Asthma

                                        Asthma
Definition
Asthma is a chronic inflammatory disease of the airways
in the lungs. This inflammation periodically causes
the airways to narrow, producing wheezing and breathlessness
sometimes to the point where the patient gasps
for air. This obstruction of the air flow either stops spontaneously
or responds to a wide range of treatments.
Continuing inflammation makes asthmatics hyper-responsive
to such stimuli as cold air, exercise, dust, pollutants
in the air, and even stress or anxiety.

Description
The changes that take place in the lungs of asthmatics
make their airways (the bronchi and the smaller bronchioles)
hyper-reactive to many different types of stimuli
that do not affect healthy lungs. In an asthma attack, the
muscle tissue in the walls of the bronchi go into spasm,
and the cells that line the airways swell and secrete
mucus into the air spaces. Both these actions cause the
bronchi to narrow, a change that is called bronchoconstriction.
As a result, an asthmatic person has to make a
much greater effort to breathe.
Cells in the bronchial walls, called mast cells, release
certain substances that cause the bronchial muscle to contract
and stimulate mucus formation. These substances,
which include histamine and a group of chemicals called
leukotrienes, also bring white blood cells into the area.
Many patients with asthma are prone to react to substances
such as pollen, dust, or animal dander; these are called allergens.
Many people with asthma do not realize that allergens
are triggering their attacks. On the other hand, asthma
also affects many patients who are not allergic in this way.
Asthma usually begins in childhood or adolescence,
but it also may first appear in adult life. While the
symptoms may be similar, certain important aspects of asthma
are different in children and adults. When asthma begins
in childhood, it often does so in a child who is likely, for
genetic reasons, to become sensitized to common allergens
in the environment. Such a child is known as an
atopic person. In 2004, scientists in Helsinki, Finland,
identified two new genes that cause atopic asthma. The
discovery might lead to earlier prediction of asthma in
children and adults. When these children are exposed to
dust, animal proteins, fungi, or other potential allergens,
they produce a type of antibody that is intended to engulf
and destroy the foreign materials. This has the effect of
making the airway cells sensitive to particular materials.
Further exposure can lead rapidly to an asthmatic response.
This condition of atopy is present in at least one
third and as many as one half of the general population.
When an infant or young child wheezes during viral infections,
the presence of allergy (in the child or a close
relative) is a clue that asthma may well continue
throughout childhood.
Allergenic materials may also play a role when
adults become asthmatic. Asthma can start at any age
and in a wide variety of situations. Many adults who are
not allergic have such conditions as sinusitis or nasal
polyps, or they may be sensitive to aspirin and related
drugs. Another major source of adult asthma is exposure
at work to animal products, certain forms of plastic,
wood dust, metals, and environmental pollution.

Causes & symptoms
In most cases, asthma is caused by inhaling an allergen
that sets off the chain of biochemical and tissue
changes leading to airway inflammation, bronchoconstriction,
and wheezing. Because avoiding (or at least
minimizing) exposure is the most effective way of treating
asthma, it is vital to identify which allergen or irritant
is causing symptoms in a particular patient. Once
asthma is present, symptoms can be set off or made
worse if the patient also has rhinitis (inflammation of
the lining of the nose) or sinusitis. When, for some reason,
stomach acid passes back up the esophagus in a reaction
called acid reflux, this condition also can make
asthma worse. In addition, a viral infection of the respiratory
tract can inflame an asthmatic reaction. Aspirin
and drugs called beta-blockers, often used to treat high
blood pressure, also can worsen the symptoms of asthma.
But the most important inhaled allergens giving rise
to attacks of asthma are:
• animal dander
• dust mites
• fungi (molds) that grow indoors
• cockroach allergens
• pollen
• occupational exposure to chemicals, fumes, or particles
of industrial materials
• tobacco smoke
• air pollutants
In addition, there are three important factors that
regularly produce attacks in certain asthmatic patients,
and they may sometimes be the sole cause of symptoms.
They are:
• inhaling cold air (cold-induced asthma)
• exercise-induced asthma (in certain children, asthma
attacks are caused simply by exercising)
• stress or a high level of anxiety
Wheezing often is obvious, but mild asthmatic attacks
may be confirmed when the physician listens to the
patient’s chest with a stethoscope. Besides wheezing and
being short of breath, the patient may cough or report a
feeling of tightness in the chest. Children may have itching
on their back or neck at the start of an attack. Wheezing
often is loudest when the patient exhales. Some asthmatics
are free of symptoms most of the time but may
occasionally be short of breath for a brief time. Others
spend much of their days (and nights) coughing and
wheezing until properly treated. Crying or even laughing
may bring on an attack. Severe episodes often are seen
when the patient gets a viral respiratory tract infection or
is exposed to a heavy load of an allergen or irritant.
Asthmatic attacks may last only a few minutes or can go
on for hours or even days. Being short of breath may
cause a patient to become very anxious, sit upright, lean
forward, and use the muscles of the neck and chest wall
to help breathe. The patient may be able to say only a
few words at a time before stopping to take a breath.
Confusion and a bluish tint to the skin are clues that the
oxygen supply is much too low and that emergency treatment
is needed. In a severe attack, some of the air sacs in
the lung may rupture so that air collects within the chest,
which makes it even harder to breathe. The good news is
that almost always, even patients with the most severe attacks
will recover completely.


Diagnosis
Apart from listening to the patient’s chest, the examiner
should look for maximum chest expansion while
taking in air. Hunched shoulders and contracting neck
muscles are other signs of narrowed airways. Nasal
polyps or increased amounts of nasal secretions are often
noted in asthmatic patients. Skin changes, like dermatitis
or eczema, are a clue that the patient has allergic
problems. Inquiring about a family history of asthma or
allergies can be a valuable indicator of asthma. A test
called spirometry measures how rapidly air is exhaled
and how much is retained in the lungs. Repeating the test
after the patient inhales a drug that widens the air passages
(a bronchodilator) will show whether the narrowing
of the airway is reversible, which is a very typical
finding in asthma. Often patients use a related instrument,
called a peak flow meter, to keep track of asthma
severity when at home.
Frequently, it is difficult to determine what is triggering
asthma attacks. Allergy skin testing may be
used, although an allergic skin response does not always
mean that the allergen being tested is causing the
asthma. Also, the body’s immune system produces an
antibody to fight off the allergen, and the amount of antibody
can be measured by a blood test. The blood test

will show how sensitive the patient is to a particular allergen.
If the diagnosis is still in doubt, the patient can
inhale a suspect allergen while using a spirometer to
detect airway narrowing. Spirometry also can be repeated
after a bout of exercise if exercise-induced asthma
is a possibility. A chest x-ray will help rule out
other disorders.

Treatment

Alternative medicine tends to view asthma as the
body’s protective reaction to environmental agents and
pollutants. As such, the treatment goal is often to restore
balance to and strengthen the entire body and provide specific
support to the lungs, immune and hormonal systems.
Asthma sufferers can help by keeping a diary of asthma
attacks in order to determine environmental and emotional
factors that may be contributing to their condition.

Alternative treatments have minimal side effects, are
generally inexpensive, and are convenient forms of selftreatment.
They also can be used alongside allopathic
treatments to improve their effectiveness and lessen their
negative side effects.

Dietary and nutritional therapies
Some alternative practitioners recommend cutting
down on or eliminating dairy products from the diet, as
these increase mucus secretion in the lungs and are


sources of food allergies. Other recommendations include
avoiding processed foods, refined starches and
sugars, and foods with artificial additives and sulfites.
Diets should be high in fresh fruits, vegetables, and
whole grains, and low in salt. Asthma sufferers should
experiment with their diets to determine if food allergies
are playing a role in their asthma. Some studies have
shown that a sustained vegan (zero animal foods) diet
can be effective for asthma, as it does not contain the animal
products that frequently cause food allergies and
contain chemical additives. A vegan diet also eliminates
a fatty acid called arachidonic acid, which is found in animal
products and is believed to contribute to allergic reactions.

Plenty of water should also be drunk by asthma sufferers,
as water helps to keep the passages of the lungs
moist. Onions and garlic contain quercetin, a flavonoid
(a chemical compound/biological response modifier)
that inhibits the release of histamine, and should be a
part of an asthmatic’s diet. Quercetin also is available as
a supplement, and should be taken with the digestive enzyme
bromelain to increase its absorption.
As nutritional therapy, vitamins A, C and E have
been touted as important. Also, the B complex vitamins,
particularly B6 and B12, may be helpful for asthma, as
well as magnesium, selenium, and an omega-3 fatty
acid supplement such as flaxseed oil. A good multivitamin
supplement also is recommended.

Herbal remedies
Chinese medicine has traditionally used ma huang,
or ephedra, for asthma attacks. It contains ephedrine,
which is a bronchodilator used in many drugs. However,
the U.S. Food and Drug Administration (FDA) issued a
ban on the sale of ephedra that took effect in April 2004
because it was shown to raise blood pressure and stress
the circulatory system, resulting in heart attacks and
strokes for some users. Ginkgo has been shown to reduce
the frequency of asthma attacks, and licorice is used in
Chinese medicine as a natural decongestant and expectorant.
There are many formulas used in traditional Chinese
medicine to prevent or ease asthma attacks, depending
on the specific Chinese diagnosis given by the
practitioner. For example, ma huang is used to treat socalled
“wind-cold” respiratory ailments.
Other herbs used for asthma include lobelia, also
called Indian tobacco; nettle, which contains a natural
antihistamine; thyme; elecampane mullein: feverfew;
passionflower: saw palmetto: and Asian ginseng. Coffee
and tea have been shown to reduce the severity of asthma
attacks because caffeine works as a bronchodilator. Tea
also contains minute amounts of theophylline, a major
drug used for asthma. Ayurvedic (traditional East Indian)
medicine recommends the herb Tylophora asthmatica.

Controlled exercise
Many people believe that those with asthma should
not exercise. This is particularly true among parents of
children with asthma. In a 2004 study, researchers reported
that 20% of children with asthma do not get
enough exercise. Many parents believe it is dangerous
for their children with asthma to exercise, but physical
activity benefits all children, including those with asthma.
Parents should work with the child’s healthcare
provider and any coach or organized sport leader to carefully
monitor his or her activities.

Acupuncture
Acupuncture can be an effective treatment for asthma.
It is used in traditional Chinese medicine along with
dietary changes. Acupressure can also be used as a selftreatment
for asthma attacks and prevention. The Lung 1
points, used to stimulate breathing, can be easily found
on the chest. These are sensitive, often knotted spots on
the muscles that run horizontally about an inch below the
collarbone, and about two inches from the center of the
chest. The points can be pressed in a circular manner
with the thumbs, while the head is allowed to hang forward
and the patient takes slow, deep breaths. Reflexology
also uses particular acupressure points on the hands
and feet that are believed to stimulate the lungs.

Other treatments
Aromatherapists recommend eucalyptus, lavender,
rosemary, and chamomile as fragrances that promote
free breathing. In Japan, a common treatment for asthma
is administering cold baths. This form of hydrotherapy
has been demonstrated to open constricted air passages.
Massage therapies such as Rolfing can help asthma sufferers
as well, as they strive to open and increase circulation
in the chest area. Homeopathy uses the remedies
Arsenicum album, Kali carbonicum, Natrum sulphuricum,
and Aconite.



Allopathic treatment
Allopaths recommend that asthma patients should
be periodically examined and have their lung functions

measured by spirometry. The goals are to prevent troublesome
symptoms, to maintain lung function as close to
normal as possible, and to allow patients to pursue their
normal activities, including those requiring exertion. The
best drug therapy is that which controls asthmatic symptoms
while causing few or no side effects.


Expected results
Most patients with asthma respond well when the
best treatment or combination of treatments is found and
they are able to lead relatively normal lives. Patients who
take responsibility for their condition and experiment
with various treatments have good chances of keeping
symptoms minimal. Having urgent measures to control
asthma attacks and ongoing treatment to prevent attacks
are important as well. More than one half of affected
children stop having attacks by the time they reach 21
years of age. Many others have less frequent and less severe
attacks as they grow older. A small minority of patients
will have progressively more trouble breathing.
Because they run a risk of going into respiratory failure,
they must receive intensive treatment.

Prevention
Prevention is extremely important in the treatment of
asthma, which includes eliminating all possible allergens
from the environment and diet. Homes and work areas
should be as dust and pollutant-free as possible. Areas
can be tested for allergens and high-quality air filters can
be installed to clean the air. If the patient is sensitive to a
family pet, removing the animal or at least keeping it out
of the bedroom (with the bedroom door closed) is advised.
Keeping the pet away from carpets and upholstered
furniture, and removing all feathers also helps. To reduce
exposure to dust mites, it is recommended to remove
wall-to-wall carpeting, keep the humidity low, and use
special pillows and mattress covers. Cutting down on
stuffed toys, and washing them each week in hot water, is
advised for children with asthma. If cockroach allergen is
causing asthma attacks, controlling the roaches (using
traps or boric acid rather than chemicals) can help.
It is important to not to leave food or garbage exposed.
Keeping indoor air clean by vacuuming carpets once or
twice a week (with the asthmatic person absent), and
avoiding use of humidifiers is advised. Those with asthma
should avoid exposure to tobacco smoke and should not
exercise outside when air pollution levels are high. When
asthma is related to exposure at work, taking all precautions,
including wearing a mask and, if necessary, arranging
to work in a safer area, is recommended. For chronic
sufferers who live in heavily polluted areas, moving to less
polluted regions may even be a viable alternative.