A Puff of Misguided Medicine: Why Did Doctors Once Prescribe Smoking Cigarettes for Asthma?

It sounds utterly counterintuitive today, a notion so jarring it might seem like a myth: doctors recommending cigarettes for a respiratory condition like asthma. Yet, strange as it sounds, there was indeed a period in medical history when inhaling smoke, sometimes from tobacco cigarettes or specially formulated "asthma cigarettes," was considered a viable treatment for asthma symptoms. This blog post delves into the perplexing question: why did doctors once prescribe smoking cigarettes for asthma, exploring the historical context and the flawed understanding that led to this dangerous advice.

The Historical Landscape of Inhaled Remedies

The practice of inhaling smoke or vapors for medicinal purposes dates back centuries. Ancient civilizations used various herbs and substances, believing their inhalation could treat respiratory ailments. When tobacco was introduced to Europe in the 16th century, it was initially lauded for its supposed medicinal properties, fitting into this existing paradigm of inhaled treatments.

The "Logic" Behind Smoking for Asthma

In the 19th and early 20th centuries, the understanding of asthma was vastly different from today. Asthma was primarily seen as a spasmodic condition – a sudden, temporary constriction of the airways. The primary goal of treatment was to relieve these acute spasms. Several theories, now thoroughly debunked, underpinned the prescription of smoking:

• Antispasmodic Beliefs: Certain substances, when burned and inhaled, were thought to have an antispasmodic effect, meaning they could relax the bronchial tubes and ease breathing. Tobacco itself, or more commonly, ingredients added to "asthma cigarettes" like stramonium, belladonna, or lobelia, were believed to provide this relief. These botanicals contain anticholinergic alkaloids which can relax smooth muscles, but their delivery via smoke was crude, uncontrolled, and laden with other harmful compounds.
• Irritation as a "Benefit": Some medical practitioners believed that the irritating nature of smoke could stimulate coughing and help expectorate mucus, supposedly clearing the airways. This overlooked the underlying inflammation that smoking itself would worsen.
• Perceived as a "Milder" Option: Compared to some other harsh medical treatments available at the time, or the frightening experience of an uncontrolled asthma attack, inhaling smoke might have been perceived by some as a relatively quick, accessible, if not entirely benign, intervention.

"Asthma Cigarettes" and Early Inhalers

It wasn't always standard tobacco cigarettes that were prescribed. The market saw a proliferation of "asthma cigarettes" or "asthmatic pastilles." These products often contained a mixture of tobacco and other dried herbs known for their supposed bronchodilating or antispasmodic properties. Advertisements from the era would boldly claim relief from asthma symptoms.

Doctors might recommend these specific products, or in some cases, even regular tobacco cigarettes, under the misguided belief that the act of smoking could deliver these supposedly beneficial compounds directly to the lungs. Early forms of nebulizers also existed, which vaporized similar substances for inhalation, but cigarettes were a common and accessible delivery method.

The Tide Turns: Understanding the True Dangers

The mid-20th century marked a significant turning point. Landmark research began to unequivocally link smoking to a host of severe health problems, most notably lung cancer, emphysema, and heart disease.

• Pioneering epidemiological studies, such as those by Richard Doll and Austin Bradford Hill in the UK, provided undeniable evidence of the devastating health consequences of smoking.
• The 1964 U.S. Surgeon General's Report on Smoking and Health was a watershed moment, publicly and officially acknowledging the severe risks associated with tobacco use.

As the profound dangers of smoking became clear, and with a more sophisticated understanding of asthma as a chronic inflammatory disease rather than just a series of acute spasms, the practice of prescribing smoking for asthma was rightly abandoned. It became evident that any potential, fleeting "benefit" from the antispasmodic components was vastly outweighed by the severe, long-term damage caused by inhaling smoke.

A Lesson in Medical Evolution

The historical prescription of smoking for asthma serves as a stark reminder of how medical understanding evolves. What was once considered a plausible treatment, based on limited knowledge and observation, is now recognized as profoundly harmful. It underscores the critical importance of rigorous scientific research, evidence-based medicine, and the continuous re-evaluation of medical practices. Thankfully, modern asthma treatments are based on a much deeper understanding of the disease, focusing on controlling inflammation and providing safe, effective relief without resorting to such dangerous methods of the past.