Coffee and herbal ‘cigarettes’ once popular treatments for asthma: talks from PMJ 90th Anniversary

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.

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.

http://pmj.bmj.com

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

Email: edickinson@bmj.com

Why worry about high blood pressure?

29.4.14: Listen to blood pressure specialist Donald Singer and pharmacist Ejaz Cheema in discussion with Annie Othen on BBC radio about blood pressure, knowing your numbers, tips on blood pressure measurement, why treatment is important, and how doctors, nurses and pharmacists can help to keep people with high blood pressure as healthy as possible.

High blood pressure is a very common preventable cause of stroke, heart attack and other serious diseases. These complications may at best cause disability and are major causes of preventable premature death in the UK and around the world.

For the public in general, the lower the blood pressure the better: most blood pressure-related heart attacks and strokes occur at blood pressure levels within what many still consider to be normal blood pressure.

A healthy lifestyle will help to keep blood pressure and other cardiovascular risk factors in check.  Keeping weight in check, regular exercise, minimising salt intake and moderation in alcohol, as well as eating healthy foods rich in fruit and vegetables all help, as does avoiding or stopping smoking.

For people with raised blood pressure, tests are important to rule out underlying causes and to identify other cardiovascular risk factors.

Blood pressure treatment is well-established as effective in helping to prevent or reduce severity of heart attack, stroke and other serious medical problems. However  blood pressure is still poorly controlled in many patients even in the most developed healthcare systems.

One of several reasons for poor blood pressure control is that many patients find it difficult to keep taking their tablets. Surprisingly, in people newly diagnosed with high blood pressure, as many as half may have stopped their tablets by 12 months.

It is as important to understand and address reasons for poor patient adherence with their medicines. These include not being sure of why blood pressure is important, reasons for choice of medicines, and concerns about possible or actual side effects of tablets.

Other contributory factors includes failure of prescribers to follow established national guidelines for choice of tablets and how they should be used singly or in combination. This risks exposing patients to avoidable side effects without achieving effective lowering of blood pressure.

An important element in approaches to improving adherence to blood pressure medicines is continuing education of health professionals and patients about high blood pressure and its treatment. Doctors, nurses and pharmacists can all play important roles in this.

Chemical genomics, bioactive molecules and alternative reading frame proteins: clues to sudden cardiac death

The cardiac drug flecainide was developed to prevent and treat serious ventricular tachycardia arrhythmias - very rapid heart rates which, if unchecked, can be lethal. However, in clinical trials, flecainide and its sister molecular encainide were reported to more than double the risk of sudden cardiac death.

Joint work by researchers in Chemistry and Medicine at the University of Warwick, and at the Biotech Company SEEK, is now allowing insight into how cardiac death risk might be increased by these drugs. The methods involve persuading viruses to provide a read-out on their surface of proteins related to human diseases.

In experiments just published in the Royal Society of Chemistry journal Chem Comm, we show that proteins from the heart may be read abnormally - through slippage in the letters of the genetic code for heart muscle components - these are called alternative reading frame proteins, a bit like a very simple old cipher.

Furthermore, flecainide is able to interact with a particular abnormally read protein. Previous research has linked this type of abnormality to serious side-effects of a drug used to treat the developing world parasitic infection Schistosomiasis.

There are two obvious implications of our new work. Testing for these abnormal proteins could be a new way to identify people and their family members who should be protected from risk of serious cardiac problems - for example by avoiding triggers of heart arrhythmias and by considering implantable defibrillators.

And by understanding how flecainide interacts with the abnormal protein, there may be clues to new treatments to interfere with the part of protein linked to cardiac problems.

Adverse effects of drugs can be very serious. When chosing a medicine, prescribers need to be aware of the balance of risks and benefits, and to chose the right drug for the right patient and the right disease, at the right time and for the right duration - long enough but not too long.

However our work shows an unexpected consequence of adverse effects of a drug: providing clues to new causes for disease and new ideas for treatments.

Commended 2011 Hippocrates entry published in Br J Psychiatry

@HealthMed 'Street-wise' by Wendy French, one of 20 NHS entries commended in the 2011 Hippocrates Prize for Poetry and Medicine, has been published in the December issue of the British Journal of Psychiatry.

 

Entries are closed for the 2012 Hippocrates Awards. With a 1st prize of £5000 for the Open International category and a separate 1st prize of £5000 for the UK National Health Service-related category, this is one of the best funded awards anywhere in the world for a single poem.

Judges for the 2012 Hippocrates Awards are New York poet and critic Marilyn Hacker, medical scientist Professor Rod Flower FRS and BBC broadcaster and journalist Martha Kearney.  

Awards will be presented in London on Saturday May 12th 2012, at the 3rd International Symposium on Poetry and Medicine, to be held at the Wellcome Collection rooms in London. 

During the 2012 Symposium, there will be readings by Jo Shapcott, Past-President of the Poetry Society, and US poet and 2012 Hippocrates awards judge, Marilyn Hacker.  

Advances in treating acute lung syndromes

@HealthMed Although only described as recently as 1967, a range of important contributory factors have been defined for acute respiratory distress syndrome (ARDS), which is now recognized to be at the severe end of a spectrum of acute lung injury, which imposes high risk for patients and which confers a major burden on health services. Outcome of treating the syndrome has been much improved by developments in devices to treat lung and other organ failure, supported by advances in expertise in intensive care. However, other than treatments for underlying causes, there is still important unmet need with regard to effective specific pharmacological treatments.

A timely review of ARDS by Dushianthan and colleagues is the Editor’s choice article in the September issue of the Postgraduate Medical Journal.  These experts from Southampton provide an update on knowledge of risk factors, including genetic biomarkers, for development of ARDS and other acute lung injury variants, and an up-to-date commentary on general and specific treatment options.

The authors note that ‘sepsis, pneumonia, and trauma with multiple transfusions’ account for most episodes. They highlight the importance for recovery of ‘general supportive measures such as appropriate antimicrobial therapy, early enteral nutrition, prophylaxis against venous thrombo-embolism and gastrointestinal ulceration’.

They discuss encouraging experimental evidence from trials of corticosteroids, nitric oxide, prostacyclins, exogenous surfactants, ketoconazole and antioxidants, however note that these findings have not as yet being translated into benefits for patients. They note as further treatment targets of interest, new approaches to modulating inflammation, and use of mesenchymal stem cells.

See the free full article for further details.