Asthma cigarettes

Some of you may have seen this particular image doing the rounds a while back.  I'm guilty of posting it myself without comment to my facebook page because, you know, smoking and asthma!  Funny!

As with every meme that does the rounds on facebook, however, the wider historical context of this one probably got a little bit missed in the details. 

So let's have a little bit of a chat about 'Asthma cigarettes'. 



Asthma is a fairly common chronic illness that causes inflammation and spasm in the lining of the lungs.  There is a strong allergic component and most asthmatics can describe "triggers" anything from cat hair, to cold, to exercise.  Around 10% of Australians are asthmatics and rates in Australia are amongst the highest in the world, for reasons unknown.  Left untreated long term it can cause emphysema - just like smoking.  So obviously, smoking and asthma together are not a good combination.  Smoking as well is often a trigger for many asthmatics - causing "asthma attacks" where the airways tighten and spasm and the person is left wheezing and short of breath if they are lucky - dead if they aren't. 

Unfortunately in Australia that message is still taking a bit of time to get through - rates of smoking in asthmatics are the same in the general population (if not higher) and are twice as high in indigenous patients.  Australian GPs spend a great deal of time trying to convince their asthmatic patients in particular and their patients in general to please, PLEASE, stop smoking. 

So it may suprise you to know that the advertisement above is not a joke, or an elaborate photoshop hoax.  Up until the 1950s when the first adequate treatment for asthma arrived on the market - an asthma 'cigarette' would be about all your doctor would have to offer you. 

First of all it's important to note that asthma cigarettes did not contain nicotine but a variety of herbs - the active ingredients of which were usually something from the nightshade family.  Nightshades contain atropine - a drug which, importantly in asthma treatment, causes dilation of the small airways in the lungs and relief of symptoms.  However it also causes dilated pupils, a rapid heart rate, nausea, confusion, dry mouth and hallucinations.  It is primarily used these days to increase a slow heart rate during resuscitation and to dilate a pupil in eye procedures. 

Inhalation of smoke to control asthma symptoms is represented in most ancient branches of medicine - Greek, Roman and Ayurvedic - and seems to stem from a united belief that asthma is a product of cold and that the best treatment is to warm the lungs sufficiently to combat it.  However prior to the 19th century their use occupied a fairly variable position in Western medicine. 

This all changed with the sharp uptake of tobacco smoking in Europe.  By the mid twentieth century  a staggering proportion of British men were smoking (something like 80%), and 20% of women.  It also changed with the introduction of stramonium, a nightshade derivative that actually worked. 

Dr James Anderson, the Scottish born physician general of Madras, and also an asthmatic, happened to try a local cure which involved smoking a cigarette containing stramonium.  He told his friend and colleague Dr. Sims, who wrote about it in the medical press.  From there asthma cigarettes really took off and were soon being sold and promoted everywhere.  

The problems with this were many.  Firstly although inhalation of atropine was useful in symptom relief - inhalation of any form of smoke was hardly helpful for asthmatics.  Particularly as, given the overall acceptance of smoking as "healthy", most asthmatics using the remedy were also being encouraged to smoke tobacco.  Secondly the amounts of stramonium (or other nightshades) contained in the cigarettes were not regulated and overdose of atropine is remarkably easy to achieve - as many teenagers who attempt to use the plant recreationally often discover.  Dr. Sims himself apparently died of an overdose just a year after making his report to the press.  If overdose didn't occur, side effects as listed above were hardly pleasant.  At the least a smoker might find themselves hallucinating with palpitations. 

By the early 20th century the allergy theory of asthma had started to gain traction and the use of cigarettes as treatment was on the decline.  However there was very little else in the way of treatment for doctors to reccomend.  The rise of the pharmaceutical industry led to more pure forms of atropine, hyoscine and scopalmine all derived from nightshades.  Adrenaline, theophylline and aminophylline also arrived in the 1920s and 1930s which had far better side effect profiles than asthma cigarettes.  What finally sounded the death knell for the product was the arrival in the 1950s and 1960s of inhaled bronchodilators - and in the 1960s of salbutamol and the blue "ventolin" puffer which is still one of the mainstays of treatment today. 

So while a smoke might seem like a good idea, this GP is just going to reiterate what she says all day. 

Please stop smoking.  Blue skin is a really bad look. 


http://www.asthmaaustralia.org.au/Statistics.aspx
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2844275/
http://books.google.com.au/books?id=b8qaI_iOh0UC&pg=PA53&lpg=PA53&dq=Theatri+Tabidorum,++Christopher+Bennett,+inhaler&source=bl&ots=XInceC7cA9&sig=wdZfPF_ng7wJ64x-eG5YZIfM2Qc&hl=en&sa=X&ei=aJlQUKG-GumzyQHnloG4BA&redir_esc=y#v=onepage&q=Theatri%20Tabidorum%2C%20%20Christopher%20Bennett%2C%20inhaler&f=false