Treatment of Asthma with Herbs and Acupuncture
By Dr. Alex Chen, L.Ac., O.M.D., Ph.D.
and Dr. John Chen, L.Ac., O.M.D., Ph.D., Pharm.D
DEFINITION: Asthma affects approximately 15 million Americans today. It’s a pulmonary disorder characterized by wheezing and dyspnea due to obstruction and inflammation of the airways. Asthma may be triggered by allergy, exertion, irritant particles, weather, psychological stress, etc.
ETIOLOGY: There are many causes of asthma. Allergens such as pollens, smoke, alcohol, house dust and animal hair may trigger an asthma attack. Asthma may also be induced by non-allergy related factors such as exertion, cold air, stress, Anxiety, crying, hearty laughing, and viral infection. Common morbidity associated with asthma include sinusitis, allergic rhinitis, gastroesophageal reflux, cardiovascular disease, diabetes, obesity, and hyperthyroidism.
CLINICAL MANIFESTATION: In an asthma attack, there will be a combination of spasm of the bronchi, inflammation of the airways, and increased mucous secretion. In mild to moderate cases, the patients will experience shortness of breath, wheezing, hyperpnea, and use of accessory muscles (such as neck and chest muscles) to facilitate breathing. Anxiety and sweating are commonly seen in asthmatics as they struggle for air. In severe cases, the patients will experience marked respiratory distress, cyanosis, use of accessory muscles, wheezes, lethargy and possibly confusion. Patients with severe asthma may not have any wheezing as there is very little air moving in and out of the lungs.
DIAGNOSIS: Asthma is diagnosed based on the characteristic episodes of wheezing, coughing, dyspnea or chest tightness interspersed with asymptomatic intervals. Objective confirmation is made with repeated spirometry tests performed over symptomatic and asymptomatic periods. Spirometry is a device that measures the breathing capacity of the lungs and is helpful in making the diagnosis, assessing the severity of the illness, and monitoring the effectiveness of the treatment.
If the asthma is allergy-induced, identification of the allergen is very important. Skin test for allergen, blood test for antibodies, and Inhalation Bronchial Challenge Test may assist in identifying the correct culprit. Allergic skin test helps to identify the allergen, but an allergen that causes an allergic reaction on the skin may not necessarily induce an asthma attack. Blood test for antibodies helps to determine the degree of sensitivity to that specific allergen. Additionally, an Inhalation Bronchial Challenge Test can be done to confirm the direct correlation between an allergen and an initiation of asthma attack. Since the patient will have to inhale a diluted solution of the allergen in the challenge test, there is a slight risk of a severe asthma attack.
TREATMENT: Drug treatments of asthma include management of an acute attack and maintenance on a daily basis. Five groups of drugs are commonly used for treating asthma.
- Beta-adrenergic Drugs: Beta-adrenergic drugs are bronchodilators that relax smooth muscle and widen the airways. They are commonly used for relieving sudden attacks of asthma and preventing exercise-induced asthma. Common examples of Beta-adrenergic drugs includes epinephrine (Primatene Mist or AsthmaHaler), isoproterenol (Isuprel), metaproterenol (Alupent), pirbuterol (Maxair), terbutaline (Brethaire) and albuterol (Proventil or Ventolin). Common side-effects of Beta-adrenergic drugs include increased Heart rate, nervousness, restlessness, headache and muscle tremors.
- Theophylline: Theophylline also relaxes bronchial smooth muscle and is commonly used to treat and/or prevent bronchial asthma. Common trade names of theophylline include Theo-Dur, Theo-24, Uniphyl and Slo-bid. Common side-effects of theophylline include nausea, vomiting, nervousness, restlessness, insomnia, and in severe cases, seizures and arrhythmia.
- Corticosteroids: Corticosteroids block the inflammatory response and reduce the asthma symptoms. Systemic corticosteroids (such as prednisone) may be used to treat acute asthma attack and inhalation of corticosteroids (such as Azmacort) may reduce the likelihood of asthma attack through desensitization to allergens. Though effective, long-term use of corticosteroids has a wide range of side-effects including but not limited to poor wound healing, decreased immunity, retarded growth in children, GI bleeding, hunger and weight gain.
- Cromolyn (Intal): Cromolyn (Intal) inhibits the release of inflammatory substances from mast cells and is used to prevent but not treat asthma. When taken regularly, cromolyn (Intal) is especially helpful in patients who have exercise-induced asthma. Cromolyn (Intal) is relatively safe but has occasional side-effects such as cough and hoarseness.
- Anticholinergic Drugs: Anticholinergic drugs produce bronchodilation by preventing smooth muscle contraction. Anticholinergic drugs are less potent and have a slower onset of action in comparison with beta-adrenergic drugs. Examples of anticholinergic drugs include atropine and ipratropium (Atrovent).
DEFINITION: In Chinese medicine, asthma is called “xiao chuan, ” which means wheezing and dyspnea, respectively. Chinese medicine classifies xiao and chuan as two separate illnesses with different treatments. Xiao (wheezing) is characterized by a whistling sound during breathing, increased respiration rate, dyspnea and inability to rest in a horizontal position. Chuan (shortness of breath) is characterized by dyspnea, constant opening of mouth to grasp air, raised shoulder, flared nostrils and inability to rest in a horizontal position. Patients with xiao (wheezing) generally will have chuan (shortness of breath), while patients with chuan (shortness of breath) may or may not have xiao (wheezing). In Western medicine, wheezing and shortness of breath are both considered as symptoms which may be present in many different types of pulmonary syndromes such as asthma, acute bronchitis, chronic bronchitis and emphysema.
ETIOLOGY: In Oriental Medicine, there are many factors that may trigger an asthma attack. Examples include the invasion of the external pathogenic factors, diet, emotional disturbances, congenital weakness and chronic illnesses.
External pathogenic factors, such as cold or heat, commonly induce asthma attacks. Lung dominates the Qi and manifests on the skin. As the environment affects the skin, the change is reflected in the Lung. As the Lung is attacked, its function to regulate water passage becomes impaired, water begins to stagnate and phlegm starts to form. Asthma attacks due to the invasion of external pathogenic factors is most likely to occur when the temperature is cold or if there is a rapid change in weather. External pathogenic factors may also include pollen, cigarette smoke, and any other allergens.
Diet can also trigger an asthma attack. Raw and cold food may injure the Spleen and tend to contribute to the stagnation of fluid circulation and the increase in the production of phlegm. Heavy, sweet, and greasy food tend to create phlegm and heat in the body. Fish, crabs, shellfish and other seafood have also been noted to increase the likelihood of asthma attacks as well.
Congenital weakness and chronic illness are also common causes of asthma. Children with asthma generally have congenital Kidney Qi deficiency. On the other hand, chronic illness, such as patients with chronic cough and recurrent cold/flu, are likely to have Lung deficiency.