Natural treatments for asthma

DEFINITION: Treatment of severe breathing difficulties caused by bronchial inflammation and contraction.

PRINCIPAL PROPOSED NATURAL TREATMENTS: Boswellia, Coleus forskohlii, tylophora, ephedra (unsafe), vitamin C

OTHER PROPOSED NATURAL TREATMENTS: Acupuncture, adrenal extract, aloe, antioxidants, astha-15 (an Ayurvedic herbal combination), brahmi (Bacopa monniera), beta-carotene, betaine hydrochloride, butterbur, Carum copticum (ajwain), chamomile, coenzyme Q₁₀, curcumin, damiana, elecampane, elimination diet, essential fatty acids (omega-3 and omega-6 fatty acids), essential oil of eucalyptus, fish oil, flaxseed oil, food allergen elimination diet, garlic, gamma-linolenic acid from evening primrose oil, green-lipped mussel, grindelia, horehound, hyssop, hypnosis, ivy leaf, licorice, Lobelia inflata, magnesium, marshmallow, massage, melatonin, mullein, onion, oligomeric proanthocyanidins, osteopathic manipulation, picrorhiza, quercetin, reishi, relaxation therapy, selenium, sublingual immunotherapy, vitamin B₆, vitamin B₁₂, vitamin E, yerba santa, yoga

Introduction

People who have an asthma attack have trouble taking a breath. For asthmatics, the bronchial tubes in their lungs become swollen and clogged. Breathing can become frighteningly difficult.

Asthma involves two conditions: contraction of the small muscles surrounding the bronchial tubes and inflammation of the lining of those tubes. Traditionally treatment primarily addressed the first aspect of asthma, but it soon became clear that tissue swelling is the underlying cause.

The conventional treatment of asthma is highly effective for most people. Treatments include both short- and long-acting bronchodilators, which relax the bronchial muscles, and anti-inflammatory medication, which helps relieve the swelling of tissue. Bronchodilators alone may be sufficient treatment for mild asthma or asthma that occurs only with exercise. Anti-inflammatory steroids in the cortisone family taken by inhalation are the mainstay of treatment for moderate to severe asthma. Although these are much safer than oral steroids, they may still increase the risk of osteoporosis and other problems when they are taken in high doses or for a long time. Other drugs used to reduce inflammation include montelukast (Singulair), nedocromil (Tilade) and cromolyn (Intal). (Intal is derived from a Mediterranean herb named khella.) The newest drug treatment for asthma, omalizumab (Xolair), appears to be safe and effective, but it is extremely expensive, and for this reason, it is seldom used.

Principal Proposed Natural Treatments

None of these treatments has been shown to be effective for severe asthma. One should not stop standard asthma medication except on the advice of a physician.

The herb Tylophora indica (also called T. asthmatica) appears to offer some promise as a treatment for asthma. It has a long history of use in the traditional Ayurvedic medicine of India. However, all of the studies on this herb were performed in India long ago and failed to reach modern standards of design and reporting.

In a double-blind, placebo-controlled study of 195 persons with asthma, the participants who were given forty milligrams (mg) of a tylophora alcohol extract daily for six days showed significant improvement compared with the placebo. Similar results were seen in two double-blind, placebo-controlled studies involving more than two hundred persons with asthma. However, the design of these studies was a bit convoluted, and various pieces of information were missing from the reports, causing some difficulty in evaluating the validity of these trials.

Another double-blind study that enrolled 135 persons and followed a more straightforward design found no benefit from tylophora. Although tylophora is promising, larger and better studies are necessary to discover whether tylophora is truly effective.

Boswellia. The herb boswellia has shown promise as a treatment for rheumatoid arthritis. It is thought to work by inhibiting inflammation. Because asthma involves inflammation and can be treated by some of the same drugs that treat rheumatoid arthritis, boswellia has also been proposed for this purpose.

One six-week, double-blind, placebo-controlled study of eighty persons with relatively mild asthma found that using boswellia at three hundred mg three times daily reduced the frequency of asthma attacks and improved objective measurements of breathing capacity. However, further research must be performed before boswellia can be described as a proven treatment for asthma.

Coleus forskohlii. Another herb sometimes recommended for asthma also comes from India, Coleus forskohlii. While there is some preliminary evidence that it might have value, this evidence is far too weak to be relied on. Furthermore, as sold, the herb is more like a drug than an herb. Natural C. forskohlii contains small amounts of a potent chemical called forskolin. Manufacturers deliberately modify the herb to dramatically increase its forskolin content; therefore, when using such products, one is essentially using an unlicensed drug. Forskolin appears to be safe, but more studies need to be undertaken before it can be recommended for self-treatment.

Ma huang. The Chinese herb ma huang, also called ephedra, is definitely effective for mild asthma because it contains the drug ephedrine. However, it is not recommended because of safety concerns. This Chinese herb is a member of a primitive family of plants that look like thin, branching, connected straws. A related species, Ephedra nevadensis, grows wild in the American Southwest and is widely called Mormon tea. However, only the Asian species of ephedra contains the active compounds ephedrine and pseudoephedrine.

Ma huang was traditionally used by Chinese herbalists in the early stages of respiratory infections and for the short-term treatment of certain kinds of asthma, eczema, hay fever, narcolepsy, and edema. Japanese chemists isolated ephedrine from ma huang around the beginning of the twentieth century, and it soon became a primary treatment for asthma in the US and abroad. Ephedra’s other major ingredient, pseudoephedrine, became the decongestant Sudafed.

Although ephedrine can still be found in a few over-the-counter asthma drugs, physicians seldom prescribe it. The problem is that ephedrine mimics the effects of adrenaline and causes symptoms such as rapid heartbeat, high blood pressure, agitation, insomnia, nausea, and loss of appetite. The newer asthma drugs are much safer and easier to tolerate. This is a situation in which synthetic drugs are less dangerous than a natural one. Ma huang is not recommended for use in treating asthma.

Other Proposed Natural Treatments

Other herbs and supplements. In a double-blind trial, thirty-two people with steroid-dependent asthma were given either a placebo or essential oil of eucalyptus for twelve weeks. The results showed that people using eucalyptus were more able to gradually reduce their steroid dosage than those taking the placebo.

Two double-blind, placebo-controlled studies enrolling more than eighty people with asthma suggest that oligomeric proanthocyanidins from pine bark might reduce symptoms. An extract made from ivy leaf has been advocated for the treatment of childhood asthma, but the meaningful supporting evidence is again limited to one placebo-controlled trial.

Another small, double-blind, placebo-controlled study evaluated the effects of four weeks of treatment with a Japanese herbal mixture traditionally called Saiboku-To. Researchers tested the tendency of the bronchial tubes to contract in response to an asthma-producing substance called methacholine. The results indicated that using Saiboku-To helped prevent such contractions, and it also reduced lung inflammation. Another study reportedly found benefit with a combination named Mai-Men-Dong-Tang.

Many studies have been conducted on the effects of vitamin C in treating asthma, but the evidence that it works remains inconsistent and highly incomplete. There is only weak and inconsistent evidence regarding whether two antioxidants in the carotenoid family, lycopene and beta-carotene, might help prevent exercise-induced asthma. One double-blind comparative study provided weak evidence that the Ayurvedic herbal combination called Astha might be helpful for mild asthma. Results remained inconclusive.

Vitamin B₆ is often mentioned as a treatment for asthma, but the evidence that it works is weak and contradictory at best. A double-blind study of seventy-six children with asthma found significant benefit from vitamin B₆ after the second month of usage. Children in the treated group were able to reduce their doses of bronchodilators and steroids. However, a double-blind study of thirty-one adults who also used either inhaled or oral steroids did not show any benefit. Supplementation with vitamin B₁₂ is also often said to be effective for asthma. However, the scientific evidence in its favor consists almost entirely of open studies that did not attempt to eliminate the placebo effect.

Preliminary evidence hints that the herb butterbur may be helpful for asthma. Another study found potential benefit with the spice Carum copticum.

Essential fatty acids, such as gamma-linolenic acid and those found in fish oil, as well as flaxseed oil, may inhibit inflammatory responses such as those that occur in asthma. However, of the studies that tried fish oil as a treatment for asthma, most failed to find significant clinical benefit; one study found that fish oil can worsen aspirin-related asthma. Nonetheless, there is some evidence from one research group that fish oil might be helpful for exercise-induced asthma. There is also some preliminary evidence that women who take fish oil during late pregnancy may reduce the risk of asthma in their children for up to sixteen years after birth.

Curcumin, a key component in turmeric, showed promise in studies as an add on therapy for those with Bronchial asthma. Curcumin contains anti-inflammatory properties. A blind study of seventy-seven patients with mild to moderate Bronchial asthma concluded that curcumin capsules helped improve their airway obstruction.  

A study of seventy-two children with moderate, persistent asthma found that combined or single supplementation with omega-3 oils, zinc, or vitamin C improved their symptoms and lung function. Combined supplementation was associated with the greatest improvement. The reliability of these results should be questioned, however, because about 20 percent of the children dropped out before the end of the thirty-eight-week study.

A preliminary double-blind, placebo-controlled trial suggests that green-lipped mussel extract might be helpful for allergic asthma. Another study suggests that the natural substance hyaluronic acid might be helpful for asthma when taken by inhalation.

Natural medicine practitioners frequently recommend the flavonoid quercetin as a treatment for asthma. However, the only basis for this recommendation consists of a few older, preliminary test-tube studies that suggest it might inhibit the release of inflammatory substances from special cells called mast cells. The asthma drugs Intal (cromolyn) and Tilade (nedocromil) are believed to work in this way. However, there is significant direct evidence from human trials that Tilade and Intal taken by inhalation actually work. In contrast, little evidence exists for quercetin, and it is highly unlikely that oral intake of quercetin could produce levels in the body similar to the levels used in those test-tube studies.

Alternative medical literature frequently mentions magnesium as a treatment for asthma. However, this idea seems to be based primarily on the use of intravenous magnesium as an emergency treatment for asthma. (Taking something by mouth is very different from having it injected into the veins.) Studies of oral magnesium for asthma have shown more negative than positive results, but some evidence exists that intravenous or inhaled magnesium may be beneficial. Also, preliminary evidence, far too weak to be relied upon, has been used to suggest that the supplement coenzyme Q₁₀ (CoQ₁₀) might be helpful for asthma.

Other natural products commonly recommended for asthma include the herbs aloe, brahmi (Bacopa monniera), chamomile, damiana, elecampane, garlic, grindelia, horehound, hyssop, licorice, marshmallow, mullein, onion, reishi, turmeric, and yerba santa, and the supplements adrenal extract and betaine hydrochloride. Lobelia inflata is sometimes recommended as an herbal treatment for asthma. According to traditional directions, though, it should be taken to the point of vomiting. None of these treatments have meaningful supporting evidence.

Antioxidants, such as vitamin E, beta-carotene, and selenium, are frequently recommended for asthma on the grounds that they may protect inflamed lung tissue. Although one study found that asthmatics placed on a low-antioxidant diet for ten days experienced a worsening of their symptoms, there is no direct scientific evidence that antioxidant supplementation improves asthma. A theoretical study found evidence that using vitamin E may decrease the inflammatory response in children with asthma exposed to ozone. However, a double-blind, placebo-controlled study found five hundred mg of natural vitamin E ineffective for asthma treatment. Similarly, in a study of nearly two hundred participants, researchers failed to find selenium helpful for asthma.

The herb picrorhiza has been advocated as a treatment for asthma, based primarily on two studies conducted in the 1970s. However, none of these studies reached modern scientific standards. Two subsequent, and better-designed, studies of picrorhiza failed to find the herb more effective than the placebo.

One study failed to find a mixture of probiotics (friendly bacteria) helpful for asthma in children. Another study, though, found that a mixture of probiotic Bifidobacterium breve and the prebiotic galacto- and fructo-oligosaccharide may help reduce wheezing in infants with eczema.

Children with asthma may have reduced growth, possibly from using inhaled steroids. One study failed to find protective benefits with a multivitamin that contained vitamin D. The tested supplement did not contain calcium. Other studies have found that combination treatment with both calcium and vitamin D may protect bone density in people taking oral corticosteroids (for various reasons, including asthma).

Two studies reported by one research group have led to publicized concerns that the use of the insomnia supplement melatonin may worsen night-time asthma. However, one double-blind study of melatonin in people with asthma found evidence of improved sleep without the worsening of asthma symptoms. Studies indicate that an individual's response to melatonin is highly dependent on their physiological make-up and other medications taken. It is generally accepted by the medical community that large doses of melatonin are not recommended for those with asthma.

Acupuncture. Although there have been numerous reports on acupuncture treatment for asthma, the results have been contradictory. A team of three researchers analyzed thirteen trials on acupuncture in the treatment of asthma. These studies were scored on the basis of design quality, with a maximum possible score of 100 points. Criteria for assigning points included size of the study population, randomization procedure, description of treatment, measurement of effects, and follow-up. Eight studies earned more than 50 points, and the highest score was 72 points. However, the overall quality of studies was judged to be mediocre In any case, the results were contradictory. The conclusion was that “claims that acupuncture is effective in the treatment of asthma are not based on the results of well-performed clinical trials.” Another review of acupuncture for asthma came to identical conclusions.

Other alternative therapies. Sublingual immunotherapy, a form of “allergy shot” that involves drops under the tongue rather than injections, has shown promise for asthma. Some people with asthma may also have food allergies. One way to discover a food allergy is to eliminate potentially allergenic foods from the diet, and then systematically reintroduce them to see if a reaction occurs. This elimination diet should be done only under the care of a doctor because of the risk of severe allergic reaction. Other ways to diagnose a food allergy include the skin scratch test and blood tests (such as RAST or ELISA). Persons with a food allergy who eliminate the offending food from the diet might reduce their asthma symptoms.

A special breathing technique called Buteyko breathing may reduce medication use and subjective symptoms, though it does not appear to actually improve lung function. Hypnosis, massage, yoga, and some other forms of relaxation therapy may offer modest benefits for asthma. The same is true of standard aerobic exercise.

In two controlled studies, chiropractic spinal manipulation has failed to prove more effective than fake manipulation for the treatment of asthma. One study of osteopathic manipulation reportedly found benefits, but the study’s design was flawed.

Homeopathic Remedies

In a double-blind, placebo-controlled study of forty people with asthma severe enough to require corticosteroid treatment, the use of an injected homeopathic remedy consisting of Asclepias vincetoxicum and sulfur significantly improved symptoms.

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