Asthma - What is Asthma, facts & Treatments
What is Asthma, facts & Treatments
What is asthma
Asthma ( which means "recurrent wheezing") is a disease of the lungs characterised by recurrent episodes of coughing and breathing problems. These problems are caused by an "over sensitivity" of the airways in the lung which over-react to certain environmental triggers and so become inflamed and clogged. This results in coughing and wheezing.
Asthma is common, affecting more than 1 in 10 children and 1 in 20 adults. It can occur for the first time at any age. It may improve or disappear completely during the teenage years, but about 50% of children with asthma will still have problems on reaching adulthood.
There is often a tendency for asthma to run in families and to be linked to other conditions such as eczema and hayfever.
Asthma cannot be cured but with appropriate treatment and awareness of the nature of the condition most asthmatics can live a normal fulfilling life with regular involvement in sport and recreation.
How does it occur
The essential disease process involves the bronchial tree. This is an arrangement of air passages which branch out into a complicated and delicate network throughout both lungs. Their role is to conduct air (and therefore oxygen) to the lung tissue and, by means of mucus (or "slime") producing special cells which line the walls of the tubes, the infection is filtered out from the inhaled air before it reaches the lungs.
Two things happen in an asthma attack :
Firstly, the air passages seize up (or go into spasm) causing the wheeze so often audible in a distressed patient
Secondly, there is a swelling of the air passages themselves due to inflammation. The mucus becomes thickened, increased in volume, and often discoloured due to infection. This combined process serves to narrow off the bronchial passages to inspired air and so leads to the symptoms.
Why does it occur
The answer to this question lies in understanding what exactly produces the alteration in the bronchial tubes.
The basic changes are brought about because the body becomes allergic (or sensitive) to agents in the local environment. These agents may be for example pollen dust, house dust, animal fur or some foods. Only people predisposed to this tendency will develop asthma. On encountering these agents the body will recognise them as being "foreign" in some way and will develop an allergic response. This may occur immediately or there may be a delay of a few weeks or even months before the response occurs.
Certain special cells called mast cells are situated in the lining of the lungs and airways in every healthy person. In asthma sufferers, however, these cells become sensitised when exposed to the outside agent and release chemical called histamine from inside the mast cells into the blood. This will cause spasm or constriction of the airway leading to wheezing.
In addition, the inflammation in the airway tubes leads to huge numbers of inflammatory cells invading the area. The blood vessels dilate and the mucus producing glands work excessively. Together these will cause the cough and breathlessness.
What are the trigger agents
The main trigger factors are:
Chest infections or flulike illness can bring on asthma
Allergies to grass pollen, house dust, cat or dog fur, for example Irritants such as tobacco smoke, industrial fumes or dust, all of which may be occupationally related
Exercise, especially during cold weather can be a factor but controllable with treatment
Emotion - anger or anxiety can bring on an attack of wheezing in some asthmatics
Drugs - about 5%-10% of asthmatics are allergic to aspirin or aspirin-like drugs (mainly the anti-arthritic drugs). Beta blockers commonly prescribed for other conditions e.g. migraine, angina, or high blood pressure can cause asthma
Foods - especially seafoods, peanuts, eggs and certain additives and colouring agents.
How is asthma diagnosed
The diagnosis is made mainly on the basis of the history of a persistent cough or wheezing brought on by exertion or becoming worse at night in the case of children - so called early onset asthma. Typically the history may be that of a minor cough or cold which "goes straight to the chest". Late onset asthma occurs in middle life and is characterised by wheezing.
The main test for diagnosing asthma is the peak flow rate (pFR) which is done by the Gp or the practice nurse in the surgery. patients can be taught to monitor their own pFR reading and record it on a chart. A gradual fall in the reading will indicate the progression of asthma. Thus it is possible to anticipate an imminent deterioration of the asthma and obtain help promptly.
What is the treatment
Treatment generally falls into two broad categories, namely acute (or "reliever") drugs which are used to treat the acute symptoms of wheezing and chronic (or "preventative") treatment taken regularly to stop symptoms occurring.
The reliever drugs work on the nerves controlling the width of the airways causing them to widen. Examples of such drugs are terbutaline and salbutamol. These are prescribed in either tablet or liquid form, or as an inhaler, and offer rapid relief from wheezing.
The preventer drugs work by dampening down the basic allergic process by reducing the inflammation, swelling and mucus in the airways. They have to be used regularly on a longer term basis to be effective. Examples of drugs commonly prescribed are sodium cromogylcate used often in children, and steroids given either as an inhaler (beclomethasone) or as prednisolone tablets. These are very effective in all age groups.
There are also a variety of "spacer devices" available for simplicity of use and to ensure that the drug reaches the necessary parts of the lung and airways with minimum of discomfort. Many practice nurses are trained in asthma counselling and can offer further information about these devices and treatment in general.
How can asthma be controlled
Having asthma should not prevent one from living a totally normal life provided one recognises the symptoms and signs that the conditions might be getting worse. Taking regular peak flow meter recordings is invaluable.
packing for a holiday should include a reliever inhaler and an emergency supply of prednisolone tablets. Always keep drugs in the hand luggage when travelling by air and make sure that an adequate supply is taken which will last the duration of the holiday.
School children should be aware of the trigger factors (e.g. when away on school trips) and to inform their teacher about controlling their condition in case emergency help is needed. There is no reason to stop children taking part in school activities such as swimming provided that they take their inhalers regularly beforehand.
Where can I get more information
Apart from contacting your own Gp the following organisations may be of help:
Action Asthma patient Service
pO Box 230
British Lung Foundation / Breathe Easy Club
78 Hatton Garden
Telephone : 020 7831 5831
Web page: http://www.lunguk.org/
National Asthma Campaign
Telephone: 020 7226 2260
Telephone Helpline : 08457 010203 (9.00-21.00 Mondays - Fridays)
"Mainstream" medical treatment of adult asthma can include prednisone, oral bronchodilators, and a variety of inhalers which usually contain either bronchodilators or synthetic corticosteroids. While these treatments can be very effective in relieving symptoms, they rarely improve the health of either the lungs or the body in general, and can cause many unwanted effects. Nutritional and natural treatment for adult asthma usually improves the health and function of both the lungs and the body in general. However, please remember that we're all individuals biochemically.
If you're an adult with asthma, allergy identification, elimination, and desensitization should be an important part of your treatment plan. Diet and diet supplementation is another important part. Your goal is to make drug treatment unnecessary, or at least to minimize any need for drugs.
In adult asthma inhalant allergy is usually more of a factor than food allergy, the reverse of the situation in childhood asthma, although working with both is necessary. Once offending inhalants are identified, exposure control can be very helpful. This might include air filtration systems, careful house cleaning (especially of the bedroom and bathroom areas), mattress and furniture covers, and other "environmental control" measures. Negative ion generators, which put negatively charged ions into the air, are very helpful to some individuals with asthma.
It's impossible to completely avoid all inhalant allergens, so desensitization is almost always necessary. Desensitization is often done with injections, though some clinics, including ours, find that carefully measured homeopathic dilutions of offending allergens, taken sublingually, are usually quite effective.
Food allergy should be checked, too. The commonly-used "scratch test", although helpful for diagnosis of inhalant allergy, is not very accurate for diagnosis of food allergy. please read the brief on Allergy Testing for a more complete discussion of food allergy testing.
Once you know what foods you're allergic to, eliminating them from your diet is usually best, at least to start. Later on, most food allergies can be desensitized, too.
Eliminating food chemicals, colorings, additives, flavorings and preservatives, as well as sugar and refined food is important in relieving some of the burden on the immune system.
Your diet supplements should start with vitamin C, usually as sodium ascorbate or calcium-magnesium ascorbate. (These are "buffered' forms of vitamin C, available at natural food stores and some drug stores.) The more severe the asthma, the more vitamin C should be used. Amounts I usually recommend can range from 1000 to 4000 milligrams, three or four times daily. (If excess gas, loose bowels, or diarrhea occur, the vitamin C should be cut back.)
Vitamin B, and magnesium are usually helpful. For adults, I usually recommend 50 to 100 milligrams of vitamin B6 three times daily, and 200 milligrams of magnesium three times daily.
magnesium deserves special mention. When given intravenously for acute asthmatic attacks (usually along with vitamin B6), magnesium is a very effective bronchodilator, and can lessen or even eliminate the acute episode. It's also quite safe, and can be repeated if necessary. Of course, intravenous injections should be given by a qualified doctor, nurse, or emergency medical technician.
Other supplemental items I usually recommend include cod liver oil, one or two tablespoons daily. Recent research has concentrated on the "inflammatory disease" aspects of asthma; cod liver oil helps to reduce inflammatory response in many conditions, and, of course, has many other uses and benefits.
N-acetylcysteine, 500 milligrams, two to three times daily, and SSKI (saturated solution of potassium iodide) two to five drops daily loosen bronchial mucous so it's much easier to "cough up" and clear out. SSKI can only be obtained on prescription; N-acetylcysteine is available through natural food stores.
Herbal remedies that can partially relieve symptoms include aloe Vera gel, one tablespoon daily, and coleus forskolii (which has just started to appear in natural food stores) 10 milligrams daily. Usually, the effects of herbal remedies are not immediate, but develop over weeks to months.
A small proportion of adult asthmatics have high levels of sulfite in their urine. We've found this is almost always due to inadequate molybdenum (a trace element) in the diet. For this small proportion of "high-sulfite" asthmatics, treatment with molybdenum reduces both urinary sulfate and asthmatic wheezing. Usually, intravenous molybdenum treatment is more effective than oral, although one milligram of molybdenum twice daily can help reduce wheezing in a "high-sulfite" individual
All of the supplements and diet changes just mentioned can be used even if you're taking anti-asthma drugs, as they don't interfere with their action. Of course, you should consult with a doctor skilled and knowledgeable in the use of both. When you take one or more individual nutrient supplement, always take with a good general multiple vitamin-mineral supplement, too.
Many adult asthmatics have one or more digestive defects which interfere with nutrient assimilation. please consider getting this checked, particularly if you have a more severe problem. Diagnosis and treatment of such problems requires a doctor skilled and knowledgeable in nutritional therapy.
Because of differences in age, sex, metabolism or potential allergy, these diet and supplement therapies may not be suitable for you. Consult a health care professional skilled in nutritional and natural therapies. To locate one near you, you might call the American College of Advancement in Medicine at 800-532-3688 or the American Association of Naturopathic physicians at 206-323-7610