A number of studies were found that support the use of some herbal medicines in asthma and allergy. From the review, there has been a role for some herbal medicines in the treatment of asthma and allergic rhinitis.

Most asthma treatments aim to control these symptoms and reduce the frequency of exacerbations and current recommendations advocate the use of anti-inflammatory treatments, in particular inhaled corticosteroids (ICS) and bronchodilators such as short and long acting β2 -adrenergic agonists (LABA; 5). However, there is concern around the inappropriate use of asthma medications, in particular the overuse of inhaled corticosteroids in children, which can effect bone growth, and the inappropriate use of long acting bronchodilator therapy in isolation which has been associated with increased morbidity [9 ]. As well as the risk of these possible adverse effects not all patients respond to these treatments and non-adherence to treatment is common due to issues such as complex treatment regimens, poor inhalation technique and delayed results [10 ] thus there is an unmet medical need for complementary therapies for asthma. Their findings also suggested that ASHMI directly affected airway narrowing through inhibition of acetylcholine-induced tracheal ring constriction ex vivo and increased production of the smooth muscle relaxants prostacyclin and prostaglandin I 2 (PGI2). ASHMI has also been shown to reduce lung inflammation and mucus in an aged mouse model of late-onset asthma [21 ]. i) Preclinical ASHMI studies: In vitro studies using a human lung fibroblast cell line showed that Gan Cao, one of the extracts used in ASHMI, decreased secretion of interleukin (IL) 8, eotaxin 1 and stat 6 [22 , 23 ] demonstrating the anti-inflammatory property of this extract and a possible mechanism of action in the treatment of asthma, particularly the recently described subtype ‘neutrophilic asthma’ where severe asthma patients suffer from airway neutrophilia (reviewed in [24 ]). Other in vitro studies carried out in primary mouse cells demonstrated a decrease in tumour necrosis factor alpha (TNFα), nuclear factor kappa β (NFκB) and brain derived neurotrophic factor (BDNF) levels in cells pretreated with ASHMI in response to lipopolysaccharide (LPS) [25 ], again emphasising the anti-inflammatory properties of this plant-based medicine. ii) Clinical ASHMI studies: Clinical trials of ASHMI have been undertaken in a 4-week double-blind, randomised, trial carried out by Wen et al. [26 ] comparing the effects of oral ASHMI, 4 capsules (0.3 g/capsule) 3 times daily, with that of oral prednisone, 20 mg once daily, in patients with moderate to severe persistent asthma over a period of 4 weeks.

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For primary outcomes (exacerbations, steroids use and lung function measurements): Two out of six studies reporting change in FEV1 were positive, with very few data available on the frequency of exacerbations. See more on using PICO in the Cochrane Handbook . Herbal interventions for chronic asthma in adults and children Chronic asthma is a inflammatory disease of the airways characterised by wheeze and breathlessness.

Peritoneal Macrophage Isolation and Culture After BALF collection, peritoneal macrophages from the experimental mice were collected according to the method described by Lin et al. [24 ]. Peritoneal cells were prepared by lavaging the peritoneal cavity with 2 aliquots of 5 mL sterile Hanks’ balanced salts solution (HBSS) (50 mL of 10x HBSS (HyClone Laboratories Inc., Logan, UT), 2.5 mL of antibiotic-antimycotic solution (100x PSA) containing 10,000 units/mL of penicillin, 10 mg/mL of streptomycin, 25 μ g/mL of amphotericin B in 0.85% saline (Atlanta Biologicals Inc., Norcross, GA), 20 mL of 3% bovine serum albumin (BSA, Sigma-Aldrich Co., St. The peritoneal lavage fluid was centrifuged at 400 ×g for 10 min at 4°C. The cell pellets were collected and resuspended in tissue culture medium (TCM, a serum replacement; Celox Laboratories Inc., Lake Zurich, IL), suspended in a medium consisting of 10 mL TCM, 500 mL RPMI 1640 medium (Atlanta Biologicals Inc.), and 2.5 mL antibiotic-antimycotic solution (100x PSA) (Atlanta Biologicals Inc.). The peritoneal adherent cells (>90% of macrophages) from each animal were adjusted to 2 × 106 cells/mL in TCM medium with a hemocytometer using the trypan blue dye exclusion method.

Secondary outcome measures were symptoms and symptom scores, use of reliever medications, changes in rates of consultation and adverse effects. Two of six studies reporting change in FEV1 were positive.