Mechanisms of an Asthma Attack
Now, lets discuss the mechanisms of an asthmatic attack. What happens to the lungs during such attack? First, we see bronchial spasm and/or constriction of the smooth muscles of the bronchi or airway tubes, leading to a narrowing of these passages. Second, we get inflammation and edema or swelling of the inner lining of the bronchi, which further narrows the airways. Third, we observe increased mucus production with the development of mucus plugs that may further block air from getting to the little air sacs in the lungs, thus preventing oxygen from getting into the bloodstream and carbon dioxide from leaving the bloodstream in order to leave the body. And, finally, we frequently see evidence of allergic phenomena on a cellular level, with allergy cells called eosinophils, resulting in further inflammation of the airways. This allergic mechanism almost always involves the substances known as platelet activating factor or PAF and histamine, to a lesser extent. In addition to causing inflammation, this allergic reaction also contributes to bronchial hyper responsiveness.

To review, the important mechanisms of asthma are: 1) an increased responsiveness of the airways to a variety of stimuli; 2) a narrowing of those airways due to a contraction of the smooth muscles of the bronchi; 3) a further narrowing due to inflammatory changes in the walls of the bronchi; and 4) an increased production of mucous and fluids in the airways causing further narrowing and even blockage.

These mechanisms are important to keep in mind as we discuss both conventional and complementary treatments.

Conventional Treatment Approaches to Asthma
A good conventional approach to asthma will look at the environmental stimuli that set off a response from the super sensitive airways. Here, a careful medical and ecologic history is most important to establish which stimuli are most important for this particular patient. Do asthma attacks occur mostly indoors or outdoors? If indoors, are they worse at home or at work? Are they worse during a particular season? Tree pollens, for example, are very high in early spring, grass pollens peak in the late spring and the classic ragweed season begins in late summer and ends with freezing weather. Sometimes asthma attacks are precipitated by exercise.

Patients will be warned about the adverse effects of active or passive tobacco smoke. They may also be advised to avoid dust or fumes of chemicals, exposures to people who have upper respiratory infections, cold air, known inhalant allergens such as cats or dogs, grasses or pollens and various drugs such as the beta blockers, ace inhibitors, aspirin and certain non-steroidal anti-inflammatory drugs. Once allergens have been identified, measures recommended to minimize exposure to them might include avoiding outdoor activities in early morning when allergen levels are highest, keeping windows closed as much as possible during the peaks of allergy seasons and keeping indoor humidity levels between 40 and 50 percent to reduce pollen and mold exposure. Eliminating carpeting and upholstery when possible and using plastic pillow and mattress casings will help to keep dust exposure to a minimum. Laundering bedclothes weekly in hot water is also recommended. High efficiency particulate air, abbreviated HEPA filtering devices, effectively reduce airborne allergens and other inhaled irritants.