Herbal remedies: integration into conventional medicine AUTHOR

Whitehead, N. (2003) Herbal remedies: integration into conventional medicine. Nursing Times; 99: 34, 30–33. There is evidence of increasing use of complementary therapies. The benefits and possible sideeffects of herbal and dietary supplements in respiratory disorders are discussed. Questions have been raised about the safety of herbal products, yet their legal status is uncertain. Promotion of the integration of conventional and traditional medicine is suggested as the way forward, together with standardisation of practice and manufacturing procedures of these products. MEDIA reports suggest that up to one in five Britons use complementary therapies and that, as a nation, we spend £350m each year on natural remedies (Walsh, 2000). Lewith (1998) found that 13 million visits were made to complementary therapists in 1981, which is one-third of the number of visits made to GPs in the same year. Which? magazine (1995a) found that the proportion of its readers using complementary therapies increased by 70 per cent between 1986 and 1991. Use of complementary therapies in the UK Zollman and Vickers (1999) concluded that at least 15 million complementary therapy consultations took place in 1997 and that almost 40 per cent of all general practices offered some form of access to complementary therapy for their NHS patients. It is interesting to note that, of these, the NHS paid for 70 per cent of the consultations. However, Zollman and Vickers’ (1999) paper pointed out that nearly 4,000 conventional health care professionals also practise complementary therapy. Thus, a substantial number of complementary therapies are provided by conventional health care professionals within existing NHS services, although this is confined to the disciplines of acupuncture, reflexology and homeopathy. These figures are significant because it suggests a growing acceptance of the concept of complementary therapy within our culture. Lewith (1998) found that complementary therapy in the UK is confined to a few major disciplines: osteopathy, chiropractic, homeopathy, acupuncture and herbalism. Kroll (2001) pointed out that, of these, herbalism is the most accessible because of the availability of these products in high street chemists, supermarkets and health food shops. Use of complementary therapies in the USA The American Thoracic Society (2001) reported that onethird of the US population use some form of complementary therapy. As in the UK, herbal remedies and food supplements are the most accessible form because of their availability in health food shops and pharmacies. However, these preparations are not subject to any form of approval by the US Food and Drug Administration and therefore their purity and potency is not regulated. Asthma is one of a number of diseases that attracts numerous complementary and alternative forms of management in the USA. However, because complementary therapies are perceived to be more natural than conventional medicines and not to have any side-effects, their use may not be reported to physicians. Johns Cupp (1999) suggested that these preparations have the potential to cause adverse effects and drug interactions (see Box 1). Herbs used to treat asthma and COPD It is known that people have experimented with strongsmelling or unappetising plant products to treat a variety of injuries and illnesses for thousands of years and that for most of the world’s population, routine medical care is based on traditional herbs and techniques provided by healers who lack formal medical training (Ziment, 2003). Aromatic plants or smoke from incense were some of the first treatments to be tried for any disease, especially respiratory disorders. Huntley and Ernst (2000) found in their study that herbal preparations are still a popular method of treatment used by people with asthma. Herbs such as menthol, eucalyptus, frankincense and balsams were favoured and were reported to soothe the inflamed mucosa, alleviate the annoying cough and enhance expectoration. Two of the most ancient favoured plant products for asthma were ephedrine and atropine, the descendants of which have a basic role in formal therapeutics today. Among other traditional plant drugs still used for the treatment of asthma and chronic obstructive pulmonary disease (COPD) are theophylline, which is derived from tea leaves, and cromolyn, which is described as a smooth muscle relaxer. Although few of the herbs available over the counter are subject to the scientific rigour of prescription medication, Lewith (1998) reviewed a number of herbal remedies used in asthma and COPD and reported on their potential benefits. For example, Coleus forskholi is a herb used in ayurvedic medicine and has a possible bronchodilating effect, and Ginkgo biloba is reported to antagonise platelet-activating factors, hence limiting bronchial hyper-reactivity. Further studies indicated that the oral administration of ginkogolides improved pulmonary function and protected against exerciseinduced asthma. A study carried out by Castiglioni and Gramolini (1986) looked at the long-term effect of sobrerol (a herbal remedy used to treat chronic bronchitis) on acute exacerbations in 706 patients. Acute exacerbations and the use of bronchodilators were reduced over a three-month period and lung function, as measured by forced expired volume in one second (FEV1), was also higher. Ferley et al (1989) investigated the use of goutes aux essences (a herbal aromatherapy mixture) to treat chest infections in patients with chronic bronchitis. They found that although the incidence of acute infections did not CLINICAL ADVANCED 30 NT 26 August 2003 Vol 99 No 34 www.nursingtimes.net