Conscious Choice: Asthma Update

July 1995 | The Holistic M.D.

Asthma Update

by Ronald Hoffman, M.D.

"Asthma on the Rise!" "Respiratory Deaths Increase." "Pollution Spawns Epidemic of Childhood Wheezing." These are but some of the headlines lately in the news about one of America’s most pervasive health problems. Asthma ranks first in causing days lost from school, saps productivity from American industry, generates huge disability claims, and ultimately sets the stage for chronic obstructive pulmonary disease (COPD). It is the fifth leading cause of death and dying in spite of aggressive drug therapy aimed at taming the disease.

Air pollution is often cited as a cause, but why the upward trend? Paradoxically, the Environmental Protection Agency (EPA) has consistently rated air quality as improving in most major metropolitan areas. Stringent emission control standards are paying off. Gone are the frequent smog alerts of the‘50s and‘60s; the smoke-belching domestic incinerators are relics of the past; everything from car exhausts to aerosol sprays to garden barbecues is subject to intense government regulation. So where have things gone awry?

To answer this conundrum, industrial engineers have gone indoors to measure air quality. The energy-crisis of the‘70s has engendered "tight building syndrome," with the practical consequence that interior air quality may be up to nine times worse than outdoor air quality even in polluted urban settings. So don’t think that retreating indoors is the answer. The proliferation of chemicalized household products, scents, wood preservatives, floor and wall treatments, carpets, rugs, drapes, and synthetic-impregnated furniture adds up to a fog of irritative substances. Some studies point to a relative increase in indoor housemite infestation, a trend occurring for no particular reason other than a natural evolution reminiscent of the ways in which new viruses or drug-resistant bacteria have come into being. Other research implicates indoor natural gas from furnaces, water heaters, and stoves which generates irritative nitric oxide residues, levels of which often far exceed that measured in high automobile-traffic areas.

Passive smoking, too, is a culprit, but with rates of smoking actually declining, tobacco plays only a supporting role in the spiraling epidemic of asthma. The decreasing wholesomeness of children’s diets may be germane to the trend, with ever more pervasive chemicalization, and higher proportions of sugar and artificial, hydrogenated fats. In addition, the widespread use of antibiotics may be undermining children’s and adults’ immune systems.

Finally, there are the asthma drugs themselves. Like most drugs which only control symptoms (like pain medications for arthritis), prescription sprays and pills for asthma provide temporary relief, but do nothing to halt the progression of the disease, and may actually hasten it. The medical profession itself suspects this; researchers blame the excess of asthma deaths on instability of breathing performance created by the push and pull of the initiation and withdrawal of powerful medications. The resultant pharmacological roller-coaster may ultimately veer out of control, with ensuing respiratory failure and death.

A recent effort to overcome the recognized limitations of standard asthma medication has culminated in well-publicized disasters. A new medication, called Serevent, designed to supersede the erratic characteristics of predecessor sprays like Proventil and Ventolin, has exhibited a disturbing tendency to be found clutched in the lifeless fingers of respiratory-arrest victims. The hapless deceased were improperly warned by their physicians that Serevent, a long-lasting spray, should not be used to provide instantaneous relief of severe wheezing.

Asthma needs to be understood at several levels so that a multi- pronged strategy can be employed to reverse it. At the most mechanical level, asthma results from a constriction of smooth muscles which line the tiny airways of the lungs. Certain herbs, like coleus forskoli, and certain nutrients, like magnesium, help the muscles to relax and permit the airways to open.

New research on asthma highlights the role of inflammation in perpetuating the disease. Inflammation may be caused by chronic infection, chemical exposure, or allergens. Natural anti-inflammatories like ginkgo biloba, GLA from Borage oil, and antioxidants like vitamin E, glutathione, and n-acetylcysteine help to put the fires out. Recent studies have correlated fish consumption with respiratory disease severity, underscoring the importance of omega 3 oils.

Allergy has long been recognized as a trigger for asthma, but a false dichotomy currently partitions asthma into "extrinsic" (allergic) and "intrinsic" (non-allergic) varieties. New research indicates that much of what has been relegated to the "intrinsic" category is actually the result of subtle food, chemical, mold, or internal candida allergy. Proper detective work can yield up the culprits. Attention to diet and environment can then minimize harmful exposures. New techniques of rapid allergy desensitization, proven successful in Europe and now adopted by a few select U.S. practitioners, can rapidly "tolerize" asthmatic patients to a host of dietary and environmental precipitants. Even recalcitrant steroid-dependent patients can thus be weaned from drug dependency.

Asthma is also a disease of autonomic nervous system dysregulation. All asthmatics are perpetually in flight from a parasympathetic-dominant state which allows mucus secretions to accumulate in the lungs and breathing tubes to collapse. One might say that asthmatics are hooked on stress, deriving stimulation for their flagging sympathetic nervous systems from sources as diverse as caffeine, sugar, emotional turmoil, and the powerful adrenalin-like drugs they take. Frantic efforts at artificially buoying the autonomic response culminate in exhaustion as energy bank accounts become overdrawn. Relaxation, yoga, sophisticated pranayama breathing exercises, and proper sports activities like swimming help to stabilize the autonomic nervous system. Acupuncture, and sometimes chiropractic, play a role in properly "rebooting" the invisible meridian channels that link lungs, adrenals, and brain.

The search for better control of asthma requires patient involvement and expert detective work by the physician. But by using the multitude of techniques now at our disposal, there is hope that asthma can be reversed.

Dr. Ronald Hoffman is Medical Director of the Hoffman Center in New York City and host of Health Talk, a syndicated radio program heard weeknights in New York on WOR (710 AM) from 9:00 to 10:00 pm, Saturdays noon to 2:00 pm. He is author of several books, including Intelligent Medicine (Fireside, 1997). Dr. Hoffman’s website contains useful health information.

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