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Epinephrine Was First An Asthma Treatment
This is the first in an occasional series on the origin of commonly used medicines.
When epinephrine was first discovered at the turn of the 20th century, it was essentially a drug without a disease.
In 1894, two British researchers -- physician George Oliver and physiologist Edward Albert Sharpey-Schafer -- discovered that the extract of the adrenal glands increased heart rate and blood pressure in animals, according to a feature in The Lancet Respiratory Medicine.
Over the next 5 years, researchers around the world tried to isolate the active component of adrenal extract, according to Hugh Sampson, MD, director emeritus of the Jaffe Food Allergy Institute at Mount Sinai Hospital in New York City.
Eventually, Japanese biochemist Jokichi Takamine isolated the "pure, stable, crystalline" form of the compound, according to The Lancet paper. He named the compound "adrenalin," for its origin in the adrenal glands, which are located just above the kidneys. His employer, now known as Parke-Davis (a subsidiary of Pfizer), quickly patented the hormone.
"Because Parke-Davis patented the name [adrenalin], people were a bit nervous about using that particular name, and that's why I guess in the U.S. It became known as epinephrine," Sampson told MedPage Today. "My U.K. Colleagues are adamant that it should be called adrenaline, not epinephrine."
Once it was identified, researchers then got to work on finding a condition for epinephrine to treat. Around 1900, American physician Solomon Solis-Cohen started testing crude epinephrine extract on patients with asthma and hay fever, according to The Lancet.
Researchers saw good results treating asthma with epinephrine, even if they didn't understand exactly how it worked. In one case report from 1920, a 30-year-old woman with nightly asthma attacks saw their frequency reduced with epinephrine injections.
Over time, experts disentangled the exact mechanisms by which epinephrine worked in asthma, and eventually, treatments became more specific, Sampson said.
"When I was a resident, we still used subcutaneous epinephrine in the treatment of status asthmaticus, whereas now, we have all these nebulized forms of the drug, which are more specific," said Sampson, who was a resident in the 1980s.
Essentially, epinephrine targets a mix of alpha- and beta-adrenergic receptors, which are widely distributed throughout the body, said Corinne Keet, MD, PhD, a pediatric allergist and immunologist at the University of North Carolina School of Medicine at Chapel Hill. Beta adrenergic receptors -- specifically, beta-2 receptors -- are involved in bronchodilation, she said, while alpha adrenergic receptors are involved in vasoconstriction.
"It's helpful when we're treating anaphylaxis to have the full range of the activity on the receptors that epinephrine acts on, but it's not as helpful when we're treating something like asthma," Keet said.
Focusing in on the bronchodilating effects of epinephrine led to the development of an important class of drugs for asthma -- the beta-2 adrenergic receptor agonists such as albuterol. These drugs, which can be either short- or long-acting, essentially relax the muscles of the airways to help patients breathe easier.
For treating anaphylaxis, clinicians want both the bronchodilating effects exerted on the beta adrenergic receptors, but also the vasoconstricting effects of alpha adrenergic receptors, Keet said.
That's because in an allergic reaction, mast cells are activated, releasing histamine and a variety of other mediators that lead to a drop in blood pressure, bronchoconstriction, and swelling.
"Vasodilation leads to lower blood pressure, and to permeability of the blood vessels, which leads to swelling of the tissues, the airway, and the skin," Keet said. "It also causes bronchoconstriction of the airways that leads to wheezing and coughing ... And increased mucous production."
But epinephrine, she said, "counteracts all of those things," opening up the airways, increasing blood pressure, increasing cardiac output, and stabilizing mast cells.
While epinephrine was used intramuscularly throughout the 20th century for treating anaphylaxis, the highly recognizable "EpiPen" brand, today made by Mylan Pharmaceuticals, wasn't approved by the FDA until 1987. (Generic formulations of EpiPen weren't approved until 2018.)
Other automated devices for delivering epinephrine, including the Auvi-Q, are now available as well -- offering relief to those with food allergies and their families, particularly as such conditions have been on the rise with the turn of the 21st century, Sampson said.
"It gives people some confidence that should they experience one of these reactions," Sampson said, "they would have an emergency plan, and they would have medication to reverse it."
Kristina Fiore leads MedPage's enterprise & investigative reporting team. She's been a medical journalist for more than a decade and her work has been recognized by Barlett & Steele, AHCJ, SABEW, and others. Send story tips to k.Fiore@medpagetoday.Com. Follow
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What To Do At Home For An Asthma Attack
Remaining calm and taking prescribed quick-relief medications can help a person manage or stop an asthma attack. People should seek medical assistance if rest and inhalers do not resolve symptoms.
An asthma attack happens when a person's airways narrow and swell. This makes breathing more difficult and worsens symptoms such as coughing and wheezing. In a 2020 survey by the Centers for Disease Control and Prevention (CDC), about 41% of individuals with asthma reported that they had experienced an attack within the past 12 months.
Research has not shown that home remedies can stop an asthma attack, but breathing exercises, eucalyptus oil, or ginger may offer some benefits.
Avoiding exposure to known triggers and maintaining a moderate weight may help prevent asthma attacks. Eating a nutritious diet, such as the Mediterranean diet, also may reduce the risk.
This article discusses steps to take immediately for an asthma attack, as well as possible home remedies. It also examines the symptoms, causes, stages, prevention, and outlook.
A person should always keep an up-to-date action plan available. This tells people how to recognize an attack and what to do when it happens. The instructions should specify the following details:
Since people never know when they may encounter something that triggers an asthma attack, they should keep their doctor-prescribed medications with them at all times.
The following actions can help someone manage an asthma attack:
Home remedies or alternative treatments are not proven methods to stop an asthma attack. More research is necessary to determine whether these methods are safe for asthma treatment. However, breathing exercises, eucalyptus oil, or ginger may offer some relief.
Breathing exercisesBreathing exercises may increase lung strength and capacity and help improve symptoms.
Researchers in a 2020 review looked at 22 clinical trials involving 2,880 participants to assess the value of breathing exercises for asthma. They found that breathing exercises may have a positive effect on hyperventilation symptoms, lung function, and quality of life in individuals with mild to moderate asthma.
There are several types of asthma breathing exercises to choose from. Two of these are pursed lip breathing and diaphragmatic breathing.
Pursed lip breathing
This technique may help slow breathing and reduce shortness of breath. It involves the following steps:
Diaphragmatic breathing
The diaphragm is a muscle below the lungs that plays a role in inhalation. "Belly breathing" is another name for diaphragmatic breathing. This method slows breathing and reduces the body's oxygen needs.
In a 2020 review, researchers looked at prior studies to determine the effect of eucalyptus oil on asthma. The results suggest that, because of its anti-inflammatory effects, eucalyptus oil may be a beneficial therapeutic add-on treatment for asthma that is resistant to steroid medications.
A person should dilute eucalyptus oil — or any other essential oil — in a carrier oil before using it. A person can place the diluted oil in a diffuser and inhale the vapor it releases, or they can apply the diluted oil to their skin.
People should never ingest essential oils or use undiluted essential oils. Also, people should be aware that inhaled eucalyptus oil can be toxic to cats and other pets.
GingerIn a 2020 study involving test tubes and dust mites, researchers examined the potential benefits of whole ginger extract and 6-shogaol — a bioactive compound in ginger — for asthma. The results indicated that both supplements have potential for relaxing smooth muscles and reducing inflammation in the airways.
Ginger is available in supplement form, but people should always check with their doctor before starting a new supplement. People can also add ginger to their diet by using it in cooking, consuming products that contain it, or drinking ginger tea.
Symptoms of an asthma attack include:
Although other conditions can cause these symptoms, they frequently follow a pattern in asthma. This may include:
Exposure to various triggers can cause an asthma attack. Experts advise that a person keep a journal to record which things provoke symptoms. This may help a person avoid some triggers in the future.
Potential triggers may include:
Asthma has the following four stages:
The duration of flare-ups varies.
It depends on the cause and how long the airways have had inflammation.
Mild symptoms may last a few minutes, but more severe symptoms may last hours or days.
According to research from 2020, certain dietary habits can help prevent asthma. Research associates greater fruit and vegetable consumption with lower asthma risk, while dairy consumption — which has a link to higher risk — may worsen symptoms.
Additionally, Mediterranean and vegan diets, which focus on fruits, vegetables, whole grains, and legumes while limiting animal foods, may decrease the risk and reduce flare-ups.
Other asthma prevention measures include:
When a person's asthma is not flaring up, it has only a minimal impact on daily life. However, uncontrolled asthma, which causes frequent or intense symptoms, can result in absences from work and school and a higher risk of emergency room visits. According to CDC data, 61.9% of adults with asthma have the uncontrolled kind.
Asthma is a life threatening illness in some people, as it causes 4,145 deaths per year in the United States. That said, a person can manage their asthma by following their doctor's prescribed action plan.
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An individual's action plan makes it easy to know what to do at home for an asthma attack. The plan lists symptoms of an attack and provides instructions on what medications to take and when to seek medical attention.
While home remedies do not stop an asthma attack, they may provide some relief. A person should always check with their doctor before taking a dietary supplement, whether for asthma symptoms or for other purposes.
Symptoms of an asthma attack may include coughing, wheezing, and shortness of breath.
A variety of triggers may provoke an attack, so it helps to keep track of triggers and avoid them if possible. Attacks can last from a few minutes to hours or days.
Because a severe asthma attack can be life threatening, a person should closely follow instructions in their action plan regarding getting emergency treatment.
Revealing Key Insights Into The Trends Of Asthma Mortality
Asthma is among the most common chronic respiratory diseases in the world. Characterized by inflammation and narrowing of the airways, it can trigger serious bouts of coughing and breathing problems. Unfortunately, asthma is becoming increasingly prevalent, with a total of over 262 million cases reported worldwide in 2019.
Interestingly, both the prevalence and mortality rates of asthma vary greatly across different regions. For example, its prevalence in the United States (US) was ~11% in 2019, which is four times greater than its prevalence in China in the same year. On the other hand, asthma mortality rates have been consistently higher in China than in the US.
Understanding how well these countries are dealing with this disease is challenging because most studies have used rather basic analytic methods that provide limited insights.
Against this backdrop, a research team from Huazhong University of Science and Technology and NHC Key Laboratory of Respiratory Diseases, both in Wuhan, China, decided to conduct a more detailed comparative analysis of asthma mortality in China and the US. Their study, led by Professor Xiansheng Liu, was published in the Chinese Medical Journal.
"The risk factors for asthma mortality in China and the US were investigated to provide public health recommendations for reducing mortality," says Prof. Liu.
To carry out their analysis, the team used data spanning the period 1990–2019 from the Global Burden of Disease Study 2019, one of the largest assessments of the impact of various diseases and their associated risk factors throughout the world. To gain deeper insights into asthma mortality, the researchers employed an age–period–cohort (APC) model.
This approach has been gaining traction as a valuable method to analyze the incidence and mortality trends of chronic diseases. Simply put, this model allowed them to use an advanced approach to study the effects of age, time period, and birth cohort on asthma mortality separately, unlike simple descriptive methods.
The results revealed substantial differences in asthma mortality between China and the US. First, China had higher asthma mortality rates than the US from 1990 to 2019. However, this gap markedly narrowed over time. Second, men had higher asthma mortality rates than women in China, whereas in the US, the case was just the opposite.
A finer analysis showed that asthma mortality rates were also different between the two countries when grouped by age. Infants, young children, and the elderly were the most affected groups in China, whereas in the US, asthma mortality rates increased slowly with age, exponentially increasing after the age of 80 years.
The researchers also found that smoking, a high body-mass index (BMI), and occupational exposure to asthmagens (asthma-inducing or -triggering particles) were the factors most strongly related to asthma mortality. In China, smoking was the leading risk factor related to asthma mortality, especially for males.
The situation was different in the US, as Prof. Liu remarks: "Compared with China, high BMI is a larger public health challenge in the US, where it ranked first in the risk factors of asthma-related death."
Interestingly, asthma mortality rates in China, albeit higher than in the US, have shown a considerably larger decline over the past three decades. This highlights the effects of China's transition to a middle-income economy and improvements in the management of asthma risk factors at the individual and societal levels.
Taken together, these findings paint a more complete picture of how asthma mortality varies over time in China and the US. The novel insights provided by the researchers could be leveraged to further reduce asthma mortality.
Prof. Liu concludes, "This study on asthma mortality can help focus on at-risk populations who might benefit the most from targeted interventions, such as tobacco control, obesity prevention and treatment, available medical services for the aging population, and practical and pragmatic guidance in the assessment and management of occupational asthma by clinicians and so on."
More information: Xiaochen Li et al, Secular trends of asthma mortality in China and the United States from 1990 to 2019, Chinese Medical Journal (2023). DOI: 10.1097/CM9.0000000000002855
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Citation: Revealing key insights into the trends of asthma mortality (2023, November 22) retrieved 30 November 2023 from https://medicalxpress.Com/news/2023-11-revealing-key-insights-trends-asthma.Html
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