Abstract
Asthma is a chronic respiratory disease that affecting the airways of the lungs and is the most prevalent and leading cause of morbidity and mortality in Pakistan. Hence, we searched the available literature to review the ethnomedicinal use of plants for Asthma in Pakistan, to present perspective for future research, and to generate scientific evidence for the formulation of Phytomedicine. The study aims to review the uses of plants used by the indigenous communities for the treatment of asthma. For the present review, data were collected by using different online databases and searching hard copies of publications, books, thesis from libraries and national organizations. In a current review article, a total of 176 species belonging to 63 families has been listed, used against asthma in Pakistan. Asteraceae was the predominant family having (19 species) followed by, Fabaceae (12 species), Solanaceae ( 11 species), Lamiaceae (7 species), Apiaceae (6 species), Euphorbiaceae (6 species), Mimosaceae (6 species), Alliaceae (4 species), Amaranthaceae (4 species), Malvaceae (4 species), Nyctaginaceae (4 species), Poaceae (4 species), Polygonaceae (4 species), Ranunculaceae (4 species), Zygophyllaceae (4 species), Apocynaceae (3 species), Brassicaceae (3 species), Ephedraceae (3 species) and so on. Data analysis shows that leaves were most frequently used (24.18%) against asthma followed by roots (15.03%), fruit (12.74%), flower (11.43%), seed (11.11%), bark(6.20%), stem(5.55%), whole plant(4.24%), shoot(1.96%), aerial parts (1.63%), bulb(1.63%), wood (0.98%), gum (0.98%), rhizome (0.98%), latex (0.65%), pod (0.32%) and resin (0.32%). From the literature search, it was concluded that most of the recorded plants have valuable and beneficial effects whereas, the other plants mentioned in many of the publications have given some valuable opportunities for further pharmacological research.
Keywords: Asthma; Plants; Ethnomedicinal Use; Treatment
Introduction
Asthma is defined as a chronic allergic pulmonary disease in the majority of developing countries characterized by unpredictable airway complexity [1,2]. Asthma word is of Greek origin which means “panting” [3]. The representative symptoms comprised of panting, breathlessness, wheezing, coughing, and stiffness of the chest [4,5]. Asthma has been recognized as one of the most widespread respiratory complaints all over the world and is identified to be triggered by a variety of factors predominantly allergens, dust, too much cold air, emotion, professional stimuli, chemicals, and histamine [6-8]. There are 2 types of asthma, that is allergic asthma and job-related asthma [9]. Allergic asthma is triggered by an allergy while occupational asthma occurs in response to a trigger in the workplace. Asthma affects people from all groups’ social, cultural and tribal backgrounds [10]. According to ISAAC (1998), asthma affects 1 child in 7 in some societies and about 15 million individuals globally. In 2011 the World Health Organization (WHO) pointed out that (235 million) people undergo asthma. It has been reported to be the main basis of both morbidity and mortality [11,12].
A lot of factors have been revealed to manipulate asthma exacerbations ranging from viruses, dust, smoking, pollution, urbanization, excessive emotions, fatness, work, genetic factors, family record and meteorological proceedings. The maximum incidence rates of asthma are found in the UK greater than (15%) and in New Zealand (15.1%) [13]. In Pakistan, more than 6 million people suffer from asthma [14]. This demonstrates that asthma is a severe global health problem. The relevance of ethnobotanical medicine remains one of the dependable approaches for discovering effective novel compounds (Fabricant and Farnsworth, 2001). Asthma is an expensive disease as the disease consequences in loss of production caused by absence from work [15]. Usually, antibiotics are not recommended to treat asthma [16]. It is welllinked with contact amongst physically powerful genetic and environmental factors [17]. The pharmacotherapy of asthma is reported to be very difficult [18]. Asthma cannot be cured but its management plays an important role in achieving the primary goals of treatment by avoiding asthma attacks, reducing inflammation and preventing lung damage. The ability to control asthma depends on the prevention of allergic triggers and taking medication as prescribed. The drugs that are currently available for the treatment of asthma are classified as relievers and controllers [19-21].
According to another report around (7.5 million), Pakistani adults and (15 million) children bear asthma owing to rising urbanization, industries, and pollution. A detailed study was conducted by doctors connected with the Aga Khan University Hospital (https://www.pakistantoday.com.pk › Karachi). Medicinal plants are used by the public everyone over the human being history and this information of the use of therapeutic plants has been transferred next to rural communities from generation to new generation and is still well conserved amongst a lot of local communities in all over the world [22-26]. Ethnobotanical surveys and ethnopharmacological studies lead to development in this field [26,27]. Until now, a lot of inhabitants use herbal recipes to treat a variety of diseases [28]. Pakistan is to be found in South Asia and is at the joint of Central Asia and the Middle East, which gives its situation enormous value. Pakistan’s total land border is 6,774 km extensive and it confines 4 countries. Pakistan limits India in the east whereas Afghanistan and Iran in the west and China are situated at the northeast.
Although surrounded by land commencing 3 sides, the Arabian Sea occurs in the south. Pakistan is well gifted with the affluence of medicinally essential plants which have compounds containing therapeutic values which are used to treat varied human disorders since remote period [29]. A country like Pakistan having diverse environmental zones widespread climatic and soil conditions thus, the country’s flora is very rich in medicinal plants. Pakistan locally trades 200 herbal drugs and widely export seventy-five crude herbal drugs. About 85 percent of these crude herbs are collected from the wild by the local community [30,31]. In Pakistan, people use plants based on their familiarity for a variety of troubles owing to the lack of accessibility of allopathic doctors, medicines, and fear of side effects related to modern medicines [32]. Local medicinal plant information has contributed to several important recent drug innovations [33]. Most of the population about (80%) of the emergent countries is still dependent on the use of conventional therapeutic remedies for their fundamental health care requirements [34-36]. Numerous realistic and prepared investigation approaches are required to care for the pharmaceutical and ethnomedicinal information of plants from loss. The approach of the ethnomedicinal survey is an appropriate practice that can be used to select plants for complete pharmacological evaluation [37-60].
Methods
Data Collection
The literature search was conducted on the ethnomedicinal use of plants against asthma in Pakistan. We searched online sources for collection of data like Science Direct, ISI Web of Science, research gate, Google Scholar and relevant journals with specific search terms such as ethnomedicinal uses of plants for asthma treatment, asthma, antiasthmatic plants, ethnomedicinal plants, medicinal plants, respiratory disorders, ethnomedicinal plants of Pakistan, ethnomedicinal plants of Khyber Pakhtunkhwa, Punjab, Baluchistan, Sindh, Gilgit Baltistan and Azad Kashmir, to limit the geographical range of the search. After collecting the data the main list was organized with information like botanical name of the plant, family name, part used to treat asthma, remedies formulation process, reference for all species and number of citations.
Data Analysis
The data was tabulated to find a total number of species, families, part percent use, percent use for several plants formulated by specific method and number of times a plant was reported. We categorized the therapeutic properties and medicinal potential of plants used by inhabitants of Pakistan against asthma.
Results
Number of Plants Reported and their Diversity
The indigenous use of medicinal plants in the treatment of asthma was evident from ethnobotanical studies that have been conducted by researchers in various parts of Pakistan. In many of these research papers, researchers have reported a higher number of plants used for the treatment of asthma. But very few publications reported medicinal plants only used for asthma. In the literature search for the current review, it was found, that most of these studies lack proper information for the oral use of the reported plants. In a current review article, a total of 176 species belonging to 63 families has been listed, used against asthma in Pakistan. Asteraceae was predominant family having (19 species) followed by, Fabaceae (12 species), Solanaceae ( 11 species), Lamiaceae (7 species), Apiaceae (6 species), Euphorbiaceae (6 species), Mimosaceae (6 species), Alliaceae (4 species), Amaranthaceae (4 species), Malvaceae (4 species), Nyctaginaceae (4 species), Poaceae (4 species), Polygonaceae (4 species), Ranunculaceae (4 species), Zygophyllaceae (4 species), Apocynaceae (3 species), Brassicaceae (3 species), Capparadaceae (3 species), Convolvulaceae (3 species), Cupressaceae (3 species), Ephedraceae (3 species), Fagaceae (3 species), Acanthaceae (2 species), Aizoaceae (2 species), Anacardaceae (2 species), Asclepiadaceae (2 species) , Chenopodiaceae (2 species), Cucurbitaceae (2 species), Gentianaceae (2 species), Moraceae (2 species), Myrsinaceae (2 species), Pinaceae (2 species), Plantaginaceae (2 species), Rosaceae (2 species), Salvadoraceae (2 species), Valerianaceae (2 species), Violaceae (2 species), Adiantaceae (1 species), Araceae (1 species), Araliaceae (1 species), Arecaceae (1 species), Asphodelaceae (1 species), Boraginaceae (1 species), Buddlejaceae (1 species), Cactaceae (1 species), Cannabinaceae (1 species), Caryophyllaceae (1 species), Elaeagnaceae (1 species), Liliaceae (1 species), Linaceae (1 species), Meliaceae (1 species), Myrtaceae (1 species) , Oxalidaceae (1 species), Portulacaceae (1 species), Primulaceae (1 species), Sapindaceae (1 species), Saxifragaceae (1 species), Scrophulariaceae (1 species), Simarubaceae (1 species), Tamaricaceae (1 species), Taxaceae (1 species), Urticaceae (1 species) and Verbenaceae (1 species). Our results concerning the high proportion utilization of family Asteraceae in Pakistan agreed with other ethnomedicinal floras [61-82].
Mostly Reported Plants
Various plants due to their spacious distribution pattern and ethnomedicinal value have been reported indicating that these plants are well-known among people as antiasthmatic plants. According to these reports, Calotropis procera is reported in 19 publications which have the highest use-value as an antiasthmatic plant. Calatropis procera is followed by Achyranthes Aspera having (14 citations), Solanum surattense (12 citations), Hyoscyamus niger (8 citations), Justicia adhatoda (8 citations). Four plants Ammi visnaga, Ephedra gerardiana, Peganum harmala, Withania somnifera having (6 Citations). Five plants Abies pindrow, Allium sativum, Datura stramonium , Euphorbia hirta, Pistacia integerrima are reported in five articles each which are ethnomedicinally used as antiasthmatic plants. Nine plants Alhagi mauroum, Bergenia ciliate, Capparis decidua, Datura metel, Lactuca serriola, Mentha longifolia, Quercus incana, Taxus wallichiana and Trianthema portulacastrum are reported in four research reports. Also nine other plants Actaea spicata, Cichorium intybus, Desmodium elegans, Ferula assafoetida, Ficus religiosa, Plantago major, Quercus leucotrichophora, Saussurea lappa and Tephrosia lupinifolia are reported in three publication each used against asthma.
Plant Parts Used
In remedies preparation, almost all parts of the plant were used against asthma in Pakistan. These include leaves, roots, fruit, flower, seeds, bark, stem, whole plant, shoot, aerial parts, bulb, wood, gum, rhizome, latex, pod, and resin. Data analysis shows that leaves were most frequently used (24.18%) against asthma followed by root s (15.03%), fruit (12.74%), flower (11.43%), seed (11.11%), bark (6.20%), stem (5.55%), whole plant (4.24%), shoot (1.96%), aerial parts (1.63%), bulb (1.63%), wood (0.98%), gum (0.98%), rhizome (0.98%), latex (0.65%), pod (0.32%) and resin (0.32%). All the plant parts are used to cure asthma but the leaves, roots, whole plant, and seeds are the most favorite parts of the therapeutic plants. Compared with the formerly available information these outcomes are in a comparable pattern as leaves be found frequently used parts [83-90]. The use of roots and whole plants in remedies preparations may create pressure on the flora if exploited accidentally. To uproot the whole plant and underground parts like roots and rhizome is not feasible [91]. The underground parts have a high number of bioactive constituents [92].
Preparation, Forms, Dose, and Using Time of Herbal Remedies
Out of a total of 176 plant species, different methods of preparation of remedies were used by different people in Pakistan. However, in most of the report’s formulation methods and time of usage are not mentioned. Different people use different parts of the plant in remedies formulation like some use fresh parts, dry parts, or both forms. The amount of the medicinal recopies preparation (quantity, dose, frequency, duration) is not very accurate, as it commonly different based on application, type of disease, age of the patient, physical health, the severity of disease, and diagnosis and experience of a local traditional healer. Remedies preparation was categorized into various methods in which water acts as dilution media in herbal preparations whereas some remedies were set from dry and fresh plant parts [93]. It is reported that approximately all of the known species used as single herbal recipes with their specific part use for particular ailment while sometimes the mixtures of various parts with extra ingredients like (Milk, honey, butter) may be also used to treat some diseases. The different forms of remedies formulation include decoction (31.01%) which is mostly used formulation method followed by infusion (25.30%), powder (21.63%), juice (7.75%), paste (6.93%), extract (5.71%), smoke (3.67%), vegetable (2.44%), poultice (2.04%), directly used (0.81%) tinctures (0.40%) and ash (0.40%). The literature search for the current review article shows that people of the region reserved remedies of medicinal plants that be utilized in case of need [94-116]. The people gather these plants from their natural habitat or buy from local traditional health healers.
Conclusion
A large amount of accessibility and ease of making of herbal drugs when compared to artificial drugs makes herbal plants the finest option to cure asthma but the purity of extract; action and incidence of side effects are the matters of concern. The ethnobotanical studies conducted revealed that people in Pakistan mostly rely on the available indigenous plant remedies for the treatment of asthma. However, in most ethnobotanical research reports from Pakistan, important information regarding remedies preparation proper dosage and time of use is not well reported. Therefore, proper information regarding parts formulation, dosage and time of use is necessary for utilization and safety in health management. It was found that most of the recorded plants have beneficial and therapeutic effects reported in many of the publications. Awareness among the community on herbal medication and conservation of antiasthmatic plants is also too much necessary. Highly utilized plants in different regions of Pakistan against asthma should be tested in-vitro and in-vivo for their phytochemical and pharmacological activities.
Competing Interest
The authors declare that they have no competing interests.
References
- Abbasi AM, MA Khan, N Khan, MH Shah (2013) Ethnobotanical survey of medicinally important wild edible fruits species used by tribal communities of Lesser Himalayas-Pakistan. Journal of Ethnopharmacology 148(2): 528-536.
- Ahmad SS, S Erum, SM Khan, M Nawaz, A Wahid (2014a) Exploring the Medicinal Plants Wealth: A Traditional Medico-Botanical Knowledge of Local Communities in Changa Manga Forest. Pakistan Middle-East Journal of Scientific Research 20(12): 1772-1779.
- Ahmad S, HM Wariss, K Alam, S Anjum, M Mukhtar (2014b) Ethnobotanical Studies of Plant Resources of Cholistan Desert. Pakistan International Journal of Science and Research (IJSR) 3(6): 2319-7064.
- Ahmad M, S Sultana, S Fazl I Hadi, TB Hadda, S Rashid (2014c) An Ethnobotanical study of Medicinal Plants in high mountainous region of Chail valley (District Swat- Pakistan). Journal of Ethnobiology and Ethnomedicine 10: 36.
- Ahmad M, MA Khan, S Manzoor, M Zafar, S Sultana (2005) Check List of Medicinal Flora of Tehsil Isakhel, District Mianwali-Pakistan. Ethnobotanical Leaflets 10: 41-48.
- Ahmad SS, F Mahmood, ZUH Dogar, ZI Khan, K Ahmad (2009) Prioritization of Medicinal Plants of Margala Hills National Park, Islamabad On The Basis Of Available Information. Pak J Bot 41(5): 2105-2114.
- Ahmed N, A Mahmood, SS Tahir, A Bano, RN Malik (2014d) Ethnomedicinal knowledge and relative importance of indigenous medicinal plants of Cholistan desert, Punjab Province, Pakistan. Journal of Ethnopharmacology 155(2): 1263-1275.
- Ahmed N, A Mahmood, A Mahmood, Z Sadeghi, M Farman (2015) Ethnopharmacological importance of medicinal flora from the district of Vehari, Punjab province, Pakistan. J Ethnopharmacol 168: 66-78.
- Ahmed E, M Arshad, A Saboor, R Qureshi, G Mustafa (2013) Ethnobotanical appraisal and medicinal use of plants in Patriata, New Murree, evidence from Pakistan. Journal of Ethnobiology and Ethnomedicine 9: 13.
- Ajaib M, Q Khan, ZUD Khan (2013) A Contribution to the Ethnobotanical Studies of Some Plants of Loralai District, Baluchistan. Biologia (Pakistan) 59(2): 323-327.
- Ajaib M, ZUD Khan, A Zikrea (2014) Ethnobotanical survey of some important herbaceous plants of District Kotli, Azad Jammu & Kashmir. Biologia (Pakistan) 601: 11-22.
- Akhtar N, A Rashid, W Murad, E Bergmeier (2013) Diversity and use of ethno-medicinal plants in the region of Swat, North Pakistan. Journal of Ethnobiology and Ethnomedicine 9: 25.
- Alam N, ZK Shinwari, M Ilyas, Z Ullah (2011) Indigenous Knowledge of Medicinal Plants of Chagharzai Valley, District Buner Pakistan. Pak J Bot 43(2): 773-780.
- Alamgeer T Ahmad, M Rashid, M Nasir, H Malik, MN Mushtaq (2013) Ethnomedicinal Survey of plants of Valley Alladand Dehri, Tehsil Batkhela, District Malakand. Pakistan International Journal of Basic Medical Sciences and Pharmacy (IJBMSP) 3(1).
- Amjad MS, M Arshad (2014) Ethnobotanical inventory and medicinal uses of some important woody plant species of Kotli, Azad Kashmir, Pakistan. Asian Pac J Trop Biomed 4(12): 952-958.
- (2001) Anonymous NWFP Forestry Sector Project (FSP) Peshawar: Operational Plan (OP) for Madyan Resources Management Sub-Unit Kalam Forest Division at Madyan. Forestry, Fisheries and Wildlife Department, NWFP.
- Arshad M, MF Nisar, A Majeed, S Smail, M Ahmad (2010) Ethnomedicinal Flora in District Sialkot, Punjab, Pakistan. Middle-East Journal of Scientific Research 9(2): 209-214.
- Awan MR, Z Jamal, A Khan (2013) Ethno-Botanical Studies Of Economically Important Plants From Mountainous Region Of Gilgit-Baltistan, Pakistan. Sci Tech And Dev 32(4): 308-318.
- Bano A, M Ahmad, TB Hadda, A Saboor, S Sultana (2014) Quantitative ethnomedicinal study of plants used in the skardu valley at high altitude of Karakoram-Himalayan range, Pakistan. Journal of Ethnobiology and Ethnomedicine 10: 43.
- Bano A, M Ahmad, MA Khan, M Zafar, S Sultana (2012) Pollen morphology of four endemic species of Pedicularis L. from alpine zone of the Deosai Plateau, Himalayan range. Bangl J Plant Taxon 19(1): 1-5.
- Barkatullah, M Ibrar, A Rauf, TB Hadda, MS Mubarak, et al. (2015) Quantitative ethnobotanical survey of medicinal flora thriving in Malakand Pass Hills, Khyber Pakhtunkhwa, Pakistan. Journal of Ethnopharmacology 169: 335-346.
- Bateman ED, SS Hurd, PJ Barnes, J Bousquet, JM Drazen (2008) Global strategy for asthma management and prevention: GINA executive summary. European Respiratory Journal 31(1): 143-178.
- Bibi S, J Sultana, H Sultana (2014a) Ethnobotanical uses of medicinal plants in the highlands of Soan Valley, Salt Range, Pakistan. Journal of Ethnopharmacology 155(1): 352-361.
- Bibi T, M Ahmad, RB Tareen, NM Tareen R Jabeen (2014b) Ethnobotany of medicinal plants in district Mastung of Balochistan province of Pakistan. J Ethnopharmacol 157: 79-89.
- Bjermer L (2007) Time for a paradigm shift in asthma treatment: From relieving bronchospasm to controlling systemic inflammation. Journal of Allergy and Clinical Immunology 120(6): 1267-1274.
- Blanco E, MJ Macia, R Morales (1999) Medicinal and veterinary plants of El Caurel (Galicia, northwest pain). J Ethnopharmacol 65(2): 113-124.
- Bousquet J, PJ Bosquet, P Godard, JP Daures (2005) The public health implications of asthma. Bulletin of the World Health Organization 83(7): 548-554.
- Braman SS (2006) The global burden of asthma. Chest 130(1): 4S-12S.
- Calixto JB (2005) Twenty five years of research on medicinal plants in Latin America: a personal review. Journal of Ethnopharmacology 100(1-2): 131-134.
- Camargo CA, G Rachelefsky, M Schatz (2009) Managing asthma exacerbations in the emergency department- summary of the national asthma education and prevention program expert panel report 3 guidelines for the management of asthma exacerbation. Proceedings of the American Thoracic Society 6: 357-366.
- Cornara L, A Rocca, S Marsili, MG Mariotti (2009) Traditional uses of plants in the Eastern Riviera (Liguria, Italy). J Ethnopharm 125(1): 16-30.
- Cox PA (2000) Will tribal knowledge survive the millennium. Science 287(5450): 44-45.
- Danoe R, Bogh HB (1999) Usage of herbal medicine against the minths in livestock. An old tradition gets its renaissance. World Animal Review 93: 60-67.
- Fabricant DS, NR Farnsworth (2001) The value of plants used in traditional medicine for drug discovery. Environmental Health Perspectives 109(1): 69-75.
- Flatie T, T Gedif K Asres, T Gebre Mariam (2009) Ethnomedical survey of Berta ethnic group Assosa Zone, Benishangul-Gumuz regional state, mid-west Ethiopia. Journal of Ethnobiology and Ethnomedicine 5: 14.
- Gibbon CJ (2005) South African medicines form ulary (7th Edn.)., In: Gibbon CJ (Edt.)., South African Medical Association, Health and Medical Publishing Group, pp.481-493.
- Giday M, Z Asfaw T Elmqvist, Z Woldu (2003) An ethnobotanical study of medicinal plants used by the Zay people in Ethiopia. Journal of Ethnopharmacology 85(1): 43-52.
- Green R, G Davis, D Price (2008) Perceptions, impact and management of asthma in South Africa: A patient questionnaire study. Primary Care Respiratory Journal 17(4): 212-216.
- Green RJ, M Plit, W Du Plessis, AD Rothberg (1998) Asthma in South Africa- a long way to go. South African Medical Journal 88(11): 1389-1393.
- Gulshan AB, AA Dasti, S Hussain, MI Atta, MAU Din (2012) Indigenous Uses Of Medicinal Plants In Rural Areas Of Dera Ghazi Khan, Punjab, Pakistan. Arpn Journal of Agricultural and Biological Science 7(9).
- Hamayun M (2007) Traditional uses of some medicinal plants of Swat Valley, Pakistan. Indian Journal of Traditional Knowledge 6(4): 636-641.
- Haq F, H Ahmad, M Alam (2011) Traditional uses of medicinal plants of Nandiar Khuwarrcatchment (District Battagram), Pakistan. Journal of Medicinal Plants Research 5(1): 39-48.
- Haq F (2012) The Ethno Botanical Uses of Medicinal Plants of Allai Valley, Western Himalaya Pakistan. International Journal of Plant Research 2(1): 21-34.
- Hayat Q, MA Khan, M Ahmad, N Shaheen, G Yasmin (2008) Ethnotaxonomical Approach in the Identification of Useful Medicinal Flora of Tehsil Pindigheb (District Attock) Pakistan. Ethnobotany Research & Applications 6: 35-62.
- Hazrat A, M Nisar, J Shah, S Ahmad (2011) Ethnobotanical Study Of Some Elite Plants Belonging To Dir, Kohistan Valley, Khyber pakhtunkhwa, Pakistan. Pak J Bot 43(2): 787-795.
- Hazrat A, J Shah, S Ahmad, M Nisar, AK Jan (2010) Medicinal plants of Usheri Valley, Dir, NWFP. Pakistan J Bot 4(1): 31-34.
- Heinrich M, S Gibbons (2001) Ethnopharmacology in drug discovery: an analysis of its role and potential contribution. J Pharm Pharmacol 53(4): 425-432.
- Heinrich M (2008) Ethnopharmacy and natural product research multidisciplinary opportunities for research in them etabolomicage. Phytochem Lett 1(1): 1-5.
- Hussain M, GM Shah, MA Khan (2006) Traditional Medicinal and Economic uses of Gymnosperms of Kaghan Valley. Pakistan Ethnobotanical Leaflets 10: 72-81.
- Hussain K, MF Nisar, A Majeed, K Nawaz, KH Bhatti (2010) Ethnomedicinal Survey for Important Plants of Jalalpur Jattan, District Gujrat, Punjab, Pakistan. Ethnobotanical Leaflets 14: 807-25.
- (1998) ISAAC Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjuctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee Lancet 351: 1225-1232.
- Ishtiaq M, AS Mumtaz, T Hussain, A Ghani (2012) Medicinal plant diversity in the flora of Leepa Valley, Muzaffarabad (AJK), Pakistan. African Journal of Biotechnology 11(13): 3087-3098.
- Jan S, MA Khan, SU Din, W Murad, M Hussain (2008) Herbal Rmidies Used For astrointestinal disorders In Kaghan Valley, Nwfp, Pakistan. Pak J Weed Sci Res 14(3-4): 169-200.
- Kamal M, SM Wazir, M Hassan, M Subhan, SU Khan, et al. (2009) Ethnobotanically important plants Of District Bannu, Pakistan. Pak J Pl Sci 15(2): 87-93.
- Kayani S, M Ahmad, S Sultana, ZK Shinwari, M Zafar (2015) Ethnobotany of medicinal plants among the communities of Alpine and Sub-alpine regions of Pakistan. Journal of Ethnopharmacology 164: 186-202.
- Kayani S, M Ahmad, M Zafar, S Sultana, MPZ Khan (2014) Ethnobotanical uses of medicinal plants for respiratory disorders among the inhabitants of Gallies Abbottabad, Northern Pakistan. J Ethnopharmacol 156: 47-60.
- Kelly HW, CA Sorknes (2005) Asthma. Pharmacotherapy- A Pathophysiological Approach (6th)., In: Dipiro JT, Talbert RL, Yee GC, Matzke TR, Wells BG (Eds.)., The McGraw-Hill, New York, pp 504.
- Khan SM, H Ahmad, H Shaheen, Z Ullah, M Ahmad (2013) Medicinal flora and ethnoecological knowledge in the Naran Valley, Western Himalaya, Pakistan. Journal of Ethnobiology and Ethnomedicine 9: 4.
- Khan N, M Ahmed, A Ahmed, S Shaukat, M Wahab (2011b) Important Medicinal Plants Of Chitral Gol National Park (Cgnp) Pakistan. Pak J Bot 43(2): 797-809.
- Khan B, AA Dir, R Qureshi, G Mustafa (2011a) Medicinal Uses of Plants by the Inhabitants of Khunjerab National Park, Gilgit, Pakistan. Pak J Bot 43(5): 2301-2310.
- Khan SW, S Khatoon (2008) Ethnobotanical Studies On Some Useful Herbs Of Haramosh And Bugrote Valleys In Gilgit, Northern Areas Of Pakistan. Pak J Bot 40(1): 43-58.
- Khan SU, SM Wazir, M Subhan, M Zahoor, M Kamal (2009) Some of the ethnobotanically important plants of F.R. Bannu, Nwfp, Pakistan. Pak J Pl Sci 15(1): 81-85.
- Khan IM, MH Arsalan, MF Siddiqui, S Zeeshan, SS Shaukat (2010) Spatial Association of Asthma and Vegetation In Karachi: A Gis Perspective. Pak J Bot 42(5): 3547-3554.
- Kunwar RM, BK Nepal, HB Kshhetri, SK Rai, RW Bussmann (2006) Ethno- medicine in Himalaya: a case study from Dolpa, Humla, Jumla and Mustang districts of Nepal. Journal of Ethnobiology and Ethnomedicine 2: 27.
- Ladio A, M Lozada, M Weigandt (2007) Comparison of traditional wild plant knowledge between aboriginal communities inhabiting arid and forest environments in Patagonia, Argentina. J Arid Environ 69(4): 695-715.
- Mahmood A, A Mahmood, RN Malik, ZK Shinwari (2013) Indigenous knowledge of medicinal plants from Gujranwala district, Pakistan. Journal of Ethnopharmacology 148(2): 714-723.
- Mahmood A, A Mahmood, RN Malik (2012) Indigenous knowledge of medicinal plants from Leepa valley, Azad Jammu and Kashmir, Pakistan. Journal of Ethnopharmacology 143(1): 338-346.
- Marwat SK, MA Khan, M Ahmad, M Zafar, FU Rehman (2009) Fruit Plant Species Mentioned in the Holy Quran and Ahadith and Their Ethnomedicinal Importance. American-Eurasian J Agric & Environ Sci 5(2): 284-295.
- Masoli M, D Fabian, S Holtand, R Beasley (2004) The global burden of asthma: Executive summary of GINA dissemination committee report. Allergy 59(5): 469-478.
- Murad W, A Azizullah, M Adnan, A Tariq, KU Khan (2013) Ethnobotanical assessment of plant resources of Banda Daud Shah, District Karak, Pakistan. Journal of Ethnobiology and Ethnomedicine 9(1): 77.
- Muslim CM, S Sikander (2010) Ethnobotany Of Medicinal Plants Of Leepa Valley, Azad Kashmir. The Pakistan Journal of Forestry 60(2).
- Naidu MT, NC Babu, M Venkaiah (2013) Ethnic remedies against snake bite from Kotiahills of Vizianagaram district, Andhra Pradesh, India. Indian J Nat Prod Resour 4(2): 194-196.
- Nasir S, J Ahmed, M Asrar (2014) Medicinal Plants: A Promising Resource for Poverty Alleviation in The Milieu of Swat. Fuuast J Biol 4(2): 237-245.
- Nasir E, SI Ali (2002) Flora of Pakistan. National Herbarium, NARC, Islamabad and Department of Botany, University of Karachi, Karachi. Fasc 41: 1-207.
- Nastro AM, AV Germano, A Marino, MA Cannattelli (2000) Extraction method and Bioaustrography for Evolution of medicinal plants Anti-microbial activity. Lett Appl Microbiol 30(5): 379-384.
- Nisar MF, S Ismail, M Arshad, A Majeed, M Arfan (2011) Ethnomedicinal Flora of District Mandi Bahaudin, Pakistan. Middle-East Journal of Scientific Research 9(2): 233-238.
- Passalacqua NG, PM Guarrera, GD Fine (2007) Contribution to the knowledge of the folk plant medicine in Calabria region (Southern Italy). Fitoterapia 78(1): 52-68.
- Patel H, C Gwilt (2008) Respiratory system at a glance. Mosby/Elsevier. Edinburgh, New York.
- Perumal R, RS Ignacimuthu (2000) Antibacterial activity of some folklore medicinal plants used by tribals in Western Ghats of India. J Ethnopharmacol 69(1): 63-71.
- Pieroni A, CL Quave (2005) Traditional pharmacopoeias and medicines among Albanians and Italians in southern Italy: a comparison. J Ethnopharmacol 101(1-3): 258-270.
- Qureshi RA, MA Ghufran, KN Sultana, M Ashraf, AG Khan (2006) Ethnobotanical Studies of Medicinal Plants of Gilgit District and Surrounding Areas. Ethnobotany Research & Applications 5: 115-122.
- Qureshi R, GR Bhatti, RA Memon (2010) Ethnomedicinal Uses of Herbs from Northern Part of Nara Desert, Pakistan. Pak J Bot 42(2): 839-851.
- Qureshi R, A Waheed, M Arshad, T Umbreen (2009) Medico-Ethnobotanical Inventory of Tehsil Chakwal, Pakistan. Pak J Bot 41(2): 529-538.
- Qureshi R, M Maqsood, M Arshad, AK Chaudhry (2011) Ethnomedicinal Uses of Plants by the People of Women of Kalat And Khuzdar Regions of Balochistan, Pakistan Pak J Bot 42(3): 1465-1485.
- Qureshi R, GR Bhatti (2009) Folklore Uses of Amaranthaceae Family from Nara Desert, Pakistan. Pak J Bot 41(4): 1565-1572.
- Qureshi R, H Qureshi, H Shaheen, G Rahim, W Ahmed (2012) Medico-Ethnobotanical Knowledge of Jhang Saiyidan, Islamabad, Pakistan. Archives Des Sciences 65(12): 259-271.
- Qureshi R, GR Bhatti (2008) Ethnobotany of plants used by the Thari people of Nara Desert, Pakistan. Fitoterapia 79(6): 468-473.
- Redzic SS (2007) The ecological aspect of ethnobotany and ethnopharmacology of population in Bosniaand Herzegovina. Collegium Antropologicum 31(3): 869-890.
- Rehman EU (2006) Indigenous Knowledge on Medicinal Plants, Village Barali Kass and its Allied Areas, District Kotli Azad Jammu &Kashmir, Pakistan. Ethnobotanical Leaflets 10: 254-264.
- Sabeen M, SS Ahmad (2009) Exploring the Folk Medicinal Flora of Abbotabad City, Pakistan. Ethnobotanical Leaflets 13: 810-33.
- Saqib Z, A Mahmood, RN Malik, A Mahmood, JH Syed (2014) Indigenous knowledge of medicinal plants in Kotli Sattian, Rawalpindi district, Pakistan. Journal of Ethnopharmacology 151(2): 820-828.
- Saric Kundalic B (2010) Ethnobotanical study on medicinal use of wild and cultivated plants in middle, south and west Bosnia and Herzegovina. Journal of Ethnopharmacology 131(1): 33-55.
- Saunders KB (1993) Origin of the word “asthma”. Thorax 48: 647.
- Shah GM, MA Khan (2016) Check List of Medicinal Plants of Siran Valley Mansehra Pakistan. Ethnobotanical Leaflets 10: 63-71.
- Shaheen H, ZK Shinwari, RA Qureshi, Z Ullah (2012b) Indigenous Plant Resources and Their Utilization Practices In Village Populations of Kashmir Himalayas. Pak J Bot 44(2): 739-745.
- Shaheen H, R Qureshi, A Akram, M Gulfraz (2012a) Some Important Medicinal Flora of Noopur Thal, Khushab, Pakistan. Archives Des Sciences 65(2).
- Shedayi AA, B Gulshan (2012) Ethnomedicinal uses of plant resources in Gilgit-Baltistan of Pakistan. Journal of Medicinal Plants Research 6(29): 4540-4549.
- Sher Z, ZU Din Khan, F Hussain (2011) Ethnobotanical Studies Of Some Plants Of Chagharzai Valley, District Buner, Pakistan. Pak J Bot 43(3): 1445-1452.
- Sher H, F Hussain (2009) Ethnobotanical evaluation of some plant resources in Northern part of Pakistan. Journal of Biotechnology 8(17): 4066-4076.
- Sher H, MN Alyemeni, L Wijaya, AJ Shah (2010) Ethnopharmaceutically important medicinal plants and its utilization in traditional system of medicine, observation from the Northern Parts of Pakistan. Journal of Medicinal Plants Research 4(18): 1853-1864.
- Shinwari S, R Qureshi (2011) Ethnobotanical study of Kohat passe Pakistan. Pakistan J Bot 43: 135-139.
- Shinwari ZK, SS Gilani (2003) Sustainable harvest of medicinal plants, Bulasbar, Nallah, Aster, Gilgat. J Ethno Pharmacol 84(2-3): 289-298.
- Taj S, SM Wazir, M Subhan, M Hassan, SU Khan (2009) Some of the ethnobotanically important plants of Godi Khel & Its outskirts hilly areas, District Karak, Pakistan. Pak J Pl Sci 15(1): 39-43.
- Takizawa H (2007) Novel strategies for the treatment of asthma. Recent Patents on Inflammation and Allergy Drug Discovery 1(1): 13-19.
- Tareen RB, T Bibi, MA Khan, M Ahmad, M Zafar (2010) Indigenous Knowledge of Folk Medicine by the Kadhi Areas of Khushab, Punjab, Pakistan. Pak J Bot 43(1): 121-133.
- Ullah S, MR Khan, NA Shah, SA Shah, M Majid (2014) Ethnomedicinal plant use value in the Lakki Marwat district of Pakistan. Journal of Ethnopharmacology, pp. 158.
- Ullah M, MU Khan, A Mahmood, RN Malik, M Hussain (2013) An ethnobotanical survey of indigenous medicinal plants in Wana district south Waziristan agency, Pakistan. Journal of Ethnopharmacology 150(3): 918-924.
- Vercelli D (2008) Discovering susceptibility genes for asthma and allergy. Nature 8(3): 169-182.
- Verpoorte R, Y Choi, H Kim (2005) Ethnopharmacology and systems biology: a perfect holisticmatch. J Ethnopharmacol 100(1-2): 53-56.
- Verstraelen S, K Bloemen, I Nelissen, H Witters, G Schoeters (2008) Cell types involved in allergic asthma and their use in in vitro models to assess respiratory sensitization. Toxicology In Vitro 22(6): 1419-1431.
- (2002) WHO Traditional and Alternative Medicine, Fact sheet No 271Ward JPT, J Ward, CM Wiener. and RM Leach 2002. Respiratory system at a glance. Blackwell Science, Cambridge.
- Wariss KM, S Ahmad, S Anjum, K Alam (2014) Ethnobotanical Studies of Dicotyledonous Plants of Lal Suhanra National Park, Bahawalpur, Pakistan. International Journal of Science and Research (IJSR) 3(6): 2452.
- Zabihullah Q, A Rashid, N Akhtar (2006) Ethnobotanical Survey in Kot Manzaray Baba Valley Malakand Agency, Pakistan. Pak J Pl Sci 12(2): 115-121.
- Zdanowicz MM (2007) Pharmacotherapy of Asthma. American Journal of Pharmaceutical Education 47(1): 1-13.
- Zereen A, ZUD Khan (2012) A survey of ethnobotanically important trees of Central Punjab, Pakistan. Biologia (Pakistan) 58(1-2): 21-30.
- Zereen A, ZUD Khan, M Ajaib (2013) Ethnobotanical evaluation of the shrubs of Central Punjab, Pakistan. Biologia (Pakistan) 59(1): 139-146.