Introduction
The prevalence of childhood asthma has increased in recent years. The World Health Organization has called for conducting research exploring the role of traditional medicine and medicinal plants in respiratory disease control.

Objective
To identify the relationship between the prevalence of childhood asthma and traditional care of the respiratory system, including cultivation and use of medicinal plants.

Methods
We conducted an observational, analytic, case-control study that included children 2 to 14 years old who used official health services in eight municipalities near Bogota between 2014 and 2015. Cases were children diagnosed with asthma. We randomly selected the controls among the remaining patients of the same healthcare facilities. We applied an 18-question survey. The Mantel-Haenszel procedure identified significant associations using 95% confidence intervals.

Results
We surveyed the caretakers of 97 cases and 279 controls in eight municipalities. Some 23.4% (88/376) and 37.9% (142/375) reported using traditional remedies for fever control and common cold management, respectively. 8.8% (33/376) reported following traditional care during a common cold, 30.4% (114/375) reported growing medicinal plants at home, and 45% (166/369) reported using medicinal plants for health purposes in their household. Multivariate analysis showed that having and using medicinal plants at home is associated with a lower reporting of asthma (odds ratio 0.49; 95% confidence interval: 0.25 to 0.99).

Conclusions
Cultivating and using medicinal plants at home is associated with a lower reporting of childhood asthma. Researchers should consider the therapeutic, environmental, and cultural properties of medicinal plants to prevent respiratory diseases.

Authors: Germán Zuluaga[1], Iván Sarmiento[1], Juan Pimentel[1], Camilo Correal[2], Neil Andersson[3]

Affiliation:
[1] Grupo de Estudios en Sistemas Tradicionales de Salud, Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
[2] Universidad de La Sabana, Departamento de Medicina Familiar y Salud Pública, Chía, Colombia
[3] CIET-PRAM, Departamento de Medicina Familiar, Universidad de McGill, Montreal, Quebec, Canadá

E-mail: gzuluaga@cemi.org.co

Author address:
[1] Calle 12 # 3A – 21
Cota, Cundinamarca
Colombia

Citation: Zuluaga G, Sarmiento I, Pimentel J, Correal C, Andersson N. Cultivation and use of medicinal plants and association with reporting of childhood asthma: A case-control study in the Bogotá savanna. Medwave 2021;21(04):e8196 doi: 10.5867/medwave.2021.04.8196

Submission date: 16/9/2020

Acceptance date: 13/4/2021

Publication date: 14/5/2021

Origin: Not commissioned.

Type of review: Externally peer-reviewed by two reviewers, double-blind.

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1. Mallol J. El asma en niños de América Latina. Allergol Immunopathol (Madr). 2004 Jan;32(3):100–3. | CrossRef |
2. Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: is prevention possible? Lancet. 2015 Sep 12;386(9998):1075-85. | CrossRef | PubMed |
3. Martinez FD, Vercelli D. Asthma. Lancet. 2013 Oct 19;382(9901):1360-72. | CrossRef | PubMed |
4. Asher MI. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J. 1998 Aug;12(2):315-35. | CrossRef | PubMed |
5. Belsky DW, Sears MR, Hancox RJ, Harrington H, Houts R, Moffitt TE, et al. Polygenic risk and the development and course of asthma: an analysis of data from a four-decade longitudinal study. Lancet Respir Med. 2013 Aug;1(6):453-61. | CrossRef | PubMed |
6. Marra F, Marra CA, Richardson K, Lynd LD, Kozyrskyj A, Patrick DM, et al. Antibiotic use in children is associated with increased risk of asthma. Pediatrics. 2009 Mar;123(3):1003-10. | CrossRef | PubMed |
7. Beasley R, Clayton T, Crane J, von Mutius E, Lai CK, Montefort S, et al. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme. Lancet. 2008 Sep 20;372(9643):1039-48. | CrossRef | PubMed |
8. Ege MJ, Mayer M, Normand AC, Genuneit J, Cookson WO, Braun-Fahrländer C, et al. Exposure to environmental microorganisms and childhood asthma. N Engl J Med. 2011 Feb 24;364(8):701-9. | CrossRef | PubMed |
9. Thornley S, Stewart A, Marshall R, Jackson R. Per capita sugar consumption is associated with severe childhood asthma: an ecological study of 53 countries. Prim Care Respir J. 2011 Mar;20(1):75-8. | CrossRef | PubMed |
10. Global Initiative for Asthma (GINA). GUÍA DE BOLSILLO PARA EL MANEJO Y LA PREVENCIÓN DEL ASMA. Global Initiative for Asthma (GINA); 2019. p. 39. [Internet] | Link |
11. Ministerio de Salud y Protección Social. Guía de práctica clínica para el diagnóstico, atención integral y seguimiento de niños y niñas con diagnóstico de Asma. Bogotá, Colombia; 2013. (Guías de práctica clínica). Report No.: GPC-2013-01.
12. Global Initiative for Asthma (GINA). GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION. Global Initiative for Asthma (GINA); 2018. p. 162. [Internet] | Link |
13. Scichilone N, Ventura MT, Bonini M, Braido F, Bucca C, Caminati M, et al. Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly. Clin Mol Allergy. 2015 Jun 22;13(1):7. | CrossRef | PubMed |
14. York T, de Wet H, van Vuuren SF. Plants used for treating respiratory infections in rural Maputaland, KwaZulu-Natal, South Africa. J Ethnopharmacol. 2011 Jun 1;135(3):696-710. | CrossRef | PubMed |
15. Bastian P, Fal AM, Jambor J, Michalak A, Noster B, Sievers H, et al. Candelabra aloe (Aloe arborescens) in the therapy and prophylaxis of upper respiratory tract infections: traditional use and recent research results. Wien Med Wochenschr. 2013 Feb;163(3-4):73-9. | CrossRef | PubMed |
16. Mosaddegh M, Naghibi F, Moazzeni H, Pirani A, Esmaeili S. Ethnobotanical survey of herbal remedies traditionally used in Kohghiluyeh va Boyer Ahmad province of Iran. J Ethnopharmacol. 2012 May 7;141(1):80-95. | CrossRef | PubMed |
17. Organización Mundial de la Salud. Promoción y desarrollo de la medicina tradicional. Informe de una reunión de la OMS (622). Ginebra; 1978.
18. Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. Lancet. 2012 Aug 4;380(9840):507-35. | CrossRef | PubMed |
19. Cameron M, Andersson N, McDowell I, Ledogar RJ. Culturally Safe Epidemiology: Oxymoron or Scientific Imperative. Pimatisiwin. 2010 Fall;8(2):89-116. | PubMed |
20. Zuluaga G. La etnobotánica medicinal en el municipio de Cota. In: El legado de las plantas medicinales en la Sabana de Bogotá. Bogotá: Fundación Herencia Verde; 1995. p. 42–52.
21. World Health Organization. ICD-10 Version: 2015. 2015.
22. Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. John Wiley & Sons. New York. 1981.
23. Sarmiento I, Amaya C, Cruz MP, Zuluaga G. Lo que podemos hacer todos para respirar bien. Cota, Cundinamarca: Centro de Estudios Médicos Interculturales; 2015. 30 p.
24. Andersson N, Mitchell S. Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. Int J Health Geogr. 2006 Jan 3;5:1. | CrossRef | PubMed |
25. World Health Organization. WHO traditional medicine strategy 2002-2005. Geneva, Switzerland; 2002.
26. Banda Y, Chapman V, Goldenberg RL, Stringer JS, Culhane JF, Sinkala M, et al. Use of traditional medicine among pregnant women in Lusaka, Zambia. J Altern Complement Med. 2007 Jan-Feb;13(1):123-7. | CrossRef | PubMed |
27. Sarmiento I, Zuluaga G, Andersson N. Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria's Cross River State: interviews with traditional practitioners and a statewide cross-sectional study. BMJ Open. 2016 Apr 19;6(4):e010417. | CrossRef | PubMed |
28. Sood P, Wood RA. Green Areas Around Homes Reduce Atopic Sensitization in Children. Pediatrics. 2015 Dec;136(Supplement):S234–S234. | CrossRef |
29. Moscato G. [Allergological risk factors of bronchial asthma and rhinitis in enclosed environments]. G Ital Med Lav. 1989. 11(3–4):177–81.
30. Montealegre F, Meyer B, Chardon D, Vargas W, Zavala D, Hart B, et al. Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment. Clin Exp Allergy. 2004 Jan;34(1):51-8. | CrossRef | PubMed |
31. Aydin Ö, Erkekol FÖ, Misirloigil Z, Demirel YS, Mungan D. Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma. Allergy Asthma Proc. 2014 Mar-Apr;35(2):e9-14. | CrossRef | PubMed |
32. Kim HH, Yang JY, Lee JY, Park JW, Kim KJ, Lim BS, et al. House-plant placement for indoor air purification and health benefits on asthmatics. Environ Health Toxicol. 2014 Oct 8;29:e2014014. | CrossRef | PubMed |
33. Wakefield S, Yeudall F, Taron C, Reynolds J, Skinner A. Growing urban health: community gardening in South-East Toronto. Health Promot Int. 2007 Jun;22(2):92-101. | CrossRef | PubMed |
34. Ohly H, Gentry S, Wigglesworth R, Bethel A, Lovell R, Garside R. A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence. BMC Public Health. 2016 Mar 25;16:286. | CrossRef | PubMed |
35. Unruh AM. The meaning of gardens and gardening in daily life: a comparison between gardeners with serious health problems and healthy participants. Acta Hortic. 2004 Jun;(639):67–73. | CrossRef |
36. van den Berg AE, van Winsum-Westra M, de Vries S, van Dillen SM. Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment. Environ Health. 2010 Nov 23;9:74. | CrossRef | PubMed |
37. Zuluaga G. La botella curada: Aproximación a los sistemas tradicionales de salud de las comunidades negras del Chocó Biogeográfico. Bogotá, Colombia: Amazon Conservation Team; 2003. p. 352.
38. Zuluaga G. El yoco: la savia de la selva. Bogotá: Centro Editorial Universidad del Rosario; 2004. p.110.
39. Pachter LM, Cloutier MM, Bernstein BA. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med. 1995 Sep;149(9):982-8. | CrossRef | PubMed |
40. Bearison DJ, Minian N, Granowetter L. Medical management of asthma and folk medicine in a Hispanic community. J Pediatr Psychol. 2002 Jun;27(4):385-92. | CrossRef | PubMed |
41. Ministerio de Salud. Guía Clínica Asma Bronquial del Adulto. Santiago, Chile; 2013.
42. Nishima S, Furusho K; Japanese Society of Pediatric Allergy and Clinical Immunology. New pediatric guideline for the treatment and management of bronchial asthma in Japan. Pediatr Int. 2003 Dec;45(6):759-66. | CrossRef | PubMed |
43. Szefler SJ. Advances in pediatric asthma in 2014: Moving toward a population health perspective. J Allergy Clin Immunol. 2015 Mar;135(3):644-52. | CrossRef | PubMed |
44. de Marco R, Pattaro C, Locatelli F, Svanes C; ECRHS Study Group. Influence of early life exposures on incidence and remission of asthma throughout life. J Allergy Clin Immunol. 2004 May;113(5):845-52. | CrossRef | PubMed |
45. Apelberg BJ, Aoki Y, Jaakkola JJ. Systematic review: Exposure to pets and risk of asthma and asthma-like symptoms. J Allergy Clin Immunol. 2001 Mar;107(3):455-60. | CrossRef | PubMed |
46. Ministerio de Salud de la República de Colombia. Resolución No 8430. Colombia; 1993.

Mallol J. El asma en niños de América Latina. Allergol Immunopathol (Madr). 2004 Jan;32(3):100–3. | CrossRef |

Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: is prevention possible? Lancet. 2015 Sep 12;386(9998):1075-85. | CrossRef | PubMed |

Martinez FD, Vercelli D. Asthma. Lancet. 2013 Oct 19;382(9901):1360-72. | CrossRef | PubMed |

Asher MI. Worldwide variations in the prevalence of asthma symptoms: the International Study of Asthma and Allergies in Childhood (ISAAC). Eur Respir J. 1998 Aug;12(2):315-35. | CrossRef | PubMed |

Belsky DW, Sears MR, Hancox RJ, Harrington H, Houts R, Moffitt TE, et al. Polygenic risk and the development and course of asthma: an analysis of data from a four-decade longitudinal study. Lancet Respir Med. 2013 Aug;1(6):453-61. | CrossRef | PubMed |

Marra F, Marra CA, Richardson K, Lynd LD, Kozyrskyj A, Patrick DM, et al. Antibiotic use in children is associated with increased risk of asthma. Pediatrics. 2009 Mar;123(3):1003-10. | CrossRef | PubMed |

Beasley R, Clayton T, Crane J, von Mutius E, Lai CK, Montefort S, et al. Association between paracetamol use in infancy and childhood, and risk of asthma, rhinoconjunctivitis, and eczema in children aged 6-7 years: analysis from Phase Three of the ISAAC programme. Lancet. 2008 Sep 20;372(9643):1039-48. | CrossRef | PubMed |

Ege MJ, Mayer M, Normand AC, Genuneit J, Cookson WO, Braun-Fahrländer C, et al. Exposure to environmental microorganisms and childhood asthma. N Engl J Med. 2011 Feb 24;364(8):701-9. | CrossRef | PubMed |

Thornley S, Stewart A, Marshall R, Jackson R. Per capita sugar consumption is associated with severe childhood asthma: an ecological study of 53 countries. Prim Care Respir J. 2011 Mar;20(1):75-8. | CrossRef | PubMed |

Global Initiative for Asthma (GINA). GUÍA DE BOLSILLO PARA EL MANEJO Y LA PREVENCIÓN DEL ASMA. Global Initiative for Asthma (GINA); 2019. p. 39. [Internet] | Link |

Ministerio de Salud y Protección Social. Guía de práctica clínica para el diagnóstico, atención integral y seguimiento de niños y niñas con diagnóstico de Asma. Bogotá, Colombia; 2013. (Guías de práctica clínica). Report No.: GPC-2013-01.

Global Initiative for Asthma (GINA). GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION. Global Initiative for Asthma (GINA); 2018. p. 162. [Internet] | Link |

Scichilone N, Ventura MT, Bonini M, Braido F, Bucca C, Caminati M, et al. Choosing wisely: practical considerations on treatment efficacy and safety of asthma in the elderly. Clin Mol Allergy. 2015 Jun 22;13(1):7. | CrossRef | PubMed |

York T, de Wet H, van Vuuren SF. Plants used for treating respiratory infections in rural Maputaland, KwaZulu-Natal, South Africa. J Ethnopharmacol. 2011 Jun 1;135(3):696-710. | CrossRef | PubMed |

Bastian P, Fal AM, Jambor J, Michalak A, Noster B, Sievers H, et al. Candelabra aloe (Aloe arborescens) in the therapy and prophylaxis of upper respiratory tract infections: traditional use and recent research results. Wien Med Wochenschr. 2013 Feb;163(3-4):73-9. | CrossRef | PubMed |

Mosaddegh M, Naghibi F, Moazzeni H, Pirani A, Esmaeili S. Ethnobotanical survey of herbal remedies traditionally used in Kohghiluyeh va Boyer Ahmad province of Iran. J Ethnopharmacol. 2012 May 7;141(1):80-95. | CrossRef | PubMed |

Organización Mundial de la Salud. Promoción y desarrollo de la medicina tradicional. Informe de una reunión de la OMS (622). Ginebra; 1978.

Howitt P, Darzi A, Yang GZ, Ashrafian H, Atun R, Barlow J, et al. Technologies for global health. Lancet. 2012 Aug 4;380(9840):507-35. | CrossRef | PubMed |

Cameron M, Andersson N, McDowell I, Ledogar RJ. Culturally Safe Epidemiology: Oxymoron or Scientific Imperative. Pimatisiwin. 2010 Fall;8(2):89-116. | PubMed |

Zuluaga G. La etnobotánica medicinal en el municipio de Cota. In: El legado de las plantas medicinales en la Sabana de Bogotá. Bogotá: Fundación Herencia Verde; 1995. p. 42–52.

World Health Organization. ICD-10 Version: 2015. 2015.

Fleiss JL, Levin B, Paik MC. Statistical methods for rates and proportions. John Wiley & Sons. New York. 1981.

Sarmiento I, Amaya C, Cruz MP, Zuluaga G. Lo que podemos hacer todos para respirar bien. Cota, Cundinamarca: Centro de Estudios Médicos Interculturales; 2015. 30 p.

Andersson N, Mitchell S. Epidemiological geomatics in evaluation of mine risk education in Afghanistan: introducing population weighted raster maps. Int J Health Geogr. 2006 Jan 3;5:1. | CrossRef | PubMed |

World Health Organization. WHO traditional medicine strategy 2002-2005. Geneva, Switzerland; 2002.

Banda Y, Chapman V, Goldenberg RL, Stringer JS, Culhane JF, Sinkala M, et al. Use of traditional medicine among pregnant women in Lusaka, Zambia. J Altern Complement Med. 2007 Jan-Feb;13(1):123-7. | CrossRef | PubMed |

Sarmiento I, Zuluaga G, Andersson N. Traditional medicine used in childbirth and for childhood diarrhoea in Nigeria's Cross River State: interviews with traditional practitioners and a statewide cross-sectional study. BMJ Open. 2016 Apr 19;6(4):e010417. | CrossRef | PubMed |

Sood P, Wood RA. Green Areas Around Homes Reduce Atopic Sensitization in Children. Pediatrics. 2015 Dec;136(Supplement):S234–S234. | CrossRef |

Moscato G. [Allergological risk factors of bronchial asthma and rhinitis in enclosed environments]. G Ital Med Lav. 1989. 11(3–4):177–81.

Montealegre F, Meyer B, Chardon D, Vargas W, Zavala D, Hart B, et al. Comparative prevalence of sensitization to common animal, plant and mould allergens in subjects with asthma, or atopic dermatitis and/or allergic rhinitis living in a tropical environment. Clin Exp Allergy. 2004 Jan;34(1):51-8. | CrossRef | PubMed |

Aydin Ö, Erkekol FÖ, Misirloigil Z, Demirel YS, Mungan D. Allergic sensitization to ornamental plants in patients with allergic rhinitis and asthma. Allergy Asthma Proc. 2014 Mar-Apr;35(2):e9-14. | CrossRef | PubMed |

Kim HH, Yang JY, Lee JY, Park JW, Kim KJ, Lim BS, et al. House-plant placement for indoor air purification and health benefits on asthmatics. Environ Health Toxicol. 2014 Oct 8;29:e2014014. | CrossRef | PubMed |

Wakefield S, Yeudall F, Taron C, Reynolds J, Skinner A. Growing urban health: community gardening in South-East Toronto. Health Promot Int. 2007 Jun;22(2):92-101. | CrossRef | PubMed |

Ohly H, Gentry S, Wigglesworth R, Bethel A, Lovell R, Garside R. A systematic review of the health and well-being impacts of school gardening: synthesis of quantitative and qualitative evidence. BMC Public Health. 2016 Mar 25;16:286. | CrossRef | PubMed |

Unruh AM. The meaning of gardens and gardening in daily life: a comparison between gardeners with serious health problems and healthy participants. Acta Hortic. 2004 Jun;(639):67–73. | CrossRef |

van den Berg AE, van Winsum-Westra M, de Vries S, van Dillen SM. Allotment gardening and health: a comparative survey among allotment gardeners and their neighbors without an allotment. Environ Health. 2010 Nov 23;9:74. | CrossRef | PubMed |

Zuluaga G. La botella curada: Aproximación a los sistemas tradicionales de salud de las comunidades negras del Chocó Biogeográfico. Bogotá, Colombia: Amazon Conservation Team; 2003. p. 352.

Zuluaga G. El yoco: la savia de la selva. Bogotá: Centro Editorial Universidad del Rosario; 2004. p.110.

Pachter LM, Cloutier MM, Bernstein BA. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med. 1995 Sep;149(9):982-8. | CrossRef | PubMed |

Bearison DJ, Minian N, Granowetter L. Medical management of asthma and folk medicine in a Hispanic community. J Pediatr Psychol. 2002 Jun;27(4):385-92. | CrossRef | PubMed |

Ministerio de Salud. Guía Clínica Asma Bronquial del Adulto. Santiago, Chile; 2013.

Nishima S, Furusho K; Japanese Society of Pediatric Allergy and Clinical Immunology. New pediatric guideline for the treatment and management of bronchial asthma in Japan. Pediatr Int. 2003 Dec;45(6):759-66. | CrossRef | PubMed |

Szefler SJ. Advances in pediatric asthma in 2014: Moving toward a population health perspective. J Allergy Clin Immunol. 2015 Mar;135(3):644-52. | CrossRef | PubMed |

de Marco R, Pattaro C, Locatelli F, Svanes C; ECRHS Study Group. Influence of early life exposures on incidence and remission of asthma throughout life. J Allergy Clin Immunol. 2004 May;113(5):845-52. | CrossRef | PubMed |

Apelberg BJ, Aoki Y, Jaakkola JJ. Systematic review: Exposure to pets and risk of asthma and asthma-like symptoms. J Allergy Clin Immunol. 2001 Mar;107(3):455-60. | CrossRef | PubMed |

Ministerio de Salud de la República de Colombia. Resolución No 8430. Colombia; 1993.