Strong black coffee and herbal ‘cigarettes’ were once popular treatments for asthma, which used tobe 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
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.
Details of all the other speakers and the topics they will be covering are available here: http://fpostgradmed.blogspot.co.uk
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