1. Antonio M. Cabrera Manuel R. Cabrera M.D. Columbia-Presbyterian Medical Center The Use of Non-Prescription Drugs and Herbal-Based Remedies by Asthmatics

2. Objective To asses the use of non-prescription drugs and natural home remedies in a group of asthmatics

3. Introduction ► The use of alternative herbal remedies for chronic ailments in common throughout many culture in the world ► In the United States the use of herbal products has been estimated to be increasing by about 25% per year ► Herbal remedies are most commonly used for allergies and asthma

4. Methods ► A survey was created regarding the use of non-prescription drugs such as allergy and cold remedies and bronchodilatiors and regarding any home-based remedies in the month prior to hospitalization ► The questionnaires were administered in either Spanish or English, during January 2001 to September 2001, at the Columbia Presbyterian Medical Center

5. Results ► 72 surveys were collected ► The ages ranged from 20-83 years old ► The mean age was 52 years old ► The racial profile is as follows:

6. Results of Non-Prescription Drugs ► 11 of 72 (15.3%) of patients disclosed taking non-prescription bronchodilators ► 1 of 72 (1.4%) took antihistamines ► 10 of 72 (13.9%) took over-the-counter decongestants or cold remedies

7. Results of Herbal Remedies ► 43 of 72 (60%) of patients disclosed taking herbal remedies ► 38 of 43 (88.4%) were Hispanic ► 26 of 43 (60.5%) took the herbal remedies in instead of their prescribed asthma medicines ► 32 of 43 (74.4%) took them in combination with their prescribed asthma medicines

8. Herbal Remedies ► The plant savila (aloe vera) was the most prevalent herbal remedy reported by 32 of 43 (74.4%) patients ► List of other herbal remedies:

9. Discussion ► Sixty percent of the Hispanic asthmatic population report using herbal-based remedies in the management of their asthma ► The prevalent use of herbal-remedies was in the month prior to hospitalization for an acute asthma attack ► The patients took non-prescription drugs and herbal remedies in attempt to alleviate asthma symptoms

10. Discussion of Savila ► The most home remedy used was savila commonly known as aloe or aloe vera ► Savila is recognized for its stomach and intestinal usage as well as for skin rashes ► The United States Federal Drug Administration has recognized aloe as safe ► One study suggested an anti-inflammatory effect of aloe in asthma

11. Discussion of Medical Concerns ► Asthmatics are substituting their prescribed medications with herbal remedies ► There is potential for unrecognized adverse effects. We identified some diabetics preparing home remedies with honey which may result in elevated blood sugar levels. ► Asthmatics may be overly relying on herbal remedies due to dissatisfaction with standard medical care

12. Conclusion Despite the advances in asthma understanding and medicines the use of herbal-based remedies is prevalent in our Hispanic, mostly Dominican and Puerto Rican, asthmatic population. This is particularly prevalent in middle aged Hispanic women. The efficacy and/or the potential adverse effects of herbal- based remedies need to be examined further. It is important for health care professionals to be aware that not only are patients self-treating their asthma with home herbal remedies but they may also be substituting them for their prescribed asthma medicines.

13. Review of Literature 1.Bielory L, Lupoli K: Herbal Interventions in Asthma and Allergy. J Asthma 1999; 36:1-65. 2.Biok J: Cancer and natural medicine: a textbook of basic science and clinical research. Princeton (MN): Oregon Medical Press; 1996 3.Blanc PD, Kuschner WG, Katz PP, Smith S, Yelin EH: Use of herbal products, coffee or black tea, and over-the-counter medications as self-treatments among adults with asthma. J Allergy Clin Immunol 1997; 100:789-791. 4. Dorsch W, Schneider E, Bayer T, et al: Anti-inflammatory effects of onions. Inhibition of chemotaxis of human polymorphonuclear leukocytes by thiosulfinates and cepaenes. Intl Arch Allergy Appl Immunol 92:39-42 (1990) 5. Engler R, Reed W: Alternative and complementary medicine: A source of improved therapies for asthma? A challenge for redefining the specialty? J Allergy Clin Immunol 2000; 106:627-629 6.Ernest E: Complementary therapies in asthma: what patients use. J Asthma 1998; 35:667-671. 7. Graham D, Blaiss M: Complementary/alternative medicine in the treatment of asthma. Ann Allergy Asthma Immunol 2000; 85:438-449. 8. Huntley A, E Ernst: Herbal medicines for asthma: a systematic review. Thorax 2000; 55:925-929 9.Shida T, Yagi A, Nishimura H, at al: Effect of Aloe extract on peripheral phagocytosis in adult bronchial asthma. Planta Med 3:273-275 (1985). 10. Ziment I: Alternative therapies for asthma. Curr Opin Pulm Med 3(1):61-71 (1997).