|Year : 2015 | Volume
| Issue : 2 | Page : 69-78
Homoeopathy for the management of Asthma - A review of Council's Clinical Research
Bindu Sharma1, Ritika Hassija Narula2, Raj K Manchanda3
1 Scientist-4, Central Council for Research in Homoeopathy, New Delhi-110058, India
2 Senior Research Fellow (H), Central Council for Research in Homoeopathy, New Delhi-110058, India
3 Director General, Central Council for Research in Homoeopathy, New Delhi-110058, India
|Date of Submission||05-Mar-2015|
|Date of Acceptance||01-Jun-2015|
|Date of Web Publication||30-Jun-2015|
Dr. Ritika Hassija Narula
Senior Research Fellow (H), Central Council for Research in Homoeopathy, New Delhi
Source of Support: None, Conflict of Interest: None
Objective: To conduct a review of the Clinical Research work of the Council in the field of asthma.
Methods: A comprehensive manual search of Council's publications pertaining to asthma was conducted to identify publications on the research work undertaken by the Council including CCRH Quarterly Bulletins (1982 to 2005), Clinical Research studies series and Indian Journal of Research in Homoeopathy (IJRH). Relevant research was categorized by study type and appraised according to study design with their clinical outcomes.
Results: Only 20 publications pertaining to Asthma were found and 10 were selected consisting of observational studies and drug oriented studies.
Conclusion: The positive outcome in controlling acute episodes of asthma, reducing the frequency and intensity of subsequent episodes and weaning of bronchodilators and other allopathic drugs have been reported. As only observational studies have been conducted, further pragmatic trials including randomized control studies are desirable.
Keywords: Bronchial asthma, Observational studies, Homoeopathy, CCRH, Bronchodilators, Drug dependence
|How to cite this article:|
Sharma B, Narula RH, Manchanda RK. Homoeopathy for the management of Asthma - A review of Council's Clinical Research. Indian J Res Homoeopathy 2015;9:69-78
|How to cite this URL:|
Sharma B, Narula RH, Manchanda RK. Homoeopathy for the management of Asthma - A review of Council's Clinical Research. Indian J Res Homoeopathy [serial online] 2015 [cited 2019 May 20];9:69-78. Available from: http://www.ijrh.org/text.asp?2015/9/2/69/159520
| Introduction|| |
Asthma is one of the major public health problems for the developed and developing countries. Worldwide, it is estimated that 300 million people are affected with bronchial asthma. India has an estimated 15 20 million asthmatics with a prevalence of about 10% and 15% in 5 11 year old children.
Asthma prevalence is increasing despite the recent advances in its management , including understanding the inflammatory nature of the disease, use of steroids with add-on long acting bronchodilators, use of devices to deliver the medications more appropriately and appreciation of the value of self-management education. ,, The human and economic burden associated with this condition is severe and the costs of asthma treatment to society could be reduced to a large extent through concerted international and national action. 
A chronic inflammatory condition characterized by airway hyper-responsiveness to a variety of stimuli largely of allergic origin with reversible airflow limitation, symptoms of asthma exhibited are wheezing, shortness of breath and cough. It is a major cause of impaired quality of life with impact on work and recreational as well as physical activities and emotions.  Current (day-to-day) control of asthma includes achievement of symptom improvement in activity, and improvement in lung function. 
Homoeopathy is the second most widely used CAM in healthcare systems according to the World Health Organization.  Studies have shown that homoeopathic treatment for respiratory diseases was associated with a significant reduction in the use and costs of conventional drugs.  One study concluded with the fact that though randomized trials are required to prove the efficacy of Homoeopathy in asthma, there is a need for observational data to document the different methods of homoeopathic prescribing and how patients respond.  Central Council for Research in Homoeopathy has conducted several studies to evaluate the therapeutic usefulness of homoeopathic medicines in the management of Asthma and has published vast literature on asthma including observational studies, case reports, theoretical compilations, literary research and personal experiences.
The objective of this review is to analyze the research work done by the Council till date in the field of asthma and the future research required to be undertaken in this less explored area. Analyses of these studies unveil the management strategy for asthma through Homoeopathy during the acute exacerbations, remission period and in patients already on anti-allergics and bronchodilators. The need at present is to conduct future research of pragmatic design to further evaluate available evidences.
| Methods|| |
Search and Selection Criteria
We searched asthma-related publications of the Council from 1982 to 2014 published in Quarterly Bulletin, Clinical research studies series and the Indian Journal of Research in Homoeopathy. The publications pertaining to the clinical research work were only included in the review. All publications are categorized as observational studies/drug oriented studies. Other publications where in only literary work or personal experiences of the clinicians and the repertorial references of asthma were cited, are excluded [Table 1].
| Results|| |
Out of 20 publications searched, 10 were included. These publications comprise of observational studies and drug oriented studies. The results of 5 observational studies were compiled and published as one research paper in Clinical Research Studies Series-I. However, 10 publications were excluded as these were not pertaining to the clinical research work of the Council. The excluded papers were the literary work, personal experiences of the clinicians [Table 3] and the repertorial references of asthma. The brief of the studies included in the analysis is given in [Table 2].
The outcome evolved is described as under:
• The observational study constituting the research work done at 5 units/institutes (Regional Research Institute, New Delhi (1978- 2000), Regional Research Institute, Gudivada, Andhra Pradesh (1984 - 2003), Regional Research Institute, Shimla (1987 - 2003), Clinical Research Unit, Udupi, Karnataka (1996 - 2003):(Compilation of 5 studies).
This observational study conducted on 2641 patients carried out at 5 centers all over India suggests the positive role of Homoeopathy in reducing the frequency and intensity of acute exacerbations of asthma, during the acute attack per se and also in reducing the drug dependence.The outcome was assessed on subjective parameters as given in Text Box I.
Pathological parameters like Pulmonary Function Test, Clinical scores and QOL scores were lacking and were not evaluated. A uniform protocol was used with the common objective of determining the therapeutic efficacy of homoeopathic medicines in the management of Bronchial Asthma and to identify its reliable indications. Out of 2461 patients enrolled, 2107 patients completed the follow up for a reasonable period of one year to arrive at definitive conclusions. The findings of the study suggest that symptomatic homoeopathic treatment can be safely relied upon to manage asthma both during the acute phase as well as to check recurrence. The study also indicated that 758 patients had an attack of asthma after being exposed to house dust. In 908 patients (43%), tolerance to triggers was enhanced, leading to either total or marked relief in frequency, duration and intensity of attacks. Patients who were dependent on allopathic medicines like inhalers, oral and other medicines reported either less dependency or did not need them at all. Arsenicum album was proved to be the most useful remedy, in managing asthma including the acute attacks. It was prescribed to 1,042 patients and was found useful in 933 patients. 73 patients reported tolerance to change of weather with the remedies like Arsenicum album, Kali carb., Hepar sulph., Phosphorus, Sulphur, Arsenicum iodatum, Bryonia alba and Carbo veg. The conventional system emphasizes drug therapy which includes bronchodilators for releasing bronchospasm and controllers to inhibit the underlying inflammatory process. Likewise, homoeopathic system evolved a drug regimen of using acute remedies for the acute attack and constitutional deep acting medicines to prevent recurrence. Most of the patients were on bronchodilators and other allopathic drugs like inhalers, bronchadilators etc., reported either less dependency or didn't need them at all and were gradually tapered off with Homoeopathy. The drugs found useful in reducing the dependency of allopathic drugs include Arsenic album, Kali carb., Hepar sulph., Natrum sulph., Merc. sol., Phosphorous., Sulphur., Lycopodium., Pothos., Arsenic iod., Antim tart., Kali sulph., Nux vomica and Pulsatilla. Viburnum opulus and Cassia sophera were explored during acute attacks of asthma and the results were found satisfactory. 
• Observational studies conducted at Clinical Research Unit, Bombay: (Compilation of 3 studies)
Arsenic iodatum was found useful in both atopic and non atopic asthma and in acute attacks of asthma. Tuberculinum has a complementary relationship with Arsenic iodatum and enhances the action of the latter if given as an intercurrent remedy as evident in the prescribed 74 cases. Significant improvement (>75%) was noticed in 82.6% of patients, moderate improvement (50-75%) noticed in 8.7% of patients and mild improvement (25%) noticed in 8.7% of patients. In another study conducted by the same institute on 207 patients, the symptomatology of Arsenic alb./Iod, Kali carb. and Natrum sulph. was verified as quoted in Materia Medica, with new symptoms added as proving symptoms in these patients. The same institute also conducted a study on 107 patients exhibiting the role of Arsenic album in Bronchial Asthma 
Drug oriented studies:
- Cinchona, Ipecac, Aralia racemosa, Natrum sulph. Justicia and Cassia sophera were the useful remedies found at RRI, New Delhi, CVU, Vrindavan and CRI (H), Calcutta ,,
- However, there were certain other publications on asthma including "Wheezing Syndrome- A Synopsis" and "Study of 413 Cases of Bronchial Asthma treated with Homoeopathic System of Medicine" consisting of the case reports which have already been included in the compiled data of the 5 institutes/units published as Clinical research series
- The paper on 'Wheezing Syndrome' consists of data of 313 patients at the CRU (H), Shimla with drawing of certain other observations like existing of a definite link between asthma and cold virus, chronic sinusitis, outside settlers in hills and dust mite.The outsiders coming from plains and settling in hills get asthma surfaced easily as compared to the natives of the hills due to sudden exposure to a vast variety of allergens coupled with high humid climate which is an established asthma precipitant. The homoeopathic remedies, Viburnum opulus and Cassia sophera Q were found beneficial in controlling acute attacks of asthma which developed a confidence in patients and ensured better compliance for further treatment. A large number of patients showed improvement with Viburnum opulus Q alone but most of the patients were benefitted both with Cassia sophera Q and Viburnum Q. The author has also tried to establish the role of 'Placebo Effect Psychology' in the treatment of asthma. Common Characteristic Variant Symptoms (CCVS) and Pivotal Expression were some of the expression based prescription. CCVS are the common characteristic variants of the disease and often inappropriately classified as individualizing symptoms. E.g. In some patients of asthmatic bronchitis where cough is an important common symptom, may experience nauseous feeling on coughing. This is a CCVS and not an individualizing symptom. Similarly the "Pivotal Expression" expresses patients idiosyncrasy which can be located, palpated or could be seen in a cause, in a modality, in a concomitant, in a pathology, in a generality or even in a common symptom 
- "Study of 413 Cases of Bronchial Asthma treated with Homoeopathic System of Medicine" concluded with 273 cases of extrinsic asthma and 140 cases of intrinsic asthma. Remedies including Arsenic alb., Kali carb, Pulsatilla, Carbo veg, Nux vomica, Natrum sulph., Hepar sulph., Spongia, Blata Q were needed the most and also effectively controlled the acute paroxysms of asthma. 
| Discussion|| |
Patient surveys around the world show consistency in the reasons why people choose homoeopathic medicine as a form of treatment. Dissatisfaction with the results of conventional treatment, the adverse effects of drugs, and the invasiveness of conventional medicine are some of the reasons for choosing Homoeopathy. In developing countries, cost effectiveness is a major factor for opting this system of medicine. Homoeopathic medicines in high dilutions are probably safe and unlikely to provoke any severe adverse reactions. The high acceptability and the second most commonly used treatment in India, Homoeopathy evokes a greater patient response as evident from the observational studies and clinical trials conducted till date worldwide and by the Council.
Homoeopathy plays a major role in the management of asthma both in its acute and chronic asymptomatic phase with a check on subsequent recurrence of episodes in terms of frequency, duration and intensity. A vital part of individualized Homoeopathy is to measure the 'package of care effect' implying the effect of the medication as well as the consultation in treatment of diseases which needs to be explored in future studies. Prolonged use of homoeopathic medicines also succeeded in reducing the drug dependence on inhalers and bronchodilators, etc., The level of patient satisfaction can be gauged from the fact that the drop out rate was small and many patients followed up for a considerable period of more than 1 year a period sufficient to monitor annual recurrence.
With international interest in propagating Homoeopathy, there is a parallel push for more research. Some authors dispute the idea that randomized controlled trials are the optimum research method for Homoeopathy research. Difficulties lie in attempting to measure the outcome because the practice remains highly individualized. The outcomes of treatment in real-life settings when measured by patient satisfaction surveys about quality of life changes have presented positive evidence in many studies. Observational studies, a highly relevant and important measurement tool, show that patient satisfaction is high and that Homoeopathy improves quality of life.  The studies conducted so far have derived certain conclusions defining the scope of Homoeopathy in both the acute and the asymptomatic chronic phase of asthma. Therefore, observational and case studies cannot to be dismissed as low in the hierarchy of significance in Homoeopathy research which can be determined further and authenticated with the pragmatic trials.
| Conclusion|| |
A comprehensive search including the findings of the clinical research studies published by the Council suggests that the evidence on the usefulness of Homoeopathy in asthma is limited. The review reveals that future risk minimization is achieved by ensuring the absence of asthma exacerbations, no side-effects from medications and the prevention of accelerated decline in lung function over time. Bronchodilators, inhalers etc., should not be abruptly withdrawn to prevent sudden aggravation. They need to be gradually tapered off along with the use of homoeopathic medicines. Homoeopathic medicines act as efficiently when given in drug dependent patients as adjunct, as in non-drug dependent patients taking Homoeopathy alone. Remedies based on keynote symptoms, acute totality during the attack, constitutional prescribing and most important by the expressions of the patients exhibited during the attack were brought forth.
Management of acute attacks successfully with Homoeopathy played an important role in the treatment/research outcome. The patients who observed relief with Homoeopathy during acute attack subsequently reported for follow up thereby enabling the investigator to prescribe a constitutional similimum during the asymptomatic phase.
As only the observational studies were carried out in this field by the Council which reported positive results including high levels of patient satisfaction but the lack of a control group, makes it difficult to assess the extent to which any response is due to Homoeopathy. The above studies were based on the symptomatology of the patients and the pathological parameters including PFTS., clinical scores and Quality of Life scores were lacking. However, on the basis of this review alone it is not possible to draw firm conclusions on the effectiveness of Homoeopathy for asthma. Consequently, further research of pragmatic design including qualitative studies is desirable.
Financial Support and Sponsorship
Conflict of Interest
There are no conflict of interest.
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[Table 1], [Table 2], [Table 3]