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 Integrative Medicine: Asthma 
 

Anti-inflammatory Drugs
Control of inflammation is currently the primary focus in managing asthma. The most effective agents for this purpose are the corticosteroids. These medications interfere with the synthesis of inflammatory mediators and prevent migration and activation of inflammatory cells. Also, they improve responsiveness of airway beta receptors, which promotes relaxation of bronchial smooth muscle. Corticosteroids, produced naturally by the adrenal cortex, include hydrocortisone or cortisol, which can be prescribed by physicians.

However, conventional physicians usually prefer to use one of the synthetic corticosteroids. During an acute severe asthmatic attack requiring hospitalization, the patient is usually given methylprednisolone (brand name Solu-Medrol) as a 60 to 80 mg intravenous push every six to eight hours for the first 36 to 48 hours of hospitalization. The patient is then switched to high doses of oral prednisone or methyl prednisolone, which is rapidly tapered over the next 10 days to two weeks. Short-term adverse effects from oral or intravenous steroids include increased appetite, weight gain, elevated blood sugar, fluid retention, mood changes, and gastrointestinal upset. Most patients can avoid long-term (months or years) use of corticosteroids, which have additional adverse effects and risks. These include a suppressed immune system, adrenal suppression, osteoporosis, muscle weakness, cataracts, skin changes, and peptic ulcers.

I have just discussed the use of intravenous and oral corticosteroids in treating acute asthmatic attacks. However, the administration of corticosteroids by inhalation is being acclaimed by many clinicians as the greatest advance in asthma management in the last 20 years. Inhalation corticosteroids are being recommended by many physicians as the first-line maintenance therapy for the adult with daily or frequent asthma symptoms. However, inhaled steroids appear to be underutilized, as they constituted less than 15% of all asthma prescriptions in 1993, according to a pharmaceutical industry survey. Their dosage varies from 1 to 5 puffs, two to four times a day, depending on the preparation. Local adverse effects include hoarseness, cough, and oral candidiasis or thrush. Generally, chronic adverse side effects of steroids given orally are not seen to any extent with the inhaled form of steroids. The inhaled steroids should be given at the lowest possible dose, capable of controlling the asthma. Examples of inhaled steroid products are: Beclovent, Vanceril, Azmacort, and Aerobid.

A non-steroidal anti-inflammatory inhaler that can be used for asthma is cromolyn sodium or Intal. It prevents mediator release from airway mast cells and inhibits both early- and late-phase immune response in asthma, but it is not as effective as the corticosteroids. The most common side effect is coughing.

Complementary Approach to Treating and Managing Asthma.
In addition to all of the triggers considered by conventional medicine such as stopping exposure to cigarette smoke, reducing exposure to known indoor allergens, and reducing exposure to outdoor allergens, the complementary physician will evaluate areas that are usually not considered by the conventional physician.

In his approach to any health problem, the complementary physician will recommend cleaning up the diet by eliminating or reducing refined carbohydrates (such as sugar and white flour), hydrogenated fats (which mess up fatty acid metabolism), and synthetic food additives, (such as preservatives and artificial sweeteners). The diet should emphasize whole organic foods, as much as possible. Water should be free of both fluoride and chlorine. In addition, tests may be run to pick up subtle food allergies to some of the good foods.

An appropriate exercise program, which includes aerobic exercise, stretching and strengthening will be recommended as tolerated. Stress management techniques will be utilized in patients for whom anxiety seems to be an important trigger.

Rather than emphasizing the bronchodilator and anti-inflammatory drugs that conventional physicians use routinely, the complementary physician will keep them on the back burner, and use them only if the disease cannot be controlled by natural means. These natural means will include dealing with detoxification, supplying natural substances like vitamins, minerals, enzymes, and herbs either orally or by injection, dealing with less accepted infections, such as Candida Albicans overgrowth in the gut, balancing the hormonal system, using homeopathic medications and/or using energy balancing techniques such as acupuncture.

If the patient has had exposure to a lot of antibiotics and steroids, as many asthma patients have, Candida overgrowth is likely and is probably contributing to the difficulty in controlling the asthma. In such cases, a sugar free, yeast free diet should be recommended. A number of natural supplements are helpful in controlling the Candida, including caprylic acid, garlic, pau d’ arco herbs, and dioxychlor. Friendly bacteria, such as lactobacillus acidophilus and bifidus, should be supplemented. Of course, exposure to antibiotics and corticosteroids should be reduced and eliminated, as soon as the patient can tolerate this. If necessary, anti-Candida medications, such as nystatin, Diflucan or Nizoral may be recommended for a limited time. Other unfriendly organisms in the gut, such as certain bacteria or parasites may also be eliminated by appropriate herbs or medications.

Detoxification
Detoxification procedures are designed to reduce exposure to toxic substances and to help the body improve its ability to rid itself of toxic substances. To do this, it is necessary to carry out earlier suggestions by both conventional and complementary physicians on reducing toxic exposure. Additionally, the organs of the body that deal with detoxification need to be addressed. These organs include the gastrointestinal system including the liver, the kidneys, the lungs and the skin.

The function of the gastrointestinal system or gut is to allow necessary nutrients into the body while preventing toxic substances from entering the bloodstream through the gut. Malabsorption problems relate to a reduced ability to get nutrients into the body. Leaky gut problems relate to the intestines allowing toxic substances, such as large molecules into the bloodstream. The latter may encourage allergic inflammatory responses, which can aggravate asthma. The leaky gut may be caused by Candida, parasites or other organisms. Other causes of the leaky gut are damage from toxic substances, such as non-steroidal anti-inflammatory drugs like ibuprofen, and nutritional deficiencies. Repair can be carried out by eliminating the toxic offenders and supplying the repair nutrients. Among the most important nutrients for repair are L-glutamine, zinc, vitamin A, vitamin C, vitamin E, GLA and gamma oryzanol. These may be given as capsules or as part of a specially designed therapeutic food powder, like Ultra Clear Sustain. By repairing the leaky gut, allergic responses will be reduced and asthma should be improved.

The liver is the major organ of the body to carry out detoxification of toxic substances that are already in the body. These toxic substances may be from external sources or as a result of normal or abnormal metabolism within the body. The details of this process will be the subject of another Medical Update. Suffice to say at this point, that bolstering the liver’s abilitly to detoxify by supplying the necessary nutrients may result in significant improvement of asthmatic conditions. The types and amounts of nutrients to be supplied in an individual case will depend on the individual and can be determined by specialized testing.

The role of the kidneys in detoxification involves the elimination of water-soluble toxins from the body. Drinking sufficient amounts of pure water will be helpful. The skin eliminates toxins through sweat and other secretions. Applying a dry brush massage to the skin helps to stimulate circulation and improve this function. The elimination of toxins through the skin by sweating can be accomplished with aerobic exercise and saunas. To eliminate heavy metal toxicity from lead, aluminum, cadmium or mercury, chelating agents may be used. The removal of mercury amalgam dental fillings may be recommended to eliminate a source of mercury contamination.

Recall that the major medications that are used to treat asthma are bronchodilators to dilate the constricted bronchi, anti-inflammatory agents to reduce inflammation, and antibiotics when infection is playing a role.

Building Immunity to Reduce Need for Antibiotics
To reduce the need for antibiotics to treat infections, a complementary physician will use nutrients to bolster the person’s own immune system. These may include liberal use of vitamin C, vitamin A, zinc, copper, thymus extracts and herbs like Lomatium and Echinacea. These may be given orally. In addition, a course of intravenous infusions of vitamin C and other nutrients, or low dose hydrogen peroxide will generally bolster the immune system and help the patient to feel better.

The mineral magnesium, which has been covered in a previous medical update, is possibly the single most important nutrient for managing asthma because of its multiple effects on the asthmatic condition. It is extremely effective in the relaxation of bronchial smooth muscle tissue, resulting in a reduction of bronchospasm and increased airways diameter. It may do this in part by stimulating production of cyclic AMP and ATP, two important mediators that bring about relaxation of bronchospasm.

Magnesium also reduces the histamine response, which mediates allergic inflammation. Patients suffering from asthma often have exaggerated histamine release from certain white blood cells, which leads to inflammation and bronchoconstriction. Magnesium helps to dull this response.

Various lifestyle practices contribute to magnesium deficiency, including chronic caffeine and alcohol consumption, dieting and excessive exercise without sufficient magnesium replacement. Use of diuretics or water pills contribute to magnesium depletion. Ironically, studies have shown that asthma bronchodilator medications, such as theophylline and albuterol can cause magnesium wasting, thereby contributing to the worsening asthmatic condition. Magnesium may be given orally or by injection. Some patients because of gut problems develop diarrhea when magnesium is given orally and those patients may need to be given magnesium by injection, until the gut problem is cleared.

The counterpart of the mineral magnesium is the vitamin pyridoxine or vitamin B6. Like magnesium, vitamin B6 is important in stimulating the production of ATP and cyclic AMP, which promote relaxation of bronchial smooth muscle, resulting in an increased bronchial diameter. As with magnesium, the bronchodilator medications deplete vitamin B6. So, vitamin B6 should be given along with magnesium, both orally and by injection.

For some asthma patients, sulfites are a major trigger. These patients may be suffering from a relative enzyme deficiency, which results in difficulty oxidizing sulfites to sulfates. Two co-factors that are involved with this oxidation are vitamin B12 and the mineral molybdenum. Sulfite sensitive patients may greatly benefit from oral and injectable supplementation with B12 and molybdenum.

Anti-inflammatory Herbs and Nutrients
Some herbs that are being used by complementary physicians for treating asthma for their anti-inflammatory and/or bronchodilating effects are Gingko Biloba, Coleus Forskholii, MaHuang, Lobelia and Glycyrriza glabra. These herbs are complicated substances containing many compounds. They have multiple effects, which may include anti-inflammatory actions, bronchodilator effects and expectorant properties.

Precursors of the anti-inflammatory prostaglandins are often helpful. These include sources of omega-3 fatty acids, like flaxseed oil and fish oils, and sources of gamma linolenic acid or GLA, like evening primrose oil or borage oil.

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 About The Author
Michael Schachter MD, FACAM Director of the Schachter Center for Complementary Medicine, Michael B. Schachter, M.D., is a 1965 graduate of Columbia College of Physicians & Surgeons. He is board certified in Psychiatry, a Certified Nutrition......more
 
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