Open Access Highly Accessed Research article Medicinal herb use among asthmatic patients attending a specialty care facility in Trinidad Yuri N Clement*, Arlene F Williams, Derick Aranda, Ronald Chase, Nadya Watson, Rochelle Mohammed, Odia Stubbs and Deneil Williamson * Corresponding author: Yuri N Clement yuriclem@yahoo Author Affiliations Faculty of Medical Sciences, The University of the West Indies, St. Augustine, Trinidad and Tobago For all author emails, please log on. BMC Complementary and Alternative Medicine 2005, 5:3 doi:10.1186/1472-6882-5-3 The electronic version of this article is the complete one and can be found online at: biomedcentral/1472-6882/5/3 Received: 27 August 2004 Accepted: 15 February 2005 Published: 15 February 2005 © 2005 Clement et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract Background There is an increasing prevalence of asthma in the Caribbean and patients remain non-compliant to therapy despite the development of guidelines for management and prevention. Some patients may self-medicate with medicinal herbs for symptomatic relief, as there is a long tradition of use for a variety of ailments. The study assessed the prevalence of use and the factors affecting the decision to use herbs in asthmatic patients attending a public specialty care clinic in Trinidad. Methods A descriptive, cross-sectional study was conducted at the Chest Clinic in Trinidad using a de novo, pilot-tested, researcher-administered questionnaire between June and July 2003. Results Fifty-eight out of 191 patients (30.4%) reported using herbal remedies for symptomatic relief. Gender, age, ethnicity, and asthma severity did not influence the decision to use herbs; however, 62.5% of patients with tertiary level schooling used herbs, p = 0.025. Thirty-four of these 58 patients (58.6%) obtained herbs from their backyards or the supermarket; only 14 patients (24.1%) obtained herbs from an herbalist, herbal shop or pharmacy. Relatives and friends were the sole source of information for most patients (70.7%), and only 10.3% consulted an herbalist. Ginger, garlic, aloes, shandileer, wild onion, pepper and black sage were the most commonly used herbs. Conclusions Among patients attending the Chest Clinic in Trinidad the use of herbal remedies in asthma is relatively common on the advice of relatives and friends. It is therefore becoming imperative for healthcare providers to become more knowledgeable on this modality and to keep abreast with the latest developments. Background Recent reports from the Caribbean suggest that the incidence of asthma is following the global trend of increasing prevalence. In Jamaica, a prevalence of 20.8% for exercise-induced asthma was estimated in a cross-sectional study in schoolchildren [1]. About one in ten patients attending an Accident and Emergency Department in Trinidad were treated for acute severe asthma [2] and over 15,000 patients attended four A&E departments throughout the island over a 12-month period [3]. Inhaled corticosteroids as prophylaxis and as required bronchodilator for symptomatic relief are established modalities for asthma management and prevention and the Commonwealth Caribbean Medical Research Council/Global Initiative for Asthma guidelines were adopted in the Caribbean in 1997 [4]. It has been noted that inefficient management predisposes patients to frequent hospitalization and reduced quality of life. In Trinidad, non-compliance and inadequate inhaler technique negatively impact on effective disease management [5,6]. The frequent unavailability of medication at public health facilities and the prohibitive cost at private pharmacies are significantly associated with non-compliance and consequently poor disease control. In these studies, some patients indicated their use of herbal remedies as an alternative to conventional medicines. Over the last few decades, a global resurgence in the use of herbal remedies has fuelled the growing multi-billion dollar international trade of botanical products. Many patients, dissatisfied with conventional medicines because they expect permanent cures, believe that herbal remedies are natural and sometimes self-medicate without informing their attending physician. Although there is a long history of traditional use of medicinal herbs throughout the Caribbean [7,8] few studies were done to assess the prevalence of use. Surveys in Jamaica reported an almost 100% use of herbal teas and remedies by respondents throughout the island [9] and 71% in paediatrics inpatients at the University Hospital [10]. These studies, however, assessed only the lifetime use of medicinal herbs and did not identify their use for any particular disease. In Trinidad and Tobago, the use of bush medicine in diabetic patients attending primary healthcare facilities throughout the island was assessed and although 42% reportedly used herbs, only 24% used this healthcare modality for self-management of diabetes [11]. Another survey conducted at an outpatient surgical facility in Trinidad indicated a lifetime prevalence of 86% among patients [12] for any healthcare issue. This study was undertaken to assess the extent of use of herbal remedies by asthmatic patients attending a specialty chest clinic in Trinidad for symptomatic relief and to determine the factors influencing the patients decision to use herbs. Methods The study was approved by the Ethics Committee of the Faculty of Medical Sciences, University of the West Indies, St. Augustine campus and permission to interview patients was granted by the Director of the Chest Clinic of the Ministry of Health, Trinidad and Tobago. The study was conducted over the two-month period June to July 2003. Sample and setting The Chest Clinic was chosen as the source of subjects as this is the only national tertiary level health facility specializing in the management of respiratory diseases. Patients entering the study were physician-diagnosed asthmatics based on self-reporting symptoms of wheezing, chest tightness and nocturnal coughing in the previous year. Patients were recruited by consecutive sampling and the nature and purpose of the study were explained on an individual basis. Those confirming their willingness to participate signed their informed consent and were interviewed using a de novo, pilot-tested, researcher-administered questionnaire. Interview instrument The questionnaire assessed demographic data such as age, gender, ethnicity, residential district, education, employment and socioeconomic status. Subjects reported their disease severity as intermittent, moderate or severe as determined by the Global Initiative for Asthma (GINA) guidelines with respect to symptom frequency [4]. Patients also reported their use of herbal remedies, identified the herbs used, the frequency of use, source of herbal medicines and the reasons for the use of herbs. Statistical analysis The sample size was calculated as 185 patients assuming a prevalence of 86% [13] with a confidence level of 95%. Since all variables were categorical, χ2 tests were performed to determine whether there were statistically significant associations between the use of herbs and these variables. The p value was set at
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