My third visit of the week to the Royal Institution was to last night’s Friday Evening Discourse: The Treatment of Asthma Through the Ages, delivered by Clive Page (Director of the Sackler Institute of Pulmonary Pharmacology and Professor of Pharmacology at King’s College London).
We had a whistle-stop tour through the history of asthma treatment: in 1550BC the Egyptians were using herbs heated on a brick and inhaled, but also the excreta of the camel and crocodile. 460BC Hippocrates thought asthma was caused by an imbalance in the four humours causing a flow of phlegm to the lungs, and recommended purging and bleeding. 450AD ayurvedic medicine used the thorn apple (which contains stramonium). 1618 you could be treated with herbs, bleeding, purging, the dung of stallions and linctus of foxes lungs. 1684 brought ‘sleeping on a chair’, powdered millipedes, and volatile salts. 1698 John Floyer published Treatise of the Asthma and recommended squill. 1860 Dr Henry Hyde Salter realised that hay and animals were possible triggers, and suggested strong black coffee (there are caffeine derived drugs now), belladonna (atropine stops muscular contractions and excretion of mucus) and stramonium. 1933 A J D Cameron was treating asthma by colonic irrigation.
After a discussion of more modern treatments, we were treated to some detail of the mechanism of asthma, the damage it can cause to the lung, and how it is still not unknown for people (most commonly aged between 15 and 30) to suffocate on the mucus that accumulates in their lungs. He described the coughing up of mucus plugs which are a cast of the lung and which look like lumps of the Great Barrier Reef.
Clive Page’s current research is a story of the fortuity and serendipity in scientific discovery: it makes a very interesting story too, dating back to his attending a wedding at Oban in Scotland, at which he became engaged in conversation with a marine biologist. This led to a collaboration between the marine biologist, a pharmacologist, a surface chemist, and starfish.
Starfish breathe through their whole surface, and being bottom feeders they live on the sea bottom; what they don’t do is get covered with stuff that falls to the seabed – it doesn’t stick to them. Starfish have a surface that is like Teflon, and the biologist and the chemist were trying to identify the mechanism to see whether it could be applied to boat bottoms to stop biofouling. Clive Page wondered if it could have an application in his field.
In asthma there are excessive white cells which stick to the edges of the blood vessels, slowing the blood flow, and some can crawl through the cells of the wall to get out (a similar thing happens with tumour cells), hence the mucus accumulating in the lungs. A material that has been extracted from the surface of starfish has been developed that has the non-stick effect on the surface of the blood vessel, stopping the cells sticking, and speeding the flow of blood. This looks like it might be a major advance in asthma treatment, as the goal is for presymptomatic treatment of asthma, rather than stopping the symptoms (the wheeziness shows that damage has already been done).
The discourse was packed with interesting facts about asthma, not least Page’s ideas on what causes there might be; he thinks it’s a syndrome rather than having a specific cause. The talk should very shortly be available to listen to on the RI website.