Asthma

What is asthma

Asthma is a chronic (and sometimes acute) condition that affects the air passages in the lungs. Asthma is a very common condition of the lungs that affects many people all around the world, in both adults and children.

According to the latest thinking, asthma can be divided into two main categories:

• Bronchial smooth muscle irritability – this category encompasses asthma that is triggered by virus or bacterial infection, environmental toxins (chemicals), food allergies and other types of allergens. This is the most common type of asthma in young children. The cause of the trigger of asthma must be determined so that it can be avoided and the asthma better managed to reduce symptoms
• Chronic eosophilic bronchitis – this category encompasses asthma that is associated with excessive mucous production in the bronchi, together with inflammation and scarring of the lung tissue. This is the most severe form of asthma. The eosinophils are the white blood cells which are released to limit allergic reaction through inflammation and this can cause the release of certain substances (platelet activating factor, PAF) that initiate symptoms associated with asthma (excessive mucous production, bronchial spasm, inability to breath). It is important to limit the release of the PAF so that symptoms are less severe and can be better managed

Classification of asthma – general types of asthma

• Allergic (extrinsic) asthma – affects people when they come into contact with an allergen when it is inhaled, absorbed or eaten. The allergens responsible for triggering this type of asthma are: foods, pollen, mould, animal dander, pollution, perfumes, smoke. About 90% of people with asthma have this type of asthma
• Exercise-induced asthma – affects people when they are exercising; at least 11% of asthmatics have this type of asthma
• Intrinsic asthma – a type of asthma that is not triggered by allergens, but rather by a variety of other factors; onset of this type of asthma starts in adults over 40 years; this type of asthma may not respond so well to treatment as allergic asthma does
• Nocturnal asthma – affects people when they are sleeping, usually between 12am and 4am; around 75% of asthmatics have this form (usually in combination with other types of asthma, but some people just have this type)
• Occupational asthma – affects people if they breath in chemicals and environmental toxins, as well as smoke and wood dust; about 15% of asthmatics have this type of asthma
• Steroid resistant asthma – over-use of asthma steroid medications can lead to a resistance in the effectiveness of the medication over time

Facts about asthma

• In the early 1900’s, Sir William Osler (a prominent physician at the time, also known as the father of modern medicine) claimed that asthma was not a life threatening disease. Unfortunately, this is not the case in modern times, as asthma causes many deaths each year, around the world
• Asthma is not yet a curable disease, but it can be (mostly) effectively managed so that asthma attacks become less frequent and less severe. Some children seem to grow out of the asthma they experience at a young age, while many others do not
• During a serious asthma attack, it is fine to keep taking some puffs of the rescue (blue) inhaler every few minutes to get some relief before the ambulance arrives – this is an emergency situation
• If you are taking any type of other medicines, herbs, vitamins, you must inform your doctor before taking them, as they could have some adverse reactions with your asthma medicines – always be safe and sure
• Ensure you understand how to use your inhaler medications properly to get the best use of them to help with your symptoms
• Use a peak flow monitor to determine lung volume capacity, to determine if it is deteriorating or stable
• Monitor any side-effects you may experience with any of the medications you take and let your doctor know
• Asthma is a very common condition in both adults and children all around the world
• Have an asthma action plan so you know what to do if you have a really severe asthma attack
• Reduce exposure to second-hand tobacco smoke and do not smoke cigarettes yourself as this will exacerbate symptoms
• Flooring is best if it is carpet free for those people who have dust or dust mite allergies
• Pregnant women need to monitor their asthma carefully to ensure they are getting enough oxygen throughout their body, to ensure their baby is also getting enough oxygen
• With proper treatment and better use of medication (and other techniques if possible), asthma should be able to be controlled with decreased symptoms and less dependence on emergency medication – talk to your doctor about creating a treatment plan for just for you
• Over 2 million Australians have asthma, which is approximately 10% of the population and this is quite a lot higher than other developed nations
• Young adults between the ages of 15 and 24 have the highest incidence of asthma
• Up to 25% of people ho have asthma are smokers
• Up to 40% of children who have asthma live with people who smoke and are most likely to be exposed to second hand smoke, which can make their symptoms worse

Symptoms of asthma

Symptoms of asthma can range from the very mild, to the severe and anything in between. Symptoms can vary greatly between individuals and asthma types.

During an asthma attack, the airways of an asthmatic narrow because the muscles around the air passages become tight, not allowing much air to go through which in turn makes the air passages inflamed and swollen. The more inflamed and swollen the air passages become, the more tight they become until breathing becomes very hard without wheezing. It then becomes very difficult for the person with asthma to breath properly without some assistance in the form of medication.

Common asthma symptoms

• Coughing – usually worse first thing in the morning or late in the evening
• Noisy breathing – occurs for some people with asthma
• Shortness of breath – inability to breath deeply and properly (inhalation or exhalation) due to pain
• Tightness of the chest – which feels like a pressure or squeezing on the chest area
• Wheezing – noisy, whistling type sound on inhalation

Symptoms of an acute, severe asthma attack

An acute asthma attack can be fatal and needs urgent emergency treatment at a hospital. The symptoms of an acute, severe asthma attack continue even after appropriate medication has been taken.

The symptoms of an acute asthma attack

• Agitation
• Blue lips
• Confusion
• Inability to breath properly
• Inability to concentrate or think properly
• Persistent coughing that does not abate
• Unable to speak a whole sentence without coughing or getting short of breath
• Unable to walk far without getting short of breath or coughing
• Wheezing

Causes of asthma

Despite over 100 years of research into asthma the actual root cause of this condition has still not been found, which means that a cure is still not available.

The following are the potential causes of asthma.

• Genetics – research shows that many people with asthma have other family members who also have asthma – it seems to run in some families. Conversely, having parents with asthma, does not automatically mean their children will definitely develop asthma
• Recurrent viral (or bacterial) infections in the bronchi – there is some evidence to suggest that some people who develop asthma do so after they have been exposed to a number of viral or bacterial infections of the mucous lining of the bronchi or bronchiole
• Not being breastfed – women who do not breastfeed their children have a higher chance of their children developing asthma (and / or allergies) at some stage in their development as their child does not receive the passive immunity from their mother which is essential in the first six months of life
• Overuse of antibiotics – there is some body of thought that the overusage of antibiotics in young children contributes to the rise in asthma cases, since antibiotics are being used for viral infections (which they are useless to combat against as they only work on bacteria), but instead they cause an imbalance of the gut and bronchial flora which can be much more susceptible to infection. This in turn usually means more antibiotics, more good gut and bronchial flora destroyed and immunity lowered. This can then ultimately give rise to asthma in those individuals whose immune systems are the most compromised.
• Omega-3 deficiencies – recent research suggests that a mother’s diet while pregnant has a major impact on whether or not her child will develop asthma. THe research suggests that pregnant women who do not eat a diet rich in omega-3 may have a higher chance of having a child that develops asthma (or allergies). The research suggested that a Mediterranean diet (lots of fresh fruit and vegetables, nut, seeds, fish, some low fat dairy and little meat and no processed foods) is the best one to prevent the development of asthma (or allergies) in their unborn child.

There are also many known triggers for asthma, which can precipitate irritation and then inflammation in the lungs and cause symptoms associated with asthma.

Prevention of asthma

Non-preventable risks

Asthma may be unpreventable in certain circumstances:

• Allergic rhinitis – people who have allergic rhinitis (or hay fever) have a much higher risk of developing asthma; children of parents who have allergic rhinitis are also at risk of developing asthma
• Allergies – parents who have any type of allergies themselves have a much higher risk of having a child who develops asthma
• Genetics – families who have children that have asthma have a higher risk of those children producing their own children who also have asthma
• Inadequate omega-3 for babies and children – several studies show that when young babies and children get adequate amounts of the omega-3 fatty acids in their diet (from breast milk from the mother, bottle feed or in foods in their diet), they have a much lower risk for developing asthma than children that do not get enough omega-3 fatty acids in their diet
• Inadequate omega-3 in pregnancy – several studies have shown that pregnant women who get adequate intake of the omega-3 fatty acids (either dietary in the form of fish or through supplementation) have a much lowered risk of their child developing asthma or allergies
• Inadequate vitamin D in pregnancy – several recent studies have suggested that there is a link between adequate vitamin D intake in pregnancy and subsequent development of asthma in the child at a young age
• Sickle cell anaemia – several studies have suggested that people who have sickle cell also generally have a higher incidence (30-70%) of also having asthma too. It is thought that sick cell anaemia has some factors which are similar to asthma, but more research is being done as these factors are not yet known

Scientists do not know why some triggers can cause asthma in some people and not in others

Preventable risk factors

There are ways to prevent asthma from occurring or at least prevent symptoms from worsening:

• Adequate intake of fish – recent studies have suggested that people who never ate fish in childhood were at an increased risk for asthma and this is directly due to the anti-inflammatory, lung protective effects of the omega-3 fatty acids in the fish. The research suggested that fish intake less than weekly in adults was associated with more asthma symptoms
• Avoid acid-suppressing medications in pregnancy – recent epidemiological evidence suggests that there is a significant link between pregnant women who use medication to suppress acid production in the stomach, such as proton pump inhibitors (for gastric conditions such as ulcers) and the development of asthma in their child. Pregnant women who have any type of gastric condition need to consider alternative treatment for their condition to avoid risking their child’s health
• Bad diet – many studies suggest that a diet rich in fruit, vegetables, fish, nuts and seeds (and lower in dairy and red meat) may prevent symptoms associated with asthma (and other lung conditions). This is because the diet is rich in antioxidants, vitamins, minerals as well as the protective and anti-inflammatory omega-3 fatty acids, but also this diet provides the correct ratio of the omega-3:omega-6 fatty acids. Recent research suggests that when teenagers and young adults have a poor diet, with little nutritional value (too little fresh fruits and vegetables, too little foods high in omega-3 fatty acids, such as fish and too little foods rich in antioxidants), this can result in asthma symptoms which are even worse in those people who also smoked
• Bottle feeding – if a baby has been predominantly bottle fed for the first 4-6 months of life, then they may have a higher risk of developing asthma because there may not be enough of the nutrients present in their diet
• Exposure to allergens – research shows that babies and young children who are exposed to allergens (such as tobacco smoke, dust, pollen, cat fur) early in life have a higher risk of developing asthma; parents who have allergies, hay fever or asthma themselves, should limit their child’s exposure to any type of possible allergen to reduce their child’s risk of developing asthma
• Bad diet while pregnant – women should follow a mostly Mediterranean diet while they are pregnant to ensure they reduce the risk that their unborn child will have asthma (or allergies)
• Overuse of antibiotics – research shows that if antibiotics are given to babies in the first year of their life, this can cause a 4-fold risk in the babies developing asthma, when compared to babies who never received antibiotics in their first year of life
• Vitamin D deficiency in pregnancy – recent research suggests that a deficiency of the fat-soluble vitamin D in pregnancy may significantly reduce the incidence of asthma in the unborn child (which may develop asthma in childhood) by as much as 40%

Complications of asthma

There are a number of complications of asthma, some of which can be quite serious:

• Collapsed lung – the lungs (either one or both) can either partially or totally collapse and make breathing very difficult. This is a life threatening condition that needs urgent medical attention
• Infection of the lungs – an infection of the lungs, such as pneumonia, can be have very serious consequences in people with asthma. The lungs of an asthmatic person are damaged and not functioning properly, so they can be more prone to developing a serious infection (like pneumonia) which can be life threatening and requires urgent medical attention
• Respiratory failure – if the levels of oxygen in the blood become dangerously low, or the levels of carbon dioxide become dangerous high (due to inability to breath properly), this can lead to respiratory failure. This is a life threatening condition that needs urgent medical attention
• Severe asthma not responding to treatment – in a small number of people, the asthma may becomes so bad and the lungs become so damaged that it does not respond to appropriate treatment. This is potentially an urgent, life-threatening condition which has built up over time and which needs urgent medical attention

Complications in children

Badly controlled asthma in children can lead to the following complications:

• Absences from school – many children with more severe forms of asthma tend to have more sick days away from school due to the severity of their condition, mainly due to the number of severe asthma attacks they have which require hospitalisation
• Psychological problems – children with asthma may feel a bit isolated from other children their age, because they may not be able to do/eat everything their friends are doing/eating such as sports, but especially they may also feel left out because they are “different” to other, more healthier children and if the isolation is prolonged, they may develop psychological problems such as stress, anxiety and depression
• Underperformance at school – if a child who has asthma needs to be away from school on a great number of days due to hospitalisation or just because they are sick quite often due to the asthma, this can cause them to fall behind in their school work, which can lead to under performance and the child may not get the opportunity to be the best they can be, due to the complications of this chronic disorder

When to see a doctor about asthma

A family doctor should be consulted if a child starts to display any of the symptoms associated with asthma.

If a child already has asthma, then a treatment plan needs to be worked out with your doctor or paediatrician, to avoid triggering asthma symptoms trough the removal of as many risk factors.

Prevention is much better than trying to cure this condition, so women who are pregnant need to ensure their diet is healthy and they are getting adequate levels of omega-3 fatty acids, vitamin D, as well as the other vitamins, minerals and other nutrients, to try to prevent asthma in their unborn child.

Adults who start to get any lung symptoms associated with asthma should consult their doctor to get a proper diagnosis which can confirm or rule out asthma.

Adults with existing asthma should ensure they have a written treatment plan which has been provided by their doctor or specialist. Avoiding the allergens or other triggers for asthma can greatly reduce risk of symptoms too.

Diagnosis of asthma

Asthma is diagnosed through a series of tests (which basically help to give a good picture of lung health and eliminate other possible causes for the symptoms):

History of symptoms

Your doctor will ask a series of questions about your symptoms, such as:

• When did the symptoms start
• When are the symptoms worse
• How often do the symptoms present
• Rating the severity of the symptoms

Physical examination

Your doctor will use his/her stethoscope to listen to your lungs as you breath in and out deeply. This will be done from the front of your body and from your back too.

If during the physical examination your doctor detects any sounds in your lungs (which are not normal), then further, more comprehensive tests can be undertaken.

Lung function test

Your doctor can refer you to have a lung function test to determine the volume of air in the lungs and severity of symptoms and damage to the lungs from asthma. The main types of lung function tests are:

• Spirometry – this test involves taking deep breaths and exhaling strongly into a special measuring tool which measures the volume of the lungs. This test is done again using a spray of a bronchodilator into the lungs to compare the results and determine if the lung capacity (volume) is the same or better when a bronchodilator is use. This test can give a good indication whether lung volume is impaired (and below average and abnormal), which means that it is caused by asthma
• Challenge test – this test involves replicating airway obstruction and asthma symptoms (usually using a histamine substance, cold air or exercise) and then performing the spirometry test (as described above) with impaired breathing. The test is done again after using a bronchodilator, which eases the constriction in the lungs, to compare the results and determine if breathing ability without the use of a bronchodilator is impaired (and below average or abnormal), indicating that asthma may be present

Other tests

Your doctor may order other tests if the spirometry or challenge tests prove inconclusive or if other symptoms are present, in order to rule out other conditions. Some of the other tests that can be ordered are:

• Allergy testing – this is done by an allergy specialist who will do a patch test on the skin, using a number of known allergens (you may be asked to bring some of your dust, pet hair and other identified allergens you are exposed to). The patch test will identify quite quickly if an allergy to a certain substance is present, which could mean that it is the cause (or causes) that trigger asthma symptoms
• Blood tests – today some allergy testing can also be done through blood tests (this is usually much less painful than patch testing but is not as reliable). The most common types of allergens that can be tested are for gluten (wheat), cow’s milk, peanuts and other foods. In addition to this, blood tests can be used to if there are any nutritional deficiencies (such as omega-3, magnesium or zinc ) which could be exacerbating symptoms and to also test blood sugar levels for hypoglycaemia
• X-ray – an x-ray can show whether there is a lot of scarring in the lung tissue (and can rule out other lung conditions)
• Food sensitivity – children with asthma often have food allergies or sensitivities and much of their subsequent behaviour may be due to this sensitivity; an elimination diet needs to be followed to work out if this food is causing any of the behavioural problems. The most common food sensitivity that can cause behavioural problems are: cow’s milk, wheat (or gluten), oranges (and other citrus fruit), chocolate, peanuts, soy, eggs, corn, oats, apples, tomatoes. In order to test a food sensitivity, that food (and foods containing it) must be totally eliminated from the diet for two weeks (as must all foods with any artificial additives) and after that, the food can be re-introduced back into the diet to see if there are any reactions to it. This requires a lot of vigilance and strict monitoring and could be better accomplished with the help of a registered dietician or naturopath
• Heavy metal testing – hair analysis or blood tests should be done to determine if there has been chronic exposure to any heavy metals, such as lead, cadmium or mercury (chelation therapy is usually used to get rid of any heavy metal toxicity in the body, but it needs to be done by a qualified professional) and not all doctors will request this test, although it can be done with some naturopaths

Conventional treatment of asthma

Treatment of an asthma attack (especially an emergency)

• Stop all activity – remain calm and try not to move around too much
• Take your medicine – use your blue (or rescue) inhaler inhaler , this is the medication to use in an emergency from a severe asthma attack and wait 5-10 minutes to allow the medication to work on opening up your airways and relieving symptoms
• Sit up – this helps the air passages with better air flow
• Medicine not working – if the blue reliever (or rescue) medication does not work (and does not settle down the symptoms) you need to call the emergency number 000 (or 911 in the USA, 999 in UK) for an ambulance and keep taking the blue inhaler medicine until the ambulance arrives
  (derived from recommendations from the Lung Association Canada)

Lifestyle management

Conventional medicine also provides the following asthma management tips to help reduce incidence and severity of symptoms:

• Avoid the allergen(s) – keep your home free from the allergic triggers (allergens such as dust, animal fur, pollen, flowers, plants, etc). This helps to reduce risk of triggering asthma symptoms
• Avoid the asthma triggers – this strategy will help to reduce the likelihood of an asthma attack from occurring. The most common triggers for an asthma attack are cigarette smoke, chemicals, perfume and other environmental substances
• Have an allergy free home – try to live in as dust and allergen-free environment as possible to help reduce the triggers of an asthma attack. Flooring should be hard (wood or tile), furnishing should be natural, cleaning product should be non-allergenic and as natural as possible (organic and free from artificial perfume), cosmetics and face care products should be non-allergenic and as natural as possible (organic and free from artificial perfume)
• Stay home on windy days – try to stay home on days which are especially windy as this may exacerbate symptoms to a high level, but if this cannot be avoided, make sure your medication is handy

Medication

The medications prescribed for asthma consist of asthma prevention and asthma rescue medications.

Asthma Prevention Medications

Asthma prevention medications should be taken every day, even if there are no symptoms, to ensure lung airways are clear and free from inflammation and mucous. These medications are:

• Inhaled corticosteroids – most common and most effective asthma medication to reduce inflammation in the lung airways and is inhaled. Examples are – Budesonide, Fluticasone
• Corticosteroid tablets – prescribed to reduce really severe airway inflammation, are a much stronger medication than the inhaled corticosteroids and consist of tablets. Examples are – Prednisone, Prednisolone, Dexamethasone
• Long-acting bronchodilators – inhaled medication, which is normally prescribed together with the inhaled corticosteroids for people whose symptoms are not resolved just with the inhaled corticosteroids. Long-acting bronchodilators medication should not be taken alone, as they do not work properly if taken alone. This medication works over a long time-frame (around 12 hours) to open up the airways and reduce inflammation and the risk of an asthma attack. Pregnant women should be careful when taking this type of medication as recent studies suggest there may be a link between using bronchodilators and congenital heart defects in the unborn foetus
• Leukotriene receptor antagonists – a tablet form of medication taken in the evening and which eases the tightening of the muscles around the airways (bronchoconstriction). This medication is usually prescribed for people with mild asthma as their sole medication, but it can also be prescribed for people taking inhaled corticosteroids too to be taken together. Examples are – Zafirlukast, Montelukast
• Theophylline – not a commonly prescribed medication, but will be prescribed if asthma is severe and affects breathing at night. A doctor will need to monitor you when you are taking this medication if others (including over-the-counter medications) are being taken at the same time as they are possibilities of adverse interactions. Examples are – TheoDur®

Asthma Rescue Medications

Asthma rescue medications should be kept on hand and taken only when necessary – during a severe asthma attack (especially if it is an emergency), at times of breathing difficulties, before exercising. Asthma rescue medication will normally help bring breathing back to normal in most cases. These medications are:

• Short-acting bronchodilators – provide relief during an asthma attack and relieve asthma symptoms (chest tightness, coughing, wheezing, difficulty breathing), as necessary prior to exercise. Examples are – Ventolin (salbutamol), Bricanyl inhaler (terbutaline sulfate)

Recent research shows that using there is a lot of controversy surrounding the regular use of short- acting beta-agonists (bronchodilators) for the treatment of asthma. Anyone who has asthma should consult their doctor for an appropriate treatment plan to avoid any adverse effects from medication.

Alternative / complementary treatment of asthma

While all the alternative treatments may be very useful for preventing asthma attacks or reducing asthma symptoms they should NOT be used in a severe asthma attack, which is when the rescue medication should be used only, in addition to calling an ambulance for assistance.

Treatment of an acute, severe asthma attack (especially an emergency)

• Stop all activity – remain calm and try to relax
• Take your medicine – use your blue reliever (or rescue) inhaler , this is the medication to use in an emergency from a severe asthma attack and wait 5-10 minutes to allow the medication to work on opening up your airways and relieving symptoms
• Sit up – this helps the air passages with better air flow
• Medicine not working – if the blue reliever (or rescue) medication does not work (and does not settle down the symptoms) you need to call the emergency number 000 (or 911 in the USA, 999 in UK) for an ambulance and keep taking the blue inhaler medicine until the ambulance arrives
  (derived from recommendations from the Lung Association Canada)

The following are the treatments advocated by alternative health therapists for managing asthma to ultimately reduce severity and frequency of symptoms and ensure a better quality of life, where possible.

Herbs

There are a few herbs with known anti-inflammatory properties, which may help reduce severity and duration of asthma symptoms:

• Garlic – the herb garlic is best if eaten fresh, cooked with food or taken as a supplement. Garlic has potent anti-viral and anti-bacterial properties and can help to reduce some symptoms
• Ginger – the herb ginger has anti-inflammatory effects on the lungs and may prevent worsening of symptoms due to any types of allergens

Vitamins

There are a number of vitamins which may be useful in helping reducing severity of symptoms or even preventing them:

• Bioflavonoids – the bioflavonoids are used together with vitamin C as they have both a potent antioxidant and anti-histamine effect and may help with asthma that is triggered by environmental allergens
• Vitamin A – the mucous membranes need adequate levels of vitamin A to be healthy and function properly and since asthma often presents with an excess of mucous, this vitamin is absolutely essential for managing asthma. Vitamin A is also an excellent antioxidant, which can help reduce infection if it is present
• Vitamin B3 – research shows vitamin B3 has important anti-histamine properties, so it may be useful for people whose asthma is triggered by any type of allergen
• Vitamin B6 – research shows vitamin B6 has important anti-histamine properties, so it may be useful for people whose asthma is triggered by any type of allergen to help reduce severity and duration of symptoms. In addition to this, many people with asthma generally have lower than normal levels of vitamin B6
• Vitamin B12 – research shows vitamin B12 reduces the spasms in the lungs and other allergic reactions which are due to sensitivity to sulphites (a preservative used in dried fruit to ensure it has a longer shelf life)
• Vitamin C – the antioxidant vitamin C may be especially required in children who have had chronic heavy metal (especially lead) exposure as this can lead to an over stimulation of histamine in the brain. Vitamin C acts as a natural anti-histamine and can reduce symptoms especially in children who have asthma that is triggered by environmental allergens
• Vitamin D3 – this is the active form of vitamin D, which is obtained from sunshine and is vital to the lung health. Studies have shown that pregnant women who did not get adequate levels of vitamin D increased the risk of their child developing asthma
• Vitamin E – studies show the antioxidant vitamin E may be beneficial for reducing inflammation in the lungs and so reduce the severity and duration of symptoms in people with any type of asthma

Minerals

There are a number of minerals which are very important in the health of the lungs and may improve symptoms:

• Calcium – studies show that the mineral calcium, together with vitamin B3 helps to reduce the allergic reaction in the lungs of people who have asthma that is triggered by an allergen, as they open up the airways and allow breathing to be much easier
• Magnesium – studies show that magnesium is an excellent bronchial muscle relaxant and reduces bronchial muscle spasms, which are associated with the more severe form of asthma. Inadequate levels of magnesium are associated with symptoms of impaired lung function, bronchial spasms and wheezing. In fact, magnesium is so important in the management of asthma, that it is used in emergency rooms to reduce the symptoms of severe asthma attacks (when other medication has not helped)
• Selenium – studies show that many people with asthma have lower than normal levels of the antioxidant mineral selenium, which is known for its beneficial immune system modulating effect. Other studies show that people with asthma may have low levels of selenium
• Zinc – studies show that people with asthma benefit from the mineral zinc as it supports the immune system to function more effectively and also heals any type of damage to the body tissues much more quickly, so may help to reduce scar damage in the lungs

Other nutrients

There are a number of other nutrients which can help to reduce symptoms of asthma:

• Co-enzyme Q10 – this nutrient has anti-inflammatory properties which prevent major histamine release in the body (reducing severity of symptoms). Coenzyme Q10 also helps enable better respiration of the cells in the lungs, which can improve breathing capacity
• Glycine – the amino acid glycine helps the body cope better with salicylates, without producing a severe allergic asthmatic reaction. Salicylates occur naturally in tomatoes and other nightshade vegetables, but are also produced synthetically
• Lipoic acid – the antioxidant lipoic acid helps to detoxify the body from the damaging effects of nitric oxide, which is a by-product of a number of metabolic processes and which is in too high levels in people with asthma, as it can constrict the airways and increase inflammation. Since lipoic acid reduce nitric oxide levels in the body, it can help to open up the airways, reduce inflammation and enable better breathing capacity
• Omega 3 fatty acids – the omega 3 fatty acids are vital to help reduce inflammation in every part of the body, including the lungs (and bronchi), which may help to reduce scarring and damage to the lungs and help with better breathing, in the person with asthma
• Quercetin – the bioflavonoid quercetin has very potent anti-inflammatory and anti-histamine properties which means it can help to reduce an allergic reaction which triggers asthma symptoms
• Taurine – the amino acid taurine is useful in reducing the allergic reaction of the lungs (and particularly the bronchi) to any allergic response by the white blood cells in the person with asthma. Taurine is also beneficial in detoxifying the body from toxic substances (which allergens are to the sensitive person)

Dietary modifications

There are a number of dietary modifications that can be used to help reduce asthma symptoms:

• Cod liver oil – if it can be tolerated by the child (or adult), then cod liver oil is the best way to obtain a natural form of vitamin A, vitamin D and omega-3 fatty acids (and some contain vitamin E too) in the diet without taking a number of supplements. Cod liver oil will help maintain healthy mucous membranes (which line the nose, throat and lungs), will help reduce sensitivity to allergens and improve immune system function overall, which may significantly improve symptoms in some people with asthma
• Elimination diet – if food allergies are suspected, then a food elimination diet needs to be done to determine how much of an impact those foods are making on triggering asthma symptoms. An elimination diet involves removing all foods from the diet that could be possible allergens (including wheat and dairy) as well as all processed foods which contain any types of artificial additives for about one month. After this point, each food should be added back to the diet, one at a time (say milk) for a week to determine if there are any reactions to it. The following week a different food should be added to the diet to see if it causes any adverse (or allergic) reactions. The reactions should be recorded and taken to a naturopath, dietician or doctor to help with diet management s
• Eat more oily fish – the diet should include oily fish about 3-4 times a week to help boost the intake of omega-3 fatty acids and reduce inflammation in the body in general. Best forms of oily fish are: salmon, trout, tuna, blue mackerel, sardines, mullet, golden perch, red fish, sea mullet, yellow fin brim, yellowtail kingfish, tailor, trevally silver, orange roughy, herring, cod. The fish should be cooked fresh as canned fish generally have less omega-3 fatty acids. If fish cannot be eaten, then a fish oil supplement should be taken on a regular basis
• Garlic and onions – both garlic and onions (but especially garlic) should be eaten every day, or as much as can be tolerated to help the open up the airways, reduce inflammation and prevent scarring
• Ginger – fresh ginger should be used as much as can be tolerated in cooking to help the open up the airways, reduce inflammation and prevent scarring
• Limit intake of processed foods – this includes all soft drinks, all canned and processed meats (from the deli), processed cheeses, instant soup, ice cream, toppings, puddings, cakes, pizza, take-away food, which can trigger symptoms in some people with asthma, mainly due to the additives, high fat content and high sugar content
• Remove all foods with artificial additives – studies now show that many artificial additives (colours, flavours and preservatives) could be responsible for many of the asthma symptoms of and so should be either strictly monitors (limit) or totally banned from their diet. This includes all lollies (sweets), cakes, toppings, some cereals, snack bars. Always check labels of food

Lifestyle modifications

• Buyteko breathing technique – clinical trials have shown that the Buyteko method is useful to reduce symptoms of asthma, provide less reliance on reliever medication and prevention medication by over 90%. This special breathing technique teaches asthmatics to breathe properly, not to over-breathe and to learn to relax and not panic which may help with reducing symptoms (especially more severe symptoms)
• Meditation and relaxation – many studies have shown that any form of meditation is a useful technique to help reduce symptoms of asthma and this is because meditation helps to control the mind, which ultimately helps to control and manage breathing
• Reduce stress – this one may be a little difficult to achieve, especially if stress is unavoidable, but parents of young children should try to reduce their stress as breathing incorrectly can make symptoms worse. The same applies for adults with asthma
• Stop smoking – people who have been diagnosed with asthma and who also smoke are advised to give up smoking, as it will continue to make symptoms worse
• Yoga – many people who practice yoga regularly report that they have reduced symptoms and better lung functioning (less pain and inflammation), especially if it is a yoga which uses breathing and relaxation techniques during the classes

Alternative treatments

• Acupuncture – some studies have shown that acupuncture greatly reduces symptoms associated with asthma and prevents attacks from becoming severe in some people. Always see a qualified acupuncturist who has experience dealing with people that have asthma
• Naturopath – children with asthma may benefit from a visit to a naturopath who can recommend an elimination diet (if food allergies are suspected), provide nutritional supplements and help to monitor progress. Parents who take their child to a naturopath must advise their doctor to ensure any naturopathic treatment plan does not conflict with any medications the child is taking. Adults with asthma need to also advise their doctor if they intend to visit a naturopath and want to try alternative treatment for their asthma, in conjunction with their medication, to avoid any complications

Always ensure that you notify your medical practitioner of any supplements that you want to take – it may interfere with other medication or conditions you have. Confirm with your doctor it is safe to take before you try it.

Living with asthma

Management of children (and adults) with asthma means the removal (or at least strictly limiting) triggers that cause their asthma symptoms. Management of asthma means looking for triggers and avoiding them as much as possible.

Common triggers that cause allergic (extrinsic) asthma

• Allergens – to pollen, mould, animal fur and dander, dust mites, dust, pollution, bush fire smoke
• Chemical toxins – any types of chemicals in the environment that produce strong fumes which can irritate the lungs, such as pollution, car fumes, paint, floor vanish, cleaning products
• Cigarette smoke – use of tobacco should be avoided by people with asthma as it is a major trigger for asthma symptoms, as cigarettes really irritate the lungs and besides cause worsening of lung scarring and smoking can result in cancer; even people who do not smoke can have their asthma symptoms triggered by second-hand smoke from smokers around them
• Cosmetics – some cosmetics are perfumed with artificial perfumes which can trigger asthma symptoms in some individuals
• Food – certain foods can trigger asthma symptoms; the most common are peanuts, eggs, cow’s milk, nuts in general, soy, wheat, chocolate, shellfish
• Food additives – especially artificial colours, flavours and preservatives (such as sulphites, MSG, benzoate, yellow dye # 102) should be avoided as they can trigger symptoms of asthma. Other additives to be avoided are:
• Medications – some medications can trigger asthma; the ones to avoid are NSAIDs (non-steroidal anti-inflammatory drugs) such as aspirin and Nurofen
• Perfumes – these can trigger asthma symptoms in most asthmatics with allergic asthma, as the strong, artificial odour from perfumes can irritate the already sensitive lungs of people with asthma

Common triggers that cause non-allergic (intrinsic) asthma

• Colds and flu – when the lungs are infected with a cold or flu (influenza), this can make the lungs more susceptible to the symptoms of asthma, as the airways are inflamed and can cause tightening in the chest, difficulty breathing properly and wheezing
• Exercise – any type of physical activity can cause symptoms of asthma either during or more commonly after the exercise
• Laughing – sometimes laughing too hard can cause asthma symptoms
• Strong emotions – such as excitement, stress and sorrow can all cause symptoms of asthma to appear in some individuals
• Temperature changes – changes in temperature and weather, especially exposure to very cold air can trigger asthma in some people

General management tips for asthma

• Avoid the allergen(s) – keep your home free from the allergic triggers (allergens such as dust, animal fur, pollen, flowers, plants, etc)
• Avoid the asthma triggers – this will help to reduce the likelihood of an asthma attack from occurring (common triggers are cigarette smoke, chemicals, perfume etc)
• Have an allergy free home – try to live in as dust and allergen-free environment as possible (have wood or tile floors, use natural furnishings and non-allergenic cleaning products, use organic non-perfumed cosmetics and face care products)
• Stay home on windy days – try to stay home on days which are especially windy as this may exacerbate symptoms to a high level, but if this cannot be avoided, make sure your medication is handy

Any nutritional supplements that are being used should be discussed with the family doctor (or paediatrician) to ensure they does not conflict with medications.

Caring for someone with asthma

Partner

People who have a partner with asthma can support their partner in practical ways:

• Allergy-free home – the home environment needs to have potential allergens removed to reduce likelihood of triggering symptoms:
  • Bed sheets/blankets/pillows – should be washed weekly and left to dry in the sun to kill any dust mites that may be present and reduce this risk of triggering an asthma attack in some people
  • Cleaning products – the best cleaning products to use should be hypo-allergenic, natural and preferably organic, without any harsh perfumes, as these can trigger asthma symptoms
  • Hard flooring – carpet harbours many potential triggers for causing an asthma attack, not just dust, so it should be removed and hard flooring should be used instead (wood or tiled flooring is the best)
  • Pets – some people with asthma may be allergic to the fur or dander from pets, so depending on the level of allergy, a pet may not be recommended in the home. There are though, some breeds of animals which are known to cause little allergic reaction and this may be an avenue for those families that want to have a pet
• Stop smoking – it is highly recommended to stop smoking around a partner with asthma as it can trigger symptoms. If you cannot give up smoking, you should at the least not smoke in the home (or car) or any other confined spaces near your partner because second hand cigarette smoke is as detrimental to them as if they smoked

Friends

People who have a friend with asthma can support their friend in practical ways:

• No smoking – cigarette smoke is a known trigger for asthma symptoms, so be courteous and do not smoke when your friend is close to you

Parents

Parents who have a child with asthma can support their child with a number of strategies:

• Appropriate treatment plan – parents of a child with asthma should understand their child’s treatment plan so that they can encourage their child to take the correct medication when required
• Allergy-free home – the home environment needs to have potential allergens removed to reduce likelihood of triggering symptoms:
  • Bed sheets/blankets/pillows – should be washed weekly and left to dry in the sun to kill any dust mites that may be present and reduce this risk of triggering an asthma attack in some children
  • Cleaning products – the best cleaning products to use should be hypo-allergenic, natural and preferably organic, without any harsh perfumes, as these can trigger asthma symptoms
  • Hard flooring – carpet harbours many potential triggers for causing an asthma attack, not just dust, so it should be removed and hard flooring should be used instead (wood or tiled flooring is the best)
  • Pets – some children with asthma may be allergic to the fur or dander from pets, so depending on the level of allergy, a pet may not be recommended in the home. There are though, some breeds of animals which are known to cause little allergic reaction and this may be an avenue for those families that want to have a pet
• Fish intake – it is highly recommended to have oily fish at least twice a week, as these types of fish have higher levels of omega-3 fatty acids, which have important and potent anti-inflammatory properties and which can help to reduce incidence and severity of symptoms. It may be advisable to also use omega-3 fatty acid supplements in some children, but only do this with the approval of your doctor
• Stop smoking – it is highly recommended to stop smoking around a child with asthma as it can trigger symptoms. Much evidence shows that many children with asthma live in conditions where the adults in their home smoke and this is know to aggravate symptoms. Parents who cannot give up smoking should not smoke in the home (or car) or any other confined spaces near your children

References

Last reviewed and updated: 14 May 2024