• Bronchi and bronchioles — spasmodic obstruction with rattling, tenacious mucus that is hard to raise; “suffocative” fits especially in damp weather [Boericke], [Clarke]. See Respiration, Cough, Chest.
• Lungs (lower lobes) — repeated catarrhal congestion in old asthmatics; attacks after every chill/rainy spell [Clarke], [Phatak]. See Fever/Chill/Heat/Sweat.
• Mucous membranes — profuse, sticky secretion; relief when expectoration becomes free [Boger], echoing modalities (Better after expectoration).
• Right heart–pulmonary circuit (strain of repeated dyspnoea) — palpitation and fatigue after paroxysm; cyanosis in severe attacks [Clinical], [Boger]. See Heart, Generalities.
• Obesity/body habitus — “Acts best in stout, corpulent persons” is a classical keynote for the asthmatic state [Boericke], guiding case selection (Generalities).
• Damp dwellings / musty basements / mouldy cellars — environmental trigger and maintaining cause; remedy often required in such settings [Clarke], [Phatak]. See Generalities, Respiration.
• Old bronchitics — “frequent attacks of bronchitis in old asthmatics,” recurring in cold-rainy seasons [Boericke]. See Chest, Respiration.
• Reflex stomach–lung axis — cough with nausea or retching from mucus burden; gagging at the height of wheeze [Boger], [Phatak]. See Stomach, Cough.

• After expectoration becomes free — oppression lifts once thick mucus is raised [Boger], [Boericke].
• Sitting up and leaning forwards — relieves suffocative tightness in paroxysms [Clarke], [Clinical].
• Open, cool air — desires fresh air at window; stale, musty rooms aggravate [Clarke].
• Dry weather; clear, crisp days — fewer attacks in prolonged dry spells [Phatak].
• Warm drinks — loosen phlegm; paroxysm abates after warm tea [Clinical].
• Gentle, slow movement — walking slowly may loosen chest and promote expectoration [Clinical].
• After bowel movement — chest seems freer after straining and evacuation in some cases [Clinical].
• Interval care (between attacks) with reduction of damp exposure — attacks diminish when moved from cellar/ground-floor rooms [Clarke].

• Damp, rainy, foggy weather — cardinal aggravation; attacks coincide with wet spells [Boericke], [Clarke], [Phatak].
• Mouldy, musty dwellings; cellars — flare-ups in basements, old houses, after floods/leaks [Clarke], [Phatak].
• Night; after midnight to early morning — paroxysms drive the patient up to sit; sleep broken [Boger], [Boericke].
• Lying down — suffocative tightness; must sit upright [Clarke].
• Dust, sweeping, old carpets — provokes wheeze and cough [Clinical].
• Exertion during an attack — brings on panting with cyanosis [Boger].
• Cold, raw air to chest — initiates coryza that “falls on the chest” [Clarke].
• Tobacco smoke, strong odours — irritate cough, intensify dyspnoea [Clinical].
• Each chill in convalescence — relapse from slight exposure [Boericke].
• Obesity and over-eating — fullness aggravates chest burden, especially at night [Boericke], [Phatak].

The mental state is typically secondary to respiratory distress: anxious restlessness with fear of suffocation crescendos as the chest tightens, especially at night, with a compelling need to find air and sit propped [Clarke], [Boger]. Irritability rises during the struggle to expectorate, and there is a dread of the next wet spell that will “bring it back,” an anticipatory fear characteristic of chronic asthmatics [Clinical]. During paroxysms the patient grows silent, inward, counting breaths; between attacks he may be practical and tolerant, if somewhat despondent about the recurring pattern (every damp change) [Clinical]. Children cling to the window or parent, wide-eyed with air-hunger; elders look watchful, guarding each movement lest wheeze return. Unlike Ars., which is anxious, chilly, and restless yet worse even in open air, Blatta. usually craves fresh air and calms when mucus moves [Kent], [Boericke]. Unlike Ipec., which is overwhelmed with nausea and cannot expectorate, Blatta. improves as expectoration becomes freer [Hering], [Boger]. Case: An obese, cellar-dwelling patient who woke nightly at 2 a.m. to sit and cough thick gelatinous phlegm improved strikingly on Blatta. 3x during a wet fortnight [Clinical]. (Cross-ref. Better after expectoration; Worse damp.)

Head feels full, congested, throbs during the cough paroxysm, with heat of face and cold extremities; vertigo on rising to sit in the night air [Clarke], [Clinical]. Sinus pressure across the forehead often precedes the chest symptoms in damp weather, then “drops” to the bronchi with rattling [Boger]. Headache is relieved as expectoration grows free (echoing the Better-after-expectoration modality). Odours (must, tobacco) bring on catarrh with frontal ache and wheeze [Clinical]. Comparison: Kali-bi. has stringy nasal mucus with sinus plugs and slow chest involvement; Blatta. moves quickly to the lower airways with coarse rales [Clarke], [Boger].