Asthma

breathfreely blueAsthma is a lung condition in which the main breathing tubes of the lungs (bronchi) reversibly close. While anyone’s tubes can close given sufficient exposure to irritants, some have a greater tendency for breathing-tube closure (bronchospasm) than others. Consider the breathing tubes/bronchi as made of muscle with an interior lining. Irritation to or inflammation of the tube’s lining triggers the contraction of these muscles, resulting in an asthma attack. Narrowed breathing tubes allow less air in and out of lungs; thus, the bronchi must be opened immediately when an attack occurs. Left untreated, the tubes may thicken and scar, rendering the airway permanently narrowed in some individuals. Since conventional Western asthma medications can both open the bronchi during an attack and prevent thickening and scarring, they are essential to asthma management.

Triggers for bronchial inflammation/contraction may be allergic (pollen, mold, dust mites, animals, food) or non-allergic (smoke, pollutants, environmental chemicals, infections, medications such as NSAIDs or beta-blockers, exercise, hormonal fluctuations, and some food additives). In those with chronic gastroesophageal reflux (or heartburn), acid and stomach contents travel up to the back of throat, are inhaled into the lung, and trigger asthma and coughing, especially after large meals.

In the last two generations, asthma rates have increased. While no one reason seems to be to blame, excessive weight/obesity does confer increased asthma risk. Recently, studies have suggested that decreased environmental allergen/bacteria exposure in childhood may play a role in increased asthma rates. Children raised on farms seem to demonstrate less asthma, while those receiving multiple early childhood antibiotic courses may demonstrate more, leading to the hygiene hypothesis: speculation about the role of diverse allergen/microbe exposure in immune system maturation/function. [5] (with fewer infectious stimuli in the environment, the in utero TH 2 allergic cytokine state never switches to the TH 1 state.)

Conventional Western asthma management has improved over the past two decades as well. First, doctors detect and diagnose asthma earlier and better. Previously, asthma was often not diagnosed until wheezing and shortness of breath (SOB) developed, late stage findings that occur when the tubes are already very much closed down. Before wheezing and SOB develop, the expiratory phase (the phase of blowing out air, after inhalation) lengthens, and cough is typically present. Second, office and home equipment for both asthma testing and monitoring (pulmonary function tests, pulse oximeters, peak flow meters) greatly assist management. Because these devices show decreased air movement before the patient feels short of breath (earlier/milder bronchospasm), daily home monitoring allows patients and doctors to detect and address the earliest phases of bronchospasm.

Treatment begins by identifying triggers, possibly with skin or blood testing, and eliminating them from the environment. Prevention is the most important factor is asthma management. Since pollens cannot be fully removed, some benefit from immunotherapy (“allergy shots”) over months-to-years to decrease sensitivity to known, specific allergens. Annual flu shots and certain other vaccinations can prevent severe asthma attacks due to infection. Weight loss and regular exercise clearly improve asthma frequency/severity.

As mentioned above, current asthma medications now used to treat asthma work in one of two ways: acutely (in the moment for an attack) or preventatively. For an acute attack, rescue medicines (tube openers, beta-agonists like albuterol) and strong anti-inflammatories (steroids like prednisone) work to open tubes and stop the triggering irritation, respectively. However, both patients and doctors prefer to prevent the irritation (inflammation) and attacks in the first place. Daily prevention medications (inhaled steroids, long-acting tube openers, leukotriene inhibitors like Singular, antibody biding medication like Xolair) stop attacks before they start. The combination of daily preventative medication and regular home lung testing can greatly reduce the number and severity of asthma attacks. [1]

Traditional Chinese Medicine (TCM) management of asthma is always complementary to conventional Western medical management. TCM has long recognized asthma, and has very many acupuncture points/meridians for addressing acute and long-term lung issues. Most dramatically, One-Needle Allergy Desensitization Therapy may actually eliminate or attenuate allergic responses, reducing symptoms in the lungs. In addition, Chinese Herbal Medicine addresses “Lung System weakness or excess”, “Wei Qi” /immune/inflammatory issues, infection, and/or “Cold Phlegm” in chronic asthma to both prevent and treat asthma attacks. [2], [3]

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These brief overviews of conditions represent distillations of basic and current medical reviews from the following sources:

[1] Conventional Medical Sources

“Harrison’s Principles of Internal Medicine: Volumes 1 and 2, 18th Edition”. Dan Longo Anthony Fauci, Dennis Kasper, Stephen Hauser, J. Jameson, Joseph Loscalzo. McGraw-Hill Professional; (July, 2011)

Medscape eMedicine Physician’s online resource. Various review articles:

Allergic and Environmental Asthma: an Overview of Asthma
William F Kelly III, MD  Associate Professor of Medicine, Uniformed Services University of the Health Sciences; Staff physician, Division of Pulmonary/Critical Care Medicine, Department of Medicine, Walter Reed National Military Medical Center

Allergic Rhinitis
Javed Sheikh, MD  Assistant Professor of Medicine, Harvard Medical School; Clinical Director, Division of Allergy and Inflammation, Clinical Director, Center for Eosinophilic Disorders, Beth Israel Deaconess Medical Center

Food Allergies
Scott H Sicherer, MD  Professor of Pediatrics, Jaffe Food Allergy Institute, Mount Sinai School of Medicine of New York University

Atopic Dermatitis
Brian S Kim, MD  Clinical Instructor, Department of Dermatology, Hospital of the University of Pennsylvania, Perelman School of Medicine, University of Pennsylvania

Seborrheic Dermatitis
Samuel T Selden, MD  Assistant Professor Department of Dermatology Eastern Virginia Medical School; Consulting Staff, Chesapeake General Hospital; Private Practice

Psoriasis
Jeffrey Meffert, MD  Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Urticaria
M Scott Linscott, MD, FACEP  Adjunct Professor of Surgery (Clinical), Division of Emergency Medicine, University of Utah School of Medicine

Cholinergic Urticaria
Robert A Schwartz, MD, MPH  Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

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