Success of Self-Treatment Measures in Adults with Asthma
May 1998; Volume 1: 60
Source: Blanc PD, Kuschner WG, Katz PP, et al. 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.
The objective of this study was to study the prevalence and morbidity of asthma self-treatment with herbs, coffee, or black tea, and over-the-counter (OTC) medications containing ephedrine or epinephrine.
The authors carried out a cross-sectional analysis of interview data for 601 adults with asthma recruited from a random sample of California pulmonary and allergy specialists. They estimated the 12-month prevalence of reported use of herbal products, coffee, or black tea and OTC products to self-treat asthma and their association with emergency department visits and hospitalization.
Herbal asthma self-treatment was reported by 46 (8%; 95% confidence interval [CI] 6-10%); coffee or black tea self-treatment by 36 (6%; 95% CI 4-8%), epinephrine or ephedrine OTC use by 36 (6%; 95% CI 4-8%), and any of the three practices by 98 subjects (16%; 95% CI 13-19%). Adjusting for demographic and illness covariates, herbal use (odds ratio [OR] 2.5; 95% CI 1.1-5.6) and coffee or black tea use (OR 3.1; 95% CI 1.2-7.8) were associated with asthma hospitalization; OTC use was not (OR 0.8; 95% CI 0.3-2.5).
Even among adults with access to specialty care for asthma, self-treatment with nonprescription products was common and was associated with increased risk of reported hospitalization. This association does not appear to be accounted for by illness severity or other disease covariates. It may reflect delay in the use of more efficacious treatments.
COMMENT
These UCSF-based authors examined specific herbal therapy for asthma and the epigram "let drink be your medicine," something Hippocrates might have said but not tested.
Significantly more women than men used herbs, and significantly more men than women used OTC products. Marital and general health status, education, ethnic group, atopic history, and predicted FEV1 were not significantly associated with self-treatment. The group that used coffee/black tea had significantly higher asthma severity and quality of life scores than the other groups. The herbal therapy group also had significantly higher quality of life scores than the other groups.
The authors found that herbal therapy and coffee/black tea users wind up in the hospital more than their non-using peers. Whether this is because users' asthma is more severe to begin with or because their regimens are not optimal or their adherence is poor cannot be divined from these data.
Recommendation
Physicians should caution their asthmatic patients about the untoward effects of medicinal drinks. Herbal and black tea and coffee should be sipped for culinary pleasure, not with the hope or expectation that they will treat asthma. That they might cause harm is worrisome.
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