Integrative Approach to Asthma

Asthma prevalence is rising worldwide

better diagnosisair pollutionallergiesdietary factorshygiene hypothesisobesityantibiotics in 1st year

Asthma prevalence in Canada 1978-1996

Asthma morbidity and mortalityAsthma prevalence: 8.4% of persons >12 years >12% of children ages 0-9

Millions of office visits>50,000 hospital admissions/year >500 deaths in Canada/yearSignificant costs: Quality of life Medications Health care system

Key features of asthma

Variable air flow obstruction

Airway hyper-responsiveness

Cellular inflammation

Asthma is a

heterogenous condition

exercise allergens infections

Integrative approach begins with good conventional care

Education

Recognize triggers

Clear treatment plan

Optimize asthma control

Minimize visits to ER,

life threatening episodes

Integrative therapy for asthma

Prevention

Diet

Botanical medicines

Mind/body therapies

TCM

Asthma Prevention: dietary fatsThe kinds of dietary fats consumed during pregnancy may have a significant impact on childhood asthma riskAn increase in omega 3 fat consumption from oily fish has been found to be beneficial Fried fish sticks (high in trans fats) have been found to increase riskConsumption of fatty fish > once per week in childhood may also be protective

Asthma prevention: breast feeding

Exclusive breast feeding has been found to childhood asthma by 30-50%

A 50% reduction has been found in high risk children

Encourage exclusive breast feeding x 6 months

Modifying the severity of exercise induced asthma (EIA)

Low salt diet

omega 3 fatty acids

omega 6 fatty acids

Increase dietary antioxidant vitamins, especially vitamin C

Low salt diet

Higher salt intakes in a population are proportional to the prevalence & severity of asthma

Several RCT’s have shown: Low salt diet improved lung function High salt diet worsened lung function

Sodium

Recommended sodium intake is 1500mg/day (or definitely < 2400mg/day)

1 teaspoon of salt = 2358mg

Average North American diet contains over 3900mg/day

75% of sodium in our diet comes directly from foods: tinned soups, snacks, processed meats, restaurant meals

Essential fatty acids

There are two main groups of essential fatty acids: omega 6 and omega 3

North American diets are generally overloaded with omega 6 fats and deficient in omega 3 fats (ratio n-6:n-3 12-40:1)

The ideal ratio of n-6 to n-3 fats is thought to be ~ 1-2:1

Diets high in omega 6 fats can promote inflammation

Fish oil (EPA+DHA) reduces inflammation

1997 AJCN: >40% of the asthmatic ‘responders’ showed a complete resolution of airway hyper-responsiveness. The others showed no change.

2003 AJRCCM: Elite athletes with exercise induced asthma who supplemented with 3.2g/day EPA and 2.2g/day DHA showed a marked improvement in post exercise pulmonary function

Omega 3 fatty acids in EIA

Linoleic acid (LA)

Gamma-linolenic acid

(GLA)

Arachidonic acid

(AA)

Alpha-linolenic acid(LNA)

Eicosapentanoic acid (EPA)

Docosahexanoic acid (DHA)

Omega 6 pathwayOmega 6 pathway Omega 3 pathwayOmega 3 pathway

Delta-6 desaturase

Elongase

PG1

PG2

PG3

Safflower, sunflower, corn, peanut oils

Flax, walnuts, hemp, canola

Salmon, halibut sardines, herring

Evening primrose oil

Meat, butter

Salmon, halibut, sardines, herring

Cell membrane composition after

omega 3 fatty acid supplementation

Study               EPA                              DHA (as % total neutrophil FA content)*Arm, et al.10 wk3.2 EPA+2.2 DHA 0.2 2.2

2.6** 2.6

*Lee, et al. 6 wk 3.2 EPA+2.2 DHA <0.1 1.7 1.5** 2.0

Antioxidants & EIA

Ascorbic acid is the major airway antioxidant useful in EIA: 50-80% response also effectiveness of bronchodilators (500mg

vitamin C 1.5 hrs prior to exercise)

-carotene (found in dark green and dark orange vegetables): benefit seen in ~50%

Lycopene (best source is cooked tomatoes): 45% in FEV₁

‘Anti-inflammatory diet’

Abundant fruits and vegetables

Healthy fats: olive oil, nuts, fatty cold water fish, fish oil

Low glycemic index/load carbohydrates

Green tea, turmeric, ginger

Boswellia serrataAyurvedic medicine- gum resin and bark usedBoswellic acids inhibit leukotriene synthesis (anti-inflammatory effect)This herb has been used for arthritis, inflammatory bowel disease and asthmaIn a 6 week study of 40 asthmatics, 70% showed improved lung function Usual dose is 400-800mg tidMore studies are needed to assess long term safety

Butterbur (Petasites hybridus)Rhizome (root) is usedSpasmolytic and anti-inflammatoryUsed for: migraine prophylaxis, hayfever & asthmaIn a study of 80 people, butterbur decreased asthma symptoms by 47- 65% Important: Butterbur may contain hepatotoxic pyrrolizidine alkaloids. Use clinically tested product such as Petadolex (free of PA’s)Usual adult dose is 50mg 3 times per day

Ginkgo biloba

Leaf is used (seed used in TCM)

Ginkgolides: anti-inflammatory, neuroprotective, anti-oxidantKEY FACT: Reduces airway hyper-responsiveness and bronchospasm

An 8 week study showed a 15% improvement in lung function

Ephedra (Ma huang)

Traditional TCM: stems are used medicinally KEY FACT: Has been misused for weight loss and as stimulant (“herbal ecstasy”)Alpha and beta adrenergic effects: can increase heart rate and also cause bronchodilationContraindicated in heart disease, hypertension, glaucomaShould only be used by an experienced practitioner of traditional Chinese Medicine

Licorice (Glycyrrhiza glabra) Often used in TCM in combination

with other herbsRoot is used medicinallyAnti-inflammatory, anti-tussive, expectorantLicorice can reduce the need for steroids (Steroid sparing effect)Safe dose is 1-1.5 gm crude licorice/dayUse only under the supervision of an experienced health care provider

Marijuana (Cannabis sativa)

Marijuana (Cannabis sativa)

Leaves and flower buds are dried and smoked

Contains delta 9- tetrahydrocannabinol (THC)

Marijuana was used as a bronchodilator in the mid 1800’s

Inhaled marijuana has been found to have bronchodilator activity greater than an inhaled beta-agonist

Mind/body therapy

Hypnosis: 50% of children with asthma have shown improvement after 1 or 2 short hypnosis sessions

Journaling: improved FEV₁ for 4 months

Journaling results

JAMA April 14, 1999 Vol 281, No 14

Relaxation & breathing exercises

Identify stress

Teach relaxation

Yoga/meditation

Osteopathy

Traditional Chinese medicine

Treatment is individualized and usually involves: dietary advice, a botanical formula, chi gong, acupuncture

IKPA (invigorating kidney for preventing asthma) tablets: significant improved lung function in asthma

Wenyang Tonglulo mixture also found effective

Acupuncture: studies show mixed results

Integrative asthma therapy

Anti-inflammatory diet

Fish oil

Low salt diet

Vitamin C

May consider the use of Boswellia or Butterbur

Mind/body therapy: hypnosis/journaling

Mind body CD’s or MP3’s

Guided imagery: Belleruth Naparstek www.healthjourneys.com

Self hypnosis: Steve Gurgevich www.tranceformation.com