Asthma

Asthma



• Signs and Symptoms
• What Causes It?
• What to Expect at Your Provider's Office
• Treatment Options
• Drug Therapies
• Complementary and Alternative Therapies
• Following Up
• Supporting Research

Asthma is chronic inflammation of the airways resulting from swelling and excessive mucus. The airways may be further blocked when an irritant, or trigger, causes spasms of the bronchial passage. This can cause coughing, wheezing, and difficulty breathing.



Signs and Symptoms
• Shortness of breath, difficulty breathing, or wheezing
• Chest tightness or constriction
• Cough (can be the only symptom)
• Skin turning blue (cyanosis)


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What Causes It?
• Sensitivity to allergens in the air, such as dust, cockroach waste, animal dander, mold, pollens
• Food allergies
• Respiratory infections
• Air pollutants, such as tobacco, aerosols, perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone levels, and fumes from paint, cleaning products, and gas stoves
• Changes in the weather, especially in temperature and humidity
• Behaviors that affect breathing (exercising, laughing, crying)


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What to Expect at Your Provider's Office

Your health care provider will probably check your blood pressure, listen to your chest and back with a stethoscope, and take blood samples. He or she may also order an electrocardiogram (EKG) or chest or sinus X rays to make sure your asthma is not a symptom of a more serious condition.

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Treatment Options

You can help control your asthma in the following ways:.

• Avoid your "triggers."
• Take anti-inflammatory drugs or antibiotics prescribed by your provider. These can help you breathe more easily.
• Use the inhaler prescribed by your provider if you have an asthma attack. An asthma attack is a serious situation. It can result in critical health problems, even death. If your inhaler does not stop the attack, call for emergency assistance or go to the nearest health care facility.
• Your provider may also prescribe oxygen for severe asthma attacks.


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Drug Therapies
• Anti-inflammatory drugs—used to prevent attacks; contain steroids; may be given intravenously or by inhaler; side effects include coughing and oral thrush
• Non-steroidal anti-inflammatory inhalers—used to prevent attacks; may cause coughing
• Bronchodilators—used during or at the onset of an attack; given by inhaler, nebulizer, or intravenously depending upon severity; side effects depend on the exact drug you take


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Complementary and Alternative Therapies

Asthma may relate to stress and anxiety. Mind/body techniques such as deep breathing, meditation, tai chi, yoga, and stress management can help.

Nutrition
Note: Lower doses are for children.
• Eliminate all food allergens from your diet. Common food allergens are dairy, soy, citrus, peanuts, tree nuts, wheat, fish, shellfish, eggs, corn, food colorings, and additives. An elimination trial may help determine food sensitivities. Remove suspected allergens from your diet for 2 weeks. Re-introduce one food every 3 days. Watch for reactions such as gastrointestinal upset, mood changes, headaches, and worsening of asthma. Check with your health care provider before doing this test.
• Reduce pro-inflammatory foods in your diet, including saturated fats (meats, especially poultry, and dairy), refined foods, and sugar.
• Increase intake of vegetables, grains, legumes, onions, and garlic.
• Vitamin C (250 to 500 mg two times per day) taken one hour before exposure to an allergen may reduce allergic reactions. Rose hips or palmitate do not cause allergic reactions.
• B6 (50 to 200 mg per day) may improve symptoms. Pyridoxal-5-phosphate (P5P), a form of B6, may be more readily used by your body.
• Magnesium (200 mg two to three times per day) relaxes bronchioles.
• Consider hydrochloric acid supplementation to decrease the number and severity of food sensitivities and aid absorption of some nutrients.
• B12 deficiency may increase reactivity to sulfites.
• N-acetylcysteine (50 to 200 mg three times per day) and selenium (50 to 200 mcg per day) protect lung tissue from damage.

Herbs
Herbs may be used as dried extracts (capsules, powders, teas), glycerites (glycerine extracts), or tinctures (alcohol extracts). Teas should be made with 1 tsp. herb per cup of hot water. Steep covered 5 to 10 minutes for leaf or flowers; 10 to 20 minutes for roots. Drink 2 to 4 cups per day.
• Green tea (Camellia sinensis) is a powerful antioxidant.
• For long-term lung support, combine equal parts of the following herbs in a tea. Licorice root (Glycyrrhiza glabra), coltsfoot (Tussilago farfara), wild cherry bark (Prunus serotina), elecampane (Inula helenium), plantain (Plantago major), and skullcap (Scutellaria lateriflora). Do not take licorice if you have high blood pressure. Prolonged use of coltsfoot can damage the liver; look for a "pyrrolizidine alkaloid-free" label.
• Essential oils that may help are elecampane, frankincense, lavender, mint, and sage. Add 4 to 6 drops in a bath, atomizer, or humidifier.

Homeopathy
Although very few studies have examined the effectiveness of specific homeopathic therapies, professional homeopaths may consider the following remedies for the treatment of asthma based on their knowledge and experience. Before prescribing a remedy, homeopaths take into account a person's constitutional type. A constitutional type is defined as a person's physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.
• Arsenicum album -- for asthma which generally worsens between midnight and 2 am and is accompanied by restlessness, anxiety, chills, and thirst
• Ipecacuanha -- for those with asthma, particularly children, who have significant tightness in the chest, a chronic cough with lots of phlegm that may lead to vomiting, and worsening of symptoms in hot, humid weather
• Pulsatilla -- for asthma with yellow or greenish phlegm that gets worse in the evening, in warm, stuffy rooms, or after consuming rich, fatty foods; this remedy is most appropriate for adults or children who are tearful and clingy or sweet and affectionate
• Sambucus -- for asthma that awakens a person at night with a sensation of suffocation; symptoms worsen when the person is lying down

Physical Medicine
Cold compresses to the chest during acute attacks may lessen severity.

Contrast hydrotherapy may decrease inflammation, relieve pain, and aid healing. Alternate three minutes hot application to the chest with one minute cold. Repeat three times for one set; do two to three sets per day.

Castor oil pack. Apply oil directly to chest, cover with a clean soft cloth and plastic wrap. Apply a heat source on top; let sit 30 to 60 minutes.

Acupuncture
Acupuncture has shown potential as an effective treatment for asthma, according to a 1997 Consensus Statement by the National Institutes of Health. Notably, however, several literature reviews have found no evidence that acupuncture treatment is beneficial for asthma and have even noted that many acupuncture studies are poorly designed. In light of these findings, many researchers recommend that acupuncture be used in addition to (rather than as a replacement for) conventional medicine. One study found that acupuncture improved the immune response of people receiving anti-asthma medication compared to those who were not receiving the medication.

Acupuncturists treat people with asthma based on an individualized assessment of the excesses and deficiencies of qi located in various meridians. In the case of asthma, a qi deficiency is usually detected in the lung, spleen, liver, or kidney meridians. In addition to performing a needling treatment that focuses on these key meridians, acupuncturists may also use an herb-burning technique called moxibustion (a technique in which the herb mugwort is burned over specific acupuncture points). Some acupuncturists may also perform a special type of massage therapy, offer lifestyle counseling, provide instruction on specific breathing exercises, and prescribe herbal remedies.

Chiropractic
Chiropractors report that some people with asthma benefit from spinal manipulation, but the results of scientific studies have been somewhat mixed. A recent review of scientific literature, for example, concluded that "there is insufficient evidence to support or refute the use of manual therapy for patients with asthma." Among the trials reviewed, two studies compared spinal manipulation to sham manipulation in people with asthma. Sham manipulation refers to maneuvers that shift soft tissues surrounding the bone but to not actually adjust the spine or joint. Participants in both the spinal manipulation group and the sham group reported similar improvements in asthma symptoms, suggesting that spinal manipulation may be no more effective than sham therapy. In another study involving 81 children with asthma, chiropractic care was associated with a 45% reduction in the number of asthma "attacks." Thirty percent of the children in the study experienced such an improvement in symptoms that they were able to decrease their asthma medication dosage by 66% while receiving chiropractic care.

Sham manipulation has been compared to placebo because both procedures look and feel the same. Interestingly, however, experts are now questioning whether sham is a fair placebo because the massage quality of the manipulation may also have a beneficial effect.

Massage
Massage may reduce stress, easing reactions to allergens.


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Following Up

Your provider may give you a peak-flow meter to use at home to closely monitor your condition.

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Supporting Research

Balon J, Aker PD, Crowther ER, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med. 1998;339:1013-1020.

Bartram T. Encyclopedia of Herbal Medicine. Dorset, England: Grace Publishers; 1995:40-41.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Cummings S, Ullman D. Everybody's Guide to Homeopathic Medicines. 3rd ed. New York, NY: Penguin Putnam; 1997: 237-238.

Fung KP, Chow OKW, So SY. Attentuation of exercise-induced asthma by acupuncture. Lancet. 1986;2(8521-8522): 1419-1421.

Graham RI, Pistolese RA. An impairment rating analysis of asthmatic children under chiropractic care. J Vertebr Sublux Res.1997;1(4):41-48.

Hondras MA, Linde K, Jones AP. Manual therapy for asthma (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.

Hope BE, Massey DB, Fournier-Massey G. Hawaiian materia medica for asthma. Hawaii Med J. 1993;52:160-166.

JAMA Patient Page. How much vitamin C do you need? JAMA. 1999;281(15):1460.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Joos S, Schott C, Zou H, Daniel V, Martin E. Immunomodulatory effects of acupuncture in the treatment of allergic asthma: a randomized controlled study. J Alt Comp Med. 2000;6(6), 519-525.

Kleijnen J, ter Riet G, Knipschild P. Acupuncture and asthma: a review of controlled trials. Thorax. 1991;46:799-802.

Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North Atlantic Books; 1992:21-27.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Linde, K, Jobst K, Panton J. Acupuncture for chronic asthma (Cochrane Review). In: The Cochrane Library, Issue 3, 2001. Oxford: Update Software.

Middleton E, ed. Allergy: Principles and Practice. 5th ed. St. Louis, Mo: Mosby-Year Book, Inc; 1998.

Monteleone CA, Sherman AR. Nutrition and asthma. Arch Intern Med. 1997;157:23-24.

Murray MT, Pizzorno JE. Encyclopedia of Natural Medicine. 2nd ed. Rocklin, Calif: Prima Publishing; 1998:150-155.

NIH Consensus Statement: Acupuncture. National Institutes of Health, Office of the Director. 1997;15(5):1-34. Accessed at http://odp.od.nih.gov/consensus/cons/107/107_statement.htm on September 24, 2001.

Nielsen NH, Bronfort G, Bendix T, Madsen F, Weeke B. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exp Allergy. 1995;25:80-88.

Rakel RE, ed. Conn's Current Therapy. 50th ed. Philadelphia, Pa: WB Saunders Co; 1998.

Ullman D. Homeopathic Medicine for Children and Infants. New York, NY: Penguin Putnam; 1992: 46-48.

Ullman D. The Consumer's Guide to Homeopathy. New York, NY: Penguin Putnam; 1995: 260-261.

Ziment I, Tashkin DP. Alternative medicine for allergy and asthma. J Allergy Clin Immunol. 2000;106(4):603-614.