Asthma

Asthma is a lung disease that causes obstruction of the airways. It is an overreaction of the body’s immune system usually caused by exposure to an allergen, a substance that the body perceives as foreign and dangerous.

During an asthma attack, spasms in the muscles surrounding the bronchi (small airways in the lungs) constrict, impeding the outward passage of air. Asthma sufferers often describe this plight as “starving for air”. Typical symptoms of an asthma attack are coughing, wheezing, a feeling of tightness in the chest, and difficulty breathing. An attack can last for a few minutes or several hours.

The spasms characterizing an acute attack are not the cause of the disorder, but a result of chronic inflammation and hypersensitivity of the airways to certain stimuli. An attack can be triggered if a susceptible individual is exposed to an allergen, but irritants, infection, stress, exercise, use of aspirin, ibuprofen, naproxen, or other NSAIDs – or even rapid changes in weather and humidity- can trigger an attack.

Common asthma provoking allergens include animal dander, cockroach allergens, pollens, mold, pet dander, chemicals, drugs, dust mites, environmental pollutants, feathers, food additives ( such as monosodium glutamate, sulfites such as sodium metabisulfite), sea food, dairy products, nuts, yeast-based food, fumes, mold, and tobacco smoke.

Factors that can trigger non allergic asthma include adrenal disorders, anxiety, temperature changes, exercise, extremes of dryness or humidity, fear, laughing, low blood sugar, and stress. A respiratory infection like bronchitis is the most common provoker. Whatever the particular instigator, the bronchial tubes swell and become plugged with mucus. This inflammation further irritates the airways, resulting in even greater sensitivity. The attacks become more frequent and the inflammation more severe.

Asthma epidemics related to atmospheric contamination – situations in which dust and chemical particles are abundant, especially in enclosed environments- are well known. Occupational exposure to certain substances, such as urethrane and polyurethrane, used in the adhesives and plastic industry, along with rubber epoxy resins from paint, textile cleaner’s fumes, dry cleaning chemicals, and others also may be major risk factors.

Asthma symptoms may resemble those of other diseases, such as emphysema, bronchitis, heart burn, and lower respiratory infections.

Common signs and symptoms of asthma include: recurrent wheezing, coughing, trouble breathing, chest tightness, symptoms that occur or worsen at night, symptoms that are triggered by cold air, exercise or exposure to allergens.

Wheezing — high-pitched whistling sounds when you breathe out — is one of the main signs of asthma and indicates obstructed airways.

Although your symptoms, medical history and physical examination may suggest that you have asthma, lung (pulmonary) function tests may be needed to confirm an asthma diagnosis. Lung function tests may include one or more of the following tests:

a. Spirometry

This noninvasive test measures how well you breathe. During spirometry, you take deep breaths and forcefully exhale into a hose connected to a machine called a spirometer. Spirometry testing reveals two measurements that are important in diagnosing asthma:

Forced vital capacity (FVC), which is the maximum amount of air you can inhale and exhale.

Forced expiratory volume (FEV-1), which is the maximum amount of air you can exhale in one second.

The two measurements are compared. If certain key measurements are below normal for a person your age, it may be a sign that your airways are obstructed. Your doctor may ask you to inhale a bronchodilator drug used in asthma treatment to open obstructed air passages and then try the test again. If your measurements improve significantly, it's likely that you have asthma. Your doctor may still suspect that you have asthma even if your initial spirometry measurements are normal. If so, you may need additional tests.

b. Challenge test

During this test, your doctor deliberately tries to trigger airway obstruction and asthma symptoms by having you inhale an airway-constricting substance or take several breaths of cold air. If you appear to have exercise-induced asthma, you may be asked to do vigorous physical activity to trigger symptoms.

After triggering your symptoms, you retake the spirometry test. If your spirometry measurements are still normal, it's likely that you don't have asthma. But if your measurements have fallen significantly, it may mean you have asthma.

Treatment

The following treatments are usually administered concurrently to achieve the most rapid resolution of the exacerbation.

Oxygen. To achieve arterial oxygen saturation of a 90% (a 95% in children), oxygen should be administered by nasal cannulae, by mask, or rarely by head box in some infants. PaCO2 may worsen in some patients on 100 percent oxygen, especially those with more severe airflow

Obstruction. Oxygen therapy should be titrated against pulse oximetry to maintain a satisfactory oxygen saturation.

Rapid-acting inhaled ß2–agonists. Rapid-acting inhaled beta2-agonists should be administered at regular intervals. Although most rapid-acting beta2-agonists have a short duration of effect, the long-acting bronchodilator formoterol, which has both a rapid onset of action and a long duration of effect, has been shown to be equally effective without increasing side effects, though it is considerably more expensive.

The importance of this feature of formoterol is that it provides support and reassurance regarding the use of a combination of formoterol and budesonide early in asthma exacerbations. A modestly greater bronchodilator effect has been shown with levabuterol compared to racemic albuterol in both adults and children with an asthma exacerbation. In a large study of acute asthma in children and in adults not previously treated with glucocorticosteroid, levabuterol

treatment resulted in lower hospitalization rates compared to racemic albuterol treatment, but in children the length of hospital stay was no different.

Studies of intermittent versus continuous nebulized shortacting beta2-agonists in acute asthma provide conflicting results. In a systematic review of six studies, there were no significant differences in bronchodilator effect or hospital admissions between the two treatments. In

patients who require hospitalization, one study found that intermittent on-demand therapy led to a significantly shorter hospital stay, fewer nebulizations, and fewer palpitations when compared with intermittent therapy given every 4 hours. A reasonable approach to inhaled therapy

in exacerbations, therefore, would be the initial use of continuous therapy, followed by intermittent on-demand therapy for hospitalized patients. There is no evidence to support the routine use of intravenous beta2-agonists in patients with severe asthma exacerbations.

Epinephrine. A subcutaneous or intramuscular injection of epinephrine (adrenaline) may be indicated for acute treatment of anaphylaxis and angioedema, but is not routinely indicated during asthma exacerbations.

Additional bronchodilators.

Ipratropium bromide. A combination of nebulized beta2- agonist with an anticholinergic (ipratropium bromide) may produce better bronchodilation than either drug alone and should be administered before methylxanthines are considered. Combination beta2- agonist/anticholinergic therapy is associated with lower hospitalization rates and greater improvement in PEF and FEV1. Similar data have been reported in the pediatric literature . However, once children with asthma are hospitalized following intensive emergency department treatment, the addition of nebulized ipratropium bromide to nebulized beta2-agonist and systemic glucocorticosteroids appears to confer no extra benefit.

Theophylline. In view of the effectiveness and relative safety of rapid-acting beta2-agonists, theophylline has a minimal role in the management of acute asthma. Its use is associated with severe and potentially fatal side effects, particularly in those on long-term therapy with

sustained-release theophylline, and their bronchodilator effect is less than that of beta2-agonists. The benefit asadd-on treatment in adults with severe asthma exacerbations has not been demonstrated. However, in one study of children with near-fatal asthma, intravenous

theophylline provided additional benefit to patients also receiving an aggressive regimen of inhaled and intravenous beta2-agonists, inhaled ipatropium bromide, and intravenous systemic glucocorticosteroids.

Systemic glucocorticosteroids. Systemic glucocorticosteroids speed resolution of xacerbations and should be utilized in the all but the mildest exacerbations, especially if:

• The initial rapid-acting inhaled beta2-agonist therapy fails to achieve lasting improvement

• The exacerbation develops even though the patient was already taking oral glucocorticosteroids

• Previous exacerbations required oral glucocorticosteroids.

Oral glucocorticosteroids are usually as effective as those administered intravenously and are preferred because this route of delivery is less invasive and less expensive.

If vomiting has occurred shortly after administration of oral glucocorticosteroids, then an equivalent dose should be re-administered intravenously. In patients discharged from the emergency department, intramuscular administration may be helpful, especially if there are concerns about compliance with oral therapy. Oral glucocorticosteroids require at least 4 hours to produce clinical improvement.

Daily doses of systemic glucocorticosteroids equivalent to 60-80 mg methylprednisolone as a single dose, or 300-400 mg hydrocortisone in divided doses, are adequate for hospitalized patients, and 40 mg methylprednisolone or 200 mg hydrocortisone is probably adequate in most

cases. An oral glucocorticosteroid dose of 1 mg/kg daily is adequate for treatment of exacer-bations in children with mild persistent asthma. A 7-day course in adults has been found to be as effective as a 14-day course, and a 3- to 5-day course in children is usually considered appro-priate. Current evidence suggests that there is no benefit to tapering the dose of oral glucocorticosteroids, either in the short-term or over several weeks.

Inhaled glucocorticosteroids. Inhaled glucocorticosteroids are effective as part of therapy for asthma exacerbations. In one study, the combination of high-dose inhaled glucocorticosteroids and salbutamol in acute asthma provided greater bronchodilation than salbutamol alone, and conferred greater benefit than the addition of systemic glucocorticosteroids across all parameters, including hospitalizations, especially for patients with more severe attacks. Inhaled glucocorticosteroids can be as effective as oral glucocorticosteroids at preventing relapses. Patients discharged from the emergency department on prednisone and inhaled budesonide have a lower rate of relapse than

those on prednisone alone. A high-dose of inhaled glucocorticosteroid (2.4 mg budesonide daily in

four divided doses) achieves a relapse rate similar to 40 mg oral prednisone daily.

Cost is a significant factor in the use of such high-doses of inhaled glucocorticosteroids, and further studies are required to document their potential benefits, especially cost effectiveness, in acute asthma.

Magnesium. Intravenous magnesium sulphate (usually given as a single 2 g infusion over 20 minutes) is not recommended for routine use in asthma exacerbations, but can help reduce hospital admission rates in certain patients, including adults with FEV1 25-30% predicted at presentation, adults and children who fail to respond to initial treatment, and children whose FEV1 fails to improve

above 60% predicted after 1 hour of care. Nebulized salbutamol administered in isotonic magnesium sulfate provides greater benefit than if it is delivered in normal saline. Intravenous magnesium sulphate has not been studied in young children.

Helium oxygen therapy. A systematic survey of studies that have evaluated the effect of a combination of helium and oxygen, compared to helium alone, suggests there is no routine role for this intervention. It might be considered for patients who do not respond to standard therapy.

Leukotriene modifiers. There is little data to suggest a role for leukotriene modifiers in acute asthma.

Sedatives. Sedation should be strictly avoided during exacerbations of asthma because of the respiratory depressant effect of anxiolytic and hypnotic drugs. An association between the use of these drugs and avoidable asthma deaths has been demonstrated.

The following are the nutrients, herbs, and other recommendations beneficial to thwart atherosclerosis:

NUTRIENTS

Supplement	Suggested Dosage	Comments
Essential
Pantothenic acid (Vit B6)	50 mg 3x a day	The anti stress vitamin
Quercitin-C from Ecological Formulas plus bromelain	500 mg 3x a day 100 mg 3x a day	Powerful immunostimulants. Antihistamine effect
Vitamin C with bioflavonoids	1500 mg 3x a day (avoid high doses when with kidney stones)	Needed to protect lung tissue and keep down infection. Also increases air flow and fights inflammation
Zinc lozenges	Do not take over 100 mg daily	Can shorten an attack or halt one before it becomes severe.
Very Important
Betaine HCl with pepsin	As directed on label, or as prescribed	Combats malabsorption problems
Coenzyme Q	100 mg daily	Has the ability to counter histamine
Magnesium plus calcium	750 mg daily 1500 mg daily	May stop the acute asthmatic episode by increasing the vital capacity of the lungs. Has a dilating effect on the bronchial muscles. Use chelate forms
Multivitamin and mineral complex with Selenium Vitamin B12	As directed on the label 200 mcg daily 2000 mcg daily	Necessary for enhanced immune function. Use a high potency formula. Destroys radicals from air pollutants

Herbs

Lobelia extract is helpful during an asthma attack attack; it is a bronchial soothing muscle relaxant and expectorant. Do not take long term.

Boswellia, an Indian herb (also known as frankincense), in studies was shown to reduce the number of asthma attacks.

Mullein oil is said to be a powerful remedy for bronchial congestion. The oil stops cough, unclogs bronchial tubes, and helps clear up asthma attacks. Users say that when they take it in tea or fruit juice, the effect is almost immediate.

Proponents of the East Indian mind-body-earth philosophy called Ayurveda recommend the following herbs for people with asthma: vasaka (Adhatoda vasica) relieves cough, bronchitis, and other asthmatic symptoms; boswellia (Boswellia serrata), to relieve pain or inflammation; and tylophora (Tylophora indica) for respiratory relief.

Other herbs beneficial for asthma include Echinacea, licorice root, and slippery elm bark tablets. Licorice root, ginger root, and elderberry open up the respiratory tract.

Caution: Do not take Echinacea if you have an autoiimune disorder. Do not use licorice on a daily basis for more than seven days in a row, and avoid it completely if you have high blood pressure.

Recommendations:

Homeopathic use of belladonna have been shown to relax the bronchioles in the lungs which alleviates the wheezing symptoms in an asthma attack.

Eat a diet consisting primarily of fresh fruits and vegetables, oatmeal, brown rice, and whole grains. The diet should be relatively high in protein, low in carbohydrate, and contain no sugar.

Include garlic and oinions in your diet. These food contain quercatin and mustard oils, which have been shown to inhibit an enzyme that aids in releasing inflammatory chemicals.

Avoid gas-producing foods, such as beans, brassicas ( broccoli, cauliflower, and cabbage) and large amounts of bran. Gas can aggravate an asthmatic condition by putting pressure in the diaphragm.

Do not eat ice cream or drink extremely cold liquids. Cold can shock the bronchial tubes into spasms.

Use a juice fast, a fast using distilled water or lemon juice or a combination of both for three days each month to help rid the body of toxins and mucus.

Eat lightly- a large meal can cause shortness of breath by making the stomach put pressure on the diaphragm

Practice methods to relieve stress as they can trigger an attack.