So it is fair to assume that there is a natural breathing spectrum with an asthmatic tendency at one end and Ku Fu or Karate breathing at the other end. For a few words on the Japanese version of Asian breathing see http://www.lrz.de/~s3e0101/webserver/webdata/OBT.pdf

I personally tend to breathe asthmatically after an evening meal or in pollen-laden air. Breathing powerfully into my lower abdomen with tensed muscles provides an effective cure for me. But then I’ve always been sceptical about medical wisdom on asthma: such a paradoxical and doctor-baffling increase in the last 40 years with modern, merely symptomatic inhalers. Respectfully, Richard Friedel

This combination of cocaine and atropine would have been probably the best treatment available at the time. If only it was inhaled into the lungs, instead of depositing mainly (and uselessly) in the nose.

If inhaled, the ‘bronchodilatation’ produced by cocaine was probably mediated by it’s constrictor effect on the blood vessels in the airway lining. This would reduce the inflammatory swelling of the airway lining and hence improve airflow. Cocaine was used for the same effect on the blood vessels in the nose in hayfever sufferers (I’ve always wondered if this is how the snorting habit arose.). Twenty years later, the less addictive drug ephedrine would surpass cocaine for both diseases (roughly the same mechanism of action).

If cocaine rapidly enters the blood stream (as it would if snorted) it increases the levels of adrenalin released by the adrenal gland. Adrenalin is the body’s best bronchodilator, so there would be an associated improvement in airflow. An adrenalin rush works: physicians around this time knew that giving a patient a jolly good fright was more effective than any drug in their bag. In addition to relaxing airway muscle, adrenaline also constricts blood vessels, which would have the same beneficial effect as cocaine itself with respect to the inflammatory swelling of the airway lining.

Atropine (and similar anti-muscarinics) inhibits the nerve supply to both the mucus glands and muscle of the airways. Thus, it would have relaxed the airways (producing bronchodilatation) as well as inhibiting the secretion of mucus. It is not much good stuck up your nose, though. Pharmacists sold herbal cigarettes containing atropine and (similarly-acting drugs) well into the 20th century; these were quite effective. Similar drugs were used in asthma until quite recently, and would still be on the crash trolley in A&E for the treatment of severe asthma attacks (they tend to try everything when things are bad enough). Longer lasting, synthetic equivalents of atropine are still the mainstay for the treatment of chronic obstructive pulmonary disease (COPD).

[Blame my tutee for not turning up on time for that lecture.]

Atropine

Does have the effect of decreasing bronchial secretions which *may* have helped some patients who would have looked like they were wheezing asthmatics but in reality actually had a heavy mucus cold. It can also slow the heartbeat (and therefore breathing will be slowed as well, which in someone who is panicking (fast heart rate, fast breathing) would appear to make them feel better.

I have serious doubts about atropine being effective in genuine asthmatic emergencies (I’m willing to be corrected). Some of the possible side effects are very nasty: distinctly fatal heart rhythms, make you nauseous, blurred vision, loss of balance and make you dizzy, extremely bad confusion, severe hallucinations.

Cocaine

Cocaine is a stimulant so patients may have seemed to those around that they are improving due to this alone. It can also raise the heart rate to dangerously high levels so the combination of cocaine and atropine would have easily had potentially fatal results.

Of course there’s nothing to stop Doctor Tucker giving a verdict that the medicine wasn’t given in time and the poor patient died of their Asthma.

As a side note in late 2004/2005 there was a number of deaths in Holland from Cocaine that was laced with Atropine.

My biochemistry is several decades old, but I do remember enough to decode the Wikipedia entry on cocaine.

Cocaine is a “serotonin–norepinephrine–dopamine reuptake inhibitor”. Norepinephrine is American for adrenaline. “Reuptake inhibitor” means that it inhibits the metabolism (and prolongs the effects) of the body’s natural supply of adrenaline. Adrenaline’s effects include bronchodilation, which means that it (adrenaline) relieves asthma.

Cocaine’s effects therefore probably include bronchodilation, which would probably be greater for inhaled cocaine.

Adrenaline is not used to treat asthma because it has loads of other effects — some nasty — and the bronchodilator wear off quite rapidly.

I can only guess at how rapidly cocaine’s bronchodilator effects would last — perhaps an hour or two — and I have no idea how potent it would be.

By the way, coffee and tea (and I guess cocoa/chocolate) are not just stimulants; they are also mild bronchodilators. This would be useful information if you are stuck on a remote desert island with an asthmatic and a ready supply of coffee.