Asthma is a common chronic inflammatory condition of the lung airways whose cause is incompletely understood. Symptoms are cough, wheeze, chest tightness and shortness of breath, often worse at night.
It has three main characteristics:
- Airflow limitation which is usually reversible spontaneously or with treatment
- Airway hyperresponsiveness to a wide range of stimuli
- Inflammation of the bronchi with plasma exudation, edema, smooth muscle hypertrophy, mucus plugging and bronchial tissue damage.
Asthma can be divided into:
- Extrinsic – implying a definite external cause
- Intrinsic or cryptogenic – when no causative agent can be identified.
Extrinsic asthma occurs most frequently in atopic (Alergic Hipersensitivity) individuals who show positive skin-prick reactions to common inhalant allergens and foods. Serum IgE levels are usually raised. However, extrinsic asthmatics can still be exacerbated by nonspecific stimuli such as cold air and exercise.
Intrinsic asthma often starts in middle age (late onset), have negative skin tests and chronic infection and other factors are thought to play a role in the disease process.
Conventional medical treatment:
The mainstay of asthma therapy is the use of therapeutic agents delivered as aerosol or powders directly into the lungs.
These can be:
Inhaled oral steroids:
Beclometasone diproprionate, budesonide, fluticasone, mometasone which are normally used to control the inflammatory process of the disease to reduce crises. It is used in inhaler form but it can be taken orally. The benefits of inhaled corticosteroids are that part of the drug is delivered directly to in the airways surpassing the liver metabolism and creating fewer side effects. Unwanted effects of inhaled corticosteroids can be oral candidiasis and hoarseness.
Short-acting β2 adrenergic agonists relievers:
Salbutamol, terbutaline used to relieve acute asthma crises.
Long-acting relief/ disease controllers:
Long-acting β2 adrenergic agonists – salmeterol, formoterol are normally used 2 times a day to improve symptoms, lung function and reduce exacerbations in patients but does not improve the underlying inflammatory susceptibility of the disease.
Leukotriene modifiers – montelukast, zafirlukast, pranlukast, zileuton. This class of drugs targets one of the principal asthma mediators by inhibiting the cysteinyl LT1 receptor. These drugs are given orally and are only effective in a subpopulation of patients. Its normally used when patients require high doses of inhaled corticosteroids to support ongoing therapy.
Other agents with bronchodilator activity:
Antimuscarinic agents are anticholinergic agents like ipratropium bromide, oxitropium.
Its similar to cafeine, and has broncodilator properties and antispasmolitic effect on the bronchi.
Precipitating factors of Asthma:
Differentiation should be made between the causes that sustain the underlying condition of the immune system and the triggers that precipitate the immune response. Many factors are associated with the asthmatic disease and that are known to influence the frequency of the asthmatic crises, not only the known allergens that come out positive in the skin test.
Non Specific Factors:
Cold Air and Exercise:
Most asthmatics wheeze after prolonged exercise. Typically, the attack does not occur while exercising but afterward. The inhalation of cold air will also precipitate attacks.
Air Quality, Atmospheric Pollution, and fumes:
Many patients with asthma experience worsening of symptoms on contact with cigarette smoke, car exhaust fumes, strong perfumes or high concentrations of dust in the atmosphere. Air pollution parameters such as NO2, ozone, and particulates have also been associated with the incidence of asthma.
A variety of foods are well-known causes of asthma attacks. Traditional knowledge suggests that the consumption of dairy products can lead to a state of unhealthy mucous membranes in sensitive patients, however, these patients may not give a positive skin test to dairy products, and these products may not provoke an acute asthmatic attack. So, in reality, there is no allergy to dairy products but avoidance to this food group will in time give some relief from their asthmatic condition.
Stress and nervous anxiety contribute to create muscular tension in the diaphragm and disturb the rhythmic nature of breathing which can further distress the condition. Patients who are upset or anxious are more likely during their asthma attacks to report exacerbation and worsening of the asthma attacks.
Some contraindicated Drugs :
Non-steroid anti-inflammatory drugs:
NSAIDs, particularly aspirin and propionic acid derivatives, have a major role in the development and precipitation of asthma attacks in approximately 5% of patients with asthma. This effect is seen especially in patients who have both nasal polyps and asthma.
Beta-blockers (examples are propranolol, atenolol) also called beta-adrenergic blocking agents, treat a variety of conditions such as high blood pressure and migraines. Beta receptors receive messages from signaling chemicals in your body and pass that message along. Beta-blocker medications prevent that message from being received. It is a general recommendation that people with asthma do not take “non-selective” beta-blockers.6Non-selective beta-blockers can target β2 receptors in your airways and cause asthma symptoms in people with asthma, they will cause the airways to narrow and become more sensitive.
The link between sinusitis and asthma is strong in patients with intrinsic asthma. There is evidence that supports that rhinosinusitis and asthma may be an expression of an inflammatory process that appears in different sites of the respiratory tract. It is recurrent that nasal symptoms may precede the onset of an asthma crisis.
Poor digestion has been linked asthma. The research found a high incidence in asthmatic patients with functional hypochlorhydria, that is a deficiency of vagal stimulation of acid production and Gastro-oesophageal reflux. Improving digestion will benefit asthmatic patients. In the old days, some doctors have concluded that very rich diet full of excesses render the crises more severe.
Viral infections are known to exacerbate asthma. Most hospital admissions for asthma occur over the winter months. Viral infections in the upper airways frequently a deterioration in the airways in asthmatics and they may worsen asthma in children as well as in adults.
The most significant allergen in asthma is house dust mite, however, this does not necessarily mean that the degree of house dust mite exposure will correlate with the day to day severity of the allergy symptoms. This is because sensitivity to the house dust mites feeds the underlying pathological process.
Other common allergens that can trigger asthma attacks are cats, dogs, grass pollens and molds, and other like foods, especially dairy products, eggs, and nuts. Royal jelly should be used with caution as it can trigger asthma attacks.
Chinese Medicine and Asthma:
Asthma is a well defined disease with very specific and characteristic etiology and pathology by western medicine. In order to diagnose and treat it properly with Chinese medicine, we must identify the symptom to which it most closely corresponds in the Chinese framework. Textbooks of Chinese medicine say that asthma corresponds to the symptom “Xiau Chuan” which means wheezing (Xiao) and Breathlessness (Chuan).
To define asthma as being a combination of these two symptoms is still not enough to give a full broad presentation of the disease. Allergic asthma does not correspond to either of them specifically, creating a challenge to western Chinese medicine practitioners to treat this condition. Nonetheless, medicine treatment can reduce significantly the intensity and frequency of crises with adequate acupuncture treatment, dietary and herbal prescription.
The etiology in Chinese medicine for wheezing and breathlessness are:
- External pathogenic factors
- Emotional problems
- Fatigue, chronic, and excessive sexual activity.
The main cause of wheezing and breathlessness is phlegm obstructing the airways. The wheezing sound is due to rebellious chi ascending along the airways obstructed by Phlegm.
But in asthma Phlegm may not the main pathogenic factor. The wheezing and breathlessness from asthma are due to the narrowing of the airways from bronchospasm following an allergic reaction.
In the old days, the Chinese doctors could not see what was causing the narrowing so the explanation was that mucus and phlegm obstructed the airways.
Interestingly some old western doctors also believed that phlegm and mucus could be the cause of asthma, but others actually perceived the allergic nature of asthma and advised to sleep in big rooms and avoid feather beds.
Some authors have brought new theories into play. Maciocia actually brings up that are two main factors
1) deficiency of lung and Kidney defensive chi systems
2) wind may account for the second factor. The first would be the root of the disease and the latter the manifestation or pathogenic agents (Wind) attacking a susceptible host.
Nonetheless, asthma involves always one or more organ systems, digestive center (Spleen/ Pancreas, stomach & intestines), Kidney Adrenals and Liver/ Gallbladder and or the Heart / Lungs. Most often, all of these pairs are involved with one of these more unbalanced than the others.
Doctors can attest that the features of this disease vary in each patient. So treatment goals will vary according to the needs of the individual case. However, important to consider treating symptoms and any underlying issues. Therefore it will be common to have different formulas addressing those underlying features unique to each patient.
Just in the case of an acute asthma attack, the patient should be referred to hospital for appropriate treatment, because it could be life threatening.
Herbal actions and herbs:
Depending on the complexity of the syndrome presented by the patient it is important to consider herbs that may have some action or actions on each symptom for a proper herbal formulation.
The main herbs for asthma are Ephedra, Grindelia, euphorbia, Lobelia, Ammi Visnaga and their actions are mainly bronchodilator, spasmolytic, expectorant, antispasmodic.
Ephedra is to be used with caution as it can cause several side effects and has some contraindications such as anxiety, restlessness, hypertension.
Herbs with actions like antiallergic, immune-enhancing, anti-inflammatory of the bronchial tract, bronchospasmolitic, expectorant, antitussive will be used for symptomatic treatment. Other herbs with different actions will be used for any underlying symptoms depending on each patient:
- Digestives and bitter tonics if there is difficulty digesting (Gentian),
- For anxiety treatment (Passiflora, Valeriana),
- Treatment of sinusitis (eyebright) etc.
In folk medicine, fresh onion juice was used as a remedy for coughs, and asthma. Onion is rich in thiosulfinates which are believed to be the antiasthmatic components responsible to inhibit the release of histamine, leukotrienes biosynthesis and thromboxane-B2 biosynthesis. They act as potent inhibitors in the prostaglandin cascade that promote inflamation.
Diet is an important factor to promote phlegm and catarrhal states in the respiratory tract and mucous membranes. Diet high in protein, refined carbohydrates, dairy products and wheat products can contribute to this process, So restriction of these foods is advisable. Chlorophyll and vitamin A Foods (spirulina, Microalgae, all green vegetables in general) are all advisable to consume with more frequency. Omega 3 and Gama Linolenic Acid are also excepional for aleviating constrictions and spasms.
To induce vomiting is sometimes useful to ease the asthma attack, especially if the symptoms worsen soon after eating.
advice is given to bite your own tongue for 4 to 5 minutes several times a day. Stimulating the tongue can work has a reflexology exercise stimulating points on the tongue and mouth. Chinese medicine also believes the tongue is connected with all your body, has it is an extremity.
Lifestyle Advice for asthma patients:
- Deep breathing exercises
- Outdoor activity
- Warm bath followed by quick cold showers that cool just the body surface
- Avoid becoming chilled
- Avoid breathing chemical fumes, smoke, dust.
Any advice in this article does not replace consultation with a qualified therapist. Self medication is not advised.
Article written by Sérgio Caroço, ND, BSc (honors) TCM: Acupuncture.