Glimpses of diagnostic tools and treatment of asthma in Sweden, Norway, and Finland from a medico-historical perspective

Abstract

During the last decades, there has been an accelerating development of diagnostic and treatment possibilities. This paper aims to remind readers of significant milestones in the medical history of asthma. In the early 1800s, important tools for auscultation of the lungs and assessment of vital capacity were developed when Laennec invented the stethoscope and Hutchinson the spirometer. Tests of allergic sensitisation were developed later; the skin prick test in the 1920s, while immunoglobulin E, IgE, was discovered in the 1960s. Dating back to ancient times, asthma has been treated using the sympathomimetic ephedrine and the anticholinergic belladonna. Asthma cigarettes act via anticholinergic effects of Datura stramonium (common name thorn apple), which contains hyoscyamine, scopolamine, and atropine. From the 1930s, ephedrine was replaced by adrenergic agents (e.g., adrenaline) and its further developments. The first selective β2-agonist, salbutamol, was introduced in 1969, followed by long-acting β2-agonists. From the 1920s until 1990, theophylline was frequently used as a bronchodilator, while cromolyn was used as a non-corticosteroid treatment of asthma in the 1970s and 1980s. Introducing inhaled corticosteroids (ICS) in the mid-1970s revolutionised asthma treatment. The use of ICS gathered momentum in the mid-1980s, with improved asthma morbidity and reduced need for hospital treatment. Recent introduction of ICS-formoterol in all treatment steps of asthma further contribute to improved adherence, asthma control and lower risk of exacerbations. At last, in management of severe asthma, monoclonal antibodies targeting IgE or different T2-cytokines, provide significant improvements in symptom control, exacerbation rate, and quality of life for patients.