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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