Asthma
W. Ali H. MD Medicine (I), John D. Mark, MD
Overview: Asthma
Asthma, a common chronic respiratory disorder, affects more than 22 million persons in the United States. Asthma is known to be a complex inflammatory process that involves many cell types and cellular elements.
Interactions among these cells along with genetic disposi tion cause asthma symptoms. The symptoms are usually recurrent episodes of wheezing, cough, chest tightness, and breathlessness from widespread but variable air-flow obstruction characterized by complete or partial reversibility either spontaneously or with treatment.
This chronic inflammation leads to bronchial hyperresponsiveness to various stimuli and results in the clinical manifestations and severity of asthma and the subsequent response to treatment.
Research into the immunologic basis for asthma has shown that, in genetically susceptible individuals, air-borne allergens are taken up at the mucosal surface and selective peptides are generated that then influence T cells to develop into type 2 helper T (Th2) cells.
The expansion of the proinflammatory Th2-cell population causes a cascade of cytokines to be released, in addition to the up-regulation of adhesion molecules, which trap and activate passing leukocytes, specifically eosinophils, basophils, and monocytes.
Finally, these Th2 cells induce the production of allergic antibody immunoglobulin E (IgE), ultimately resulting in the clinical manifestation of allergy and asthma.
Important points to consider
Complications, including death, have been reported when Ma Huang is taken in high doses or with caffeine-containing products. Death has even been noted with only one use of this substance.
The newer anti-inflammatory steroidal inhalers, used alone or in combination with a long-acting bronchodilator, constitute the most innovative pharmacologic approach to chronic asthma care.
Prevention Prescription
Eliminate potential allergens and triggers in the environment.
Increase fruit and vegetable intake, along with that of omega-3-rich fats, which are found in cold-water fish, nuts, greens, and ground flaxseed.
Follow an exercise regimen, and consider other types of activities that incorporate both exercise and meditation, such as yoga and martial arts.
Take controller medications, such as inhaled steroids and leukotriene-modifier medication, routinely until
asthma is no longer persistent and the medications can safely be decreased or discontinued.
Consider adding a multivitamin with antioxidants (vitamins C, D and E, B-complex, selenium) to the diet.
Botanicals may be helpful in controlling and decreasing asthma symptoms but are best taken under the guidance of a health care provider with experience in using them.
Mind-body therapies such as relaxation, visualization, and self-hypnosis may decrease asthma exacerbations and reduce the need for asthma medications.
Stress reduction in the home, work place, and school may prevent or decrease asthma symptoms and airway inflammation.
Integrative Therapeutics Review
The following is a summary of therapeutic options. for treating asthma. If a patient is having persistent symptoms (daily wheezing, shortness of breath, difficulty sleeping, or difficulty exercising) or severe symptoms (even if intermittent), it is best to prescribe more aggressive therapy such as the beta-agonist drugs and anti-inflammatory medications as controller medications For the patient who has mild to moderate or intermittent symptoms, this stepwise approach may be considered.
Lifestyle
As with many chronic illnesses, asthma prevention would be the best treatment. Unfortunately, changing a person's lifestyle, including the environment, is difficult. Because of the cultural and regional differences just in the United States, patient populations differ in how they approach a chronic illness and even in the way they use medical care.
Environmental
Reducing exposure to asthma triggers can be therapeutic in itself. Such things as house dust mite reduction, frequent cleaning, use of HEPA filters, avoidance of secondhand smoke, and removal of all pets from the home will help decrease the "irritability" of the airways.
Nutrition
With elimination of allergenic type foods such as dairy products (at least for a trial period), shellfish, foods with nitrites, sulfites, added food coloring, and artificial sweeteners, asthma symptoms often diminish. Patients should consider increasing intake e of of organic fruits and a vegetables for their antioxidant contribution, as well as foods rich in omega-3 fatty acids while decreasing those containing omega-6 fatty acids (vegetable oils).
Supplements
Vitamin B 100 mg/day Magnesium: 200 to 400 mg/day
Fish oil: 1 g (eicosatetraenoic acid plus docosahexaenoic acid) twice daily
Vitamin D: 400 units for children younger than 4 years of age and 600 units daily for adults
Vitamin C: 250 mg twice daily
Vitamin E: 400 units a day or less of mixed tocopherols
Mind-Body Therapy
These techniques can be very rewarding in the ত treatment of asthma, and breathing and relaxation are excellent places to start.
Guided imagery and hypnosis therapies therapies are readily available in most communities and also help decrease symptoms, medication use, and physician. or urgent care visits. Usually, these methods should be used regularly (once or twice daily) until familiar to the patient, they can then be used as needed for asthma symptoms.
Journaling is also recommended, and patients should spend at least 20 minutes writing about their asthma or other stressors in their lives three times per week
Cognitive therapies should not be used in place of medications, especially if symptoms are moderate or severe. If the patient is wing a peak flow meter, these therapies can be used if peak flow values are in a safe range.
Exercise
Not only will routine exercise help with asthma (three to five periods of exercise lasting a minimum of 20 minutes per week), it will also help with self-esteem, weight loss, and cardiovascular health. Exercise should be used with caution in patients with exercise-induced asthma.
Botanicals
Coleus: 50 mg three times/day
Kampo (also known as Kanpo) is a mixture of Chinese herbs and found in powder form. such as Easy-Breather Tea (Yama's Herbs, New York): 3 rounded teaspoons in warm water two to three times/day
Pycnogenol: 30 to 100mg/day or 10 mg/kg/day. taken two to three times/day
Pharmaceuticals
For patients with mild to moderate symptoms that are persistent, starting with pharmaceuticals with antiinflammatory properties such as fluticasone, two puffs of the 110 metered-dose inhaler (110 mcg/inhalation) twice daily, or budesonide, one actuation twice daily, will improve symptoms in most patients while the other interventions mentioned previously can be started. For acute symptoms, one should use albuterol, two puffs twice daily, or levalbuterol, two puffs twice daily. These medications should be considered as first-line therapy if a patient has persistent or severe symptoms.
Other medications, such as leukotriene modifiers (montelukast 10mg daily), may also be considered.
Biomechanical Approaches
As adjuncts to other modalities and depending on the patient's preferences, massage, osteopathic manipulative treatment, and chiropractic therapies may be very beneficial. All three have different approaches and regimens, but finding a practitioner who is familiar with treating patients with asthma is the key.
Key Web Sources
http://www.buteyko.com/
http://www.aanma.org/
http://www.nhlbi.nih.gov/guidelines/asthma/
http://www.allergysolution.com/default.asp
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