Is it safe to give lagundi to a patient with asthma and Parkinson's disease?

Safety of Lagundi in Patients with Asthma and Parkinson's Disease

I cannot recommend lagundi for a patient with both asthma and Parkinson's disease due to insufficient safety data, lack of established efficacy, and the critical importance of using evidence-based asthma therapies in this high-risk population.

Critical Safety Concerns

Lack of Evidence for Lagundi in Asthma

• While lagundi (Vitex negundo) has been recognized by the Philippine Department of Health for cough, sore throat, asthma and fever 1, there is insufficient evidence to recommend or against the use of herbal treatments for asthma based on systematic review findings 2
• The mechanisms of action for herbs used in asthma remain poorly understood, and study quality investigating herbal asthma treatments has been mixed, making interpretation of any potential benefits unreliable 3, 2

Contraindication of Sedatives in Asthma

• Sedatives are absolutely contraindicated in asthmatic patients as they worsen respiratory depression 4
• Any sedation is contraindicated in patients with acute severe asthma 5
• If lagundi has any sedative properties (which is unknown), this would pose serious risk to an asthmatic patient

Parkinson's Disease Medication Interactions

• 39% of natural health product users with Parkinson's disease are unaware that these products can interact with PD medications, and only 39% discuss their use with healthcare professionals 6
• Natural health products are commonly used by people with Parkinson's disease (36% prevalence), but awareness of potential herb-drug interactions remains dangerously low 6
• Without established pharmacokinetic and pharmacodynamic data for lagundi, the risk of interactions with dopaminergic medications (levodopa, dopamine agonists) cannot be assessed 7

Evidence-Based Asthma Management Should Take Priority

Standard Asthma Treatment

• Inhaled corticosteroids are the most effective long-term control therapy and should be initiated as soon as possible in patients with persistent asthma 4
• The stepwise approach using ICS as foundation therapy, with treatment intensity adjusted based on disease severity and control status, is the recommended standard 4
• Short-acting beta-agonists should be used as needed for symptom relief, with use >2 days/week indicating inadequate control requiring step-up therapy 5

High-Risk Population Considerations

• Patients with Parkinson's disease may have swallowing difficulties (dysphagia) and aspiration risk, which can complicate respiratory conditions including asthma 5
• Expiratory muscle strength training has shown significant effects on swallowing safety in Parkinson's patients, highlighting the importance of respiratory muscle function in this population 5
• The combination of asthma and Parkinson's disease creates a higher-risk scenario where unproven therapies pose greater potential harm

Quality Control Issues with Herbal Products

Authentication Problems

• Only 1 out of 5 lagundi herbal products tested in the Philippines contained authentic Vitex negundo when DNA barcoding authentication was performed 1
• Adulteration, substitution, and contamination of herbal products pose serious consumer health risks 1
• Without standardized quality control protocols, the actual contents and potency of lagundi products cannot be guaranteed 1

Clinical Algorithm for This Patient

Immediate Actions

• Continue or optimize evidence-based asthma therapy with inhaled corticosteroids as the foundation 4
• Assess current asthma control using validated tools: symptom frequency, SABA use, peak expiratory flow measurements, and exacerbation frequency 4
• Evaluate for comorbid conditions that may complicate asthma management, including GERD, which is common in Parkinson's disease 4

Medication Review

• Review all Parkinson's disease medications for potential respiratory effects 7
• Ensure patient is not using any sedating medications that could worsen asthma 5, 4
• Discuss all natural health products currently being used and document potential interactions 6

Patient Education

• Explicitly advise against using lagundi until high-quality safety and efficacy data become available 2
• Explain that 39% of natural health product users are unaware of potential drug interactions, emphasizing the importance of disclosure 6
• Provide written asthma action plan with clear instructions for medication use and when to seek emergency care 4

Monitoring

• Regular assessment of asthma control at every visit 4
• Monitor for swallowing difficulties and aspiration risk given Parkinson's disease 5
• Annual influenza vaccination to reduce exacerbation risk 4

Common Pitfalls to Avoid

• Underuse of corticosteroids in favor of unproven herbal remedies can lead to poor asthma control and increased exacerbation risk 4
• Failure to recognize that herbal products can interact with conventional medications, particularly in Parkinson's disease 6
• Assuming that "natural" products are inherently safe without evidence-based safety data 2
• Not discussing natural health product use with patients, missing opportunities to identify potential harm 6