Asthma information by Ray Sahelian, M.D. Asthma Treatment - Natural Options

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Twice a month we Email you a brief abstract of several new studies on various supplements and natural medicine topics and their practical interpretation by Ray Sahelian, M.D. We will mention research updates on natural options for Asthma relief.

 

Asthma is a chronic inflammatory disease of the airways that affects 15 million people in the United States. An estimated 5 million children have asthma, which makes it the most common chronic disease of childhood. You will find more information about the causes and symptoms of asthma and commonly used medications later, but for now I want to discuss some natural options the medical profession has yet to address.

Natural treatment for asthma
There is little doubt that diet and lifestyle, along with herbal and nutritional methods can have an influence on asthma symptoms and severity. However, research is still too early to make any firm recommendations. In the meantime, I want to share with you some of the preliminary research I have come across. This information is not meant to replace your doctor's advice, however, you could inform your doctor about these natural asthma treatment options and he or she could learn more about them to see if they would be helpful to you.

Eat more cold water fish with high content of fish oils. Eating oily fish like salmon, halibut, sardines (packed in mustard or tomato sauce, not oil), or tuna regularly may reduce the risk of asthma symptoms. Children who eat lots of amounts of whole grain products and fish seem to have a reduced risk of developing asthma. "The rise in the prevalence of asthma in western societies may be related to changed dietary habits. Studies of children have shown that asthma is less likely with increasing intake of "fruits, vegetables, whole grain products, and fish. Teens who don't eat enough fruit and vegetables and omega-3 fatty acids are more likely to suffer from bronchitis, wheezing and asthma.

Eat more fresh fruits and vegetables. Have a wide variety of produce, preferably organic. People who eat plenty of tomatoes, carrots, leafy greens and other vegetables appear less likely to have asthma. Though it's uncertain whether the foods are the reason, the findings suggest that some or many vegetables may protect against adulthood asthma. A number of studies have suggested that antioxidants or certain other nutrients in plant foods may help prevent or ameliorate asthma and other allergic conditions. Carrots, tomato juice, spinach and other vegetables contain nutrients called carotenoids and flavonoids.
Reduce hydrogenated and trans fats which are often found in pastries, cookies, cakes, etc.
Reduce omega-6 oils such as corn, safflower, and sunflower. Substitute a little bit of flax or olive oil.
Have hot soup and tea -- warm liquids lessen severity
Obese adults with asthma are at risk for having more severe, persistent disease relative to their leaner counterparts, therefore weight loss could help.

And now, a few supplements that may be helpful: Click on each link for more information.
If you don't like fish, consider taking fish oil capsules. Fish oil supplements may, in some people, help reduce the severity of asthma, including exercise-induced asthma.
Flavonoids may be helpful, including Genistein and Quercetin. These are available as supplements. Flavonoids are found in vegetables, fruits, and herbs. They have anti-inflammatory activity. See study on genistein below.
Boswellia is an Ayurvedic herb that has been found to be helpful for asthma in one study
Vitamin C, magnesium, and ginkgo may help
Sylimarin may protect against histamine-induced bronchoconstriction. Sylimarin is found in milk thistle.
Alpha Lipoic Acid has been found to be helpful in one mouse study.
Butterbur extract could be helpful in many people, see butterbur web site for more information.
Yoga is helpful

Again, the research in this area is still scant, and I will update this page as more information becomes available. If you plan to take supplements, discuss with your doctor, and learn as much about each one before you take them.

Asthma triggers include
Avoid or reduce exposure to allergens or asthma triggers listed below:

Additives to alcoholic beverages or foods — metabisulfites, MSG, tartazine (yellow dye #5), yeast, sulfite additives in wine.

Allergens from animal dander, cockroaches, dust mites or mold spores, pollen (trees, grass, weeds), indoor and outdoor pollutants. People with asthma caused by allergies to a pet may have to choose between their furry friend or better health. Removing the pet from the home is more effective than even optimal drug therapy in reducing wheezing and airway constriction. A tailored approach, involving cockroach extermination and using air cleaners to reduce dust, smoke and levels of other indoor allergens may consequently reduce asthma symptoms in inner-city children. Vacuum cleaners with "high-efficiency particulate-air" filters or HEPA filters are no better than basic vacuum cleaners at reducing an individual's exposure to dust mites in the home. Dust mites, which infest even the cleanest homes and thrive in bedding and carpets, disrupt the protective function of the skin, leaving it vulnerable to other allergens and irritants in the environment. House dust mites and their droppings have long been linked to attacks of asthma and eczema. Mites and their feces contain an enzyme which destroys the protective function of the skin, leaving it vulnerable to other irritants.

Foods such as eggs, milk, nuts, soy, wheat and peanut. Toddlers who consume large amounts of margarine and foods fried in vegetable oil may be twice as likely to develop asthma as their peers who eat less of these foods.

Changes in humidity or barometric pressure.

Diseases such as GERD, sinusitis, rhinitis, viral infections, hyperthyroidism.

Drugs-- aspirin, NSAIDs, beta blockers, sulfites, estrogen.

Irritants -- tobacco smoke, wood-burning, perfumes, cleaning agents, carbon dioxide, pollutants such as sulfur dioxide, nitrogen dioxide, ozone. Children who live near a busy road may be at increased risk of wheezing, a symptom of asthma. Exposure to air pollution may increase the risk of death among people with severe asthma. Almost 100 million people in 21 U.S. states breathe unhealthy levels of tiny particles spewed by coal-burning power plants, cars and factories.

Pesticides can trigger or worsen asthma in farmers. The following pesticides are associated with the allergic variety of asthma: Coumaphos, EPTC, lindane, parathion, heptachlor, and 2,4,5-TP are most strongly linked to allergic asthma. For non-allergic asthma, DDT, malathion, and phorate have the strongest effect.

Physical triggers -- exercise, hyperventilation, cold air.

Physiological factors - stress, psychological factors. Stress of finals may worsen the symptoms of asthma.

Environmental control measures include removing carpets from the patient’s bedroom and living areas, weekly washing of bedding and clothing in hot water, specially designed mattress and pillow covers, removing stuffed animals, keeping pets outdoors. Quilts made of synthetic fibers like polyester might trigger wheezing in some children with asthma.

Indoor exposure to nitrogen dioxide (NO2) from gas-fueled stoves, even at levels well below the Environmental Protection Agency outdoor standard, may cause respiratory symptoms in asthmatic children living in multi-family housing units. Chronic exposure to indoor nitrogen dioxide is a public health concern, in part, because more than half the households in the US have a source of NO2, usually a gas-fueled cooking appliance.

Housework may raise the risk for asthma if exposed to high amounts of common cleaning sprays and air fresheners. Perhaps natural cleaners would not raise the risk as much. Reduce your exposure to air fresheners, furniture cleaners and glass-cleaners.

Avoid indoor swimming pools due to the high chlorine vapors which can damage lung tissue and aggravate asthma
Avoid acetaminophen (Tylenol).

Bleaching agents widely used in hair salons put hair stylists at risk of asthma and inflammation of the eyes, nose and throat.

Nurses are more likely to develop asthma, and so are cleaners. Exposure to certain cleaning chemicals, bioaerosols, mites, agricultural products, and latex in the workplace raise the risk of developing asthma.

Asthma medicines
Asthma may be classified as mild, moderate, or persistent. Patients with persistent asthma require medications that provide long-term control of their disease and medications that provide quick relief of symptoms. Medications for long-term control of asthma include inhaled corticosteroids, cromolyn, nedocromil, leukotriene modifiers and long-acting bronchodilators. Inhaled corticosteroids remain the most effective anti-inflammatory medications in the treatment of asthma. Quick-relief medications include short-acting beta2 agonists, anticholinergics and systemic corticosteroids. Some 60 percent of people who use steroids long term for asthma and other diseases will develop a mood disorder, such as depression or manic depression.

Asthma Inhaler Medicines
Children with mild-to-moderate persistent asthma, treatment with fluticasone (Flovent), an inhaled steroid, is consistently more effective than treatment with montelukast (Singulair), an oral anti-asthma drug from the leukotriene receptor antagonist (LTRA) class of agents.

Asthma and airway inflammation
Airway inflammation is the primary problem in asthma. An initial event in asthma appears to be the release of inflammatory mediators (e.g., histamine, tryptase, leukotrienes and prostaglandins) triggered by exposure to allergens, irritants, cold air or exercise. The mediators are released from bronchial mast cells, alveolar macrophages, T lymphocytes and epithelial cells. Some mediators directly cause acute bronchoconstriction, termed the "early-phase asthmatic response." The inflammatory mediators also direct the activation of eosinophils and neutrophils, and their migration to the airways, where they cause injury. This so-called "late-phase asthmatic response" results in epithelial damage, airway edema, mucus hypersecretion and hyperresponsiveness of bronchial smooth muscle.

Asthma and Anxiety, Panic
Individuals with asthma appear to have an increased risk of developing panic disorder, and the presence of panic disorder predicts subsequent asthma activity.

Cause of Asthma
There are several causes of asthma, the most common is allergic:
1. Asthma due to allergy (extrinsic/ atopic) - This type of asthma usually starts in childhood and is often preceded by eczema. But most of the young adults developing asthma also fall in this category. Genetic factors play a significant role. In this type of asthma the allergen leads to production of excessive (IgE) immunoglobulins.

2. Asthma due to an infection - This is not hereditary or allergic asthma, but may be caused by, or at least associated with upper respiratory tract or bronchial infection which is usually viral.

3. Asthma due to damage to lungs from smoking or inhaling smoke.

4. Psychological factors (like anxiety, emotional stress etc) are often considered to be the sole cause of some asthma attacks, but it is still not certain whether it can be the sole cause or is only a precipitating factor.

5. Occupational asthma - This type of asthma can occur in certain industries in which there is exposure to metallic dusts (esp. platinum salts), biological detergents, toluene diisocyanate, polyurethane, flour and dust from grains etc.

Asthma Research Update
Regular use of the painkiller acetaminophen, also known as paracetamol, is associated with higher rates of asthma and chronic obstructive pulmonary disease (COPD) and reduced lung function. Animal experiments have suggested that acetaminophen might lower antioxidant activity in the lungs, and causes harm to the liver. Why is acetaminophen still available for sale without a prescription?

Blocking a powerful immune system chemical could provide a new treatment for patients suffering from severe asthma. Patients with severe asthma had higher levels of a chemical called tumour necrosis factor alpha (TNF-alpha) than other sufferers.

Children of Mexican descent who are born in the US are nearly twice as likely to develop asthma as those born in Mexico.

Fish oil and inflammatory disease: is asthma the next target for n-3 fatty acid supplements?
Nutr Rev. 2004 Dec;62(12):486-9.
Eating fish or taking n-3 fatty acid supplements can decrease the risk and severity of cardiovascular disease. Recent research suggests that asthma, another highly prevalent, chronic inflammatory disease, may also respond to fish oil supplements.

A water-damaged workplace may trigger asthma and other breathing problems in employees, and be a substantial source of sick days. In a study of workers at one leaky, mold-contaminated office building, U.S. government researchers found that the rate of adult-onset asthma among employees was more than three times the norm for the general population. Two-thirds of these cases were diagnosed after the employees had started working in the building.

Clinical efficacy of n-3 fatty acid supplementation in patients with asthma.
J Am Diet Assoc. 2005 Jan;105(1):98-105.
The rising prevalence of asthma is an alarming health concern. The morbidity and mortality associated with asthma not only disrupts the quality of life, but it also escalates health care costs. Asthma is a chronic inflammatory disease of the respiratory tract. An exaggerated production of the arachidonic acid-derived eicosanoids, leukotrienes, has been implicated as the chemical trigger for asthma inflammation. n-3 fatty acid supplementation has been shown to suppress the synthesis of the n-6 series of leukotrienes by competing and inhibiting the metabolism of arachidonic acid. The results from epidemiological studies suggested that fish consumption was beneficially associated with lung function and prevalence of asthma. The data generated from clinical trials, however, indicated that n-3 fatty acid supplementation did not consistently improve severity of asthma symptoms, lung functions, airway responsiveness, and medication use in asthmatic patients. Leading organizations have not included nutrition as part of the management guidelines for asthma. Meanwhile, regular fish consumption at least three times per week should be highly encouraged as part of a well-balanced diet and to meet the adequate intake levels established for n-3 fatty acids in asthma patients.

In vitro effects of astaxanthin combined with ginkgolide B on T lymphocyte activation in peripheral blood mononuclear cells from asthma subjects.
J Pharmacol Sci. 2004 Feb;94(2):129-36.
This study was undertaken to identify novel approaches to pharmacological treatment of asthma. Here we hypothesize that the platelet-activating factor receptor antagonist ginkgolide B (GB) in combination with the antioxidant carotenoid astaxanthin suppresses T cell activation comparably to two commonly-used antihistamines: cetirizine dihydrochloride (CTZ) and azelastine (AZE). These results suggest that astaxanthin and GB may have application as novel anti asthma formulations.

Dietary intake of soy genistein is associated with lung function in patients with asthma.
J Asthma. 2004;41(8):833-43.
To determine if micronutrient intake is associated with asthma severity, we administered the Block food frequency questionnaire to participants in a randomized clinical trial of the safety of influenza vaccine for asthmatics. The nutrition substudy included 1033 participants, aged 12-75. Intake of antioxidant vitamins, soy isoflavones, total fruits and vegetables, fats, and fiber was compared with asthma severity at baseline [forced expiratory volume in 1 second (FEV1), peak expiratory flow rate (PEF), asthma symptoms] and the rate of asthma exacerbations during the 2 weeks following influenza vaccination. The only nutrient that had a consistent association with asthma severity was genistein, a soy isoflavone. Thus, increasing consumption of genistein is associated with better lung function in patients with asthma. Further studies are needed to determine whether dietary supplementation with genistein can reduce asthma severity.

Airborne fungi are increasingly being seen as a risk factor for asthma and now, new research indicates that high levels of such fungi are found in inner city homes with cats, cockroaches, and dampness problems. The findings, which appear in the Journal of Allergy and Clinical Immunology, are based on an evaluation of the homes of 414 mold-sensitive children with asthma. The subjects were drawn from seven urban communities in the US. The fungi seen indoors were usually the same type as that found outdoors, lead author Dr. George T. O'Connor, from Boston University, and colleagues note. The most common species found outdoors and indoors was Cladosporium, followed by Penicillium and Aspergillus. The strongest predictor of high indoor fungi levels, compared with outdoor levels, was having a cat live in the home within the last six months. Evidence of cockroaches in the child's bedroom was linked with high levels of Aspergillus, whereas dampness in the bedroom was tied to high levels of Cladosporium.

For children who need to go to the ER because of a severe asthma attack, giving them an intravenous infusion of magnesium sulphate along with conventional medications provides an additional benefit. Dr. D. K. L. Cheuk, at the University of Hong Kong, and colleagues analyzed clinical trials involving a total of 182 children. The studies evaluated the effects of intravenous magnesium sulphate with or without inhaled beta-2-agonist bronchodilators and oral steroid drugs in subjects suffering acute asthma who were seen in the emergency department. The main point was to see if the treatment kept the children from being hospitalized for treatment. "After pooling the results together, intravenous magnesium sulphate was effective in avoiding hospitalization," Cheuk's team reports in the Archives of Disease in Childhood. A significant improvement was also seen with magnesium treatment in short-term lung function tests and symptom scores.

A key ingredient in the aroma from citrus fruits such as oranges and lemons appears to protect rats from the symptoms of asthma. The citrus ingredient is called limonene, and it likely protects against asthma by "burning" inhaled ozone, which can increase inflammation in the lungs. Other scents - such as those emitted from pine trees, geraniums and roses - contain similar ingredients to limonene, which may help explain why asthma is much more common in urban areas that lack vegetation. Squeezing an orange peel releases liquid that contains a high concentration of limonene.

Children who make regular visits to an indoor pool may develop damage to a type of lung cell that helps prevent airway inflammation, and perhaps aggravate asthma. The researchers speculate that repeated exposure to chlorine byproducts in the air around indoor pools may harm these respiratory cells, known as Clara cells. A number of past studies have found elevated rates of airway inflammation and asthma among competitive swimmers, with researchers attributing it to inhalation of chlorine gas and its byproducts.

Inner-city families can help relieve children's asthma symptoms by making simple changes in their homes. Such steps include using pillow covers that are impermeable to dust mites, and air purifiers to get rid of tobacco smoke, mold and cat or dog allergens

Melatonin Improves Sleep in Asthma: A Randomized, Double-blind, Placebo-controlled Study.
Am J Respir Crit Care Med. 2004 Aug 11
Disturbed sleep is common in asthma. Melatonin has sleep-inducing activity and reportedly affects smooth muscle tone and inflammation. The aim of this study was to evaluate the effect of melatonin on sleep in patients with mild and moderate asthma. This was a randomized, double-blind, placebo-controlled study. Twenty-two consecutive asthmatic women were randomized to receive melatonin 3 mg (n= 12) or placebo (n= 10) for four weeks. Sleep quality and daytime somnolence were assessed by the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale, respectively. Pulmonary function was assessed by spirometry. Use of relief medication, asthma symptoms and morning and evening peak expiratory flow rate (PEFR) were recorded daily. Melatonin treatment significantly improved subjective sleep quality, as compared to placebo (p= 0.04). No significant difference in asthma symptoms, use of relief medication and daily PEFR was found between groups. We conclude that melatonin can improve sleep in patients with asthma. Further studies looking into long-term effects of melatonin on airway inflammation and bronchial hyperresponsiveness are needed before melatonin can be recommended in asthmatic patients.

The Effect of a Herbal Water-Extract on Histamine Release from Mast Cells and on Allergic Asthma.
Ain Helwan, Cairo, 11795, Egypt.
J Herb Pharmcother. 2003;3(4):41-54.
A water extract of a mixture of eight herbs (chamomile, saffron, anise, fennel, caraway, licorice, cardamom and black seed) was tested for its inhibitory effect on histamine released from rat peritoneal mast cells stimulated either by compound 48/80 or be IgE/anti-IgE. The effect of the herb extract was compared to that of the flavonoid quercetin. The herbal water-extract inhibited histamine released from chemically- and immunologically-induced cells by 81% and 85%, respectively; quercetin treated cells were inhibited by 95% and 97%, respectively. The clinical results showed significant improvements of sleep discomfort, cough frequency and cough intensity in addition to increased percentages of FEV₁/FVC in patients suffering from allergic asthma, who used the herbal tea compared to those who used the placebo tea.

Exposure to fumes emitted by cleaning products in the home could cause asthma in children

Biofeedback training aimed at increasing heart rate variability appears to allow asthma patients to reduce the amount inhaled steroid drugs they need to control their symptoms.

Ratio of omega-6 to omega-3 fatty acids and childhood asthma.
Curtin University of Technology, Perth, Western Australia, Australia.
Asthma. 2004;41(3):319-26.
Asthma is a leading cause of morbidity for children and is a major public health problem in Australia. Ecological and temporal data suggest that dietary factors may have a role in recent increases in the prevalence of asthma. AIM: The aim of conducting this study was to investigate whether childhood asthma was associated with the ratio of omega 6 (n-6) to omega 3 (n-3) fatty acids in the diet (n-6:n-3). METHOD: The Western Australian Pregnancy Cohort Study is a prospective birth cohort of 2602 children. Using a nested case-control cross-sectional study design within this cohort, a group of children were identified as cases with current asthma at 6 or at 8 years of age or as controls with no asthma at 6 or at 8 years. Dietary details including n-6 and n-3 fatty acid intake data were collected by parent response to a questionnaire when the children were 8 years old. Logistical regression was used to compare quartiles of n-6:n-3 intake in cases and controls. Adjustment was made for covariates: gender, gestational age, breastfeeding, older siblings, maternal smoking during pregnancy, maternal age, maternal asthma, child's current age in months, body mass index, total energy intake, and antioxidant intake (vitamins A, C, E, and zinc). RESULTS: A response rate of 83% was achieved by providing complete data from 335 children [49% cases with current asthma (n = 166), 51% controls (n = 169)]. Following adjustment for covariates the association between the ratio of n-6:n-3 fatty acids and risk for current asthma was statistically significant . ONCLUSION: We found evidence for a modulatory effect of the dietary n-6:n-3 fatty acid ratio on the presence of asthma in children. Our results provide evidence that promotion of a diet with increased n-3 fatty acids and reduced n-6 fatty acids to protect children against symptoms of asthma is warranted. cause of asthma.

Antioxidant supplements could ease asthma symptoms
Journal of Allergy and Clinical Immunology 2003;111:72-78.
Indian scientists who conducted an extensive chemical analysis of blood samples from people with asthma say that beefing up levels of antioxidants may help thwart symptoms of the lung disease. Asthma is a chronic disease in which airway inflammation causes attacks of wheezing, coughing and breathlessness. The underlying causes of asthma, and the factors that trigger attacks, are under investigation. Genetics, developmental factors and environmental triggers are all believed to play important roles. Previous research has shown that a disturbance in the balance between the body's oxidant production--the formation of molecules such as free radicals that can damage tissue but are a normal byproduct of body processes--and natural antioxidant defenses is involved in asthmatics' inflammation response. Antioxidants are a class of chemicals that neutralize oxidants, and include vitamins C and E and certain substances found in fruits and vegetables. In the present study, published in the January issue of the Journal of Allergy and Clinical Immunology, researchers measured the levels of antioxidants and oxidants in the blood of 38 men and women with asthma and compared them to levels in blood samples from 23 healthy people. Dr. Ahmad Nadeem of the University of Delhi and colleagues write that asthmatic patients showed "alterations in a wide array of oxidants and antioxidants, with balance shifting toward increased oxidative stress in asthma." The good news, according to the researchers, is that "the observations in the present study also have clinical implications" for asthmatics. The findings suggest, the authors conclude, that boosting the antioxidant defenses of asthma patients could be "beneficial."