Condition used to be regarded as
psychosomatic and brought on by stress
Strong black coffee and herbal
‘cigarettes’ were once popular treatments for asthma, which used to
be thought
of as a psychosomatic condition, brought on by stress, reveals a review of the
evolution of common respiratory diseases over the past century.
The review, presented by Peter
Barnes, Professor of Thoracic Medicine and Head of Respiratory Medicine at the
National Heart and Lung Institute, Imperial College London, is one of a series
of historical perspectives on key aspects of health and medicine, and their
relevance to future practice, delivered by distinguished clinicians at a
symposium in London today for the Fellowship of Postgraduate Medicine (FPM).*
See programme and speaker abstracts and biographies
The lectures mark the 90th anniversary of Postgraduate
Medical Journal, which began publishing in 1925, the year television
pictures were first transmitted by Logie Baird and enclosed double decker buses
were introduced to London’s streets.
In ancient times, asthma used to be
treated with various herbal extracts, derived from horsetail, thorn-apple, and
deadly nightshade (belladonna), and available as a tincture or in “asthma
cigarettes.”
By the 1850s the use of strong black
coffee was recommended to treat symptoms, and by the early 20th century adrenal gland extract, from
which adrenaline is derived, emerged as an effective airway opener
(bronchodilator) followed by the discovery in the 1920s that theophylline,
which occurs naturally in tea, was similarly effective.
The adrenal gland was a source of
another treatment for asthma—steroids, the precursor to the mainstay of
treatment today. Glucorticosteroids were first extracted in the 1940s, when
adrenaline also became available as an inhaled treatment for the first time.
During this period in history,
asthma was thought of as a largely psychosomatic condition, brought on by
stress. It wasn’t until the 1980s, when chronic inflammation was recognised as
a key factor in the airway restriction that characterises the condition.
In 1925 patients with chronic
obstructive pulmonary disease (COPD), which includes emphysema and bronchitis,
were treated with the same bronchodilators used for asthma. Now long acting
bronchodilators and their combination are the treatments of choice, although
they don’t work as well in COPD as they do in asthma.
But oxygen was considered to be
dangerous and only became available in the 1980s. New treatments for COPD that
dampen down the underlying inflammation are urgently needed but have proved
difficult to develop.
In another presentation, looking
towards the future, Professor Karol Sikora, Medical
Director of CancerPartnersUK, points out that cancer could well become a
long term condition in 20 years’ time. But this promise critically depends on
sustained investment in innovative diagnostics and therapies, such as robotics,
genomics, biosensors, and personalised medicine.
He suggests that as the population
continues to age, and the prevalence of cancer rises, the interaction of four
factors will determine the future success of curbing deaths from the disease:
new technology; society's willingness to pay; evolving healthcare delivery
systems; and the financial mechanisms that underpin them.
Other speakers include Professor
Dame Carol Black, principal of Newnham College Cambridge and past president
of the Royal College of Physicians, who will talk about the opportunities
to improve public health by focusing on workplace health; Professor Sir Munir
Pirmohamed, David Weatherall Chair in Medicine at the University of Liverpool
who will outline progress in the use of personalised medicine; and Dr Paul
Nunn, former Coordinator, WHO Tuberculosis Programme, who will cover the
epidemiology and treatment of TB.
Commenting on the relevance and
significance of the symposium, FPM President, Professor Donald Singer said:
“Today’s symposium showcases many of the tremendous advances in medicine over
the past 9 decades. Yet many of the medical challenges present in the 1920s still
need further research and more global investment in health systems in developed
and less developed regions. “
He added “The Postgraduate Medical
Journal continues to play an important role in publishing new medical research
and in educating young doctors and their teachers around the world.”
Notes for editors:
*90th Anniversary of the
Postgraduate Medical Journal: Medicine from 1925 to 2015 One Day Symposium -
1st October 2015, Medical Society of London
Postgraduate Medical Journal is one of more than 50
specialist journals published by BMJ, which publishes the title on behalf of
the Fellowship of Postgraduate Medicine.
The
Fellowship of Postgraduate Medicine,
founded in 1918, pioneered educational programmes in all branches of
postgraduate medicine. The FPM publishes 2 international journals: the
Postgraduate Medical Journal since 1925 and Health Policy and Technology since
2012.
Further information (including
contact details for the speakers)
Emma Dickinson, Media Relations
Manager, BMJ, BMA House, London, UK
Tel: + 44 (0) 207 383 6529
