Asthma is a disease in which inflammation of the airways restricts airflow in
and out of the lungs. The word asthma comes from the Greek word for "panting."
The panting and wheezing sound characteristic of asthma occur because of the
restricted flow of air.
Normally, when you breathe in an irritant or are subjected to a stressor such
as exercise, your airways relax and open, allowing the lungs to get rid of
irritants or take in more air. In a person with asthma, muscles in the airways
tighten and the lining of the air passages swells. The immune system gets
involved, but instead of helping, it causes inflammation.
Asthma is a disease of both adults and children. In fact, asthma is the most
common chronic childhood illness. About half of all cases of asthma develop
before the age of 10. Many children with asthma also have allergies. While there
is no cure for asthma, it can be controlled.
Signs and Symptoms
Most people with asthma have periodic attacks separated by symptom-free
periods. Some asthmatics have chronic shortness of breath with episodes of
increased shortness of breath. Asthma attacks can last minutes to days, and can
become dangerous if the airflow becomes severely restricted.
The primary symptoms of asthma include:
Shortness of breath
Wheezing -- usually begins suddenly; may be worse at night or early in
the morning; aggravated by exposure to cold air, exercise, heartburn and
relieved with the use of bronchodilators (drugs that open the airways; see
Cough (dry or with sputum) -- sometimes this is the only symptom
Call for emergency assistance if you have or are with someone having any of
these serious symptoms:
Extreme difficulty breathing or cessation of breathing
Bluish color to the lips and face (called cyanosis)
Decreased level of consciousness (such as drowsiness or confusion)
Additional symptoms that may be associated with an asthma attack include:
Abnormal breathing pattern, in which exhalation takes more than twice
as long as inhalation
Use of the muscles between the ribs (called intercostals) to help with
the increased work of breathing
Coughing up blood (called hemoptysis)
Asthma is most likely caused by a combination of several factors. Experts
suggest that in people who are susceptible (genetically predisposed), factors
such as allergens (substances that commonly induce an allergic reaction),
infections, dietary patterns, exercise, cigarette smoke, and stress can bring on
an asthma attack.
The following factors may increase the risk of developing
Allergies -- children with asthma often have allergies as well
Family history of asthma or allergies
Cigarette smoke, including second hand smoke from, for example,
parents or a spouse
Food allergies - a true food allergy,
particularly one that induces asthma, is difficult to identify and, therefore,
it is not clear exactly how frequently (or infrequently) this contributes to
asthma; it seems to be more common in children than in adults and the
responsible foods include eggs, milk, wheat, soy, peanuts, fish, shellfish, and
sulfite food perservatives.
Living in a Western or industrialized country
- some experts believe that dietary habits (more
processed foods, less fruits and vegetables), indoor living (resulting in
overexposure to indoor allergens), energy-efficient homes (trapping allergenic
dust mites inside), immunizations, and possibly, declining rates of
breastfeeding contribute to the rising rates of asthma
Gender -- among younger children, asthma develops twice as frequently
in boys as in girls, but after puberty it may be more common in girls
Obesity - controversial; a recent study
suggests that asthma is overdiagnosed among obese people
Childhood asthma in particular can be triggered by almost all of the same
things that trigger allergies, such as the following:
Sensitivity to allergens in the air, such as dust, cockroach waste,
animal dander, indoor and outdoor mold, pollens
Air pollutants, such as smoke from tobacco or a fireplace, aerosols,
perfumes, fresh newsprint, diesel particles, sulfur dioxide, elevated ozone
levels, and fumes from paint, cleaning products, and gas stoves
Changes in the weather, especially in temperature (particularly cold)
Other triggers include:
Behaviors that affect breathing (exercising, laughing, crying,
The symptoms of asthma can mimic several other conditions, and a doctor must
take a thorough history to rule out other diseases. Questions will likely be
asked about how and when symptoms occur, and if there is a family history of
allergies and asthma or occupational exposure to chemicals. If asthma is
suspected, tests (called pulmonary function tests) will probably be done to
measure, among other things, the volume of your lungs and how much air you
exhale. Other tests may include chest and sinus x-rays, blood tests, or allergy
Although there is no method guaranteed to prevent asthma, there are a number
of measures parents can take to reduce their child's risk of developing asthma.
Exclusively breastfeeding for the first 3 to 6 months of life; this
issue is controversial, however, with the most recent (and largest) study
suggesting that breastfeeding for the first 6 months of life helps to protect
the child up to age two, but may increase the risk once the child is older than
Delaying the introduction of solid food until age 6 months
Manipulating the child's environment (not smoking during pregnancy or
around infants, eliminating household allergens such as mites and cockroaches.
For example, to reduce exposure to dust mites, encase mattresses and pillows in
special covers that are impermeable to allergens; also, remove carpets from
According to certain studies on adults, apples and selenium-rich food in the
diet may protect against asthma, and moderate consumption of red wine may be
associated with less severe asthma attacks. These foods are high in antioxidants
(namely, flavonoids). It is too early to say definitively that these nutrients
protect against asthma, however. Plus, it is important to note that in certain
individuals, red wine may actually induce asthma symptoms if you have an allergy
to sulfites, a food additive, or any other substance found in wine. Often, wine
labels indicate if sulfites are present.
Key steps in preventing asthma attacks include identifying the allergens and
the triggers that bring on or worsen your asthma symptoms and then working to
eliminate or avoid them. Sometimes it takes exposure to more than one of these
factors before an asthma episode is triggered. Keeping a diary to determine
triggers may be helpful. Certain medication can help to prevent an attack due to
triggers; in other words, if you know your triggers, you can anticipate when you
might be exposed, and use your medication before that expected exposure.
The following conditions are common triggers for asthma. Reduce your chances
of exposure to them by taking some common-sense steps:
Viral infections (colds, flu, bronchitis, pneumonia)
- stay away from people who you know are ill
Sinusitis and allergic rhinitis (hay fever or year-round allergies)
- avoid seasonal allergens by staying indoors in air
conditioning as much as possible and eliminating indoor allergens; fewer allergy
attacks generally means fewer cases of sinusitis and asthma
If sensitive or allergic, aspirin and nonsteroidal anti-inflammatory
Beta-blockers (such as acebutolol, atenolol, esmolol, labetalol,
metoprolol, nadolol, pindolol, propranolol, and timolol) including those in eye
If sensitive or allergic, processed potatoes, shrimp, dried fruit,
beer, and wine - these often contain sulfite food
Allergy desensitization, if you have a known allergy, may decrease the number
of asthma attacks you experience, diminish the intensity of each attack, and
lower the amount of medication that you need. Desensitization includes regular
injections of the allergen (substance causing the allergic reaction) given in
increasing doses (each dose is slightly larger than the previous one). The aim
of desensitization is to gradually accustom the immune system to the allergen so
that it no longer reacts to that substance. This is done very slowly and
carefully, starting with minute amounts of the substance, in a controlled
setting (namely, your doctor's office). Talk to your doctor about whether
desensitization is right for you.
Avoiding asthma attacks, reducing inflammation, and preventing lung damage
are the primary goals of treatment. This requires educating yourself about
asthma, working closely with your doctor to determine the severity of your
asthma and to define a treatment plan, and following recommendations. Adjusting
your environment as much as possible to prevent exposure to allergens or
irritants and taking
medication as prescribed are important
for the successful control of asthma. Emergency medications are needed during an
asthma attack, but daily monitoring of your asthma as well as a daily drug
regimen are necessary in order to affect the course of the disease over the long
term. Severe attacks of asthma require hospitalization for oxygen and
medications that are given intravenously (that is, through a vein). Certain
nutritional changes, particularly
increasing the amount of omega-3 fatty acids in your diet and decreasing omega-6
fatty acids, and
acupuncture may be useful adjuncts to
conventional medical care to treat your asthma.
Lose weight if you are overweight and already have asthma; although
the connection between obesity and asthma is not entirely understood, excess
weight may put pressure on the lungs and trigger an inflammatory response.
Monitor your asthma every day using a peak flow monitor (a portable
device for measuring the highest exhalation flow, which is an indicator of lung
volume). Working with your doctor to adjust medications according to readings
may reduce hospitalizations and improve quality of life. Keep a diary of
readings to show your doctor; together, you will establish your "personal best"
reading. When your daily reading is between 50% and 80% of your personal best,
this is considered a moderate asthma attack while values below 50% are severe.
You should call your doctor if your peak flow reading falls below 80% and go to
the hospital if it falls below 50%.
Keep a diary of respiratory complaints - this
may help determine triggers
Medications for asthma are prescribed for two different purposes. One is to
halt an acute attack, and the other is to control inflammation and reduce lung
damage over the long term.
Quick relief ("rescue" medications) - needed
promptly during a moderate or severe asthma attack to open the airways. Such
drugs are bronchodilators called short-acting beta-adrenergic agonists
(beta2-agonists such as albuterol, isoproterenol, metaproterenol, pirbuterol,
terbutaline, bitolterol, and levalbuterol). Other drugs used less commonly for
acute attacks include theophylline and certain anticholinergic agents (like
ipratropium bromide). Sometimes, steroids (such as prednisone, prednisolone,
methylprednisolone, or hydrocortisone) are needed (either taken by mouth or, if
in the hospital, given intravenously) for an acute asthma attack.
Long-term disease control is necessary for those taking short-acting beta2
agonists more than twice a week. The standard agents for these purposes are
inhaled corticosteroids (including beclamethasone, budesonide, dexamethasone,
flunisolide, fluticasone, and triamcinolone). Others include
leukotriene-antagonists (namely, montelukast and zafirlukast), and cromolyn. For
those with moderate to severe asthma, combinations of steroids and other
medications (such as long-acting beta2 agonists or leukotriene-antagonists) are
proving to be effective for both treating and preventing asthma attacks. The
intention of long-term therapy is to reduce inflammation and prevent injury to
Nutrition and Dietary Supplements
Studies indicate that people with asthma tend to have low levels of certain
nutrients (for example, selenium and potassium) and that the Western diet (high
in fast foods and low in fresh fruits and vegetables) has been associated with
higher rates of asthma. In fact, fried foods and margarine may be particularly
bad, especially in children. On the other hand, it has been suggested that
adding onion, garlic, pungent spices, and antioxidants (such as foods rich in
vitamin C, vitamin E, flavonoids, and beta-carotene) to the diet may help reduce
Two large studies found that low dietary magnesium intake may be associated
with risk of developing asthma in both children and adults. While studies
suggest that intravenous magnesium (magnesium administered through a vein) can
help treat acute attacks of asthma in children over age 6 and adults, it is not
known if eating foods high in magnesium or taking magnesium supplements would
make any difference in terms of asthma symptoms. During an acute asthma attack,
a doctor will determine if intravenous magnesium is necessary and appropriate in
a hospital setting.
A review of scientific studies suggests that N-acetylcysteine may help
dissolve mucus and improve symptoms associated with asthma.
Omega-3 Fatty Acids
Preliminary research on adults with asthma suggests that an omega-3 fatty
acid supplement (from perilla seed oil, which is rich in alpha-linolenic acid
[ALA], an important omega-3 fatty acid) may reduce inflammation and improve lung
function. ALA is also found in flaxseed and flaxseed oil. In addition, although
controversial because of mixed reports from scientific studies, at least a few
studies have found that fish oil supplements (rich in two other important
omega-3 fatty acids, namely eicosopentaenoic acid [EPA] and docosahexaenoic acid
[DHA]) may improve symptoms in children and adults with asthma. The studies on
fish oil have only included a small number of people, however; therefore,
definite conclusions cannot be drawn about whether fish oil supplements will
help you or not if you have asthma.
One thing that can be said about omega-3 fatty acids is that if you enrich
your diet with this type of essential fatty acid (from foods such as cold-water
fish, flaxseeds, pumpkin seeds, and walnuts) and reduce your intake of omega-6
fatty acids (from foods like meat, egg yolks, and certain cooking oils), this is
likely to help improve your symptoms.
Data from several studies suggest that compared to diets with normal amounts
of potassium, diets low in potassium are associated with poor lung function and
even asthma in children. Improving dietary intake of potassium through foods
such as fish, fruits, and vegetables may therefore be valuable for preventing or
treating asthma. Adequate amounts of magnesium are needed to maintain normal
levels of potassium. In addition, the drug theophylline (used sometimes for
asthma) may deplete potassium, as can excessive intake of salt or caffeine in
Quercetin, which is a member of a group of antioxidants called flavonoids,
inhibits the production and release of histamine and other allergic/inflammatory
substances. Histamine is a substance that contributes to allergy symptoms such
as a runny nose, watery eyes, and hives. Like other flavonoids, quercetin is a
plant pigment responsible for colors seen in fruits and vegetables. Quercetin
supplements often include bromelain (an enzyme found in pineapple), which is
also an anti-inflammatory and anti-allergy agent. Bromelain increases the
absorption of quercetin.
Studies suggest that people with asthma tend to have low blood levels of
selenium. In addition, a population-based study (studies that evaluate groups of
people) suggested that eating selenium-rich foods may have a protective effect
against asthma. Plus, taking selenium supplements may prove to be helpful as
well. In a study of 24 people with asthma, for example, those who received
selenium supplements for 14 weeks demonstrated a significant improvement in
symptoms compared to those who received placebo. More studies, with larger
numbers of people and lasting longer than 14 weeks, are needed to determine
whether selenium supplementation is truly safe and effective for people with
Although research is limited, there is some indication that vitamin C,
particularly from fresh fruit in your diet, may be useful for treating
allergy-related conditions such as asthma.
Other supplements that may have benefit for asthma include:
Coenzyme Q 10 (CoQ10) - if you have asthma,
you may have low levels of this antioxidant in your blood. It is not known at
this time, however, whether taking CoQ10 supplements will make any difference in
Lactobacillus acidophilus - there is some
evidence that this "good" organism (called a probiotic), which is found
naturally in the gut, may reduce the risk of developing an allergic reaction,
including asthma. In fact, some early evidence suggests that if mothers who have
at least one relative with asthma, or some other allergy-related illness, take
this probiotic while pregnant and breastfeeding, their babies may be less likely
to develop asthma.
Lycopene and beta-carotene - preliminary data
suggests that each of these two antioxidants may prove useful for preventing
exercise induced asthma symptoms when taken daily.
Vitamin B6 - may be needed if you are taking
theophylline because this medication can lower blood levels of this nutrient.
Herbs, like medications, may produce side effects or interact with other
substances including drugs. They should, therefore, be used with caution and
only under the guidance of a professionally trained and qualified herbalist.
Preliminary research suggests that omega-3 fatty acids (including flaxseeds)
may decrease inflammation and improve lung function in adults with asthma.
French Maritime Pine (Pinus pinaster)
A 2002 review of studies on a standardized extract from French maritime pine
bark suggests that the extract may reduce symptoms and improve lung function in
people with asthma.
Lobelia (Lobelia inflata)
Lobelia has a long history of use. It is considered an effective expectorant,
meaning that it helps clear mucus from the respiratory tract. Although there are
few thorough studies on the safety and effectiveness of lobelia, some herbalists
today incorporate lobelia into a comprehensive treatment plan for asthma.
Lobelia is a potentially toxic herb, but is considered relatively safe when used
in combination with other herbs that affect the respiratory system. Lobelia use
should only be considered with the guidance of a qualified healthcare
Herbalists may select from the following herbs that have been used
traditionally to treat asthma:
Feverfew (Tanacetum parthenium)
Ginkgo (Ginkgo biloba)
Goldenrod (Solidago virgaurea)
Marshmallow (Althaea officinalis)
Red Clover (Trifolium pretense)
Wild Yam (Dioscorea villosa)
Also, aloe (Aloe vera) is under investigation for its possible use in
helping to treat asthma.
Acupuncture has shown potential as an effective treatment for asthma,
according to a 1997 Consensus Statement by the National Institutes of Health. It
is important, however, that if acupuncture is used for asthma, it be used in
addition to (rather than as a replacement for) conventional medicine. One study
found that acupuncture improved the immune response of people taking anti-asthma
medication compared to those who did not receive acupuncture.
In addition to needling, acupuncturists may also use an herb-burning
technique called moxibustion (a technique in which the herb mugwort
[Artemesia vulgaris] is burned and the heat is held over specific
acupuncture points) when treating you for asthma. Some acupuncturists may also
perform a special type of massage therapy (called tui na), offer lifestyle
counseling, provide instruction on specific breathing exercises, and prescribe
Chiropractors report that some people with asthma benefit from spinal
manipulation, but the results of scientific studies have been somewhat mixed. A
recent review of scientific literature, for example, concluded that
"there is insufficient evidence to support or refute the use of manual therapy for patients with asthma."
Among the trials reviewed, two studies compared spinal manipulation to sham
manipulation in people with asthma. Sham manipulation refers to maneuvers that
shift soft tissues surrounding the bone but do not actually adjust the spine or
joint. Participants in both the spinal manipulation group and the sham group
reported similar improvements in asthma symptoms, suggesting that spinal
manipulation may be no more effective than sham therapy. In another study
involving 81 children with asthma, chiropractic care was associated with a 45%
reduction in the number of asthma "attacks." Thirty percent of the children in
the study experienced such an improvement in symptoms that they were able to
decrease their asthma medication dosage by 66% while receiving chiropractic
In another small study, 36 children with asthma who received chiropractic
care in addition to their usual medical management reported improved symptoms
after three months. Chiropractic therapy should be used in addition to (never as
a substitute for) your regular medical treatment for
Massage and Physical Therapy
A few studies of small numbers of children and adults with asthma have
suggested that massage therapy may reduce anxiety associated with asthma,
improve symptoms, and even improve lung function. Given the limited scope of
these studies, however, more research is needed to understand the relationship
between massage therapy and asthma, beyond the ability of this technique to
reduce stress and induce relaxation.
Although very few studies have examined the effectiveness of specific
homeopathic therapies, professional homeopaths may consider the following
remedies for the treatment of asthma based on their knowledge and experience.
Before prescribing a remedy, homeopaths take into account a person's
constitutional type. A constitutional type is defined as a person's physical,
emotional, and psychological makeup. An experienced homeopath assesses all of
these factors when determining the most appropriate treatment for each
Arsenicum album -- for asthma that generally worsens between
midnight and 2 am and is accompanied by restlessness, anxiety, chills, and
Ipecacuanha -- for those with asthma, particularly children,
who have significant tightness in the chest, a chronic cough with lots of phlegm
that may lead to vomiting, and worsening of symptoms in hot, humid weather
Pulsatilla -- for asthma with yellow or greenish phlegm that
gets worse in the evening, in warm, stuffy rooms, or after consuming rich, fatty
foods; this remedy is most appropriate for adults or children who are tearful
and clingy or sweet and affectionate
Sambucus -- for asthma that awakens a person at night with a
sensation of suffocation; symptoms worsen when the person is lying down
Asthma can be made worse by stress, anxiety, and sadness. In the other
direction, if you have asthma, it is not uncommon to feel anxious or depressed.
Incorporating stress management techniques into daily life may help reduce
symptoms. Experts suggest that the following may prove helpful for people with
Education about asthma
Hypnosis - this may be especially useful in
children because they are more easily hypnotized and can readily learn the
Yoga - in addition to general relaxation and
reduction of stress, several studies of people with asthma have suggested that
lung function and exercise capacity may improve with the regular practice of
yoga and that, eventually, the amount of medication taken may be reduced. The
yoga that has been practiced in most of these studies has involved breathing
exercises (called pranayama), stretches (known as postures in yoga), and
meditation. Additional research would be helpful on larger numbers of people to
understand more about the effects of yoga on asthma. Medication should never be
adjusted without discussing this with your doctor.
Joining a support group
Boswellia serrata (also known as Salai guggal), an herb commonly used in
Ayurvedic medicine (a traditional Indian system of health care), was tested in a
small group of people with asthma and compared to a placebo. 70% of those taking
a preparation of boswellia had improvement in their symptoms (namely, less
shortness of breath) and improved lung function by pulmonary tests. Only 27% of
those receiving placebo showed any improvement.
Traditional Chinese Medicine
The practice of Traditional Chinese Medicine often involves taking herbs,
applying acupuncture, and making lifestyle changes. Such changes may include
doing movement exercises that encourage particular breathing exercises and
meditation. Examples of such exercises include tai chi and qi (pronounced
"chee") gong. In a review of the use of qi gong for asthma, the authors
concluded that combining a regular practice of qi gong with medication may allow
you to reduce your drug dose, your need for sick leave from work or school, the
length of time that you spend in the hospital, and the overall cost of your
asthma therapy. (Note that your medication dosage should never be adjusted
without the discussion and consent of your doctor.)
A few herbs that a Traditional Chinese medical specialist might recommend
In Chinese medical practice, Asian ginseng (Panax ginseng) is often a
standard part of therapy. One test tube study performed in a laboratory suggests
that the reason this may work is because ginsenoside, an active ingredient of
ginseng, relaxes bronchial smooth muscle cells; these are the cells that line
the airway and, when restricted, cause diminished air flow and a feeling of
shortness of breath.
Ephedra (Ephedra sinica), also called ma huang, has been used in
Traditional Chinese Medicine for more than 5,000 years. It is sometimes used to
treat asthma, and synthetic ephedrine compounds, such as pseudoephedrine, are
widely used in over-the-counter cold remedies. However, ephedra and its
derivatives are potentially dangerous and addictive. Take only under the close
guidance and supervision of an appropriately trained specialist.
Japanese Herbal Medicine
Saiboku-to is an herbal complex approved by the Japanese government for the
treatment of asthma. In one Western study, people with asthma who took the
formula for 4 weeks had significantly improved symptoms. This study also found
that saiboku-to has anti-inflammatory effects.
Although exercise can be a trigger for asthma in some people, with
appropriate treatment and monitoring of the condition, exercise, even vigorous
exercise, is possible. In fact, many world-class athletes have asthma. Consult
with your doctor before starting an exercise program, and carry an inhaler at
Women who are pregnant or breastfeeding should avoid the
Ephedra and ephedra alkaloids such as ephedrine
Warnings and Precautions
Flaxseed may interfere with the absorption of medication. Avoid taking it at
the same time of day as medications and other supplements:
You should never take more than 20 mg of lobelia per day. People with high
blood pressure, heart disease, tobacco sensitivity, paralysis, seizure disorder,
and acute shortness of breath as well as those recovering from shock should not
Long-term treatment with theophylline for asthma may reduce blood levels of
Prognosis and Complications
Fourteen million Americans have asthma. People with asthma can live normal,
active lives. The condition requires self-care and monitoring over the long
term, as well as close contact with your doctor. Most people with asthma have
periodic attacks separated by symptom-free periods. Some asthmatics have chronic
shortness of breath with episodes of increased shortness of breath. Asthma
attacks can last minutes to days, and can be dangerous, even life threatening,
if the airflow becomes severely restricted. With that said, death from asthma is
extremely uncommon, especially if the proper treatment recommendations are
followed, including use of inhaled steroids which can reduce the risk of dying
from asthma by ninety percent. Poor mood can adversely affect self-care. Paying
attention to mood and life stress and having adequate emotional support will
help to ensure that self-care is consistent. Those who have occupation-related
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Review Date: December 2002
Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Gary Guebert, DC, DACBR, (Chiropractic section October 2001)
Login Chiropractic College, Maryland Heights, MO; Dahlia Hirsch, MD, Center for
Holistic Healing, BelAir, MD; Jacqueline A. Hart, MD, Department of Internal
Medicine, Newton-Wellesley Hospital, Boston, Ma and Senior Medical Editor
A.D.A.M., Inc.; Richard A. Lippin, MD, President, The Lippin Group, Southampton,
PA; Paul Rogers, MD, Facility Medical Director, Bright Oaks Pediatrics, Bel Air
MD; Joseph Trainor, DC, (Chiropractic section October 2001) Integrative
Therapeutics, Inc., Natick, MA; Marcellus Walker, MD, LAc, (Acupuncture section
October 2001) St. Vincent's Catholic Medical Center, New York, NY; Terry Yochum,
DC, Rocky Mountain Chiropractic Center, Arvada, CO; Ira Zunin, MD, MPH, MBA,
(Acupuncture section October 2001) President and Chairman, Hawaii State
Consortium for Integrative Medicine, Honolulu,
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