Bronchial Asthma -A Homoeopathic Perspective

Dr Appu Gopalakrishnan

Bronchial Asthma is a chronic inflammatory disorder characterized by episodes of breathlessness, wheezing, cough, chest tightness etc caused due to bronchial hyper-responsiveness and variable air flow obstruction which is reversible spontaneously or with treatment.(1) Many factors can be seen associated with the risk of developing asthma other than atopy and genetic predisposition.

Currently about 300 million people in the world suffer from asthma.(2) Recent increase in the prevalence of asthma and allergic diseases has been attributed to environmental changes to life style of the people.(3) Asthma was the cause for more than 3,45,000 deaths worldwide in 2010 as per global burden of disease study.(4) According to World Health Organization, asthma cases are increasing at rate of 50 percent every decade worldwide and by the year 2020 asthma along with COPD will become third leading cause of death.(5) Approximately three out of every 100 adults in India suffer from asthma around the globe. It also poses an emotional, economic and physical burden on patients in India. (6)

Homoeopathy has a greater understanding of factors that cause asthma and reduce the morbidity and mortality rate. It has got better overall outcome on comparing with the conventional treatment, in managing acute episodes as well as intensity and frequency of recurrences of bronchial asthma, by the use of similar homoeopathic constitutional remedies. Homoeopathy provides cost effective treatment compared to the heavy financial burden related to the long term treatment expenses of asthma in modern medicine.(7)

EPIDEMIOLOGY
Bronchial asthma is recognized as major health problem by the World Health Organization.(8)  About more than 300 million people in the world currently have asthma.(2)(9) Prevalence of asthma is high in developed countries compared to developing countries.(10) In India, about 15-20 million were estimated to be asthmatic. In India, its prevalence is about 2 percent.(11) Recently, the prevalence of asthma shows an increasing trend in developing countries, which has been associated with increased atopic sensitization and other allergic disorders like eczema, allergic rhinitis etc.(12) It is also due to adoption of western life style and urbanization.(13)  It has been estimated that there may be an addition of 100 million persons with asthma by 2025.(9)

Asthma accounts about 1% of all DALYs lost due to high prevalence and severity. This condition causes severe human and economic burden.(10) The economic cost associated with asthma is estimated to be more than those of TB and AIDS combined. It was estimated that approximately 139.45 billion Indian rupees have been spent for treating asthma in the year 2015.(10) Asthma can be controlled, but not cured.(14)

Urban and female predominance with a wide inter-regional variation in prevalence was also observed.(15) Women experiences more severe exacerbations compared to males. It worsens during the premenstrual period in 80% of women.(16) .

AETIOLOGY AND RISK FACTORS
Asthma is a heterogeneous disease condition with firmly established strong genetic basis.(17) Multiple genetic and environmental factors contribute to the causation of asthma.(1) Endogenous risk factors include genetic predisposition, gender, atopy, ethnicity and exogenous risk factors are allergens, occupational sensitizers, smoking, infection, obesity, dietary factors etc.

Genetics play important role in developing asthma. Risk of developing asthma become greater when both genetic and environmental factors are present simultaneously. (18)  Multiple genes are involved in development of asthma. Chromosomes 5q31-33, 6p21.3, 11q13 and 12q14.3-24.1 are consistently found to be associated with asthma and associated phenotypes.(19)

Atopy, the genetic predisposition to IgE mediated response to common allergens is the strongest identifiable factor predisposing factor for the development of asthma.(20) About 80% of asthmatic patients suffer from other allergic diseases like allergic rhinitis and atopic dermatitis.(2) Epidemiological study shows that proportion of asthma cases that are attributable to atopy is less than one half.(21)

Classically indoor allergens constitute a greater risk for asthma and its IgE sensitization positively correlated to the frequency and severity of it.(22) Mold spores are significantly related to the hospitalization of asthmatics.(23)(24) Air pollution especially due to higher concentrations of sulphur-dioxide[SO2 ] and particulate matter due to unfavorable meteorological conditions and air stagnation poses risk for asthma.(22)

Prenatal risk factors like diet, nutrition, maternal smoking, stress, use of antibiotics and mode of delivary also contribute to early development of allergy and asthma.(10) Introduction of infant formula instead of breast milk earlier than 14 weeks of age shows increased risk for non- atopic asthma.(25)

Respiratory tract infections with respiratory syncytial virus, rhinovirus, metapneumovirus etc associated with increased risk of developing chronic asthma in children (26) and influenza virus are mostly associated with exacerbations in adults. Atypical bacteria such as mycoplasma pneumonia and Chlamydia pneumonia involved in asthma. (16)

Changes in the structure of gut microbiome[early life antibiotic use] may lead to disruption of normal immune-regulation and thereby causes increased risk of asthma and  allergic diseases.(27)

Obesity increases incidence and prevalence of asthma and reduces asthma control. It is likely to have larger effect on non-allergic asthma. (28) Lung volume and tidal volume is reduced and adipose derived hormones like leptin and adiponectin enhances the systemic inflammation and exacerbate asthma.(29) Its co-morbidities such as dyslipidemia, gastro-esophageal reflux, sleep disordered breathing, type 2 diabetes etc may provoke or worsen asthma.(30) Decrease in physical activity increases asthma prevalence and severity.(31)

Occupational asthma has become common work related respiratory disease in the world and common among adults of working age.(32) Occupational exposure associated with about 1 in 10 cases of adult asthma which includes new onset disease and reactivation of pre-existing one.(33) (34)

Among the respiratory diseases asthmatics show a greater  prevalence of emotional disturbances like anxiety, sadness, hysteria, depression and panic disorders.(35)(36) Depression typically have an impression on asthma by reducing adherence of patients to treatment and follow up.(16) Asthma and these psychological distress mutually potentiate each other through psycho-physiological mediation, asthma trigger exposure, inaccuracy in asthma symptom perception and non-adherence to medical regimen(37) and there by affects quality of life.(38) Post traumatic stress disorder is also a risk factor for development of asthma and worsening of pre-existing asthma.(39).

PATHOPHYSIOLOGY
Genetic disposition and exogenous factors trigger mainly three patho-physiological changes which characterize bronchial asthma. They are bronchial hyper-reactivity, bronchial inflammation and endo-bronchial obstruction.(40) Increase in proliferation of airway smooth muscles, extra cellular matrix protein secretion and myofibroblasts in fibrotic lung tissue.(41)  Airway hyper-reactivity is brought about by several non-specific stimuli like irritants especially pollen and dust, exercise, foods, drugs, stimulants etc. Sensitization to allergens causes degranulation of mast cells with IgE molecules on its surface and release of chemical mediators like histamine, bradykinin and leukotrienes.(42) Thus type 1 hyper-sensitivity reaction ensues. Type 3(delayed) hyper-sensitivity reaction can also lead to asthma. In some persons both reactions may occur.(1) In course of years, the range of allergens become wider and thus making more difficult and impossible for patients to avoid allergens.(28)

Airway inflammation leads to airflow limitation by bronchospasms, mucosal edema and formation of mucus plug. This inflammation persists for several years.  Endo-bronchial obstruction, especially small and medium sized airway is the end product of these patho-physiological phenomena. Severity of asthma depends on the severity of pathology. Eventually this results in reduction of forced expiratory volume in 1s, forced vital capacity, peak expiratory flow and increase in airway resistance.(2)

CLASSIFICATION OF ASTHMA
Bronchial asthma is classified into extrinsic [atopic] and intrinsic [cryptogenic] asthma. In intrinsic variety, external precipitating factors are known and are usually associated with atopic eczema etc. Family history of bronchial asthma can be observed in many cases and has raised level of IgE in serum. Extrinsic variety has better prognosis and usually sets by the age 10-15yrs. Intrinsic asthma occurs by the age 30 and here precipitating causes and raised antibody levels are not seen, but they have tendency to eosinophilia.(1) Although this classification is also has been challenged.(42)

CLINICAL FEATURES
Typical asthmatic symptoms are recurrent episodes of dyspnoea [sometimes at rest], expiratory wheeze, cough and chest tightness usually having an abrupt onset. Asthmatic symptoms are usually brought by coughing or sneezing on allergen exposure. Asthma shows diurnal pattern with aggravation of symptoms and PEF in the morning. Attacks may occur seasonally or during all times of year. Each attack last for several hours if untreated. (1)

In moderately severe cases patient show orthopnoea, increased ventilation, cyanosis and active accessory muscles of respiration.  Patients with hypercapnia or severe cases show greater airway obstruction, high respiratory rate, inability to talk, cyanosis, quiet chest on auscultation, pulsus paradoxus and diminished expansion of chest.(43) The small airway dysfunction can be correlated with worse control of asthma, more number of exacerbations, severe bronchial hyper-responsiveness, presence of nocturnal asthma and exercise induced asthma.(44) Inadequate symptom control, smoking, allergic rhinitis, chronic sinusitis, psychological factors, improper medication, viral infections of upper respiratory tract, gastro-esophageal reflux, occupational factors, climatic variations and disturbed sleep etc. contributes to severe asthmatic exacerbations.(45)

Acute severe asthma
Life threatening medical emergency condition characterized by severe dyspnoea not relieved by using inhalers, cyanosis, wheezing, and dehydration and in a declining state.  Usually it is seen as a complication of asthma, precipitated by infection, allergens or psychological stress. Patient presents with respiratory rate >25/min, PEF >200ml, heart rate >110/min with inability to complete sentence in 1 minute.(1)

Complications
Even though rate of mortality is low, severe asthma can cause respiratory failure and death. Tendency to frequent respiratory infections, pulmonary collapse caused by mucus collection, pneumothorax, mediastinal emphysema and rib fractures due to violent cough etc. Children who have taken cortical steroids for control of asthma may show growth retardation. Frequent infections can lead to emphysema or chronic cor pulmonale.(1)

DIAGNOSIS AND INVESTIGATION OF ASTHMA
Diagnosis of asthma is based on clinical signs and symptoms; history of paroxysmal dyspnoea, cough and auscultatory hallmark of expiratory wheezing over chest. Allergic history, occupational exposure, positive family history and physical examination also helps in diagnosis. (45)

Peak airflow meter- helps in the objective assessment of airflow obstruction and monitoring progression of disease and treatment. It measures peak expiratory flow rate [PEFR]; maximum expiratory flow rate over the first 10 milliseconds during a forced expiration. It is done by blowing out as hard as possible after a maximum inspiration to move the pointer on the calibrated dial of instrument. Normal range is 450-700L/min in men and 300-500L/min in women. Serial PEFR measurement helps in diagnosis of asthma. A diurnal variation of >20% is considered as diagnostic

Pulmonary function tests
Pulmonary function tests are non-invasive tests to know how lungs are functioning. It also helps to diagnosis, identify the severity of pulmonary impairment and monitor the treatment and progress of disease. It measures the lung volumes, capacities, rate of flow, gas exchange etc and compares with normal values adjusted for age, gender, height and ethnicity. It can be assessed using a spirometer.(46)

Spirometry
Spirometry means measuring breath, the most commonly used test for measuring the lung function and magnitude of airway obstruction, specifically the volume/amount and flow/speed of air during respiration.(47) It is the simplest test for all respiratory functions. Spirometry begins with a full inspiration followed by a forceful expiration which empties the lungs rapidly and expiration is continued as long as possible [preferably 6 seconds], followed by full inhalation. It generates pneumotachographs- plots volume and flow of air during each respiration. The flow-volume curves are produced with a positive expiratory limb and a negative inspiratory limb.(46)

Estimated FEV1 and FVC are the important parameters to assess the ventilatory capacity. By assessing the breathing patterns, it can detect the conditions like bronchial asthma, COPD, pulmonary fibrosis etc. thus it helps to diagnose of disease at the earliest, prognosis, assess effect of therapy, monitor lung growth, delineate risk factors etc.(1)

FEV1 [Forced Expiratory Volume in One Second] is the volume of air expelled in the first one second of a forcible expiration after a full inspiration. Normally it is more than 75%. It depends on the effort made by the patient, elastic recoil of lungs and positive thoracic pressure applied by the expiratory muscles. Airway obstruction is indicated by value less than 70%.

FEV1/ FVC measurement (Tiffeneau- Pinelli index) helps to detect obstructive and restrictive lung disease. It is the proportion of a person’s vital capacity that they are able to expire in the first second of forced expiration to full forced capacity, represented as FEV1%. FEV1/FVC > 70%, means restrictive defect as FVC is reduced more than FEV1, seen in interstitial lung diseases like pulmonary fibrosis and chest wall deformities. FEV1/FVC < 70%, indicate obstructive defect as FEV1 is reduced more than FVC, seen in bronchial asthma and chronic obstructive pulmonary disease. Bronchodilator challenge testing is done to differentiate patients with reversible airway obstruction like asthma. A bronchodilator is given and spirometry is repeated after several minutes, increase of FEV1 by 12% and FVC by at least 200ml considered to be positive. Obstructive defects in patients with asthma have reversibility, where as those with COPD typically are not. The average forced expiratory flow rate over middle 50% of the FVC is called mid-expiratory rate [FEF25-75%]. Its reduction of less than 60% of predicted value with normal or low FEV1/FVC ratio confirms airway obstruction.(48)

In flow-volume graph, patients with obstructive lung diseases show reduced expiratory flow shown by a concave appearance to the descending portion of expiratory limb instead of straight line, where as restrictive lung diseases show either convex or linear appearance.(48)

Table 1; Spirometry indices in respiratory diseases

Indices (Units)

Obstruction

Restriction

Normal values

FVC (lts)

120+/- 20%

FEV1 (lts)

120+/- 20%

FEV1/FVC %

Normal

>80%

FEF 25-75ml/s

120+/- 35%

Broncho-provocation testing [BPT] to measure the hyper-responsiveness of airways done by increasing doses of triggering substance are inhaled and FEV1 is measured. The dose which reduces FEV1 by 20% is called provocating dose [PD20%]. The cutoff value for methacholine for this is 8mg/dl. Thus positive response indicates hyper-reactive airways consistent with asthma. It is done in cases with unusual presentations and when Spirometry show no airway obstruction or reversibility. (45)

Exhaled nitric oxide [FeNO] levels are elevated in asthma patients due to increased levels of nitric oxide synthase in the respiratory mucosa. This test is done to measure airway inflammation. It is raised due to eosinophilic inflammation seen in acute airway inflammation, sputum eosinophilia and viral infections of respiratory tract. (45)

Radiological examination helps to rule out other respiratory disease conditions. Acute asthma maybe associated with hyperinflation and lobar collapse, if mucus has occluded the large bronchus.

Elevated serum total IgE levels are usually seen in allergic asthma. Skin prick test helps in assessment of atopy. Total eosinophil count raised in asthma and helps in early detection of exacerbations.(49)

Induced sputum and exhaled breath allow in the non-invasive assessment of airway inflammation and useful in diagnosing and monitoring asthma case. Triggering factors of asthma can be identified by skin prick tests and blood tests for allergic specific IgE. (45)

DIFFERENTIAL DIAGNOSIS
Chronic bronchitis emphysema syndrome [CBES]

  1. Congestive heart failure
  2. Mechanical obstruction to airway
  3. Pulmonary embolism
  4. Vocal cord dysfunction: It is caused by paradoxical adduction of the vocal cords during inspiration which may disappear with panting, speech or laughing. It may exist alone or in association with asthma. Shows normal Spirometry, poor response to asthma medications. Diagnosis can be made using direct laryngoscopy during symptomatic periods.(50)
  5. Tracheal and bronchial lesions- Includes airway tumors like endo-bronchial carcinoid and muco-epidermoid tumors, sub-glottic web or stenosis, tracheal hamartoma, bronchogenic cysts etc. They also exhibit same symptoms of asthma and can be ruled out using x-ray or HRCT.(50).

MANAGEMENT

  • Patient education should be done at the very beginning of diagnosis and treatment. A close interaction between health care providers and patient is necessary. A written asthma action plan should be provided to the patient for self monitoring and how to respond in acute exacerbations.(51) Effective self management education can improve asthma and thus reduce exacerbations. Patients who are educated about management of asthma show improved health and quality of life compared to those not educated.(52)
  • Avoiding the aggravating factors and allergens especially in case of occupational and atopic asthma. Avoidance of sensitizing agents in few instances cured or substantially improved asthma patients. Maintain optimal humidity, prevent mould spores, cleaning house regularly to avoid dusts.
  • Maintain healthy weight; overweight can worsen asthma symptoms.(53)
  • Smoking should avoided
  • Cognitive behavioral therapy improves the quality of life, anxiety levels and asthma control especially in adults.(36)
  • Breathing exercises and Yoga known to be helpful in management of allaying paroxysms.(1) It improves asthma specific health status but not asthma patho-physiology. (20) The mean FEV1, PEFR are improved with yoga breathing exercises. This also reduced the use of inhalers. Usefulness of controlled ventilation exercises should be further investigated.(54) Buteyko breathing exercises can improve symptoms, but not lung function or bronchial responsiveness.(55)
  • Regular exercising can strengthen the lungs and there by relieve symptoms. But exercise induced asthma typically develop clinical features with exercise. Swimming causes increased pulmonary function and lowers the risk of asthma related symptoms.(56)
  • Gastro-oesophagial reflux is a common symptom among asthmatics which triggers bronchospasm and potentiates bronchomotor response . 20-30% has clinically silent GE reflux. Treatment for GE reflux improved asthmatic symptoms(57) and also said not to improve asthma.(58)
  • Vitamin D deficiency is associated with severe asthma exacerbations, so its supplementation may help to prevent exacerbations.(40)(59) Similarly supplementation of vitamin A and C also shown to improve asthma.(60) (61).

APPROACH BY MODERN MEDICINE
Asthma action plans include use of daily controller anti-inflammatory medications, pro-inflammatory environmental exposure minimization, and control of co-morbidities that worsens asthma.(5) Conventional therapy uses inhaled cortico-steroids, long acting bronchodilators [ beta agonists and anticholinergics] theophylline, leucotriene modifiers, anti-immunoglobulin E [IgE] antibodies and anti-IL-5 antibodies.(62) Bronchial thermoplasty used for asthma. (53) Even though, these medications effectively control the symptoms and acute exacerbations of asthma, but not its recurrences.

HOMOEOPATHIC APPROACH
Homoeopathy is therapeutic system based on the principle ‘similia similibus curenteur’. Hahnemann said to treat patient not the disease and considers patient as a whole and not the diseased part. Medicines are selected after detailed case taking on the basis of totality of symptoms. In 5th aphorism Hahnemann describes the significance of case taking in short.(63)

Among the disease classification of Hahnemann, asthma comes under true natural chronic disease caused by the chronic miasms. It also excited by a number of precipitating and maintaining factors and influenced by genetic family history. Asthma can be considered as intermittent disease as it recurs at regular intervals in some patients. Similarly it can be regarded as alternating disease as they sometimes alternates with skin diseases.

Asthma can be caused by psora, syphilis, sycosis or the combinations of these. In 80th aphorism, Hahnemann says ‘the monstrous internal chronic miasm- the psora, the real fundamental cause and producer of all other numerous diseases including asthma and ulceration of lungs etc’. Intermittent tendency of asthma is due to psora and alternating tendency may be due to psora or psora complicated with syphilis.

MIASMATIC EXPRESSION OF BRONCHIAL ASTHMA

PSORA

Usually affects upper respiratory tract. The natural curves of the chest remain unchanged. Respiratory complaints with a sensation of burning and band around the chest, aggravated during winter and from cold and they are ameliorated by warmth in general and appearance of natural discharges. There will be associated anxiety and apprehension.(64)

SYCOSIS

In sycosis, there will be oedematous appearance nose, uvula, tonsils etc. with hypertrophy of nasal turbinate and dilatation of bronchi and bronchioles. Stitching and aching pains usually relieved by pressure. Sycotic asthma usually aggravated in humid moist weather, changes in weather and during rainy seasons with restlessness. Asthma presents with profuse expectoration aggravated in early morning compelling the patient to move about and relieved by lying on the abdomen. Prolonged and teasing cough required to raise a few amount of expectoration (yellow).(64)

SYPHILIS

Syphilitic patient experiences sensation of rawness and soreness; feels worse at night and during the morning. Hoarseness and paroxysmal cough with sticky thread/ pus like putrid expectoration. Dyspnoea before and going to bed or while lying down. (1)

TUBERCULAR

Tubercular patients are poor breathers resulting in labored respiration. Curves and lines of the chest are imperfect (pigeon chest). Chest cannot expand fully as the expansive power of lungs is greatly diminished. Symptoms are worse at night and aggravated from cold air and from milk and relieved by open air and epistaxis. Sensation of mucus stuck in the throat with tickling.  Dry, deep and prolonged coughs induce headaches or whole body is shaken by explosive paroxysms. Dyspnoea present on ascending stairs with weakness and debility.(1)  (65).

RELATED STUDIES IN HOMOEOPATHY
A review of clinical research works of the Central Council of Homoeopathy in the field of asthma concluded that the evidences on the usefulness of Homoeopathy in bronchial asthma are limited,(3) but Homoeopathy helps to control the acute episodes of asthma, reduce the frequency and intensity of exacerbations, wean from bronchodilators and prevent accelerated decline in liver function overtime.(4)

The outcome of the study done by Dr. Parth Aphale in 2018, concluded that the medicines Ars.Alb, Spongia, Pulsatilla are effective in the managing the acute attacks and recurrent exacerbations of asthma. Among them Arsenicum album was most effective one.(5)

A retrospective evaluation study on the results of homoeopathic treatment conducted by Eizayagas, in 62 bronchial asthma patients showed very significant statistical improvement.(6)

An open label study on the role of homoeopathy in the management of bronchial asthma, based on Spirometry evidence in 2019, by Dr. Farokh J Master concluded that homoeopathy has an important role in treating chronic and seemingly difficult condition of asthma with minimizing the future risk. The study also showed that FEV1 values significantly increased during and post treatment. Among the constitutional remedies used in treatment, Kali carb was maximally used followed by Arsenicum alb and Pulsatilla.(7)

A study on the effect of homoeopathic medicines in absolute eosinophil count among allergic bronchial asthma patients concluded that constitutional homoeopathic remedy produced more effect. Pulsatilla & Kali.Carb were the most indicated. Age group between 45-55years had maximum number of cases.(8)

The study on the efficacy of homoeopathic treatment in modulation of immunoglobulin E (IgE) levels in bronchial asthma demonstrated the reduction in the IgE and Absolute Eosinophil Count level and improvement in pulmonary functions along with clinical improvement in bronchial asthma under homoeopathic treatment. Sulphur, Arsenicum album and Pulsatilla were found to be more effective in reducing IgE in this study. (9)

REPERTORIAL REPRESENTATION

KENT’S REPERTORY (72)

RESPIRATION – ASTHMATIC

Acon. Agar. all-c. aloe alum. AMBR. Am-c. anac. ant-c. Ant-t. Apis ARG-N. arn. ARS. ARS-I. arum-t. Asaf. asar. Aur. Bar-c. bar-m. Bell. Blatta-a. Bov. Brom. Bry. Cact. Calad. Calc. camph. Cann-s. Caps. carb-an. carbn-s. Carb-v. card-m. caust. cham. chel. Chin. Chinin-ar. Chlol. Cic. cina cist. cocc. coc-c. Coff. Colch. coloc. Con. croc. Crot-h. crot-t. CUPR. daph. Dig. Dros. Dulc. eup-per. Euph. Ferr. Ferr-ar. ferr-i. ferr-p. Gels. Graph. grat. grin. Hep. Hippoz. hydr-ac. hyos. Ign. Iod. IP. KALI-AR. Kali-br. KALI-C. Kali-chl. Kali-i. KALI-N. Kali-p. Kali-s. lac-d. Lach. lact. Laur. Led. LOB. Lyc. manc. Med. meny. Meph. merc. mez. Mosch. Naja nat-act. nat-c. Nat-m. nat-p. Nat-s. Nit-ac. nux-m. Nux-v. ol-an. Op. par. petr. phel. Phos. Phyt. plat. plb. podo. Psor. PULS. ran-s. raph. rhod. rumx. Ruta sabin. SAMB. Sang. sars. sec. sel. Seneg. Sep. SIL. sin-n. spig. SPONG. squil. Stann. Still. STRAM. stront-c. SULPH. Sul-ac. Thuj. Verat. verat-v. viol-o. viol-t. zinc.

RESPIRATION – ASTHMATIC – morning

Aur. Calc. carb-an. Carb-v. Coff. Con. dig. KALI-C. Meph. phos. Verat. zing.

RESPIRATION – ASTHMATIC – evening

bell. Cist. ferr. nux-v. Phos. PULS. stann. Sulph. Zinc.

RESPIRATION – ASTHMATIC – night

am-m. Ant-c. ARS. aur. Brom. bry. Carb-v. CHEL. Chlol. Cist. coff. coloc. daph. Dig. Ferr. ferr-ar. Ip. kali-ar. Kali-c. lach. Meph. nux-v. Op. phos. PULS. sang. Sep. Sulph. Syph. Thuj. zinc.

RESPIRATION – ASTHMATIC – midnight,after

ARS. calc-ar. Carb-v. Ferr. ferr-ar. Graph. Lach. SAMB.

RESPIRATION – ASTHMATIC – change of weather

Ars. chel. dulc.

RESPIRATION – ASTHMATIC – cold,from taking

acon. dulc. Lob. Podo. Puls. sil. SPONG. Stann.

RESPIRATION – ASTHMATIC – emotions,after

Acon. ambr. cham. Coff. cupr. Gels. Ign. nux-v. pall. verat.

RESPIRATION – ASTHMATIC – eruptions,after suppressed

Apis Ars. Carb-v. Dulc. Ferr. hep. Ip. Psor. PULS. sec. Sulph.

RESPIRATION – ASTHMATIC – hay asthma

Ambro. Ars. Ars-i. Bad. Carb-v. Dulc. Euphr. IOD. Kali-i. Lach. Naja Nat-s. Nux-v. Op. Sabad. Sil.

Sin-n. Stict.

RESPIRATION – ASTHMATIC – hysterical

MOSCH. NUX-M. Nux-v. phos. PULS. stann. stram. sulph.

RESPIRATION – ASTHMATIC – periodic

all-s. Alum. ant-t. ARS. Asaf. Carb-v. Chel. Hydr-ac. nux-v. Phos. Plb. Seneg. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – spasmodic

am-c. Ant-t. arg-n. ARS. Asaf. Bell. Cact. caust. Cocc. coff. con. Cupr. Dros. Ferr. ferr-p. Gels. Graph. Hydr-ac. Hyos. IP. Kali-br. Kali-c. Lach. laur. led. LOB. Mag-p. Meph. merc. Mez. Mosch. Nux-v. Op. ph-ac. phos. Plb. Puls. raph. samb. Sars. Sep. SPONG. Stram. sulph. Sumb. Tab. VALER. zinc.

SYNTHESIS REPERTORY (73)

RESPIRATION – ASTHMATIC

abies-c. acet-ac. acetan. acetylch. Acon. acon-ac. adam. Adren. Agar. agath-a. alco. alis-p. all-c. aloe alum. alum-p. alum-sil. Am-c. AMBR. aml-ns. ammc. amyg. anac. ant-ar. ant-c. ant-i. ant-s-aur. Ant-t. Apis aral. arg-cy. ARG-N. arist-cl. arn. ARS. ARS-I. arum-d. arum-m. arum-t. Asaf. asar. asc-c. asc-t. Aspidin. asthm-r. Aur. aur-i. aur-m. Aur-m-n. aur-s. bac. bacls-10. bacls-7. Bar-c. bar-i. bar-m. bar-s. Bell. benz-ac. Bit-ar. Blatta-a. blatta-o. Bov. Brom. Bry. Cact. Calad. Calc. calc-ar. calc-hp. calc-i. calc-ln. calc-s. calc-sil. camph. Cann-s. Caps. carb-an. Carb-v. carbn-s. carc. card-m. cassia-s. caust. cham. chel. chen-a. Chin. Chinin-ar. chinin-s. Chlol. Chlor. Cic. cina cist. coc-c. coca cocc. coch. coenz-q. Coff. Colch. coloc. Con. cordyc. cortiso. coxs. croc. Crot-h. crot-t. cumin. CUPR. Cyt-l. daph. der. des-ac. Dig. digin. Dros. Dulc. eos. ephe. erio. eucal. eup-per. Euph. euph-hi. euph-pi. fel Ferr. Ferr-ar. ferr-i. ferr-p. form-ac. fuma-ac. gad. gal-ac. galph. galv. Gels. Graph. grat. grin. hed. Hep. Hippoz. hist. hydr. hydr-ac. hyos. hyper. hypoth. iber. ictod. Ign. Iod. IP. junc-e. KALI-AR. kali-bi. Kali-br. KALI-C. Kali-chl. kali-chls. kali-cy. Kali-i. kali-m. KALI-N. Kali-p. Kali-s. kali-sil. kola lac-d. lac-e. Lach. lact. lact-v. Laur. Led. lem-m. limen-b-c. linu-u. LOB. lob-s. luf-op. Lyc. lyss. magn-gl. mal-ac. manc. mang. Med. meny. Meph. merc. merc-d. merc-i-r. mez. mill. morg. morg-g. morg-p. Mosch. mut. Naja naphtin. nat-ar. nat-c. Nat-m. nat-ox-act. nat-p. Nat-s. nig-s. Nit-ac. nux-m. Nux-v. oci-sa. ol-an. ol-j. onis. Op. osm. par. Passi. pect. penic. pert. petr. ph-ac. phel. Phos. phos-pchl. Phyt. pisc. pitu-p. plat. plb. plb-xyz. podo. pop-cand. positr. pseuts-m. Psor. ptel. pulm-v. PULS. pycnop-sa. queb. ran-s. raph. rhod. rhus-t. rumx. Ruta sabad. sabin. SAMB. samb-c. Sang. sangin-n. sanic. saroth. sars. sec. sel. Seneg. Sep. SIL. silphu. sin-n. sol-x. spig. SPONG. squil. Stann. stict. Still. STRAM. stront-c. stry-xyz. succ. succ-ac. succ-xyz. Sul-ac. sul-h. sul-i. sulfa. SULPH. sumb. syc. syph. tab. ter. thala. Thuj. thymu. trach-xyz. trios. tub. uncar-tom. vario. Verat. verat-v. verb. viol-o. viol-t. visc. wye. x-ray xan. zinc. zinc-p. zinc-val. zing. ziz.

RESPIRATION – ASTHMATIC – morning

Aur. Calc. carb-an. Carb-v. carc. Cassia-s. Coff. Con. dig. KALI-C. Meph. nux-v. phos. Verat. zing.

RESPIRATION – ASTHMATIC – evening

bell. bit-ar. Cist. ferr. Kali-s. nat-m. nat-p. nux-v. petr. Phos. PULS. stann. Sulph. Zinc.

RESPIRATION – ASTHMATIC – night

am-m. Ant-t. Arg-n. ARS. ars-s-f. arum-d. aur. aur-ar. bit-ar. Brom. bry. calc-ar. Carb-v. carc. cham. CHEL. Chlol. Cist. coff. coloc. daph. des-ac. Dig. Ferr. ferr-ar. Ip. kali-ar. Kali-c. Kali-s. lach. limen-b-c. meph. naja nux-v. Op. phos. PULS. Samb. sang. Sep. spong. Sulph. Syph. Thuj. Tub. zinc. zinc-p.

RESPIRATION – ASTHMATIC – bronchial

ant-t. arist-cl. ARS. bar-c. bell. Bry. Calc. Camph. CHIN. con. cortiso. Cupr. cupr-ar. DULC. Ferr. Graph. hed. hep. hippoz. Influ. ip. Lach. merc. nux-v. Phos. PULS. SENEG. SEP. sil. STANN. Sulph. zinc.

RESPIRATION – ASTHMATIC – eruptions, after suppressed

ant-c. Apis Ars. calc. Carb-v. cupr. Dulc. Ferr. graph. hep. Ip. mez. Psor. PULS. rhus-t. sec. Sulph.

RESPIRATION – ASTHMATIC – flatulence, from

Carb-v. Cham. Chel. Chin. Lyc. mag-p. Nux-v. op. phos. Sulph. zinc.

RESPIRATION – ASTHMATIC – hay; from

Ambr. Ars. Ars-i. arum-t. Bad. Carb-v. Dulc. Euphr. IOD. Kali-i. kali-s-chr. Lach. lob. Naja Naphtin. Nat-s. Nux-v. Op. phle. Sabad. sang. Sil. Sin-n. Stict. sul-i.

RESPIRATION – ASTHMATIC – hysterical

acon. ambr. asaf. aur. bell. caul. caust. cham. cocc. coff. con. cupr. ign. ip. Lach. MOSCH. NUX-M. nux-v. phos. PULS. stann. stram. sulph.

RESPIRATION – ASTHMATIC – periodical

all-s. Alum. ant-t. ARS. Asaf. Carb-v. Chel. chin. chinin-ar. Hydr-ac. ip. nux-v. Phos. Plb. Seneg. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – sitting upright amel.

Ars. kali-c.

RESPIRATION – ASTHMATIC – smoking – after

asc-t. NAT-AR.

RESPIRATION – ASTHMATIC – sudden attacks

Acon. Ant-t. Ars. bell. bry. CAMPH. Cham. chin. cupr. ip. Lach. MOSCH. nux-m. nux-v. OP. pitu-a. puls. Samb.

RESPIRATION – ASTHMATIC – weather – change of

Ars. Cassia-s. chel. dulc. hyper. pitu-a.

RESPIRATION – ASTHMATIC – weather – cold

Hep.

RESPIRATION – ASTHMATIC – weather – cold – wet

ant-t. aur. DULC. Med. Nat-s. thuj. verat.

MIND – ANXIETY – asthma; with

Arg-n. ars. Dig. hydr-ac. kreos. m-ambo. plat.

HOMOEOPATHIC MEDICAL REPERTORY – MURPHY (12)

Lungs – ASTHMA, general

Carb-v. CARC. card-m. caust. cham. chel. Chin. Chinin-ar. Chlol. chlor. Cic. cina cist. coc-c. Coca cocain. cocc. Coff. Colch. coloc. Con. croc. Crot-h. crot-t. CUPR. Cupr-act. cupr-ar. daph. Dig. Dros. Dulc. eup-per. Euph. Ferr. Ferr-ar. ferr-i. ferr-p. gal-ac. Gels. glon. Graph. grat. grin. Hep. Hippoz. hydr-ac. hyos. ictod. Ign. ille. Iod. IP. KALI-AR. Kali-bi. Kali-br. KALI-C. Kali-chl. Kali-i. KALI-N. Kali-p. Kali-s. Kola lac-d. Lach. lact. Laur. Led. lem-m. LOB. Lyc. magn-gr. manc. Med. meny. Meph. merc. merc-i-r. mez. morph. Mosch. Naja Naphtin. nat-act. nat-c. Nat-m. nat-p. NAT-S. Nit-ac. nux-m. Nux-v. ol-an. Op. par. petr. phel. Phos. Phyt. plat. plb. podo. Psor. ptel. PULS. queb. ran-s. raph. rhod. rumx. Ruta sabad. sabin. SAMB. Sang. sars. scroph-n. sec. sel. Seneg. Sep. SIL. sin-n. spig. SPONG. squil. Stann. Still. STRAM. stront-c. stry. Sul-ac. SULPH. syc. syph. tab. tela ter. Thuj. tub. vario. Verat. verat-v. viol-o. viol-t. VISC. xan. zinc. zinc-m. Zing.

Lungs – ASTHMA, general – allergic, hay fever, with

ALL-C. Ambr. apis aral. ARS. Ars-i. arum-t. Bad. Carb-v. CARC. chinin-ar. chlor. Dulc. Euphr. IOD. Ip. Kali-i. Lach. linu-u. Lob. Med. Naja naphtin. Nat-s. Nux-v. ol-an. Op. phle. Sabad. sang. sep. Sil. Sin-n. Stict. sul-i. sulph. THUJ. tub.

Lungs – ASTHMA, general – allergic, hay fever, with – sneezing, with

ALL-C. Ars. Carb-v. Dulc. Euphr. lach. Naja Nat-s. Nux-v. sin-n. stict.

Lungs – ASTHMA, general – alternating, with – eruptions

Ars. Calad. caust. Crot-t. dulc. graph. Hep. Kalm. lach. mez. mut. Psor. rat. rhus-t. Sulph.

Lungs – ASTHMA, general – anxiety, with

Arg-n. ARS. Dig. Kali-ar.

Lungs – ASTHMA, general – coughing, asthmatic

Acon. Alum. Am-c. am-m. ambr. anac. ANT-T. aral. arg-n. arn. ARS. Ars-i. asaf. aspar. bar-c. bar-m. Bell. Brom. bry. calad. calc. calc-s. carb-an. Carb-v. carbn-s. caust. cham. Chin. chinin-ar. chlor. cic. CINA coc-c. cocc. con. cor-r. croc. Crot-t. CUPR. dig. dol. DROS. dulc. Euph. euphr. ferr. ferr-ar. ferr-i. ferr-p. guaj. Hep. hyos. ign. iod. IP. Kali-ar. Kali-bi. Kali-c. kali-chl. kali-n. kali-p. Kreos. Lach. lact. laur. Led. lob. lyc. merc. mez. mosch. mur-ac. nat-m. nat-s. nicc. nit-ac. Nux-m. NUX-V. op. petr. phel. Phos. prun. psor. Puls. rhus-t. sabad. Samb. Sang. Sep. Sil. spig. Spong. squil. stann. Stram. sul-ac. sulph. verat. viol-o. zinc. zing.

Lungs – ASTHMA, general – eruptions, after suppressed

Apis Ars. calad. Carb-v. Dulc. Ferr. hep. Ip. Psor. PULS. sec. Sulph.

Lungs – ASTHMA, general – wet, weather, in

Aur. carc. Chin. con. DULC. NAT-S. sil. Thuj. verat.

Lungs – ASTHMA, general – wheezing

ail. all-c. aloe Alum. am-c. Ambr. Ant-t. Apoc. aral. arg-n. ARS. Ars-i. Brom. calad. calc. calc-s. Cann-s. Caps. CARB-V. carbn-s. card-m. Cham. Chin. Chinin-ar. chlol. Cina crot-t. Cupr. dol. Dros. erio. ferr. ferr-i. Fl-ac. graph. Grin. hep. hydr-ac. Iod. iodof. IP. just. Kali-ar. Kali-bi. KALI-C. Kali-s. Lach. LOB. Lyc. Lycps-v. manc. merc. murx. naja Nat-m. Nat-s. Nit-ac. Nux-m. nux-v. ox-ac. phos. prun. sabad. Samb. sang. sanic. seneg. sep. spong. squil. stann. sulph. Syph.

Lungs – ASTHMA, general – dust, from inhaling

Blatta-o. brom. ictod. Ip. kali-c. pot-a. Sil.

BOENNINGHAUSEN’S CHARACTERISTICS AND REPERTORY BY BOGER (13)

RESPIRATION – Asthma

ACON. Am-c. Ambr. ant-c. Ant-t. ARS. Aur. BELL. BRY. Calc. CAMPH. CARB-V. caust. Cham. CHIN. Cocc. coff. CUPR. Dulc. FERR. HYOS. ign. IP. KALI-C. LACH. lyc. merc. Mosch. Nit-ac. nux-m. NUX-V. Op. PHOS. PULS. SAMB. sep. Sil. stann. STRAM. SULPH. Verat. ZINC.

RESPIRATION – Asthma – attack, during

ACON. ANT-T. ARS. bell. bry. CAMPH. CHAM. chin. IP. LACH. MOSCH. nux-m. Nux-v. OP. Puls. SAMB.

RESPIRATION – Asthma – bronchial

Ant-t. ARS. bar-c. bell. BRY. CALC. CAMPH. CHIN. con. CUPR. DULC. FERR. GRAPH. Hep. Ip. LACH. merc. nux-v. PHOS. PULS. SENEG. SEP. Sil. STANN. SULPH. zinc.

RESPIRATION – Asthma – recurrence against

Am-c. ANT-C. ARS. CALC. carb-v. Caust. Cupr. ferr. graph. KALI-C. Lach. lyc. NIT-AC. NUX-V. Phos. sep. Sil. Stann. SULPH. zinc.

RESPIRATION – Asthma – spasmodic

ant-c. ANT-T. arg-n. Ars. BELL. bry. camph. Caust. COCC. CUPR. ferr. HYOS. KALI-C. LACH. lyc. MOSCH. NUX-V. op. SAMB. Sep. Stann. STRAM. SULPH. ZINC.

RESPIRATION – Asthma – thymic

ACON. Am-c. ambr. ANT-T. asaf. aur. BELL. CON. cupr. ferr. HEP. ign. IP. Lach. MERC. Phos. SENEG. SPONG. VERAT. Zinc.

RESPIRATION – Expiration – difficult

Chlor. IP. meph. Viol-o.

BOERICKES REPERTORY (14)

RESPIRATORY SYSTEM – Respiration – Wheezing

alum. am-c. ant-i. Ant-t. aral. Ars. cann-s. carb-v. card-m. erio. Grin. Hep. iod. iodof. Ip. just. kali-bi. Kali-c. lob. lycps-v. nux-v. prun. Samb. seneg. Spong.

COMPLETE REPERTORY(15)

RESPIRATION – ASTHMATIC

abel. acetan. ACON. acon-f. act-sp. adam. adon. adren. aesc. aeth. AGAR. ail. alco. ald. all-c. all-s. aloe alth. alum. alumin-p. alumin-sil. alumn. AM-C. am-i. am-m. AMBR. ambro. aml-ns. ammc. amyg. anac. ang. anh. anis. ant-ar. ant-c. ant-i. ANT-T. apis APISIN. aral. aran-ix. arg-cy. arg-met. ARG-N. arist-cl. arn. ARS. ARS-I. ars-s-f. arum-d. arum-dru. arum-m. arum-t. ASAF. ASAR. asc-i. asc-t. aster. astra-e. atro-pur. AUR. aur-ar. aur-i. AUR-M-N. aur-s. bac. BACLS-10. bad. bapt. BAR-C. bar-i. bar-m. bar-s. BELL. bell-p. benz-ac. blatta-a. BLATTA-O. boerh-d. bomb-pr. borx. BOV. brom. BRY. buni-o. CACT. CALAD. CALC. calc-ar. calc-hp. calc-i. calc-lac. calc-s. CALC-SIL. calth. camph. cann-i. CANN-S. CAPS. carb-an. CARB-V. carbn-s. carc. card-b. card-m. castor-eq. caust. cedr. cetr. cham. chel. chen-a. CHIN. CHININ-AR. chinin-s. CHLOL. chlor. chlorpr. CIC. cimic. CINA cist. coc-c. COCA cocain. cocc. coch. COFF. coffin. COLCH. coll. coloc. con. conv. crat. croc. CROT-H. crot-t. CUPR. CUPR-ACT. cupr-ar. CYCL. cyt-l. daph. der. DIG. digin. DROS. DULC. elmen ephe. equis-a. ERIO. EUCAL. eup-per. EUPH. euph-pi. euphr. fel FERR. ferr-act. FERR-AR. ferr-i. ferr-p. form. form-ac. fuc. fum. gad. gal-ac. galeo. galv. GELS. gins. glech. glon. glycyr-g. GRAPH. grat. grin. guaj. guare. hed. hedeo. helodr-cal. HEP. HIPPOZ. hydr. hydr-ac. hydrc. HYOS. hyper. hyss-o. iber. ictod. IGN. imp. IOD. iodof. IP. JAB. jatr-u. junc-e. juni-c. just. KALI-AR. KALI-BI. KALI-BR. KALI-C. KALI-CHL. kali-chls. kali-cy. kali-fcy. KALI-I. kali-m. KALI-N. KALI-P. KALI-S. kali-s-chr. kali-sil. kalm. KOLA KREOS. kres. lac-c. lac-d. lac-e. LACH. lact-v. LAUR. LED. lem-m. levo. lil-t. limen-b-c. linu-u. lipp. LOB. lob-p. lob-s. LYC. lycpr. lycps-v. m-arct. M-AUST. mag-p. magn-gl. magn-gr. manc. mang. mang-act. marr. MED. melis. menth. mentho. meny. MEPH. merc. merc-cy. merc-i-f. merc-pr-r. mez. mill. moni. morg-g. morg-p. morph. MOSCH. mut. NAJA napht. NAPHTIN. narc-ps. nat-ar. NAT-C. NAT-M. nat-n. nat-p. NAT-S. nat-sil. NIT-AC. nuph. NUX-M. NUX-V. oci-sa. oena. oeno. ol-an. ol-j. onis. OP. orig. osm. ox-ac. oxyg. pall. par. pareir. parth. passi. PECT. petr. ph-ac. phel. phenob. phle. PHOS. phos-m. PHYT. pimp. pitu-a. plan-l. plat. plb. plb-i. plut-n. podo. polyg-a. polyg-h. polygl-a. pop-cand. prim-v. pseuts-m. PSOR. ptel. pulm-v. PULS. queb. querc-r. RAN-B. ran-s. raph. rat. rhod. rhus-g. RHUS-T. rumx. RUTA SABAD. sabal sabin. SAMB. samb-c. SANG. sangin-n. sanic. sars. scroph-n. sec. sel. SENEG. SEP. SIL. silphu. sin-n. sol-in. solid. SPIG. SPONG. SQUIL. STANN. STAPH. stict. STILL. STRAM. stront-c. stroph-h. stry-n. stry-xyz. succ. SUL-AC. sul-h. SUL-I. sulo-ac. SULPH. sumb. SYC. syph. tab. tax. tela ter. tet. teucr. teucr-s. THUJ. thymu. thymu-vg. thyreotr. trach. trif-p. trios. tub. tub-a. tus-fa. v-a-b. valer. vario. VERAT. verat-v. verb. vero-o. vib. viol-o. viol-t. VISC. wye. xan. zinc. zinc-phic. zinc-val. ZING. ziz.

RESPIRATION – WHEEZING

acon. adam. agar. ail. aloe ALUM. alumin-p. alumin-sil. AM-C. AMBR. anac. ang. ANT-T. APOC. aral. arg-met. arg-n. arn. ARS. ARS-I. ars-s-f. ASAF. ASTRA-E. AUR. BAC. BELL. bov. BROM. bry. buni-o. calad. calc. calc-s. camph. CANN-S. CAPS. carb-an. CARB-V. carbn-s. card-m. caust. CHAM. CHIN. CHININ-AR. chlol. chloram. CIC. CINA COCC. coloc. con. croc. crot-t. CUPR. cycl. DIG. dol. DROS. dulc. erio. euphr. ferr. ferr-i. FL-AC. form. graph. GRIN. hell. helo. helodr-cal. hep. hydr-ac. hydrog. HYOS. ign. IOD. iodof. IP. just. KALI-AR. KALI-BI. KALI-C. KALI-I. kali-m. kali-n. KALI-S. kreos. lac-e. LACH. laur. LED. limen-b-c. limest-b. lob. LYC. LYCPS-V. m-ambo. m-aust. manc. merc. mez. mosch. mur-ac. murx. naja nat-c. NAT-M. NAT-N. NAT-S. neon NIT-AC. NUX-M. nux-v. op. ox-ac. par. ph-ac. phos. PLB. prun. PULS. pyrog. ran-b. ran-s. RHOD. rhus-t. ruta sabad. sabin. SAMB. sang. sanic. sars. SENEG. sep. SIL. sol SPONG. squil. stann. staph. stram. sul-ac. sul-i. sulo-ac. sulph. syc. SYPH. teucr. THUJ. tung-met. VERAT. vero-o. VISC. ZINC.

RESPIRATION – ASTHMATIC – night

am-m. ANT-T. aral. ARG-N. ARS. ars-i. ars-s-f. arum-d. aur. aur-ar. BROM. bry. CARB-V. carc. cham. CHEL. CHLOL. CIST. coff. coloc. con. daph. DIG. FERR. ferr-act. ferr-ar. grin. IP. kali-ar. KALI-C. lach. limen-b-c. MEPH. merc-pr-r. naja nux-v. OP. pect. phos. pitu-a. PULS. samb. sang. SEP. stict. stram. SULPH. SYPH. THUJ. zinc. zinc-phic.

RESPIRATION – ASTHMATIC – periodic

all-s. ALUM. ant-t. ARS. ASAF. CARB-V. CHEL. CHIN. chinin-ar. cist. HYDR-AC. ign. ip. nux-v. parth. PHOS. PLB. SENEG. sulph. tab. thuj.

RESPIRATION – ASTHMATIC – eruptions – suppressed, after

acon. AMMC. APIS ARS. calc. CARB-V. cupr. DULC. elmen FERR. hep. IP. med. mez. PSOR. ptel. PULS. sec. SULPH. verat.

RESPIRATION – ASTHMATIC – sitting – up amel.

ant-t. aral. ars. ARS-I. bar-m. BROM. crot-t. FERR. ferr-act. HEP. ip. kali-bi. kali-c. KALI-N. lach. lact-v. meph. parth.

RESPIRATION – ASTHMATIC – sleep – during, coming on

ACON. am-c. ARS. CARB-V. GRIN. HEP. KALI-C. lac-c. LACH. meph. merc-pr-r. nat-s. op. samb. sep. SULPH.

RESPIRATION – ASTHMATIC – hay asthma

ail. all-c. ambro. ARAL. ARS. ARS-I. arum-t. BAD. bomb-pr. camph. CARB-V. carc. caust. chinin-ar. chlor. cycl. DULC. eucal. euph. euph-pi. EUPHR. gal-ac. GELS. GLYCYR-G. grin. hydr-ac. IOD. IP. kali-bi. kali-fcy. KALI-I. KALI-P. kali-s-chr. LACH. LOB. lob-p. med. moni. mosch. NAJA napht. naphtin. nat-m. NAT-S. nuph. NUX-V. ol-an. OP. phle. plb. psor. PULS. SABAD. sang. sep. SIL. SIN-N. STICT. sul-i. ter. tub.

RESPIRATION – ASTHMATIC – recurrent

am-c. ANT-C. ARS. CALC. carb-v. caust. cupr. ferr. graph. KALI-C. lach. lyc. MED. NAT-S. NIT-AC. NUX-V. phos. sep. sil. stann. SULPH. zinc.

CONCISE REPERTORY- PHATAKS (16)

A – Asthma; bronchial

acon. ambr. arg-n. ARS. ars-i. cupr. Ip. kali-ar. Kali-c. kali-n. Lach. Lob. merc-i-r. Nux-v. PULS. Samb. Sil. SPONG. stann. stram. sulph. tab. ter. thuj. tub. visc.

THERAPEUTICS

ARSENICUM ALBUM
One of the great remedies in asthma, whether acute or chronic with aggravation after midnight and lying down and greatly relieved by cough with expectoration of mucus.(17) Breathing : asthmatic causes patient to sit or bend forward; springs out of bed at night, especially after twelve o’clock; unable to lie down for fear of suffocation; attacks like croup instead of the usual urticaria.(18) Asthma with constriction of chest and anguish.(81) Unable to lie down; fears suffocation. Air-passages constricted, burning as if coals of fire were in chest, suffocative catarrh.(82) Expectoration scanty, frothy. Darting pain through upper third of right lung. Wheezing respiration. Haemoptysis. Pain between shoulders; burning heat all over. Cough dry, as from sulphur fumes; after drinking, (76)

SULPHUR
Suffocative attacks, wants the doors and windows open; becomes suddenly wide awake at night and drowsy in afternoon after sunset followed by wakefulness the whole night. Complaints that are continually relapsing; patient seems to get almost well when the disease returns again and again.  Oppression as of a load on chest with burning sensation in chest, heat throughout chest. Loose cough with much rattling of mucus < talking, morning. Greenish purulent or sweetish expectoration. Chest feels heavy; stitches, with heart feeling too large and palpitating. Stitching pains shooting through to the back, <lying on back or breathing deeply.  Dyspnoea appears in middle of night, relieved by sitting up.(76)

PULSATILLA
Dry cough in the evening and at night; must sit up in bed to get relief; and loose cough in the morning, with copious mucus expectoration. Pressure upon chest and soreness. Urine emitted with cough. Expectoration bland, thick, bitter, greenish. Shortness of breath, anxiety and palpitation when lying on left side. Smothering sensation when lying down. (76) Thirstlessness with nearly all complaints. Chilly in warm room. (80) Chest oppressed as by a load. Hoarseness comes and goes. Asthma from suppressions. Cough after measles. (78)

NATRUM MURIATICUM
Cough with tickling in the pit of stomach, accompanied by stitches in liver and spurting of urine. Stitches over chest. Cough with bursting pain in head. Shortness of breath, on going upstairs. Flow of tears with cough.  Bad effects of grief, fright, anger etc. Depressed particularly in chronic disease. Consolation aggravates. Dry mucus membranes. (76)  respiratory catarrh after suppressed sweats. (78) Hay fever with squirming sensation in the nostrils, as of a small worm.(80)

SILICEA
Sputum persistently muco-purulent and profuse. Slow recovery after pneumonia. Cough and sore throat, with expectoration of little granules like shot, smells offensive. Cough with expectoration in day, bloody or purulent. Stitches in chest through back. Violent cough especially when lying down, with thick yellow lumpy expectoration; suppurative stage. Inveterate cases of catarrh with asthmatic wheezing. Humid asthma with coarse rattling. Chest seems to be filled with mucus which seems as if he would suffocate. Especially asthma of old sycotics or in children of sycotic parents. Dry teasing cough with hoarseness. Fine dust causes chronic irritation. Chronic tendency for colds to settle in the chest and bring on asthmatic symptoms.(82)

PHOSPHORUS
Cough due to  tickling in throat, which is worse from cold air, reading, laughing, talking and going from warm room in to cold air. Sweetish taste while coughing. Hard dry tight racking cough. Congestion of lungs. Burning pains, heat and oppression of chest. Tightness across chest; great weight on chest. Respiration quickened oppressed. Much heat in chest, worse lying on left side. Sputa rusty blood colored or purulent. Useful remedy in old bronchial catarrh, in complaints that date from pneumonia or from bronchitis. Every cold settles in the chest.(82)

LACHESIS
Sensation of suffocation and strangulation on lying down, compels patient to spring from bed and rush for open window. Feels he must take a deep breath. Cramp like distress in pre-cordial region. Cough; dry suffocative fits, tickling. Breathing almost stops on falling asleep.For the bad effects of long lasting grief; sorrow, fright, vexation, jealousy or disappointed love. Diseases begin in left goes to right. Aggravation after sleep. (80)

CALCAREA CARBONICUM
Hahnemann’s great anti-psoric. Tickling cough troublesome at night and free expectoration in morning. Persistent irritating cough from arsenical wall paper. Extreme dyspnoea. Painless hoarseness, worse in the morning. Expectoration only during day; thick, yellow, sour mucus. Bloody expectoration; with sour sensation in chest, worse going upstairs, slightest ascent, must sit down. Longing for fresh air. Scanty salty expectoration. (76)

SEPIA
Dyspnoea worse from sitting, after sleep, in room and relieved while dancing or walking rapidly. Dry fatiguing cough apparently coming from stomach. Rotten egg taste with coughing. Oppression of chest morning and evening. Cough in morning with profuse salty expectoration, excited by tickling in larynx or chest. (76) Asthma < rapid change of temperature and > pressure of hand.(78)

BRYONIA
Irritable, angry and vehement people. Complaints < by motion, inspiration, coughing; > absolute rest and lying on painful side. Cough dry hard racking with scanty expectoration. Complaints when warm weather sets in after cold days; from cold drinks; after taking cold or getting hot in summer; from chilling when overheated; suppressed discharges. (80) Cough dry at night; must sit up; worse after eating or drinking with vomiting and stitches in chest. Rusty colored sputa. Frequent desire to take a long breath to expand the lungs. Coming into warm room excites cough. (76)

LYCOPODIUM
Deep seated progressive chronic diseases. Affects right side. Ailments from fright, anger, mortification, vexation with reserved displeasure. Cough deep and hollow even raising mucus in large quantities which affords little relief. (80) Cough worse when going downhill. Gray thick bloody purulent salty expectoration. Night cough as from sulphur fumes. Better by warm food and drinks, on getting cold, from being uncovered.(76)

IPECAC
Asthma, yearly attacks of difficult shortness of breathing. Cough incessant and violent, with every breath. Suffocative cough which causes the child becomes stiff and blue in the face. Dyspnoea with constant constriction in chest. Continued sneezing, coryza; wheezing cough.(76) Cough dry, spasmodic, asthmatic, constricted. Difficulty in breathing from least exercise with violent dyspnoea,  wheezing and anxiety about the stomach. < winter and dry weather; slightest motion. (80)

KALI CARBONICUM
Asthma relieved by sitting up or bending forward or by rocking; worse from 2-4am. (80) Dry hard cough with stitches in chest. Pain in chest, worse lying on right side. Whole chest is over sensitive. Scanty tenacious expectoration. Coldness of chest. Better in warm climate. (76)

NATRUM SULPHURICUM
Dyspnoea desire to take a long breath during damp cloudy weather. Humid asthma in children; with every change to wet weather; worse in damp rainy weather; sputa green and copious. Lower lobe of left lung is affected. Great soreness  of chest, during cough, has to sit up in bed and the chest with both hands. (80) Constant desire to take deep long breath. Constitutional remedy in asthma. Every fresh cold brings on attack of asthma. (76)

NUX VOMICA
Greatest polychrest. Asthma with fullness of stomach, morning or after eating. Cough associated with sensation of something were torn loose in chest. Shallow respiration. Oppressed breathing. Tight dry hacking cough which brings on bursting headache and bruised pain in epigastrium. (76)

LESSER KNOWN SPECIFIC MEDICINES  (76) (82)(83)(84)

ASCLEPIAS TUBEROSA:
Respiration painful, esp. at base of l. lung.Breath smells like pepper.Humid asthma; <after eating: < after smoking a little.Oppression and difficulty of breathing; 

ANTIFEBRINUM:
Severe dyspnea, the patient seized and clenched the hands of those around him. He felt as if the diaphragm had ceased working and he must go on breathing on his own account at any cost.

ARMORACEA SATIVA:
Increases activity of respiratory organs.Mucous asthma, and consumption.Oedema of lungs.Chest painful to touch.

CHLORUM:
Sudden Dyspnoea from spasms of the vocal cords, with protruding eyes, blue face, cold sweat. Inspiration free but Can Not Exhale. Asthma of hay fever. As if air were forced into upper chest.

DERRIS PINNATA:
Feeling of suffocation with fetid breath; must sit up in bed at night.Cramp-like pains, and lancinations behind sternum. 

ELECTRICITAS:
Asthma, sometimes lasting for life, with palpitation of the heart, and disposition to syncope; oppression of the chest. 

ERIODICTYON GLUTINOSUM:
Wheezing voice, 5 p.m. Asthmatic symptoms; with coryza and mucous secretions.Dull pain in r. lung, front.  near nipple, occurring at short intervals or on sudden changes of position.

GUAREA:
Breathing, sobbing; difficult during chill.Sensation of hollowness and dilatation of chest.Respiratory symptoms <from putting hand to throat

GADUS MORRHUA:
Fits of wheezing cough with pain deep in chest.  Very.Breath short, laborious; as if air passages were closed. Rush of blood to chest, without palpitation. Lumps seem adherent to parietes.Sharp pains, burning shootings, 2 p.mSharp pains running through chest; not <by walking, though renewed on first movement

GALVANISMUS:
Cough, dry; humid; with patients who have tubercles the nodosites speedily soften and break, and the fatiguing cough disappears.Difficult respiration; asthma (c) respiration deep, slow, rattling.Respiration impeded by  each shock

HIPPOZAENINUM:
Noisy breathing; loud snoring respiration before fatal termination; breath fetid.Cough and obstructed respiration, resulting from cicatricial contraction of mucous membrane of nose and larynxPatients cough severely and expectorate profusely, sputa usually bearing a strong resemblance to the discharge from the nostrils, size of millet seed to a pea, of a grey, yellowish, or reddish colour.

LACTUCA:
Spasmodic asthma.Sudden anxiety, with dyspnœa and sweat, followed by stool and relief of that and other complaints.Inclined to take a deep breath: with hollowness of chest; with constriction in fauces and chest.Asthma,< or caused by dust

LINUM USITATISSIMUM:
Picture of an aggravated case of bronchial asthma; it was with the most extreme effort that I could breathe.Livid, and struggles for breath; her friends thought she was dying.

MANCINELLA:
Whistling breathing.Asthma, chronic.Frequent hawking with nauseaViolent cough and painful stitches in trachea from slightest exertion.Cough: < night; after drinking.Expectoration > oppression of chest.

NAPHTHALINUM:
SpasmodicSpasmodic asthma; better in open air. Soreness in chest and stomach; must loosen clothing. Dyspnœa and sighing inspiration. Emphysema in the aged with asthma. Whooping-cough, long and continued paroxysms of coughing, unable to get a respiration. Acute laryngo-tracheitis.

PECTEN:
Quick, laboured breathing; cannot lie flat or on left side; constriction of chest, especially right side. Attacks preceded for two or three days by sneezing and excessive coryza; burning sensation in throat and chest; fulness of head; pulse very quick and wiry; subsequently copious expectoration of tough, stringy, and frothy mucus. Cough < after 6 p.m. Symptoms < at night. 

PULMO VULPIS:
Accelerated short breath amounting to suffocation, even without corresponding heaving of the chest, frequently with cough and inability to expectorate. [Sometimes, in light cases, there is no catarrh present, and only persistent shortness of breath, becoming a paroxysm of asthma on the least bodily exertion.] The patient could only live sitting up, bent forward; constant lividity of face, lips, and extremities, and dropsy of legs.

SILPHIUM LACINATUM:
Cough with expectoration profuse, stringy, frothy, light-colored. Excited by sense of mucus rattling in chest and worse by drafts of air. Constriction of lungs. Catarrh, with copious, stringy, mucous discharges. Desire to hawk and scrape throat. Irritation of posterior nares, involving mucous membranes of nasal passages with constriction of supra-orbital region

TEREBINTHINA:
Breath short, hurried, and anxious.Choking sensation (worms).Emphysema.Cough as if a foreign body had entered larynx, spasmodic inspiration.─Dry, hacking cough.─Voice gone.─Expectoration streaked with blood.─Respiration impeded by congestion of lungs.

VERBASCUM THAPSUS:
Hoarse; voice deep, harsh; sounds like a trumpet; “basso profundo”. Cough; worse at night. Asthma. Soreness in pharynx, cough during sleep.

XANTHOXYLUM:
Shortness of breath; no appetite; bowels constipated; urine light-coloured, alkaline, sp. gr. 1025; fluttering in stomach, pain in l. side; limbs weak and bloated.Had to sit up in bed and turn first one way, then another, as in a severe fit of asthma, with several spasmodic coughing spells.Thought she could not get air enough into lungs, inspiration was so difficult

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