Sandra Justice, P.D.,FACA
Asthma is a chronic inflammatory disorder. The inflammation in the lungs causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough. These symptoms are often associated with widespread but variable airflow limitation. More than 12 million Americans have asthma and must deal with its frequently overwhelming symptoms.
People with asthma have very sensitive airways. The airways often react to substances or conditions called “triggers.” These triggers can cause asthma episodes. When an asthma episode occurs, the airways become swollen, tighten, and produce excess mucus. Hence, it is important for patients with asthma to identify their asthma triggers and learn ways to avoid them. Avoiding asthma triggers can help asthma patients better manage their disease.
What types of triggers precipitate an attack?
- Sensitivity to allergens in the air, such as dust, cockroach waste, animal dander, mold, pollens, house dust mites
- Food allergies
- Respiratory infections
- Air pollutants, such as tobacco, wood smoke, aerosols, perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone levels, and fumes from paint, cleaning products, and gas stoves
- Changes in the weather, especially in temperature and humidity
- Behaviors that affect breathing (exercising, laughing, crying)
How can you minimize exposure to triggers?
OUTDOOR POLLENS AND MOLDS
- Stay indoors early in the morning, when pollens counts are the highest.
- Keep windows closed during seasons when pollen and mold counts are high.
- Avoid yard work or wear a protective mask when mowing or raking leaves.
- Use HEPA (high-efficiency particulate air) filters.
HOUSE DUST MITES
- Remove stuffed animals from the home.
- Wash your bedding, including the pillowcase, in water at 130 degrees once a week.
- Encase mattress and box spring in airtight cover.
- Avoid sleeping or lying on upholstered furniture.
- Remove carpets that are laid on concrete.
- Use HEPA filters in your home.
- Remove animals from the home or at least the bedroom.
- Avoid visits to friends or relatives with pets in the house.
- Choose pets without fur or feathers (e.g.,fish).
- Avoid pillows stuffed with feathers.
- Wash the pet weekly.
- Asthma patients absolutely should not smoke.
- Do not allow smoking in the home, especially in the bedroom.
- Encourage family members to stop smoking.
- Warm up adequately before exercise and cool down slowly afterward.
- Develop a medicine plan with a doctor and pharmacist to allow exercise without asthma symptoms.
COLDS AND INFECTIONS
- Avoid people with colds or flu.
- Talk to your doctor and pharmacist about getting a flu shot.
- Do not take over-the-counter medications without talking to your doctor or pharmacist first.
STRONG ODORS AND SPRAYS
- Avoid perfume and scented cosmetics.
- Do not use room deodorizers.
- Use non-perfumed cleaning supplies.
- Reduce cooking odors by using a fan or opening the windows.
The traditional treatment of asthma is the combination of avoidance of asthma triggers and a medication regimen that is constructed for each individual patient. Anti-inflammatory drugs or antibiotics prescribed by your provider can help you breathe more easily. Properly used inhalers can prevent or resolve an asthma attack. Your provider may also prescribe oxygen for severe asthma attacks.
COMPLIMENTARY AND ALTERNATIVE THERAPIES
The following nutritional guidelines may be effective in reducing inflammation and hypersensitivity reactions.
Eliminate all food allergens from the diet. The most common allergenic foods are dairy, soy, citrus, peanuts, wheat, shellfish, eggs, corn, food colorings, and additives. Remove suspected allergens from the diet for at least two weeks. Re-introduce foods at the rate of one food every three days. Watch for reactions which may include gastrointestinal upset, mood changes, headaches, and exacerbation of asthma.
Reduce pro-inflammatory foods in diet including saturated fats (meats, especially poultry and dairy), refined foods, and sugar. Patients sensitive to antibiotics should eat only organic meats to avoid antibiotic residues. Increase intake of fresh vegetables, fish ( especially fresh salmon, tuna and mackerel), whole grains, legumes, onions, and garlic if not sensitive to these foods.
Recommendations for nutritional supplements are as follows: (Note: lower doses are for children)
- Vitamin C (250 to 1,000mg two to four times per day) taken one hour before exposure to an allergen may reduce allergic reactions. This also applies to exercise-induced asthma. Vitamin C from rose hips or palmitate do not cause allergic reactions.
- Vitamin E (400 IU per day) and Beta-Carotene (up to 25,000 IU per day) repair free- radical damage and neutralize the free-radical activity generated in every inflammatory condition.
- B6 (50mg to 200mg per day) may improve symptoms, particularly in children with a defect in tryptophan metabolism. Pyridoxal-5-phosphate (P5P), a form of B6, may be more readily used by your body.
- Omega-3 fatty acids found in fish and flaxseed oils are nature’s anti-inflammatories.These nutrients soothe inflammation in the bronchial passages, heal damage already done, and inhibit potential inflammation caused by allergic reactions. For those who eat fish 3gm of fish oil per day is recommended. For those who do not eat fish 6gm of fish oil per day is beneficial. For those who do not tolerate fish oil capsules, one tablespoonful of flaxseed oil per day can be substituted.
- Magnesium (200mg two to three times per day) relaxes bronchioles.
- B12 deficiency is linked to low stomach acid and may increase reactivity to sulfites, a preservative found in food. Hydroxycobalamin 1cc (1,000 mcg) IM every day for 30 days, then three times weekly for two weeks, two times weekly for two weeks, then once weekly (according to response), has shown beneficial effects in treating childhood asthma.
- N- acetyl cysteine (50 to 200 mg three times per day) and selenium (50 to 200 mcg per day) protect lung tissue from damage.
- Bioflavonoids, particularly quercetin (400mg two times per day) and grape seed extract, stabilize the membranes of the cells that release antihistamine. Since their actions are preventative, it’s better to start supplementing a week or two before allergy season begins and continue use until the end of the season.
High doses of vitamins are contraindicated in pregnancy. Nutritional supplements should be undertaken only with healthcare professional supervision.
Asthma may relate to stress and anxiety. Mind-body techniques such as deep breathing, meditation, tai chi, yoga, massage, and stress management can help. Physical medicine such as contrast hydrotherapy and castor oil packs may decrease inflammation, relieve pain, and aid healing. Acupuncture may reduce frequency and intensity of asthma attacks.
It is critical that asthma patients monitor their condition. Patient diaries and peak flow meters are excellent tools that patients can use in monitoring and documenting their asthma condition. These tools not only help the asthma patient understand their condition, including symptoms and triggers, but they also provide valuable information to their healthcare providers.
You Can Breathe Easier
Americans spend about $2 billion a year for asthma-related hospital care. Billions more are lost in wages of employees staying home from work because of asthma, or to care for a child with asthma. Much of this expense- not to mention the inconvenience and stress it creates- is unnecessary. Far too much management of asthma begins and ends with acute attacks- the worst possible way to deal with asthma.
Pharmacists, physicians, and other healthcare professionals can assist their asthma patients in developing and maintaining a successful preventative-management plan. Working together, utilizing traditional and alternative approaches, you can develop the right plan for you or your child.