lumpy expectoration; suppurative stage. Inveterate cases of catarrh with asthmatic wheezing. Humid asthma with coarse rattling. Chest seems to be filled with mucus which seems as if he would suffocate. Especially asthma of old sycotic or in children of sycotic parents. Dry teasing cough with hoarseness. Fine dust causes chronic irritation. Chronic tendency for colds to settle in the chest and bring on asthmatic symptoms.³²

LYCOPODIUM
Cough worse when going downhill. Gray thick bloody purulent salty expectoration. Night cough as from sulphur fumes. Better by warm food and drinks, on getting cold, from being uncovered.²⁸Deep seated progressive chronic diseases. Affects right side. Ailments from fright, anger, mortification, vexation with reserved displeasure. Cough deep and hollow even raising mucus in large quantities which affords little relief.²⁹

LACHESIS                                                                                                                                                               Sensation of suffocation and strangulation on lying down, particularly when anything is around throat; compels patient to spring from bed and rush for open window. Little secretion and much sensitiveness; worse, pressure on larynx, after sleep, open air. Breathing almost stops on falling asleep. [Grind.]³²

STANNUM METALLICUM                                                                                                                                 Hoarse; mucus expelled by forcible cough. Violent, dry cough in evening until midnight. Cough excited by laughing, singing, talking; worse lying on right side, drink anything warm >coughing and expectorating. During day, with copious green, sweetish, expectoration. Chest feels weak; can hardly talk. Respiration short, oppressive; stitches in left side when breathing and lying on same side.²⁸

NUX VOMICA                                                                                                                      Asthma with fullness of stomach, morning or after eating. Cough associated with sensation of something were torn loose in chest. Shallow respiration. Oppressed breathing. Tight dry hacking cough which brings on bursting headache and bruised pain in epigastrium.²⁸

SAMBUCUS                                                                                                                                                                 Chest oppressed with pressure in stomach, and nausea Hoarseness with tenacious mucus in larynx. Paroxysmal, suffocative cough, coming on about midnight, with crying and dyspnoea. Loose choking cough. Child awakes suddenly, nearly suffocating, sits up, turns blue. Cannot expire. [Meph.] Millar’s asthma.²⁸

FERRUM METALLICUM                                                                                                                                     Asthma associated with orgasm of blood to the chest, aggravation after 12 P.M, when the patient must sit up and uncover his chest, which he does to get cool and sits up in order to breathe and moves slowly about for relief. It acts best in young persons, male or female, who are subjects to irregular distribution of blood.²⁸

CUPR METALLICUM                                                                                                                                                 Cough as a gurgling sound, better by drinking cold water Suffocative attacks, worse 3 a.m. [Am. c ]. Spasm and constriction of chest; spasmodic asthma, alternating with spasmodic vomiting. Dyspnoea with epigastric uneasiness. Spasmodic dyspnoea before menstruation. Angina with asthmatic symptoms and cramps (Clarke).²⁸

PSORINUM                                                                                                                                                            Asthma, with dyspnoea; worse, sitting up, open air; better, lying down and keeping arms spread wide apart. Cough c/c of years duration<morning on waking and evening on lying down. Sputa green, yellow or salty mucous. cough a long time before expectorating. Dry, hard cough, with great weakness in chest. Pain in chest; better, lying down. Cough returns every winter, from suppressed eruption. Hay-fever returning irregularly every year.²⁸

CALCAREA CARBONICUM
Hahnemann’s great anti- psoric. Tickling cough troublesome at night and free expectoration in morning. Persistent irritating cough from arsenical wall paper. Extreme dyspnoea. Painless hoarseness, worse in the morning. Expectoration only during day; thick, yellow, sour mucus. Bloody expectoration; with sour sensation in chest, worse going upstairs, slightest ascent, must sit down. Longing for fresh air. Scanty salty expectoration.²⁸

BLATTA ORIENTALIS                                                                                                                                             A remedy for asthma. Especially when associated with bronchitis. Indicated after arsenic when this is insufficient. Cough with dyspnoea in bronchitis and phthisis. Acts best in stout and corpulent patients. Much pus-like mucus. Lowest potencies during an attack. After the spasm, for the remaining cough, use the higher. Stop with improvement to prevent return of aggravation.²⁸

GRINDELIA                                                                                                                                                                 An efficacious remedy for wheezing and oppression in bronchitic patients. The sibilant rales are disseminated with foamy mucus, very difficult to detach. Asthma, with profuse tenacious expectoration, which relieves. Stops breathing when falling asleep; wakes with a star, and gasps for breath. Must sit up to breathe. Cannot breathe lying down.²⁸

ARALIA RACEMOSA                                                                                                                                            Asthma with cough<lying down. Dry cough coming on after first sleep, around middle of night. Sensation of foreign body in throat. Extremely sensitive to draught. Least current of air causes sneezing, copious excoriating watery discharge from nostrils with salty acrid taste. Asthma on lying down at night with spasmodic cough. Constriction of chest. Obstruction worse in spring.²⁸

LOBELIA                                                                                                                                                                      Dyspnoea from constriction of chest; worse, any exertion. Sensation of pressure or weight in chest; better by rapid walking. Asthma; attacks, with weakness, felt in pit of stomach and preceded by prickling all over. Cramp, ringing cough, short breath, catching at throat. Senile emphysema.²⁸

BROMIUM                                                                                                                                                                Sailors suffer from asthma “on shore”. Dyspnoea can’t inspire deep enough as if breathing through a sponge or air passage full of smoke or vapour of sulphur; rattling sawing danger of suffocation from mucus in larynx. Cold sensation in larynx on inspiration>after shaving.²⁸

CARB VEG                                                                                                                                                               Asthma in aged with blue skin. Cough, with burning in chest; worse in evening, in open air, after eating and talking. Spasmodic cough, bluish face, offensive expectoration, neglected pneumonia. Breath cold; must be fanned.²⁸

JUSTICIA ADHATODA                                                                                                                                           Highly efficacious medicine for acute catarrhal conditions of the respiratory tract. Dry cough from sternal region all over chest. Hoarseness, larynx painful. Paroxysmal cough, with suffocative obstruction of respiration. Cough with sneezing. Severe dyspnoea with cough. Tightness across chest. Asthmatic attacks, cannot endure a close, warm room. Severe aggravation has been noticed from lower potencies.²⁸

LESSER-KNOWN REMEDIES FOR BRONCHIAL ASTHMA ^{(28, 32,33,34,35,36)}

ASCLAPIEUS TUBEROSA                                                                                                                        Respiration painful, esp. at base of l. lung. Breath smells like pepper. Humid asthma; <after eating: < after smoking a little. Oppression and difficulty of breathing.

ANTIFEBRINUM
Severe dyspnoea, the patient seized and clenched the hands of those around him. He felt as if the diaphragm had ceased working and he must go on breathing on his own account at any cost.

ARMORACEA SATIVA
Increases activity of respiratory organs. Mucous asthma, and consumption. Oedema of lungs. Chest painful to touch.

CHLORUM
Sudden Dyspnoea from spasms of the vocal cords, with protruding eyes, blue face, cold sweat. Inspiration free but Can Not Exhale. Asthma of hay fever. As if air were forced into upper chest.

DERRIS PINNATA
Feeling of suffocation with fetid breath; must sit up in bed at night. Cramp-like pains, and lancinations behind sternum. 

ELECTRICITAS
Asthma, sometimes lasting for life, with palpitation of the heart, and disposition to syncope; oppression of the chest. 

ERIODICTYON GLUTINOSUM
Wheezing voice, 5 p.m. Asthmatic symptoms; with coryza and mucous secretions. Dull pain in r. lung, front.  near nipple, occurring at short intervals or on sudden changes of position.

GUAREA
Breathing, sobbing; difficult during chill. Sensation of hollowness and dilatation of chest. Respiratory symptoms <from putting hand to throat.

GADUS MORRHUA
Fits of wheezing cough with pain deep in chest. Breath short, laborious; as if air passages were closed. Rush of blood to chest, without palpitation. Lumps seem adherent to parietes. Sharp pains, burning shootings, 2 p.m. Sharp pains running through chest; not <by walking, though renewed on first movement.

GALVANISMUS
Cough, dry; humid; with patients who have tubercles the nodosites speedily soften and break, and the fatiguing cough disappears. Difficult respiration; asthma, respiration deep, slow, rattling. Respiration impeded by each shock

HIPPOZAENINUM
Noisy breathing; loud snoring respiration before fatal termination; breath fetid. Cough and obstructed respiration, resulting from cicatricial contraction of mucous membrane of nose and larynx. Patients cough severely and expectorate profusely, sputa usually bearing a strong resemblance to the discharge from the nostrils, size of millet seed to a pea, of a grey, yellowish, or reddish colour.

LACTUCA
Spasmodic asthma. Sudden anxiety, with dyspnœa and sweat, followed by stool and relief of that and other complaints. Inclined to take a deep breath: with hollowness of chest; with constriction in fauces and chest. Asthma, < or caused by dust.

LAUROCERASUS
Dyspnoea worse sitting up. Tickling dry cough. Constriction of chest. Cough with copious, jelly – like, or bloody expectoration. Small and feeble pulse. Threatening paralysis of lungs. Gasping for breath.

LINUM USITATISSIMUM
Picture of an aggravated case of bronchial asthma; it was with the most extreme effort that I could breathe. Livid, and struggles for breath; her friends thought she was dying.

MANCINELLA
Whistling breathing. Asthma, chronic. Frequent hawking with nausea. Violent cough and painful stitches in trachea from slightest exertion. Cough: < night; after drinking. Expectoration > oppression of chest

NAPHTHALINUM
Spasmodic asthma; better in open air. Soreness in chest and stomach; must loosen clothing. Dyspnœa and sighing inspiration. Emphysema in the aged with asthma. Whooping-cough, long and continued paroxysms of coughing, unable to get a respiration. Acute laryngo-tracheitis.

PECTEN
Quick, laboured breathing; cannot lie flat or on left side; constriction of chest, especially right side. Attacks preceded for two or three days by sneezing and excessive coryza; burning sensation in throat and chest; fulness of head; pulse very quick and wiry; subsequently copious expectoration of tough, stringy, and frothy mucus. Cough < after 6 p.m. Symptoms < at night.

PENTHORUM SEDOIDES
Wet feeling in trachea and bronchi; passing from above down, as if a coryza would set in, followed by a slight feeling of constriction, which passed from above down through chest. In morning cough from deep in chest, throughout chest.

PULMO VULPIS
Accelerated short breath amounting to suffocation, even without corresponding heaving of the chest, frequently with cough and inability to expectorate. [Sometimes, in light cases, there is no catarrh present, and only persistent shortness of breath, becoming a paroxysm of asthma on the least bodily exertion.] The patient could only live sitting up, bent forward; constant lividity of face, lips, and extremities, and dropsy of legs.

SILPHIUM LACINATUM
Cough with expectoration profuse, stringy, frothy, light- coloured. Excited by sense of mucus rattling in chest and worse by drafts of air. Constriction of lungs. Catarrh, with copious, stringy, mucous discharges. Desire to hawk and scrape throat. Irritation of posterior nares, involving mucous membranes of nasal passages with constriction of supra-orbital region.

SINAPIS NIGRA
Hoarseness, evening from 4 p.m. Cough, short, hacking, all evening: 7 to 8 p. m.; seldom during day. Cough mostly dry or with expectoration of lump of mucous < in cold air; > lying down and by eating; excited by laughing. Expectoration from posterior nares much mucous, which felt cold; white in tenacious masses. Pituitous asthma.
TEREBINTHINA
Breath short, hurried, and anxious. Choking sensation (worms). Emphysema. Cough as if a foreign body had entered larynx, spasmodic inspiration ─ Dry, hacking cough ─Voice gone ─Expectoration streaked with blood ─ Respiration impeded by congestion of lungs.

VERBASCUM THAPSUS
Hoarse; voice deep, harsh; sounds like a trumpet; “basso profundo”. Cough; worse at night. Asthma. Soreness in pharynx, cough during sleep.

XANTHOXYLUM
Shortness of breath; no appetite; bowels constipated; urine light-coloured, alkaline, sp. gr. 1025; fluttering in stomach, pain in l. side; limbs weak and bloated. Had to sit up in bed and turn first one way, then another, as in a severe fit of asthma, with several spasmodic coughing spells. Thought she could not get air enough into lungs, inspiration was so difficult.

REFERENCES

1. Krishnadas KV. Text book of Medicine. 5TH ed. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2008.
2.  Longo, Fauci, Kasper, Hauser, Jameson, Lascalzo. Harrison’s Principles of Internal Medicine. 18th. USA: McGraw Hill company.
3. Peat JK, van den Berg RH, Green WF, Mellis CM, Leeder SR, Woolcock AJ. Changing prevalence of asthma in Australian children. BMJ. 1994 Jun 18;308(6944):1591–6.
4. Network GA. The Global Asthma Report 2018. Available from: http://www.globalasthmareport.org/Global%20Asthma%20Report%202018.pdf
5. Gowda G, Nagaraj C, Parasuramalu B. G, Huliraj N. Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore. International Journal of Health & Allied Sciences. 2013 Oct 1; 2(4):237-4. Available from: http://www.ijhas.in/temp/IntJHealthAlliedSci24237-57326_155525.pdf
6.  Subbarao P, Mandhane PJ, Sears MR. Asthma: epidemiology, aetiology and risk factors. CMAJ.2009 Oct 27;181(9): E181–90.
7. McDonald VM, Hiles SA, Jones KA, Clark VL, Yorke J. Health‐related quality of life burden in severe asthma. Medical Journal of Australia. 2018 Jul;209(S2): S28-33. Available from: https://www.mja.com.au/system/files/issues/209_02/10.5694mja18.00207.pdf
8. Asthma NAE and PP (National H Lung, and Blood Institute) Second Expert Panel on the Management of. Expert Panel report 2: guidelines for the diagnosis and management of asthma. DIANE Publishing; 1997. 153 p.
9. Mapp CE. Agents, Old and New, Causing Occupational Asthma. Occupational and Environmental Medicine. 2001 May 1;58(5):354–354.
10. Singh V. Bronchial Asthma. In: Munjal YP (ed). API Textbook of medicine, 10/e, Vol 2 2015. Jaypee Brothers Medical Publishers (P) Ltd. New Delhi 110002 India; P 2347
11. GmbH DMS. Bronchial asthma [Internet]. DocCheck Flexikon. Available from: https://flexikon.doccheck.com/en/Bronchial-asthma.
12. Singh N, Singh V. Clinical Presentations and Investigations in Asthma. Journal of the association of physicians of India. 2014; 62:5.
13. Pulmonary Function Testing: Spirometry, Lung Volume Determination, Diffusing Capacity of Lung for Carbon Monoxide. 2019 Feb 3. Available from: https://emedicine.medscape.com/article/303239-overview.
14. Ranu H, Wilde M, Madden B. Pulmonary Function Tests. Ulster Med J. 2011 May;80(2):84–90.
15. Asthma – Diagnosis and treatment – Mayo Clinic [Internet]. [cited 2019 Apr 18]. Available from: https://www.mayoclinic.org/ diseases-conditions/asthma/ diagnosis – treatment/drc-20369660.
16.  Ahmedani BK, Peterson EL, Wells KE, Williams LK. Examining the relationship between depression and asthma exacerbations in a prospective follow-up study. Psychosom Med. 2013 Apr;75(3):305–10.
17. Swimming pool attendance, asthma, allergies, and lung function in the Avon Longitudinal Study of Parents and Children cohort. [Internet]. Available from: https://reference.medscape.com/medline/abstract/20889905.
18. Sharma Bindu, Narula Rithika Hassija, Manchanda K Raj. Homeopathy for the management of asthma- A Review of council’s clinical research. ijrh 2015[cited 2021 11 May] Vol(9) issue(2); P.69-78.  Available from: http://www.ijrh. org/article.asp?issn=09747168;year=2015;volume=9;issue=2;spage=69;epage=78;aulast=Sharma
19. Qutubuddin M, Murty Singh S, Nayak C, Koley M, Saha S. Efficacy of individualized homeopathy in bronchial asthma in adults: Double-blind, randomized, placebo-controlled, clinical trial in the context of usual care. Advances in Integrative Medicine [Internet]. 2018 [cited 2021 May 5]; Available from: https://www.sciencedirect.com/science/article/abs/pii/S2212958817301015
20. Sitharthan R. Efficacy of homoeopathic treatment in modulation of immunoglobulin E (IgE) levels in bronchial asthma. [Salem, Tamilnadu]: Vinayaka Missions University; 2015.
21.  Eizayaga FX, Eizayaga J, Eizayaga FX. Homoeopathic treatment of bronchial asthma: Retrospective study of 62 cases. J. 1996 Jan;85(1):28–33.[cited on 2021 May 11] Available from: https://doi.org/10.1016/S0007-0785(96)80022-6
22.  Aphale DP. To Study the Efficacy of Arsenic album, Pulsatilla & Spongia in Management of Bronchial Asthma. [Internet]. [cited 2021 May 5]. Available from: https://www.homeopathy360.com/2018/02/08/to-study-the-efficacy-of-arsenic-album-pulsatilla-spongia-in-management-of-bronchial-asthma/
23. Kent JT. Repertory of the Homoeopathic Materia Medica and a word index. 5th edition. New Delhi: B Jain publishers; 2012.
24. Murphy R. Homoeopathic Medical Repertory. 3rd revised. New Delhi: B Jain publishers; 2014.
25. Zandvoort RV. The Complete Repertory.
26. Shroyens F. Repertorium Homoeopathicum Syntheticum. 9.1 edition. New Delhi: B Jain publishers; 2011.
27. Boger CM. Boenninghausen’s characteristics Materia Medica and repertory with word index. New Delhi: B Jain publishers; 2007.
28. Boericke’s new manual of Homoeopathic Materia medica with Repertory. 3rd revised and augmented edition. New Delhi: B Jain publishers; 2016.
29.  Lippe AV. Keynotes and red line symptoms of the Materia Medica. Reprint. New Delhi: B Jain publishers; 1998.
30. Allen’s keynotes rearranged and classified with leading remedies of the Materia medica and bowel nosodes. 10th edition. New Delhi: B Jain publishers
31. Kent JT. Lectures on Materia Medica. Reprint. New Delhi: B Jain publishers.
32. Lesser O. Textbook of Homoeopathic Materia Medica. B. Jain Publishers; 2015.     992 p.
33. Clarke JH a dictionary of practical Materia Medica.
34. Murphy R Lotus Materia Medica.
35. Phatak SR. Materia Medica of Homoeopathic Medicines. B. Jain Publishers; 2002. 792p.
36. Farrington MEA. Lectures on Clinical Materia Medica in Family Order. B Jain Publishers Pvt Limited; 2010. 1040 p. 

Dr Rajisha Ramachandran
PG Scholar,Department of Practice of medicine
U/G/O Dr Praveen Kumar P. D (HOD of Dept of Medicine)
Government Homoeopathic Medical College and Hospital,
Dr. Siddhaiah Puranik Road, Basaveshwar Nagar, Bengaluru,560079