Monday, September 18, 2017

1970-2000: Does rescue medicine make asthma worse?

The 1970s saw a third spike in asthma related deaths, and this time the location was isolated to New Zealand.  This prompted researchers to further investigate the relationship between asthma rescue medicine and asthma morbidity and mortality.

According to Ann Janet Woolcock, data from death certificates were investigated from Australia, New Zealand, U.S.A., West Germany, Canada, Japan, Britain and Wales.  Regarding these results, she said:
Deaths were lowest in about 1975 in all countries and then increased somewhat (dramatically in new Zealand) until about 1985, but since then, and especially since 1990, mortality has decreased or remained steady in all the countries shown.  There has been much speculation about the reasons for the fluctuations, but it is difficult to draw conclusions about these figures in the absence of accurate data about the prevalence and severity of the disease, and methods of treatment used in this age group (which was 4-34) in each country.
So did the same medicines that were supposed to make life better or asthmatics cause the rise in morbidity and mortality.  Lawrence K. Altmon suggests that perhaps Dr. Parkinson, in 1995, may have been right on when he suggested that morbidity and mortality was negligible prior to the arrival of adrenaline (epinephrine) in 1902.  (8, page 8)

 Altmon said:
Dr. parkinson wrote that it is "possible that mortality from asthma first appeared when adrenaline (epinephrine) became available.  It was identified in 1902.  Theoretically, lethal asthma could be the result of adrenal medullary suppressoin secondary tothe exogenous administration of its own hormones." (8, page 8)
 "The pattern of events of no adrenaline, no deaths; some adrenaline, some deaths; powerful adrenaline analogues prescribed generously, an epidemic of deaths; withdrawal of the more potent drugs, the epidemic disappears; and supports the thesis of iatrogenic adrenal medullary suppression.  (8, page 8)
There was no doubt that by review trends from New Zealand, rises in asthma morbidity and mortality rates corresponded with the sales of fenoterol.  Sales started to spike when the medicine was introduced to the market in the mid 1970s, and they began to decline when the product was pulled from the market in the early 1990s.

The trend was similar to that of which occurred during the 1940s when asthma morbidity and mortality rates spiked in New Zealand, Australia, Britain and Wales as sales of isoprenaline forte increased.  When the medicine was later pulled from the market, the death rate likewise declined.

Statistics showed similar trends for the rest of the nation, although the rise in morbidity and mortality was more subtle and gradual.  There was a gradual increase following the introduction of isoprenaline solution in the 1940s and again following the introduction of the the rescue inhaler in 1957.

There were now two questions researchers set out to answer:
  1. Do beta adrenergics make asthma worse
  2. If so, why?
The neat thing about this latest spike in asthma morbidity and mortality was, unlike those that occurred in the 1940s and 1960s, the experts now had an array of data to learn from.

The following were the theories to explain the rise in morbidity:

1.  High doses of beta agonists increases the risk for cardiac arrest.  The was especially the case with non-specific B2 agonists such as epinephrine and isopreterenol.  The high dosing provided by use of this medicine was suspected of  of  overworking the heart, thus causing cardiac arrest.  Beasley, Pearce and Crane suspect this to be most likely to be the case in cases "relating to their overuse in the situation of a life-threatening attack of asthma, in which the cardiac side effects are likely to be particularly harmful in the presence of severe hypoxia." (1, page 20)

Janet Woolcock suggests that "there is little evidence that it (fatal asthma or near fatal asthma) results from a cardiovascular event).  Likewise, she also suggests that "on the other hand, drugs such as albuterol, terbutaline, and salmeterol are partial beta-agonists (specific to the lungs only), and there is no substantial evidence that they increase the risk of death from asthma."  (2, page 190)

2.  High doses use of beta agonists increase tolerance to the medicine:  This subject was taken up by Benoy, Fellah, and Schneider in 1975.  They said that: (11)
The longer animals were pretreated and the higher the dose of bronchodilator given (isoprenaline or adrenaline) the greater was the degree of tolerance developed in the isolated lungs.  Tolerance could develop to such a degree that regardless of the dose of bronchodilator used to challenge the lungs (adrenaline, isoprenaline or aminophylline) no significant bronchodilation was produced.(11, pages 551-552)
Benson &Periman (1948) and Laurence & Moulton (1960) reported that tolerance developed in the brochodilator effect of adrenaline after excessive use of this drug in man...(11, page 552)
These results suggest that asthmatic patients who are heavy users of bronchodilators may become resistant to these drugs.  the valueof these drugs in relieving mild asthmatic attacks in such patients becomes less.  In an extreme case, a patient may die because the drug he is using has become completely ineffective.  A young asthmatic has been found dead clutching an empty bronchodilator aerosol container (Pickvance, 1967).  The same conclusion was reached by  Herxheimer (1973)...(11, page 552 )
Conolly et al. (1971)... suggested that in asthmatic patients who use sympathomimetic pressurized aerosols excessively cross-resistance developsto both exogenous sympathomimetic amines and to the natural transmiter release by the adrenergic nerves, and that this may lead to a deterioration of the asthmatic state and explain the rise in the asthma mortality rate.  The cross tolerance experiments described here may exlain the good results which were obtained only after the withdrawal of adrenergic bronchodilator therapy from some asthmatic patients (Keighley, 1966, Reisman, Friedman & Arbesman, 1968)...(11, page 553 )
The work described in this paper has demonstrated that the tolerance which developed as a result of the repeated administration of isoprenaline or adrenaline remained for periods of upto three weeks after the last administration of isoprenaline or adrenaline to guinea-pigs. (11, page 553)
Developing a tolerance to rescue medicine may result in worsening severity.

3.  High doses of beta agonists increase severity of asthma.  Some studies showed that high doses of beta adrenergics may increase the severity of asthma.  This may result from high dose beta adrenergics such as isoprenaline forte and fenoterol, or from frequent use of regular doses of beta adrenergics such as isoprenaline.  Later studies showed that frequent use of epinephrine, terbulatine, metaproterenol, and albuterol also resulted in increased severity.  (2, pages 189-190)(3, pages 468-470) Some experts have gone as far to suggest that albuterol should not be used on a regular frequency, and should only be used as a rescue medicine as needed.

Regarding these studies, Malcolm R. Sears said the following:
These studies suggest a class efectof regular B-agonists which is likely to be more evident if higher doses of more potent B-agonists are given, and perhaps also more evident in patients with more severe asthma. If this is so, then the natural  tendency to use higher doses of B-agonist in subjects with worsening asthma, and to change to more potent B-agonists for those patients when a new drug is marketed, would escalate the adverse effects (developing a vicious circle of worsening asthma), leading to increased opportunity for a fatality in disadvantageous circumstances. (2, page 469)
The "more potent B-agonists" being referenced to here would be isopreterenol forte and fenoterol. Sears further notes that:
"Strong support for the hypothesis that B-agonists increase the severity of asthma ocmes from the abrupt reversal of both morbidity and mortality in New Zealand in 1990, when, on advice from the drug regulatory agency, fenoterol was effectively withdrawn from use over a period of a few months." (2, page 469)
Other evidence that supports this theory is the decline in asthma morbidity and mortality following increased warnings regarding the risks of isoprenaline forte that resulted in decreased sales(1, page 18) Likewise, following warnings regarding the overuse of the medihaler epi and medihaler iso, morbidity and mortality declined as well.

4.  Over reliance on beta agonists results in delay in seeking help.  Various studies showed that those asthmatics who were found dead with a rescue inhaler clutched in their grasp may have had a false sense of security, and a belief that the medicine would eventually make their asthma better.  Buy the time they realized this was not true it was too late. (2, pages 471-473)

5.  Lack of use of inhaled corticosteroids:  Woolcock said that some patients may develop worsening asthma and have an increased risk of death, "but the lack of inhaled coticosteroids (ICS).  Where salbutamol and ICS are used otgether, there is no increased risk.  One message that is clear an dcan be used in educational campaigns is that increasing frequency of use of beta-agonists such as albuterol is a sign of increasing severity of asthma and thus of increased risk of death. (2, page 190)

These continue to be theories debated by the medical community. Albert L. Schefler, the editor of Fatal Asthma, sums up
A recent study in this regard explored the effect of regular beta agonist use on the bronchoprotective effect of beta agonists. Among a small group of persons with mild, stable asthma, subjects were randomly assigned to use either albuterol or placebo 2 puffs four times daily; both groups could use as-needed albuterol for "rescue." Although the bronchodilator effect of albuterol was not changed by regular use of albuterol, the bronchoprotective effect of albuterol was reduced. Albuterol did not blunt methacholine- or allergen-induced bronchoconstriction as effectively after regular beta-agonist inhalation for two weeks as it did in the placebo group. Tolerance to the bronchoprotective effect of beta agonists may be one way in which overuse of inhaled beta agonists might contribute to fatal outcomes in asthma.
Molecular studies of the beta-agonist receptor have revealed polymorphisms in the general and asthmatic populations. Some genetically determined beta-receptor types may be more susceptible to phosporylation and thereby to down-regulation, a potential mechanism for the development of tolerance to the bronchoprotective effects of beta agonists. An estimated 5-10% of the population have this particular phenotypic expression of their beta receptor and may as a result be at increased risk for severe, potentially fatal asthma. 
The message here is not that beta agonists are dangerous. Used properly, they can be life- saving. The key point is that their role in asthma is as rescue medication for relief of acute asthmatic symptoms. We do no longer prescribe albuterol for regular use on a Q.I.D. basis. Frequent use of albuterol (more than one cannister [=200 puffs]/month should be a warning sign for poorly controlled asthma requiring an intensification of anti-inflammatory therapy. (10)
6.  Rescue medicine by metered dose inhaler (MDI)  causes inert bronchospasm:  A 1985 study by J. Yarbrough, L.E. Lansfield, and S. Ting concluded that the alupent inhaler was likely to cause bronchoconstriction in the smallest air passages of the lungs. They concluded that high doses from frequent use may worsen some cases of asthma.  (12)

7.  Socioeconomic status:  Some studies suggest that asthma is more likely to be uncontrolled and more severe in people who live in poor economic conditions.  The following have been shown by various studies:
  • The asthma mortality rate is 5.6 higher in blacks compared to whites (13, page 238)
  • Studies in Chicago showed that the highest mortality rates are among a city's poorest neighborhoods (13, page 238)(3, page 471)
  • The highest death rates were in the nations poorest communities (13, page 238)
  • Morbitity and mortality were highest among the nations least educated (13, page 239)
  • Impoverished people are more likely to be exposed to their asthma allergens, such as dust mites, cockroaches, etc. (3, page 472)  
  • Impoverished people (including children) are more likely to be exposed to cigarette smoke
  • Studies in Philadelphia showed that that areas of the city with the highest percentage of minorities (particularly African Americans) had the greatest chance of using beta agonist medicine as the sole Treatment, as compared to beta agonists combined with inhaled corticosteroid therapy.  (3, page 472)
  • Crowding increases risk of severe asthma, perhaps due to increased risk of being exposed to viruses that have been shown to worsen asthma (13, page 239, 244)
  • Impoverished people are less likely to have the educational knowledge to adequately care for their own, or their child's, asthma.  (13, page 247)
  • Poor children are 40% less likely to visit a doctor, compared to non-poor children (13, page 247)
  • Poor children are 40% more likely to require hospitalization, compared to non-poor children (13, page 247)
  • Poor children are "more likely to utilize the emergency department." (13, page 247)
  • A study in Boston showed that minority children were "less likely to have been on preventative therapy prior to hospitalization, and were less likely to receive a nebulizer at discharge. These differences were not explained by source of payment.  Instead, the racial diferences in outpatient medication use were attributed to practice site, with hospital-based clinics and neighborhood health centers differing from private practices." (13, page 249)
It has also been established that poverty makes it unlikely for an asthmatic to:
  • Escape from potential asthma triggers (mainly from poorly maintained homes) (13, page 244)
  • Afford asthma medicines, either rescue or preventative
  • Afford to see a physician (i.e. family practice, internist)
  • Afford to see an asthma specialist (allergist, pulmonologist, etc.)
  • Have access to well located medical clinics, hospitals (i.e. physician), resulting in delayed treatment. This increases the risk of near fatal and fatal asthma. 
  • Be educated on the proper management of asthma (i.e. have an asthma action plan, the need for 
  • Escape from family conflicts, single parent families, substance abuse, crime, etc., all of whihc have been linked with worsening asthma. (13, page 245)
  • Escape inner city pollution that has been linked with worsening asthma (13, page 245)
  • Escape "psychosocial variables associated with asthma death."  This is particularly true for impoverished asthma children (emotion due to family dysfunction, separation from parents or one parent, etc. (13, page 245)
So it is possible that worsening asthma morbidity and mortality due to socioeconomic status may skewer statistics, making it appear as though asthma is getting worse in a particular nation overall. 

Conclusion:  Keep in mind that all of these theories based on just a few studies, and further studies are definitely indicated.  Experts continue to wonder whether the results from the studies listed above are isolated to particular beta adrenergic medicine studies (such as adrenaline and isopreterenol only) or if they are indicative of a class action effect of the medicine.

Ann Janet Woolcock said the following:
On the other hand, drugs such as albuterol, terbutaline, and salmeterol are partial beta agonists specific only to the lungs, and not the heart), and there is no substantial evidence that they increase the risk of death from asthma. Regular use of albuterol did not increase the severity of disease in patients with mild asthma. (2, page 190)
 I added the emphasis there. Albuterol is specific to beta 2 adrenergic receptors in the lungs only, and not to beta 2 adrenergic receptors in the heart.  Is it possible, therefore, that this makes albuterol exempt from all the studies mentioned above?

"Regular use of albuterol did not increase the severity of disease in patients with mild asthma."

Albuterol is the best selling asthma medicine of all time, and part of the reason is that it relieves asthma symptoms and it comes with essentially negligible side effects.  Some studies do suggest, however, that high doses due to frequent use of albuterol may increase asthma severity.  Further studies are ongoing to determine if this is true, and, if so, to determine the reason why.

References.

  1. Beasley, Charles Richard William Beasley, Neil Edward Pearce, Julian Crane, authors of chapter two in the book "Fatal Asthma" edited by Albert L. Sheffer, 1998, New York, Hong Kong, Marcel Dekker, Inc. Chapter two is titled "Worldwide trends in asthma mortality during the twentieth century." 
  2. Woolcock, Ann Janet, author of chapter 14 of the book, "Fatal Asthma," edited by Albert L. Sheffer, 1998, New York and Hong Kong, Marcel Dekker, Inc. Chapter 14 is titled "Natural Histor of Fatal Asthma." 
  3. Sears, Malcolm R., "author of chapter 29 in the book "Fatal Asthma," edited by Albert L. Sheffer, 1998, New York and Hong Kong, Marcel Dekker, Inc.  Chapter 29 is titled "Role of B-Agonists in Asthma Fatalities." 
  4. Jackson, Mark, "Asthma: The Biography," 2009, New York, Oxford University Press 
  5. Bisgaard, Hans, Chris O'Callaghan, Gerald S. Smaldone, editors, "Drug Delivery to the Lung," 2001, New York, Marcel Dekker, Inc 
  6. Mittman, Gregg, "Breathing Space," 
  7. Speizer, F.E., R. Doll, P. Heaf, "Observations on Recent Increase in Mortality from Asthma," British Medical Journal, February 10, 1968, 1, pages 335-339 
  8. Altman, Lawrence K., "The Public Perception of Asthma," Chapter one of the book "Fatal Asthma," edited by Albert L. Sheffer, New York, Marcel Dekker, Inc, pages 3 and 11 
  9. Speizer, F.E., R. Doll, P. Heaf, and B. Strang, "Investigation into use of drugs preceding death from asthma," British Medical Journal, 1968, 1, 339-343Sheffer, Albert L, "Partner Asthma Center's Grand Rounds," asthma.partners.org, http://www.asthma.partners.org/newfiles/ShefferFatalAsthma.html, accessed 10/5/13 
  10. Bendy, Christine J., E.L-Fellah, R. Schneider, "Tolerance to sympathomimetic bronchodilators in guinea-pig isolated lungs following chronic administration in vivo," 1975, British Journal of Pharmacology, 55, pages 547-554 
  11. Yarbrough, J., L.E. Lansfield, and S. Ting, "Metered dose inhaler induced bronchospasm in asthma patients," , Annals of Allergy, Asthma and Immunology," July, 1985, (55)1, pages 25-27 
  12. Grant, Evalyn N., Kevin B. Weiss, "Socioeconomic risk factors for asthma mortality," chapter 17 of the book, Fatal Asthma," edited by Albert L. Sheffer, 1998, New York, Hong Kong, Marcel Dekker, Inc.

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  13. Am Laura Mildred by name, i was diagnosed with Herpes 4 years ago i lived in pain with the knowledge that i wasn't going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw Mr. Morrison Hansen post on how Dr. Emu saved him from the VIRUS with herbal medicine i contacted Dr. Emu on his Email: Emutemple@gmail.com we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me and told me how to use it, after 14 days of usage I went to see the doctor for test,then the result was negative, am the happiest Woman on earth now thanks to Dr. Emu God bless you. Email him at: Emutemple@gmail.com Call or Whats-app him: +2347012841542

    ReplyDelete
  14. Greetings to every one here. I want to let every one know that HPV is a serious and deadly disease which can't be cured through drugs or injections by the American doctors but the best way to deal with HPV is by taking natural herbs medicine for it to flushes out the virus and is only few American doctors that know about this herbal medicine from doctor Afrid a great herbalist doctor. I have read about Dr Afrid the great herbalist doctor from African who can cure HPV with his powerful herbal medicine. for the people suffering from the following diseases Epilepsy, Hiv, Herpes, Cancer, Als, Hepatitis, Diabetes, Hpv,Infections ETC should contact him for his herbal medicine because his herbal medicine cured all kinds of diseases or virus, i am telling you all this because i am a living testimony and i was cured of Hpv. and my child was cured of epilepsy. Although, i sent him what he requested and he sent me his medicine which i took for two weeks and today when i went for test i was tested Hpv negative. you can reach him through his EMAIL;[drafridherbalhome@gmail.com] And you can also whatsapp/call him through his number +2349057260738                 website  https://dr-afrid-herbal-home.webnode.com/    
              

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  15. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete
  16. I want to use this medium to let everyone know that Herpes Simplex Virus has a complete and Permanent cure and that Dr Razor Herbal Medicine is the solution. I was Diagnosed with Herpes Virus type 1 in January 16, 2015, I have made several Research Hoping to see a true Cure or Healer, Fortunately for me i saw on a blog site how Dr Razor has been saving different lives and marriages with his herbal medicine, At first i did not believe but on a second thought, i decided to give him a try, I contacted him and he assured me of a cure, he prepared the herbal medication for me, which i took for 18 days, he told me to go for a medical check up, could you believe that i was confirm Herpes type 1 Negative after the test, and i went to a different hospital and it was also Negative, I became very happy and decided to write my appreciation article about this Good man. If you are battling with this same Infection or you know of a person who is infected with any disease like Herpes, HIV, Cancer, Syphilis, Hepatitis A,B,C, all types of Cancer, Gonorrhea, life's problems that you might have etc. kindly Reach out to Doctor Razor on Email : drrazorherbalhome@gmail.com. Whatsapp/Call him on +2349065420442. You can Also Visit His website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome . My Sincere Gratitude to you Sir, God will surely Keep you safe from harm's way. Please share so Other lives can be saved

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  17. Joy and happiness is all i can see around ever since i came in contact with this great man. i complained bitterly to him about me having herpes only for him to tell me it’s a minor stuff. He told me he has cured thousands of people but i did not believe until he sent me the herbal medicine and i took it as instructed by this great man, only to go to the hospital after two weeks for another test and i was confirmed negative. For the first time in four years i was getting that result. i want to use this medium to thank this great man. His name is Dr Oyagu, i came in contact with his email through a friend in USA and ever since then my live has been full with laughter and great peace of mind. i urge you all with herpes or HSV to contact him if you are willing to give him a chance. you can contact him through this email oyaguherbalhome@gmail.com or you can also WhatsApp him +2348101755322
    He also cured my friend with HIV and ever since then i strongly believe he can do all things. Don't be deceived thinking he does not work, i believe if you can get in contact with this man all your troubles will be over. i have done my part in spreading the good news. Contact him through his email and you will be the next to testify of his great work.


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  18. I Want To Appreciate Dr.OYAGU for his great deeds, I Was Diagnosed With type 2 Herpes Virus Last year,And i Was Looking For Solution To Be Cured Luckily I Saw Testimonies On How Dr.OYAGU Cure Herpes Virus I Decided To Contact Dr.OYAGU I Contacted Him He Prepared A Herbal Medicine Portion And Sent It To Me,I Started The Herbal Medicine For My Health.He Gave Me Step By Step Instructions On How To Apply It, When I Applied It As Instructed, I Was Cured Of This Deadly Herpes Within 2 weeks, I Am Now Herpes Negative.My Brother And Sister I No That There Are So Many People That Have The Same Herpes Virus Please contact Dr OYAGU To Help You Too,And Help Me To Thank Dr.OYAGU For Cure Me, I’m Cured By Dr. OYAGU Herbal Medicine,His Contact Email:oyaguherbalhome@gmail.com
    Or Cell Whatsapp Number +2348101755322 thank you

    ReplyDelete
  19. Greatest thanks to Dr Oyagu for his herbal drugs that he prepared for me and when i start using it in just 2weeks i was completely cured and that ended my HERPES SIMPLEX 1&2 DISEASE i am so happy and grateful to Dr Oyagu . after reading about him on a testimony of Jason Cash on a blogger. i knew suddenly Dr Oyagu was the right Doctor to cure my HERPES SIMPLEX 1&2 DISEASE. i discuss with Dr Oyagu and he prepared a herbal medicine for me and when it got sent to me in south korean . i used the herbal medicine and 2weeks and i went to check up again. after 15years of suffering from HERPES SIMPLEX 1&2 at last i am smiling once again. Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from your suffering. contact his WhatsApp line: +2348101755322 or his Email:Oyaguherbalhome@gmail.com

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  20. Hello Am From The UK , I want to write a little testimony about the good work of doctor Oyagu who cured me from Hsv 1 and 2 for just 2 weeks with his herbal medicine, I never believe I can be normal again and have a good life like others I always regretted the day I got diagnose with the virus, I was lost of hope when my doctor told me there is no cure for it but I keep thinking and thinking about my future, if I can have kids of my own well I am so grateful for my helper who get me cured with his herbal medicine, I go online in search of anything that can help me because I can’t deal with it forever so I found this doc Oyagu email on a blog of someone who was cured by him I quickly contact him for help and explain all my pain to him, he told me not to worry about it there is cure for real, I never believe until he send me the herbal medicine when I order for it and I have it within 4 days that is how I took the medicine for 2 week and the following week I go for test just to confirm I was 100% cured from this sickness what a miracle in my life I am so happy right now, you can also get in contact with him if you have such sickness through email address oyaguherbalhome@gmail.com or text him on what's app, phone number +2348101755322 Dr Oyagu also has remedy to others disease like COLD SORES,HIV/AIDS,DIABETES.CANCER,HIGH BLOOD PRESSURE AND MANY MORE. I oblige everyone to contact this powerful herbalist Dr Oyagu and be free from suffering.

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  21. Happiness is all i see now, i was herpes sicker for 6 years but i thank God for directing my footsteps to Dr Emu, he gave me instructions and i followed and in 2 weeks i was completely cured using his medicine, I am now Herpes Negative Contact Dr Emu for more information, He also has other cure to other ailment, HIV AIDS, CANCER, DIABETES, HEART DISEASE, HEPATITIS B/C And also restore broken relationships such as Ex HUSBAND, Ex WIFE, BROKEN MARRIAGES, Any kind of Problem in any relationship can be restore back in 24hours, Just Email: emutemple@gmail.com  Whatsapp or call: +2347012841542

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  22. I am so happy writing this article here, I am here to explore blogs forum about the wonderful and most safe cure for HERPES SIMPLEX & HIV VIRUS. I was positive with the deadly Virus called HERPES & HIV and I lost hope completely because I was rejected even by my closet friends. I searched online to know and inquire about cure for HERPES & HIV and I saw Dr Theo testimonies online on how he cured so many persons from Herpes Disease, HIV, Fibroid, Cancer, Retinitis, Hepatitis, etc so I decided to contact the great herbalist because I know that nature has the power to heal everything. I contacted him to know how he can help me and he told me never to worry that he will help me with the natural herbs from God! He sent me the herbal medicine, I used the medicine as he instructed me (MORNING and EVENING) and I was cured! it’s really like a dream but I’m so happy! That’s the reason I decided to also add more comment of Him so that more people can be saved just like me! and if you need his help, contact his Email: (drtheoherbalhome@gmail.com) he own a shop in US here

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  23. Dr. Obodubu Monday is recognised all over the world of marine kingdom, As one of the top fortunate and most powerful native doctor of charms casts from the beginning of his ancestors ship until now Dr. Obodubu Monday lives strong among all other native doctors, there have never been any form of impossibility beyond the control of Dr. Obodubu Monday it doesn't matter the distance of the person with the problems or situation, all you have to do is believe in the native doctor Dr. Obodubu Monday cast that works, he always warns never to get his charms cast if you do not believe or unable to follow his instruction. it is the assignment of the native doctor Dr. Obodubu Monday to offer services to those in need of spiritual assistance not minding the gravity of your situations or distance as long as water, sea, ocean, lake, river, sand, etc. are near you, then your problems of life would be controlled under your foot. if you need any spiritual help on any of these call Doctor Obodubu on :+2349058774809
    Get Your Love Back
    Fruit Of The Womb
    Fibroid
    Business Boom
    Financial Breakthrough
    Get Rich Without Ritual
    Do As I Say
    Bad Dream
    Promise And Fail
    Epilepsy
    Land/Court Case
    Mental Disorder
    Political Appointment
    Visa Approval
    Cancer
    Examination Success
    Spend And Get Back
    Good Luck
    Natural Neath
    Hypertension
    Stroke
    Sickle cell
    Impotency
    Win Court case
    Promotion At Work
    Commanding Tone
    Protection Ring
    Marriage Success
    Love Ring
    Favour Ring
    Recover Lost Glory
    Spiritual Power For Men Of God
    Travel Success Ring
    Job Success
    Lotto/Pool Win/betnaija win
    And Many
    More make haste to call or Or WhatApp Baba Doctor Obodubu Monday on +2349058774809 for spiritual problem today and you will surely get solution to all your predicament

    ReplyDelete
  24. Dr. Obodubu Monday is recognised all over the world of marine kingdom, As one of the top fortunate and most powerful native doctor of charms casts from the beginning of his ancestors ship until now Dr. Obodubu Monday lives strong among all other native doctors, there have never been any form of impossibility beyond the control of Dr. Obodubu Monday it doesn't matter the distance of the person with the problems or situation, all you have to do is believe in the native doctor Dr. Obodubu Monday cast that works, he always warns never to get his charms cast if you do not believe or unable to follow his instruction. it is the assignment of the native doctor Dr. Obodubu Monday to offer services to those in need of spiritual assistance not minding the gravity of your situations or distance as long as water, sea, ocean, lake, river, sand, etc. are near you, then your problems of life would be controlled under your foot. if you need any spiritual help on any of these call Doctor Obodubu on :+2349058774809
    Get Your Love Back
    Fruit Of The Womb
    Fibroid
    Business Boom
    Financial Breakthrough
    Get Rich Without Ritual
    Do As I Say
    Bad Dream
    Promise And Fail
    Epilepsy
    Land/Court Case
    Mental Disorder
    Political Appointment
    Visa Approval
    Cancer
    Examination Success
    Spend And Get Back
    Good Luck
    Natural Neath
    Hypertension
    Stroke
    Sickle cell
    Impotency
    Win Court case
    Promotion At Work
    Commanding Tone
    Protection Ring
    Marriage Success
    Love Ring
    Favour Ring
    Recover Lost Glory
    Spiritual Power For Men Of God
    Travel Success Ring
    Job Success
    Lotto/Pool Win/betnaija win
    And Many
    More make haste to call or Or WhatApp Baba Doctor Obodubu Monday on +2349058774809 for spiritual problem today and you will surely get solution to all your predicament

    ReplyDelete
  25. I want to thank Dr Emu a very powerful spell caster who help me to bring my husband back to me, few month ago i have a serious problem with my husband, to the extend that he left the house, and he started dating another woman and he stayed with the woman, i tried all i can to bring him back, but all my effort was useless until the day my friend came to my house and i told her every thing that had happened between me and my husband, then she told me of a powerful spell caster who help her when she was in the same problem I then contact Dr Emu and told him every thing and he told me not to worry my self again that my husband will come back to me after he has cast a spell on him, i thought it was a joke, after he had finish casting the spell, he told me that he had just finish casting the spell, to my greatest surprise within 48 hours, my husband really came back begging me to forgive him, if you need his help you can contact him with via email: Emutemple@gmail.com or add him up on his whatsapp +2347012841542 is willing to help any body that need his help. 

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  26. I am here to give my testimony about Dr Ebhota who helped me.. i want to inform the public how i was cured from (HERPES SIMPLEX VIRUS) by salami, i visited different hospital but they gave me list of drugs like Famvir, Zovirax, and Valtrex which is very expensive to treat the symptoms and never cured me. I was browsing through the Internet searching for remedy on HERPES and i saw comment of people talking about how Dr Ehbota cured them. when i contacted him he gave me hope and send a Herbal medicine to me that i took for just 2 weeks and it seriously worked for me, my HERPES result came out negative. I am so happy as i am sharing this testimony. My advice to you all who thinks that there is no cure for herpes that is Not true just contact him and get cure from Dr Ebhota healing herbal cure of all kinds of sickness you may have like (1) CANCER,(2) DIABETES,(3) HIV&AIDS,(4) URINARY TRACT INFECTION,(5) CANCER,(6) IMPOTENCE,(7) BARENESS/INFERTILITY(8) DIARRHEA(9) ASTHMA(10)SIMPLEX HERPES AND GENITAL(11)COLD SOREHERPES. he also cure my friend from cervical cancer Email: drebhotasoultion@gmail.com or whatsapp him on +2348089535482

    ReplyDelete
  27. Thanks to God and also to Dr. Kham, the great herbalist that cured me of Herpes Virus 1 years ago. I contacted the virus from my partner unknowingly to me, i almost spent all i had because i was restless , until i saw people testifying about Dr. Kham on herbal cure and also recommendation online for curing Herpes virus with his herb roots made from natural products, and i emailed him without hesitation and he told me how to get the herbal medicine which i did that changed my entire life to wonders and testimonies on how God can us a man that's not known over the whole world to have such a gift to use natural products to cure Herpes Virus and other types of deadly illness Advice: To anyone out there having health problems of any kind should please drop the doubt and contact this natural herbal healer whose contact info is (dr.khamcaregiver@gmail.com) or Call and Whats App him on +2348159922297 From a soul that care and also love to share good things to people in need  

    ReplyDelete
  28. I am here to spread this good news to the entire world on how Dr Emu helped me solve my infertility problem and i am so happy now that i am now a mother because for over 4 years i have been trying to get pregnant and needed help, i and my husband always go for medical check up and the doctor always say that the both of us are fine and i have nowhere else to get help from and all hope was almost lost until one day i visited a friend of mine and i told her what i was passing through and she introduce me to this great spell caster called Dr Emu who helped her when she was in need of help, so i took a try to contact Dr Emu through his email and i explain all my problem to him and after we have talked he perform an infertility spell for me and after that he told me what i should do, and i followed the instruction he gave and after that he instructed to sleep with my husband and also i followed the instruction and he said that the next week i should go for medical check up and the doctor confirmed that i was 4 months pregnant and i was so happy that all my sorrows were gone for ever, i am so very happy now and also you need any kind of help or the same line with mine, contact Dr Emu on his email: emutemple@gmail.com or Call/Text his whatsapp phone number +2347012841542

    ReplyDelete

  29. TRUE LIFE TESTIMONY.
    HOW I GOT RID OF MY 8 YEARS GENITAL HERPES Cured WITHIN 24hrs time,by ONOBUN GABRIEL (WATER) IS AWESOME!
    THIS IS REAL,PLEASE DON'T IGNORE.Call/Text WATER on is phone Number via; +2349132393661
    HIS WEBSITE email onobunwinhome@gmail.com
    My name are Nancy Johnny from USA.
    I caught genital herpes from my Ex Husband in 2013,he never told me about the virus. I had it for 8 year's with so many outbreak,and it affected my life that almost led to my death.. People think herpes is really a mynor type irritation.herpes has a long term effects on health that led to death. The stigma attached to this virus by ignorant people is ridiculous. Most people have herpes in one form or another,i was first taking Antiviral medicines, such as acyclovir(Zovirax), famciclovir (Famvir), and valacyclovir (Valtrex), are recommended for testing primary genital herpes outbreaks, This medicine can be taken when an outbreak occurs. It can also be taken every day to help prevent and secure outbreaks,it is not a total cure without Dr ONOBUN GABRIEL (WATER)... I will like to tell everyone who is reading this my testimony on how i get rid of my genital herpes vires.I was reading a comment on the internet,and i saw a testimony posted by a young lady from USA that she got rid of her herpes with the help of Dr ONOBUN GABRIEL (WATER),A GENUINE TRADITIONAL HERBALIST.So i was so very convinced and happy when i saw that post,that, his herbal medication Cure herpes virus totally.I quickly copied the herbal doctor email address onobunwinhome@gmail.com and i email him within 30 minutes, he respond to my mail in 2mins ahead.I explain things to him, he told me that not to worry that i should fill his herbal form, which i did..That same day he told me that he has prepare the herbal medicine,that i should send him my address that he want to sent his HERBAL MEDICINE for the cure to me via DHL or FedEx and HTCN, that was how i got the herbal medication and i use it as i was instructed.After 24hrs time I was cured and one week later i went to see a Medical Doctor who confirmed my herpes was no more.When some of my friend who has herpes saw me they were surprise that I was cured and i also told them that Dr ONOBUN GABRIEL (WATER) is the man that cured me, and they where also in need of the cure from the same Genital herpes cure today.I also refer my cousin to the same herbalist that someone have HIV and today she is fully cured by my Dr ONOBUN GABRIEL (WATER)...If you have Genital or Oral herpes or any kind of Diseases or infections,kindly contact HERBALIST Dr ONOBUN GABRIEL (WATER) via his email onobunwinhome@gmail.com OR make call through his phone call Number +2349132393661
    He also have a herbal cure for Following DISEASES, Dr ONOBUN GABRIEL (WATER) is not scam is 100% Real and sure for his medicine.
    (1)PENIS ENLARGEMENT AND WEAK ERECTION
    (2)VIRGINAL PROBLEM
    (3)DIABETES
    (4)WHOOPING COUGH
    (5)HEPATITIS B
    (6)FORDYCE SPOT
    (7)COLD SORE
    (8)ALS
    (9)LOWER RESPIRATORY INFECTION
    (10)LOW SPERM COUNT
    (11)MRSA(METHICILLIN(12)RESISTANT STAPHYLOCOCCUS AUREUS
    (13)ZIKA VIRUS
    (14)COPD
    (15)STROKE
    (16)IMPOTENCE
    (17)PILE
    (18)HYPERTENSION
    (19)LOW SPERM COUNT
    (20)MENOPAUSE DISEASE
    (21)ASTHMA
    (22)CANCER
    (23)BARENESS/INFERTILITY
    (24)PCOS
    (25)SHINGLES
    (26)VIRAL HEPATITIS/HEPATITIS B
    (27)FIBROID
    (28)ASTHMA
    (29)SICKLE CELL
    (30)TINNITUS
    (31)BARENESS/INFERTILITY
    (32)DIARRHEA and so on...
    Contact him today onobunwinhome@gmail.com or call Dr ONOBUN GABRIEL (WATER) phone Number on +2349132393661 and you will have a testimony to give for sure..
    GOD IS TRULY GREAT.
    GOOD LUCK.

    ReplyDelete
  30. My name is rose viabushes🌹, I am from USA, United States of America.
    My first time of meeting with medical healthcare and bringing EX back, I have to say this in the internet, i really worth it. It had been 6 months since my husband dump me and left me with another woman without saying anything.All thanks to Dr Onobun Gabriel(WATER) that was able to bring my husband back to me in 24hrs time because I was able to connect with my husband again with the help of Dr ONOBUN GABRIEL(WATER) powerful geunion Love Spell, and now my husband loves me more than he used to do then, I eternally grateful to The Great Dr ONOBUN GABRIEL(WATER) for his good work he has done for me. I highly recommend Dr ONOBUN GABRIEL(WATER) genunity. You can contact him on onobunwinhome@gmail.com or his phone Number +2349132393661 for help.

    ReplyDelete
  31. My name his Steve Maries and I am from United State.I am so happy today, and i also appreciate the genuine work done by one love spell caster DR ONOBUN GABRIEL(WATER). And to give me the right direction to get back my Ex, so today I got my wish fulfilled under the guidance of my love Spell caster Dr ONOBUN GABRIEL (WATER). ❤️ love is an important part of relationship. I can understand this, when my boyfriend had cheated on me and dump me, by engaging another girl’s with affairs at that time, I was Broken and realized the importance of love when my boyfriend, dump me in my life in relationship with him of love. My boyfriend did not give me the importance's of true love, and he always embarrassed me in front of his friends and family's, and I love my boyfriend so much. Then I search on the Internet to fine a spell caster that can
    bring back Ex, fine on me “one day" I find a real spell caster Called DR ONOBUN GABRIEL (WATER) So I got the contact number +2349132393661 and his Email onobunwinhome@gmail.com of this spell caster DR ONOBUN GABRIEL (WATER)” then I drop a message on his email that I want my Ex boyfriend back, because I so much love my boyfriend and also on his WhatsApp Number too, and I explain all my problems that is happening with me. So then Dr ONOBUN GABRIEL (WATER) show me his previous work done by himself and how he had help so many people to get there Ex back and also help so many pretty once to get cured in there diesass and sinkness and to guide me on how the work will be done. Then i start work to get my boyfriend back in a positive way that Dr ONOBUN GABRIEL (WATER) have interested me to do to get my boyfriend back, to start giving me respect and also never to leave me again for another girl. Then and now, I am 😀 so happy and thankful to Dr ONOBUN GABRIEL (WATER). So Dr ONOBUN GABRIEL (WATER)
    prepared a magic spell and cast a spell on my boyfriend to get him back to me, immediately, it work, my boyfriend
    was back within 24hrs time and now my Ex boyfriend his back to me now begging me in positive and nagative side effects, and to have him back again,
    and my boyfriend promise now that he will never, to leave me again for another girl. Me and my boyfriend is 🍷 wine forever more. I am so happy now that my Ex boyfriend is back by DR ONOBUN GABRIEL (WATER) spell. Dr said I should share is testimony on interview and internet once my boyfriend is back to me, and that is why I am sharing his good testimony in the internet and interview to have others to come for help in contact. So if you have a broke up with your Ex, contact Dr ONOBUN GABRIEL (WATER) on his email onobunwinhome@gmail.com and explain, Or call his phone Number or Whatsapp +2349132393661 for help.



    ReplyDelete
  32. Eliminate Herpes simplex virus (HSV) forever.. through herbal means…💯💯💯💯💯

    This herbal Doctor has a new development on herpes virus,

    Email:Robinson.buckler((@yahoo.com))…………

    ReplyDelete