Articles

Asthma

Introduction

Asthma is defined by the American Thoracic Society as a disease characterized by increased responsiveness of the trachea and bronchi to various stimuli and manifested by a widespread narrowing of the airways. (1) Asthma is a disease that affects a person's essential ability to breathe, and is one of the most demanding pathologies on the human being, both physically and mentally.

Asthma is a chronic lung disease characterized by bronchoconstriction that is reversible, airway inflammation resulting from edema in the lining of the bronchial tubes, and increased airway responsiveness to a variety of stimuli. Symptoms usually occur during the first five years of life in 65 percent of the patients. A key feature of the disease is a hyper-responsiveness of the airways to various triggering stimuli, which causes the airways to react to irritation with severe bronchospasm and inflammation, resulting in symptoms of wheezing, shortness of breath, and tachycardia.

There are two classifications of asthma, intrinsic and extrinsic. Intrinsic asthma usually develops in adulthood and may begin with risk factors such as cold air, exercise, or emotional trauma. Extrinsic, or atopic asthma, is considered an immunologically mediated condition with a rise in serum IgE.

Allergic Causes of Asthma Attacks (2)

    Grass/Tree/Plant pollens Animal dander Cat hair, saliva, urine Dog hair, saliva Cockroaches Dust mites Mold Foods (peanuts, corn, citrus, milk, wheat, yeasts) Food additives (sulfites, MSG, dyes, other preservatives) Pharmaceutical drugs (ASA, beta-blockers, estrogen, NSAIDs, PCN)

Non-Allergic Causes of Asthma Attacks (3)

    Additives Air pollution (ozone, smog) Chemical odors (cleaners, nail polish, paint) Coal smoke Cold air Cold drink Cooking fuel (kerosene, natural gas, propane) Emotional stress Exercise Foods (wine) Gastroesophageal reflux (heart burn) Heating units (coal, gas, kerosene, wood) Infection (upper respiratory) Nutritional deficiencies (magnesium, omega-3 fatty acids, selenium, vitamin B6 and vitamin C) Paint fumes Scents (air fresheners, colognes, perfumes) Tobacco smoke Weather changes Wood smoke

Statistic

American Academy of Allergy, Asthma, and Immunology, 2005.

    20.3 million American report having asthma. More than 70% of people with asthma also suffer from allergies. The prevalence of asthma increased 75% from 1980-1994. From 1982-1996, the prevalence of asthma increased by 97 percent among women, compared with 22 percent among men. 9 million children under 18 report having asthma. Asthma rates in children under the age of five have increased more than 160% from 1980-1994. There were 1.9 million asthma-related visits to emergency departments in 2002. There are more than 5,000 deaths from asthma annually. More than 14 million school days are missed annually due to asthma. Asthma accounts for approximately 24.5 million missed work days for adults annually.

Signs and Symptoms

[span class=alert]The following list does not insure the presence of this health condition. Please see the text and your healthcare professional for more information.[/span]

Wheezing, coughing, and dyspnea are the major symptoms associated with asthma and are of variable duration and severity. (4) , (5) These symptoms are frequently precipitated by upper respiratory tract infections (viral and bacterial), exercise, exposure to irritants (allergic, chemical, and physical), psychological problems, or climate. (6) , (7) A deterioration in airflow may precede overt symptoms. (8) A diagnosis of asthma should be considered when wheezing and coughing accompany respiratory difficulty, especially when associated with upper respiratory tract infection in the pediatric population.

General

    Wheezing Coughing Dyspnea Respiratory difficulty A deterioration in airflow

Treatment Options

Conventional

Long-term Preventative Medications

    Anti-inflammatory agents Corticosteroids Sodium cromoglycate Nedocromil

Bronchodilators

    Long acting b2- agonists Sustained release theophylline

Anti-allergenic agents

    Ketotifen

Quick Acting Medications

    Bronchodilators
Short acting b2-agonists Anticholinergics Short acting theophylline Epinephrine

Nutritional Supplementation


Vitamin B6

Theophylline drugs, which are commonly used by individuals with asthma, are reported to inhibit the enzyme pyridoxal kinase. This inhibition prevents the conversion of vitamin B6 (pyridoxine) to its active form in the body, which is pyridoxal 5’-phosphate. In a cross-over, placebo controlled study, 15 healthy volunteers were supplemented with vitamin B6 or placebo for two weeks before theophylline therapy. It was found that people who regularly take theophylline-containing medications could be at a greater risk of developing a vitamin B6 deficiency. (9) In fact, several studies have documented that patients taking theophylline medications do have depressed levels of vitamin B6. (10) , (11) Thus, people taking theophylline medications might consider taking additional vitamin B6.


Vitamin B12

In one study, IM injections of vitamin B12 (1,000 mcg once weekly for four weeks) enabled 18 of 20 patients to experience substantial improvement, which included reduced wheezing, improved breathing upon exertion, better sleep, and improved general condition. (12) Several other older studies also report substantial improvements in asthma patients receiving vitamin B12, but unfortunately, more recent studies have not been performed. (13) , (14) Vitamin B12 is also effective in reducing the incidence of bronchial asthma attacks in individuals who are sensitive to sulfites. (15)


Vitamin C

The authors of a 1994 review reported finding a number of studies that support the use of vitamin C in asthma and allergy. Significant results included positive effects on pulmonary function tests, bronchoprovocation challenges with methacholine, or histamine, or allergens, improvement in white blood cell function and motility, and a decrease in respiratory infections. However, there were also negative studies, which prompted the authors to state in their conclusion that the role of vitamin C in asthma is still not well defined. (16) Differences in dosage levels are one big variable that could cause conflicting outcomes.

Exercise-induced asthma is a common form of non-allergic asthma that can be beneficially affected by antioxidant nutrients. A placebo-controlled, doubleblind crossover study, 20 patients with asthma were all diagnosed with excercise induced asthma based on study criteria. Each received pulmonary function tests at rest, before and 1 hour after receiving 2 grams of oral ascorbic acid. Following a double-blind randomization each received either 2 grams of ascorbic acid or a placebo 1 hour before an exercise session on a treadmill. Pulmonary function tests remained unchanged following a 1 hour rest period, however, a protective effect on exercise-induced hyperreactive airways was documented in 9 participants. The investigators noted that though difficult to predict, vitamin C may provide a protective effect against exercise-induced asthma. (17)

Smog and other forms of air pollution are capable of triggering asthma attacks in susceptible individuals. A double-blind crossover study with 17 subjects revealed that those who received supplementation with both vitamin C and vitamin E responded less adversely to a sulfur dioxide challenge than the placebo subjects. Antioxidant supplementation may benefit adults with asthma who are exposed to air pollutants. (18)


Magnesium

Increased bronchial smooth muscle contractility with consequent bronchial hyperreactivity are characteristic pathophysiological events of asthma. Since magnesium intervenes in calcium transport mechanisms and intracellular phosphorylation reactions, it constitutes an important determinant of the contraction/relaxation state of bronchial smooth muscle. The results of one study indicate that there is a strong positive correlation between bronchial reactivity and intracellular magnesium levels. (19) In general, asthma patients have been found to have significantly lower magnesium levels than normal controls. Low cellular concentrations of magnesium in asthmatic patients are associated with increased airway hyper-responsiveness. (20)

Magnesium is also used intravenously in the treatment of children with moderate to severe asthma, resulting in significant improvement in short-term pulmonary function. As were the results in a randomized, double-blind, placebo-controlled clinical trial of the patients who were adminstered intravenous magnesium infusions. (21) Other studies report that inhaled magnesium provides a mild bronchoprotective effect for asthmatic patients. (22)


Eicosapentaenoic Acid (EPA)

Eicosapentaenoic acid (EPA) is the 20-carbon omega-3 fatty acid that is derived from alpha linolenic acid. EPA helps regulate the production of prostaglandins and leukotrienes that provide anti-inflammatory effects. Administration of 1,800mg/day of EPA to asthmatics produced improvements in symptom score, therapeutic score, asthma score, and peak flow. (23)


Lactobacillus, Bifidobacteria

The use of probiotics acidophilus/bifidus supports immune function. For many asthmatics, food intolerance can be a trigger to the inflammatory mediator cascade. By reducing the permeability in the gut by enhancing its integrity, a subsequent reduction in total load of the passage of antigens, toxins, and proteins into the blood stream can be accomplished.


L-Glutamine

Glutamine can reduce intestinal inflammation that leads to increased permeability, with a subsequent enhanced potential for antigen load in the gut. Glutamine is capable of improving intestinal integrity by protecting and rebuilding the mucosal lining of the intestine. (24)

Herbal Supplementation


Cordyceps

Cordyceps is a unique black mushroom that extracts nutrients from and grows only on a caterpillar found in the high altitudes of Tibet and China. Cordyceps is one of the most valued medicinal agents in the Chinese Materia Medica. Cordyceps has been used in traditional Chinese medicine as the herb of choice in lung and kidney problems, and as a general tonic for promoting longevity, vitality, and endurance. (25) Cordyceps is beneficial in helping individuals with decreased energy restore their capacity to function at a greater level of activity.

Cordyceps has been used in humans for centuries as a tonic for improving performance and vitality, with the proposed mechanism of action being improved oxygen consumption by the cardiopulmonary system under stress and increased tissue "steady state" energy levels. Cordyceps may modulate immune function and optimize endocrine systems, increasing physical strength and endurance. (26) , (27)

Cordyceps has traditionally been used for its improvement in respiration and in individuals with decreased lung function, such as in asthma and bronchitis, by increasing oxygenation (improving VO2 max by 9-15 percent). (28) Cordyceps is an antioxidant that increases serum levels of the enzyme superoxide dismutase (SOD), thereby increasing free radical scavenging ability. (29) It has PAF inhibiting action in laboratory studies. (30) It has also been reported to positively affect blood lipid metabolism, and therefore may be useful in atherosclerosis. (31) Development of a patented lab fermentation process has allowed large-scale production and availability.


Tylophora

Tylophora has been used traditionally in Ayurvedic medicine for thousands of years for problems with the lungs and breathing. Tylophora is used in the nutritional support of bronchial asthma and symptoms of allergies. Numerous studies report the beneficial effects of tylophora in the treatment and management of bronchial asthma. (32) , (33) , (34) Tylophora has been reported to have short acting bronchodilator activity, but anti-asthmatic effects are believed to be more accurately explained by tylophora’s reported depression of cell-mediated immunity. (35) Tylophorine has also been reported to stimulate adenylate cyclase in leukocytes isolated from asthmatic children, but not normal children or adults, which may be reflective of beta-receptor activity. (36)

Tylophora has been reported to stimulate the adrenals. (37) Tylophora was reported to antagonize dexamethasone/hypophysectomy-induced suppression of pituitary activity of the adrenals, with a conclusion by the researcher that tylophora may act by a direct stimulation of the adrenal cortex. Tylophora has also been reported to have beneficial effects on the immune system, possibly stimulating phagocytic function while inhibiting the humoral component of the immune system. (38)


Coleus

Coleus is a relatively new medicinal herb in the United States, although it has been extensively researched in India over the last twenty years. There have been studies to support its hypotensive (blood pressure lowering), anti-asthmatic, and spasmolytic effects. (39) , (40) Most studies have been done with the isolated extract, forskolin, but current research supports that the whole plant and all its constituents may actually be more effective.

Coleus is reported to have two significant mechanisms of action. First, it is claimed to activate the enzyme, adenylate cyclase. (41) Coleus reportedly creates c-AMP activation independent of receptor site specificity. (42) This action would have the effect of increasing energy within the cells, activating several biochemical pathways. The stimulation of c-AMP has an impact on body chemistry in several ways: may stimulate thyroid function; may increases insulin secretion; inhibition of mast cell release of histamine; cause smooth muscle relaxation and subsequent bronchodilation; and possibly increase in the burning of fats as fuels. (43)

Coleus is claimed to inhibit platelet activating factor (PAF) by possibly directly binding to PAF receptor sites. (44) , (45) PAF is a key factor in allergic and inflammatory pathways. By inhibiting it, neutrophil activation may be inhibited, vascular permeability reduced, smooth muscle contraction decreased, and coronary blood flow increased. (46)


Grape Seed Extract

Grape seed contains flavonoid-rich compounds termed proanthocyanidins (PCOs), reported as free radical scavengers or antioxidants. PCOs enhance absorption of and work synergistically with vitamin C in decreasing oxidative stress. (47)

Proanthocyanidins are believed to neutralize lipid peroxidation damage to cell membranes through their free radical activity. (48) , (49) PCOs may strengthen the capillary walls and skin. PCOs have been reported to inhibit the release of mediators of inflammation, such as histamine and prostaglandins. (50) , (51) Proanthocyanidins are claimed to neutralize many free radicals, including hydroxyl, lipid peroxides, and iron-induced lipid peroxidation. (52) , (53) , (54) They may also inhibit the enzyme xanthine oxidase, as reported in a laboratory study. (55) PCOs have been used in allergies and asthma because of their reported ability to inhibit degradation of mast cells and the subsequent release of histamine and other mediators of inflammation. The PCOs of grape seed have also been reported to have PAF inhibiting ability in laboratory studies. (56)

Homeopathic

Antimonium tartaricum

Typical Dosage: 6X or 6C, 30X or 30CChest full of phlegm but unable to expectorate it

Aralia racemosa

Typical Dosage: 6X or 6C, 30X or 30CSpasmodic irritation of respiratory tract in the evening or upon lying down

Arsenicum album

Typical Dosage: 6X or 6C, 30X or 30CVery restless and anxious with perspiration, worse at night; Chronic asthma

Ipecacuanha

Typical Dosage: 6X or 6C, 30X or 30CSudden wheezing; Weight in chest; Dyspnea; Constant, gagging cough; Worse by motion; Worse from cold air

Natrum muriaticum

Typical Dosage: 6X or 6C, 30X or 30CWorse in damp weather; Rattling in the chest; Sneezing; Worse early in the morning

Acupuncture & Acupressure

Acupuncture Therapy
Hu, et al. reported a total effective rate of 81.97% in treating 61 cases of bronchial asthma with acupuncture. The acupoints treated included the following: Dazhui (D 14), Dingchuan (EX-B 1), Fengmen (B12), Feishu (B13), Zusanli (S36), Sanyinjiao (SP 6), Kongzhui (L 6), etc. Measurements were taken before and after the treatment on T-lymphocyte subgroup, serum IL-4 and IgE, and the results indicated that the treatment could raise the sagged CD+ |~8| value (P

Traditional Chinese Medicine

Asthma

Extensive information regarding the treatment of this health condition using Traditional Chinese Medicine is available through the link above.

Diet & Lifestyle

    Drink plenty of quality water. Avoid food additives, coloring and preservatives (aspartame, dyes, MSG) Avoid refined, pre-packaged, and boxed foods when possible. Be cautious of excess salt intake. Avoid alcohol, soft drinks, and chronic use of caffeine and sugar-containing beverages. Reduce dietary arachidonic acid, which can lead to inflammatory mediators (leukotrienes) and precipitate asthmatic attack; diet should be low in meat, eggs, shellfish, vegetable oils (omega-6), and dietary fat. Reduce excess carbohydrate load, especially refined carbohydrates (may increase insulin secretion and inflammation). May want to begin a "vegan" diet; elimination of all animal products including dairy. Patient education, including, initiation of home peak flow monitoring and aiding in establishing a self-management program. Proper diet and exercise program. Address allergy issues and potential immune-triggering events. Make sure that the home is free of any mold or mildew problems. Limit the use of carpet whenever possible. Take steps to purify whole house air. Use hypoallergenic bedding and wash bedding frequently.

Clinical Lab Assessment

Some of the following laboratory testing can provide information necessary for the diagnosis and treatment of asthma. In addition, the tests listed may also give insight to functional metabolism and functional nutrient status in the body.

Organic Acids

Organic acids analysis is a useful method for measurement of biochemical intermediates in urine. Vitamin B12 has applications in preventing bronchospasm. (57) Organic acids assay provides an excellent functional assessment of B12. A subset of organic acids, the dysbiosis markers, may provide useful information regarding gastrointestinal pathogens that can contribute to immune compromise.

Allergy and Food Sensitivity Response Assessment

Allergic responses to foods, inhalants, environmental chemicals, and other substances can cause a variety of responses that induce or aggravate asthma.

Fatty Acids

There is evidence that increased omega-6 fatty acids and decreased levels of omega-3 fatty acids are involved in the etiology of asthma. (58) Shifts in dietary habits have been related to increases in the prevalence of asthma and fatty acid balances have been implicated. (59)

Ova Parasites

Gastrointestinal pathogens play a role in efficient digestion and absorption of nutrients as well as the production on toxic metabolic products. A stool evaluation for these microbial agents can provide useful information regarding causes for nutrient deficiencies contributing to the disease process in asthma.

Magnesium Level

There is considerable attention in the scientific community regarding the significance of magnesium in various chronic disease conditions including asthma. (60) Magnesium has been found to be low in PMNs when compared to controls, even when serum magnesium is normal. (61) Magnesium exerts an important regulatory affect on the contraction/ relaxation state of bronchial smooth muscle. (62)

Clinical Notes

Dietary Factors

Magnesium deficiency is associated with many diseases including asthma and allergies. Low magnesium may actually be a causative factor in asthma, increasing both wheezing and hyperreactivity of the air passages. (63)

Many individuals that present symptoms of minor respiratory problems including allergies, sinus, and asthma may have dysbiosis. The human intestinal microflora is an enormous microcosm that is estimated to contain over 100 trillion living bacteria, comprised of from 100 to 400 different species of bacteria. Dysbiosis refers to a state of disordered or dysfunctional intestinal microflora that causes ill health, which can produce symptoms ranging from mere discomfort to outright disease. Usually, an overgrowth of Candida albicans is present, causing problems associated with fungal overgrowth including allergies, food and chemical sensitivities, malabsorption of nutrients, autoimmune disorders, and asthma. A primary cause of dysbiosis is the consistent use of antibiotics without supportive probiotics. When an individual takes a course of antibiotics, the drug not only kills off the bad bacteria, it also kills off a majority of the beneficial bacteria. Other causes of dysbiosis include:

    Alkaline gastric pH - acidity is the body’s first line of defense against intestinal infection. Killing off the acid-producing “friendly" bacteria causes a shift towards a more alkaline intestinal pH, creating an environment that is favorable for yeast and pathogenic bacteria to proliferate. Use of some medications including oral contraceptives, antacids, steroid medications, chemotherapy and radiation, and anti-ulcer medications. Stress - due to excessive cortisol. Consumption of refined or processed foods, excessive alcohol intake, fluoridated and/or chlorinated water, toxic metals and other forms of environmental toxins. High consumption of refined sugars.

When dysbiosis develops, toxin-producing intestinal bacteria can cause a wide variety of symptoms. Digestive complaints are most common, including flatulence, bloating, intestinal pain and inflammation, cramping, and constipation and/or diarrhea. Unfortunately, the cause of these symptoms is frequently misunderstood and misdiagnosed. When the symptoms are treated, but the cause of the problem is not corrected, as is often the case, more serious systemic disorders can develop. Intestinal dysbiosis should be considered as a contributing factor in patients with asthma and allergies.

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