Research Brief :
Asthma: Ease the Wheeze
By Felicia M. Tomasko
Asthma is a chronic disease characterized by periodic flare-ups when the airways become inflamed. Irritants or allergens can trigger inflammation of the lining inside the airways leading to the lungs as well as constriction of the surrounding muscles. This causes symptoms such as wheezing, chest tightness, difficulty breathing, coughing, pain and shortness of breath. Mucus production increases and further interferes with breathing.
Because of the aggravating effects of allergens, asthma is linked to a person’s other allergies, including foods, substances in the environment such as smog, sulfites in food, dust mites, pollens, mold or animal dander. Environmental pollutants and toxins including cigarette smoke, smog or strong-smelling volatile chemicals can also contribute to the cascading reaction leading to inflammation. Additionally, stress, strong emotional expression, infections and many pharmaceutical medications can be irritants which aggravate asthma attacks.
National Institute of Health (NIH) statistics identify more than 20 million Americans with asthma; nearly half of them are children. The NIH states that asthma is one of the primary reasons why children are absent from school.
The current thought on asthma is that it cannot be cured, but instead managed. In Western biomedical practice, inhalers and steroids are often used to reduce the irritability of the airways. A July 2006 study by Salpeter in the Annals of Internal Medicine brings up a question of differences in safety of many of the long-term medications used for asthma. While some drugs, specifically the inhaled anticholinergics, are relatively safe, others (beta-agonist bronchodilators like Serevent and Advair) can, in some people, increase risk of complications and even death.i This is not to advise that people should not follow their doctor’s advice, but looking into complementary treatments for asthma may be helpful.
Since stress can exacerbate asthma attacks, reducing stress is an important intervention for prevention and management of asthma. Yoga practice is shown to reduce stress and reduces levels of the stress hormone cortisol. ii,iii Recommendations are made specifically in regards to yoga, stress and asthma. For example, an article written by a family practice physician in the journal Primary Care recommends yoga to reduce stress and thus help manage asthma.iv Other reviews find yoga practices beneficial in treating asthma.v,vi
A number of studies examine the benefits of yoga practice to help manage asthma. In a study following people incorporating a holistic program of asana (postures), pranayama (breathing) and meditation, people in the yoga group had fewer weekly asthma attacks, improved breathing and better response to their medication.vii Practice focused on meditation has also been found to be helpful in reducing symptoms and reliance on medication.viii
Improper or ineffective use of the breath can aggravate asthma. Breathing too quickly, or mouth breathing (particularly in children) can increase airway hyper-reactivity. From a yogic perspective, practicing pranayama, or controlled breathing techniques can help manage hyper-reactivity of the airways. Studies using a variety of pranayama techniques found benefit from the practice including decreased use of medications.ix
Focusing on the exhalation is an important technique in managing asthma and reducing frequency and intensity of asthma attacks. Buteyko is an often-taught and researched technique developed by Russian doctor Konstantin Buteyko that focuses on normalizing the amount of carbon dioxide in the body by reducing hyperventilation through breath training.x,xi In a randomized, placebo-controlled trial in people with asthma, pranayama techniques were found to reduce participant’s inhaler use and reduced the frequency of symptoms.xii
The Ayurvedic perspective is that it is important to improve digestion, as it reduces the hyper-reactivity of the body in general to foreign proteins. Herbs, including turmeric, or the traditional combination mahasudarshan, are traditionally important for treating allergies and reducing the body’s hyper-reactivity.
Additionally, keeping the sinuses open with practices like neti, or salt water rinse can be helpful for reducing allergies and improving breathing. Although not specifically studied in people with asthma, a study of daily neti practice improved breathing and reduced medication use in people with chronic sinus infections.xiii
Tulsi or holy basil (Ocimum sanctum) is one of the most beloved Ayurvedic herbs. It contains potent medicinal properties and among other uses, is one of the primary herbs for treating disorders and imbalances of the lungs and respiratory system. It reduces mucus, particularly in asthma and reduces symptoms of irritability of the respiratory system. It is also used to relieve cold symptoms and shorten cold duration and to decrease fever. The chemical eugenol is one of the active constituents of tulsi and contributes to its therapeutic effects.xiv,xv Tulsi can be grown in an herb garden or window box; the fresh leaves can be used to make tea.
Essential fatty acids, particularly omega-3 oils found in vegetarian food sources such as almonds, walnuts, pumpkin and flax seeds are found to be beneficial for reducing inflammation and alleviating problems with asthma.xvi An initial study found supplementing a diet with omega-3 fatty acids reduced the hyperactivity of the airway common in asthma.xvii Continued studies have found that supplementation decreases symptoms of asthma and reduces cough prevalence.xviii,xix,xx
While some studies of acupuncture and asthma have been inconclusive or conflicting, newer studies have utilized longer trials of acupuncture sessions, with better effect. Participants in some acupuncture studies have even been able to reduce their use of medication.xx Acupuncture improved the quality of life for people with asthma, including reduced distress during asthma attacks and improved ability to breathe and engage in activity. People also demonstrated improvement with the use of acupressure on points to their own body, self-administered after training from a clinician.xxii
There are a number of resources available to provide information on managing asthma with complementary and integrative therapies. The following are a few book titles that may be helpful.
Yoga Beats Asthma, Simple Exercises and Breathing Techniques to Relieve Asthma and Breathing Disorders by Stella Weller
Asthma Free Naturally, Everything You Need to Know to Take Control of Your Asthma by Patrick McKeown
My House is Killing Me! The Home Guide for Families with Allergies and Asthma by Jeffrey Ca. May
Natural Relief for Your Child’s Asthma, A Guide to Controlling Symptoms & Reducing Your Child’s Dependence on Drugs by Steven J. Bock
i Press release, Asthma inhaler type could boost death risk. Study fuels debate over beta agonists such as Serevent and Advair, announcing Salpeter article in July 4 issue of Annals of Internal Medicine. Accessed from NIH website http://www.nlm.nih.gov/medlineplus/news/fullstory_34643.html, June 14, 2006.
ii Michalsen, A., Grossman, P., Acil, A., Langhorst, J., Ludtke, R., Esch, T., Stefano, G.B., and Dobos, G.J. 2005. Rapid stress reduction and anxiolysis among distressed women as a consequence of a three-month intensive yoga program. Medical Science Monitor. 11(12): CR555-561.
iii Robert-McComb, J.J., Tacon, A., Randolph, P., and Caldera, Y. Mindfulness-based stress reduction in relation to quality of life, mood, symptoms of stress and levels of cortisol, dehydroepiandrosterone sulfate (DHEAS) and melatonin in breast and prostate cancer outpatients. Psychoneuroendrocrinology. 2004; 29(4): 448-74.
iv Jaber, R. 2002. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Primary Care. 29(2): 231-61.
v Blazek-O’Neill. 2005. Complementary and alternative medicine in allergy, otitis media, and asthma. Current Allergy and Asthma Reports. 5: 313-8.
vi Khalsa, S.B. 2004. Yoga as a therapeutic intervention: a bibliometric analysis of published research studies. Indian Journal of Physiology and Pharmacology. 48(3): 269-85.
vii Nagarantha, R., and Nagendra, H.R. 1985. Yoga for Bronchial Asthma: a controlled study. British Medical Journal (Clinical Research Edition), 291: 1077-79.
viii Manocha, R., Marks, G.B., Kenchington, P., Peters, D., Salome, C.M. 2002. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax. 57(2): 110-15.
ix Singh, V., Wisniewski, A., Britton, J., Tattersfield, A. 1990. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet. 335: 1381-3.
x Vasiljeva, A., and Nias, D. 2003. The buteyko method and the importance of carbon dioxide. Positive Health. October: 26-30.
xi Courtney, R. 2003. Breathing therapies for asthma: buteyko and eucapnic breathing training. Townsend Letter for Doctors and Patients. April: 62-4.
xii Cooper, S., Oborne, J., Newton, S., Harrison, V., Thompson Coon, J., Lewis, S., and Tattersfield, A. 2003. Effect of two breathing exercises (Buteyko and pranayama) in asthma: A randomised controlled trial. Thorax. 58(8): 674-79.
xiii Rabago, D., Zgierska, A., Mundt, M., Barrett, B., Bobula, J., and Maberry, R. 2002. Efficacy of daily hypertonic saline nasal irrigation among patients with sinusitis: a randomized controlled trial. The Journal of Family Practice. 51(12): 1049-55.
xiv Prakash, P. 2005. Therapeutic uses of Ocimum sanctum Linn (Tulsi) with a note on eugenol and its pharmacological actions: a short review. Indian Journal of Physiology And Pharmacology.
49 (2), 125-31.
xv Gupta, S.K. 2002. Validation of traditional claim of Tulsi, Ocimum sanctum Linn. as a medicinal plant. Indian Journal Of Experimental Biology. 40 (7), 765-73.
xvi Jaber, R. 2002. Respiratory and allergic diseases: from upper respiratory tract infections to asthma. Primary Care.
xvii Villani, F., Comazzi, R., De Maria, P., Galimberti, M. 1998. Effect of dietary supplementation with polyunsaturated fatty acids on ronchial hyperreactivity in subjects with seasonal asthma. Respiration. 65:265-69.
xviii Nagakura, T., Matsuda, S., Shichijyo, K., Sugimoto, H., and Hata, K. 2000. Dietary supplementation with fish oil rich in omega-3 polyunsaturated fatty acids in children with bronchial asthma. European Journal of Respiration. 16: 861-65.
xix Surette, M.E., Kounemis, I.L., Edens, M.B., Tramposch, K.M., Clayton, B., Bowton, D., and Chilton, F.H. 2003. Inhibition of leukotrine biosynthesis by a novel dietary fatty acid formulation in patients with atopic asthma: a randomized, placebo-controlled, parallel-group, prospective trial. Clinical Therapies. 25:972-9.
xx Peat, J.K., Mihrshahi, S., Kemp, A.S., Marks, G.B., Tovey, E.R., Webb, K., Mellis, C.M., and Leeder, S.R. 2004. Three-year outcomes of dietary fatty acid odification and house dust mite reduction in the Childhood Asthma Prevention Study. Journal of Allergy and Clinical Immunology. 114:807-13.
xxi Zijlstra, F.J., van den Berg-de Lange, I., Huygen, F.J.P.M., and Klein, J. 2003. Anti-inflammatory actions of acupuncture. Mediators of Inflammation. 12(2): 59-69.
xxii Maa, S.H., Sun, M.F., Hsu, K.H., Hung, T.J., Chen, H.C., Yu, C.T., Wang, C.H., and Lin, H.C. 2003. Effect of acupuncture or acupressure on quality of life of patients with chronic obstructive asthma: a pilot study. The Journal of Alternative and Complementary Medicine. 9(5):659-70.
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