Betel-nut chewing and asthma

Lancet. 1992 May 9;339(8802):1134-6. doi: 10.1016/0140-6736(92)90732-i.


Two Asian patients admitted to hospital with acute severe asthma had been chewing betel nut immediately before the attacks. Arecoline, a cholinergic alkaloid, is a major constituent of Areca catechu (betel) nut and causes the euphoric effects. We sought an association between betel-nut chewing and bronchoconstriction in asthmatic patients. In vitro, arecoline caused dose-related contraction of human bronchial smooth-muscle strips, with one-tenth the potency of methacholine. In a double-blind challenge study, inhalation of arecoline caused bronchoconstriction in six of seven asthmatic patients and one of six healthy subjects; methacholine caused bronchoconstriction in all the asthmatic patients and in five controls. The geometric mean concentrations of arecoline and methacholine that caused 20% falls in the forced expiratory volume in 1 s (PC20 FEV1) in the asthmatic subjects were 5.2 mg/ml and 1.6 mg/ml, respectively. We then studied four Bengali asthmatic patients, regular users of betel nut, during a betel-nut challenge. Three showed no adverse effects, but one showed a 30% fall in FEV1 by 150 min after chewing; the effect was reproducible. In the UK, the rate of hospital admission for acute asthma is higher among Asians than among other groups in the population; betel-nut chewing may be one of several factors that affect asthma control and severity of attacks.

Publication types

  • Case Reports
  • Clinical Trial

MeSH terms

  • Adult
  • Animals
  • Areca* / chemistry
  • Arecoline / adverse effects*
  • Arecoline / chemistry
  • Asthma / chemically induced*
  • Asthma / epidemiology
  • Asthma / physiopathology
  • Bangladesh / ethnology
  • Bronchial Provocation Tests
  • Bronchoconstriction / drug effects*
  • Dose-Response Relationship, Drug
  • Double-Blind Method
  • Female
  • Forced Expiratory Volume
  • Guinea Pigs
  • Hospitals, Special
  • Humans
  • London / epidemiology
  • Male
  • Methacholine Chloride / adverse effects
  • Methacholine Chloride / chemistry
  • Middle Aged
  • Plants, Medicinal*
  • Risk Factors


  • Methacholine Chloride
  • Arecoline