Many patients with asthma use CAM therapies
Many patients with asthma use CAM therapies
Herbs, acupuncture may be helpful for asthma
There’s probably no physical ailment more frightening to have, or to witness, than an acute asthma exacerbation. The wheezing, coughing, swollen airways, and inability to breathe is terrifying — and most patients will do almost anything to avoid it. That may be why asthma patients seek remedies, any remedies, to prevent attacks and to stop attacks under way.
CAM use may reduce number of attacks
While most experts agree that complementary medicine offers little to stop an asthma attack when it is under way, there are a number of herbs and complementary modalities that may offer anti-inflammatory and bronchodilatory relief to asthma sufferers and minimize the number of attacks. Most practitioners also agree that little research has been done on these remedies, although their time-tested traditional use should be taken into consideration.
"There’s really nothing new here. It’s a reintroduction of ancient remedies that worked in the past and still work," says Irwin Ziment, MD, chief of medicine at Olive View-UCLA Medical Center and a professor of medicine at the University of California at Los Angeles. Ziment points out that 80% of the world’s population still uses traditional medicines, and that many herbs and other so-called "alternative" therapies are effective in treating asthma. "For mild and moderate asthma, herbal and other complementary therapies provide a useful option since most patients don’t need regular medical supervision and over-the-counter and herbal remedies work just fine," he says. He says he does not recommend herbal therapies for severe or very severe asthma.
A University of California San Francisco survey showed that 8% of adult patients with asthma reported herbal self-treatment and 6% reported use of ephedrine or epinephrine.1 Researchers concluded that self-treatment was associated with an increased risk of hospitalization because "it may reflect delay in utilization of more efficacious treatments."
Other studies have shown that as many as 59% of all patients with asthma have used complementary therapies at some time and approximately 30% of all patients with asthma use complementary therapies regularly, with the largest numbers employing homeopathic and herbal therapies followed by yoga and acupuncture. Use of herbs is particularly high among patients with severe asthma, with one survey reporting that 44% of patients with severe asthma used herbs.2
Many patients also use coffee and tea for their bronchodilating effects. Homeopathic remedies frequently include belladonna, allium cepa, ephrasia, mixed pollens, and coffee in microdoses.
Ephedra use
Despite recent accounts of long-term, high-dose use of ephedra by dieters, which can lead to adverse cardiovascular and central nervous system events, Ziment and some of his colleagues agree that ephedra is one of the most effective herbal treatments for mild-to-moderate asthma. "It has been used for centuries and traditional Chinese medical practitioners are still using it. Obviously they’re satisfied," says Ziment.
Ephedra, also known as ma huang, has been shown to be an effective bronchodilator, says Mary Hardy, MD, medical director of the Integrative Medicine Program at Cedars-Sinai Medical Center in Los Angeles. "There are good data showing ephedra has been used effectively in the context of traditional Chinese medicine for treating asthma," she says. "However, patients using it should be monitored by a physician."
Ziment, who served on the Food and Drug Administration (FDA) panel that investigated adverse reactions to asthma, contends the FDA made a "bad tactical error" when it issued warnings about the possible adverse effects of ephedra. The directive that patients should consume no more than 8 mg of ephedra three times a day for no more than one week is "not realistic," he says. "I personally have taken much larger doses for much longer periods of time and so have my patients," says Ziment, author of a review of complementary therapies for asthma published in October.3 "Ephedra can be given perfectly safely to the majority of people without any worry," says Ziment, emphasizing that physicians should use caution with patients with cardiovascular disease.
"It is extremely important to recognize what our patients may be using and to properly advise them about these modalities and the possible physiological and immunological adverse events," says Leonard Bielory, MD, director of the division of allergy and immunology at the University of Medicine and Dentistry, New Jersey Medical School in Newark.
Standardization needed
Bielory says he is skeptical about ephedra because of the lack of standardization in the variety of products that are on the market, but he doesn’t object to patients with mild-to-moderate asthma using Sudafed or other over-the-counter preparation that are standardized. He says some of his patients have found relief for allergies and asthma with echinacea, honey bee pollen, and Ginkgo biloba.4
Acupuncture
In a 1997 consensus paper, the National Institutes of Health said acupuncture may be useful as an adjunct treatment, an acceptable alternative or as part of a comprehensive management program for asthma and a number of other chronic conditions, including adult postoperative and chemotherapy nausea and vomiting, postoperative dental pain, addiction, stroke rehabilitation, head-ache, menstrual cramps, tennis elbow, fibromyalgia, myofascial pain, osteoarthritis, low back pain, and carpal tunnel syndrome.
"I think acupuncture can be useful under the right circumstances," says Hardy, who also encourages her allergy and asthma patients to use a multivitamin regimen that includes antioxidants, flavonoids, quercetin and grapeseed extract.
Ziment says acupuncture has proven beneficial to many of his patients with mild-to-moderate asthma, and he has no objections to the therapy, although he thinks the evidence for its efficacy is "not convincing."
What works best? Hardy endorses a combination of vitamin therapy and yogic breathing exercises. (See table, below.) "It’s important to modify the emotional triggers of asthma as well as the emotional responses during an event. Yogic breathing techniques like simple diaphragmatic breathing, three-stage breath, breath locking, and alternate nostril breathing are all very effective for this purpose."
Diaphragmatic Breathing Technique for Asthma | |
Mary Hardy, Medical director of the Integrative Medicine Program at Cedars-Sinai Medical Center in Los Angeles, recommends diaphragmatic breathing for stress reduction and relief of asthma and allergy symptoms: | |
• | Sit in a comfortable relaxed position with spine straight. |
• | Place your hands on your belly and push it in and out a few times to become accustomed to the idea. |
• | Now take a deep, slow comfortable breath in through your nose, allowing the belly muscles to relax and press out as you inhale. |
• | When you are ready to exhale, gently pull your belly muscles in, squeezing the last of the air out of your lungs. |
• | Continue breathing in this manner in a slow, gentle relaxed way, for five minutes. |
Each patient is unique and responds to therapies in a different way, says Hardy. "I tell physicians and other practitioners not to have a knee- jerk reaction to the patient. Use the same analytical and diagnostic tools to look at the various components of asthma and you’ll find an effective holistic treatment," she says.
Bielory says he prefers a nonsteroidal menthol and eucalyptus nasal lavage. "The results have been good and I’ve seen a 30% to 40% reduction in the number of events. It seems to be especially helpful if a patient has been heavily exposed to allergens because it can be used to wash out the irritants, although it also helps with inflammation."
Ziment says traditional Chinese medicine, especially ephedra, works well, and there has been some promising preliminary research on Ayurvedic or traditional Indian medicine remedies for asthma.
Hardy, Ziment, and Bielory all call for more research on these remedies.
References
1. Blanc PD, Kuschner WG, Katz PP, et al. Use of herbal products, coffee or black tea, and over-the-counter medications as self-treatments among adults with asthma. J Allergy Clin Immunol 1997; 100:789-791.
2. Ernst E. Complementary therapies for asthma: What patients use. J Asthma 1998; 35:667-671.
3. Ziment I, Tashkin DP. Alternative medicine for allergy and asthma. J Allergy Clin Immunol 2000; 106:603-614.
4. Bielory L. Complementary medicine for the allergist. Allergy Asthma Proc 2001; 22:33-37.
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