asthma

[Guest guest]

for those interested, here is a write-up on asthma, taken from a

clinical training manual I wrote

please note that this is for educational purposes only, and may not

be republished without my prior, written consent

note that this is not ayurveda per se, but an integrative, holistic

approach...

if folks want something specific to bronchitis, check out: http://

www.toddcaldecott.com/Bronchitis.html

 

todd caldecott

 

***

 

"Like chronic bronchitis, asthma is a kind chronic obstructive

pulmonary disorder (COPD). It is characterized by inflammation and

obstruction of the bronchus and bronchioles, mediated by a hyper-

reactivity to a variety of stimuli, including smoke, noxious gases,

pollen, animal dander and dust, as well as the heaving breathing that

accompanies exercise, laughing, crying or emotional stress.

Recently, the role of volatile organic compounds (VOCs) found in

carpeting and building materials have been identified in the

pathogenesis of asthma. Another factor is a concurrent respiratory

infection, such as coryza or pneumonia. With asthma it is thought

that these factors or combination of factors initiates the release of

inflammatory mediators promoting the release histamine and

arachidonic acid metabolism. When activated these inflammatory

chemicals promote the smooth muscle spasm of the bronchial wall and

edema of the mucosa, enhancing mucus production and bronchial injury

by activated immune cells (primarily eosinophils, lymphocytes and

neutrophils). It is important to note that production of inflammatory

mediators is enhanced by a pre-existing deficiency of vitamins,

minerals and accessory nutrients such as n-3 PUFAs and flavonoids

that counter or prevent inflammation.

 

The frequency and severity of asthma attacks vary to a large degree.

Some patients have only occasional episodes that are mild and brief,

whereas others experience a chronic cough and mild bronchial

congestion that is interrupted by severe episodes of bronchospasm,

usually after exposure to some type of stimuli that enhances

bronchial hypersensitivity. An asthma attack typically has an acute

onset, with sudden wheezing, coughing, and dyspnea, sometimes

preceded by pruritis over the neck and chest. The cough of an asthma

attack is distinctively tight, hard and sharp, generally

unproductive, and accompanied by wheezing, a sensation of chest

constriction and the subsequent distress this causes the patient. In

less severe attacks a dry cough may be the only presenting symptom.

After the attack subsides many patients will produce a thick,

tenacious mucus.

 

The Merck Manual of Diagnosis (1992) classifies asthma into four

categories according to the severity of symptoms. In many cases a

patient will move back and forth between these categories, depending

upon treatment and the presence of stimuli that promotes

hypersensitivity:

 

Stage I

Mild and intermittent dyspnea. Lung capacity 50-80% of normal.

Pulmonary (Pa) CO2 levels normal or decreasing, pH normal or

increasing; PaO2 normal or decreasing.

 

Stage II

Moderate, with obvious dyspnea and wheezing. Lung capacity 50% of

normal. Usage of accessory muscles. PaCO2 decreasing, pH increasing;

PaO2 decreasing.

 

Stage III \

Severe, with obvious distress, visible cyanosis. Lung capacity 25%

of normal. Marked use of accessory muscles. PaCO2 normal or rising,

pH normal or decreasing; PaO2 decreasing dramatically.

 

Stage IV

Severe distress, lethargy, confusion, 'pulsus paradoxus' (decrease in

systolic pressure and pulse amplitude). Lung capacity 10% of

normal. Marked use of accessory muscles. PaCO2 rapidly increasing,

pH rapidly decreasing; PaO2 dramatically diminished.

 

Medical treament

The medical treatment of asthma consists of a consideration for

environmental triggers (including animal dander, dust mites,

cockroaches, airborne molds, and pollens) and symptomatic drug

interventions. Potential allergens are typically identified by the

RAST method. Typical interventions include furniture and flooring

changes, emphasizing dust covers and hardwood floors. Patients may

be counseled to give up a pet, or limit exposure. Pollen allergies

however are difficult to control by such methods, and thus

densensitization immunotherapy may be recommended, apart from drug

therapy.

 

Drug therapy for asthma consists of bronchodilators, used to control

acute symptoms, and corticosteroids, used to inhibit chronic

inflammation. Among the bronchodilators used in acute inflammation

are beta-adrenergic agonists, often administered in metered doses by

inhalation, including epinephrine, albuterol, terbutaline,

pirbuterol, metaproterenol, bitolterol, isoetharine and the long-

acting (12h) salmeterol. Anticholinergic drugs such as atropine may

also be administered in emergency situations to control symptoms.

Theophylline is a methylxanthine found in black tea that is

administered orally as fast acting bronchodilator, but has a number

of severe side-effects including ventricular arrhythmia and even

death. Theophylline should be discontinued immediately if there are

any symptoms of nausea and vomiting.

 

Chronic inflammation in asthma is typically treated with

corticosteroids, given orally or as an aerosol, the latter of which

is also used to treat late responses to inhaled allergens, blocking

the subsequent bronchial hyperactivity. Adverse effects of inhaled

corticosteroids include hoarseness and mucocutaneous candidiasis.

Systemic effects include suppression of the adrenal-pituitary axis,

growth suppression in children, osteoporosis in women, thinning of

the skin, and easy bruising. Care must be taken when withdrawing

corticosteroids as too rapid of a withdrawal can precipitate

secondary adrenocortical insufficiency. Other prophylactic drugs

used to control inflammation include cromolyn and nedocromil, but are

not used in acute scenarios.

 

Holistic treatment

In Ayurvedic medicine asthma, or svasa, is the result of a worsening

cough (kasa), or from similar etiological factors that include the

upward movement of apana vayu, which invades the chest and throat,

causing a vitiation of Kapha, which causes dyspnea, wheezing, catarrh

and distress. Other etiological factors include poor digestion,

exposure to poisons, noxious fumes and dust, anemia, chronic fever,

wind, injury or from drinking very cold water. The clinical features

of svasa are differentiated into five types with different causative

factors: Kshudrasvasa (dyspnea), Tamakasvasa (bronchial asthma),

Chinnasvasa (anaphylaxis), Mahansvasa and Urdhvasvasa: the latter

three are incurable and are premonitory symptoms of death.

Kshudrasvasa is a mild form of asthma caused by excessive exertion.

Tamakasvasa or bronchial asthma is caused by apana vayu invading the

chest and throat, causing a vitiation of Kapha. Tamakasvasa can be

further classified on the basis of secondary doshic manifestations,

i.e. Pittaja, Vataja, but the condition remains primarily an

affliction of Vata and Kapha.

 

In traditional Chinese medicine asthma is an affliction of the Lungs

by one of three etiological agents, including Cold, Heat and Qi

deficiency. Dyspnea, wheezing and coughing are clinical features of

all three types. Cold-type asthma is more frequent attacks in winter

and exposure to cold, identified by a white, moist and glossy coating

on the tongue, and taut and tight pulse. Heat-type asthma is

identified by its occurrence in hot weather, a yellowish mucoid

sputum, thirst, a red tongue with yellow greasy coating, and a

slippery and rapid pulse. Deficiency-type asthma is caused by a

deficiency of Lung and Spleen Qi and manifests as the chronic form of

asthma, with a weak, fragile cough, aversion to wind, debility, a

pale tongue a dry coating, and a deep fine, weak pulse.

 

From the Western herbal perspective asthma is caused by the same

etiological factors as the medical perspective, in addition to a more

complete analysis of environmental triggers, the role of food

allergens, digestive weakness (including hypochlorhydria),

nutritional deficiencies (e.g. omega 3 fatty acids), intestinal

permeability and dysbiosis. Important considerations are also made

for stress and anxiety.

 

1. Open the airways. This is the most obvious treatment for asthma,

and can consist of both short and long term strategies. Generally

speaking, botanicals hold no special advantage over ²-adrenergic

inhalers, but can be used when such medications are unavailable, e.g.

Datura (oral, inhaled smoke), Atropa (oral), Lobelia (oral, inhaled

smoke), Ammi (oral), Ma Huang (Ephedra sinica). IgE-mediated attacks

may respond to freeze-dried Urtica, two capsules every five minutes.

In a pinch very strong black coffee or black tea given in small sips

may be life-saving.

 

2. Eliminate bronchial congestion and inflammation. A variety of

methods are used, including those which ease muscular spasm, promote

vasoconstriction of the mucosa, assist in the expectoration mucus,

and soothe irritation and inflammation.

¥Respiratory antispasmodics, specifically used in cold and dry (Vata)

conditions, e.g. Lobelia, Drosera, Symplocarpus, Grindelia,

Cimicifuga, Dioscorea, Thymus, Prunus, Verbascum, Tussilago, Inula,

Populus candicans, Draconitum, Lysichiton, Drosera, Lactuca,

Sanguinaria Hingu (Ferula foetida), Vasaka (Adhatodha vasica), Tai Zi

Shen (Pseudostellaria heterophylla), Xing Ren (Prunus armeniaca)

¥Stimulating expectorants, used in highly congestive conditions with

a thick profuse catarrh (Kapha), e.g. Viola, Urginea, Stillingia,

Primula, Bellis, Polygala, and Euphorbia, Commiphora, Populus

candicans, Grindelia, Vibhitaki (Terminalia chebula), Tulasi (Ocimum

sanctum), Ban Xia (Pinellia ternate), Jie Geng (Platycodon grandiflorum)

¥Mucolytics, digestive stimulants to enhance digestion and decrease

viscosity of mucus, e.g. Zingiber, Cinnamomum, Pimpinella, Capsicum,

Zanthoxylum, Allium, Angelica, Ela (Elettaria cardamomum)

¥Astringing expectorants, to dry up excessive mucus secretions and

constrict mucosal capillaries, e.g. Myrica, Euphrasia, Abies,

Solidago, Verbascum, Hydrastis, Vibhitaki (Terminalia chebula)

¥Antiinflammatory expectorants, for symptoms of symptoms of heat

(Pitta), Vasaka (Adhatodha vasica), Vamsarochana (Bambusa spp.),

Bhumyamalaki (Phyllanthus amarus), Chuan Bei Mu (Fritillaria

cirrhosa), Zhe Bei Mu (Fritillaria thunbergii), Gua Lou (Gua Lou Ren,

Tian Hua Fen) (Trichosanthes kirilowii)

¥Demulcents and vulneraries, used in acute inflammation, heat and

dryness (Vata, Pitta), and not in profound catarrh, e.g. Glycyrrhiza,

Hypericum, Symphytum, Plantago, Althaea, Stellaria, Mai Men Dong

(Ophiopogon japonicus), Shi Di Huang (Rehmannia glutinosa), Shi Hu

(Dendrobium nobile)

 

3. Correct dysfunctional breathing patterns. Assess for the

breathing patterns mentioned under Part IV: A Guide To Breathing.

Emphasize meditation, relaxation and stress-reduction techniques.

Nervine relaxants and trophoretoratives may be indicated, including

Avena, Passiflora, Valeriana, Stachys, Anenome, Lycopus, Leonorus,

Chamomila, Hypericum, Scutellaria, Ashvagandha (Withania somnifera),

Brahmi (Bacopa monniera), Ling zhi (Ganoderma spp.)

 

4. Support immune function.

¥Lymphagogues as supportive, and specifically with lymphadenopathy,

e.g. Echinacea, Ceanothus, Phytolacca, Thuja, Galium, Trifolium

¥Immunomodulants in chronic or recurring conditions, e.g. Echinacea,

Tabebiua, Amalaki (Emblica officinalis), Ling zhi (Ganoderma spp.),

Huang qi (Astragalus membranaceus), Wu Wei Zi (Schizandra chinense),

Dong Chong Xia Cao (Cordyceps chinensis)

¥Immunosupportive nutrients, including vitamins A (25,000 IU daily),

B complex (50 mg daily), C (to bowel tolerance) and E (800 IU daily),

as well as zinc (50 mg daily) and selenium (100 mcg daily)

 

5. Correct inflammatory tendency by addressing nutrient deficiencies.

¥Decrease consumption of feed-lot, grain-fed meat and animal

products, including beef, pork, chicken and eggs.

¥Increase consumption of omega-3 fatty acids, equivalent of 1000 mg

of EPA/DHA daily

¥Flavonoids and anthocyanidins-rich compounds and foods, e.g.

quercitin, grape seed extract, turmeric, berries (e.g. blueberries,

strawberries), Rubus, Rosa (hips), Hibiscus, Gingko, Amalaki (Emblica

officinalis)

¥Magnesium and calcium, 800-1000 mg each daily

 

6. Detoxification.

¥Cholagogues and hepatotrophorestoratives to enhance liver

detoxification with cholagogues and supportive nutrients (see The

Inner Alchemist: Hepatobiliary function and Botanical medicine), e.g.

Berberis, Peumus, Silybum, Haritaki (Terminalia chebula), Haridra

(Curcuma longa), Guduchi (Tinospora cordifolia). Bhumyamalaki

(Phyllanthus amarus), Katuka (Picrorrhiza kurroa), Huang Qin

(Scutellaria baicalensis),

¥Diuretics and lymphagogues, e.g. Apium, Galium, Urtica, Solidago,

Equisetum Phytolacca, Thuja, Galium, Ceanothus

¥Hydration and heat: showers, baths, steam baths, sweating under

blankets; drinking 2 liters of water daily

 

7. Eliminate environmental triggers. Patients should be assessed for

possible allergens (e.g. dust mites, pollen, animal dander), and then

placed on an elimination-challenge diet to determine food allergens.

Attention must be directed to the removal of noxious agents including

volatile organic compounds (VOCs) and other chemical irritants and

toxins found in building materials including paints, flooring,

carpets, and pressed wood (e.g. fiberboard, plywood). Cessation of

smoking (tobacco, cannabis) is highly recommended. Workplace hazards

include recycled air and dust.

 

8. Specific formulae:

¥Compound Tincture of Lobelia (King's American Dispensatory, 1898), 5

- 10 mL, up to five times daily.

¥Nayopayam kvatha, 48 mL bid-tid

¥Balajirakadi kvatha, 48 mL bid-tid

¥Shiva gutika, 3-6 g bid-tid

¥Chaturdasangha churna, 3-6 g bid-tid

¥Ma Xing Shi gan Tang (Ephedra Apricot, Gypsum and Licorice

decotion), 1 cup thrice daily

¥Ren Shen Ge Jie San (Ginseng and Gecko powder), 3-6 g bid-tid

¥Ding Chuan Tang (Arrest Wheezing decoction), 1 cup bid-tid

¥Chuan Ke Ling, 4 pills bid-tid

¥Ping Chuan Wan, 10 pills bid-tid"

 

©2003, 2004, 2005, 2006 by Todd Caldecott. .

 

best regards... todd caldecott