Transcript Integrative Approach to Asthma

Integrative Approach to
Asthma
Asthma prevalence is
rising worldwide
better diagnosis
air pollution
allergies
dietary factors
hygiene hypothesis
obesity
antibiotics in 1st year
Asthma prevalence in Canada
1978-1996
Asthma morbidity and mortality
Asthma 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/year
Significant costs:
 Quality of life
 Medications
 Health care system
Key features of asthma
Variable air flow obstruction
Airway hyper-responsiveness
Cellular inflammation
exercise
allergens
infections
Asthma is a
heterogenous condition
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 fats
The kinds of dietary fats
consumed during pregnancy
may have a significant impact
on childhood asthma risk
An 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 risk
Consumption 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 3050%
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
Omega 3 fatty
acids in EIA
Fish oil (EPA+DHA) reduces inflammation
1997 AJCN: >40% of the asthmatic ‘responders’
showed a complete resolution of airway hyperresponsiveness. 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 6 pathway
Linoleic acid (LA)
Safflower, sunflower,
corn, peanut oils
Omega 3 pathway
Alpha-linolenic acid
(LNA) Flax, walnuts,
hemp, canola
Delta-6 desaturase
Gamma-linolenic acid
Evening primrose oil
(GLA)
Elongase
Eicosapentanoic acid
halibut
(EPA) Salmon,
sardines, herring
PG1
Arachidonic acid
(AA)
PG2
Meat,
butter
PG3
Docosahexanoic acid
halibut,
(DHA) Salmon,
sardines, herring
Cell membrane
composition after
omega 3 fatty acid
supplementation
Study
EPA
DHA
(as % total neutrophil FA content)
*Arm, et al.
10 wk
3.2 EPA+2.2 DHA
*Lee, et al.
6 wk
3.2 EPA+2.2 DHA
0.2
2.6**
2.2
2.6
<0.1
1.5**
1.7
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)
b-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 serrata
Ayurvedic medicine- gum resin and
bark used
Boswellic acids inhibit leukotriene
synthesis (anti-inflammatory effect)
This herb has been used for
arthritis, inflammatory bowel
disease and asthma
In a 6 week study of 40 asthmatics,
70% showed improved lung
function
Usual dose is 400-800mg tid
More studies are needed to assess
long term safety
Butterbur (Petasites hybridus)
Rhizome (root) is used
Spasmolytic and anti-inflammatory
Used for: migraine prophylaxis,
hayfever & asthma
In 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-oxidant
KEY 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 bronchodilation
Contraindicated in heart disease,
hypertension, glaucoma
Should only be used by an
experienced practitioner of
traditional Chinese Medicine
Licorice (Glycyrrhiza glabra)
Often used in TCM in
combination with other herbs
Root is used medicinally
Anti-inflammatory, anti-tussive,
expectorant
Licorice can reduce the need for
steroids (Steroid sparing effect)
Safe dose is 1-1.5 gm crude
licorice/day
Use 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 9tetrahydrocannabinol (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