Managing Asthma – Your Step by Step Guide

Asthma is inflammation of the bronchi; the breathing tubes that carry air into the lungs.

These airways swell and tighten, restricting airflow and making it hard to breathe. During an asthma attack, the narrowest airways (the bronchioles) constrict.

This causes the release of chemicals such as histamine that further increase inflammation and swelling and produce excess mucus.

Asthma is a long- term condition and is associated with immune imbalance/ dysfunction and allergies.

One in ten people in Australia has asthma and it affects people of all ages. Some people get asthma when they are young; others when they are older.

The causes of asthma are not fully understood, although people with asthma often have a family history of asthma, eczema and hay fever.

A Note on Food Allergies

People who are more prone to suffer from allergies seem to be at higher risk of developing asthma, the most common being dairy and/ or wheat.

If there is suspicion that you or your child has food allergies, a test that measures certain allergy antibodies (IgE) will need to be done to confirm that allergies exist.

Some supplements that can cause asthma symptoms and should be used with caution are echinacea (for those with daisy allergies), bee pollen or royal jelly (propolis), garlic and products containing aspirin.

Triggers

People with asthma have lungs with sensitive airways that react to triggers, causing a ‘flare-up’.
Triggers could be anything ranging from:

• House dust mites
• Medication
• Animal fur
• Pollen
• Tobacco smoke
• Exercise
• Cold air
• Chest infections

In a flare-up, the muscles around the airway squeeze tight, the airways swell and become narrow and there is more mucus. All of these processes make it harder to breathe.

An asthma flare-up can come on slowly (over hours, days or even weeks) or very quickly (over minutes). A sudden or severe asthma flare-up is called an asthma attack.

This can be a truely frightening experience.

A person’s asthma symptoms can vary over time – sometimes it is harder for a person with asthma to breathe in and out, but at other times their breathing is normal especially if their asthma is well-controlled.

Symptoms vary from person to person, but the most common symptoms are:

• Breathlessness
• Wheezing
• Tight feeling in the chest
• Continuing cough

Although there is currently no cure, with the right knowledge and good management, most people with asthma can lead full and active lives.

Conventional Medicines 

The two main types of asthma medicines prescribed to asthma sufferers are relievers and preventers. These are usually in the form of inhalers or puffers.

Relievers

Most people who have asthma has a reliever (e.g. a ‘puffer’) to use when they have asthma symptoms.

In Australia, most relievers are available from pharmacies without a prescription. Relievers should only be used when the individual has symptoms and should not be over-used.

The most common side-effects of inhaled corticosteroid medicines are hoarseness of the voice and fungal throat infections.

The risk can be reduced by taking the medicine using a spacer (a specially designed plastic container that attaches to the puffer), and by rinsing the mouth with water after using the puffer.

Common Relievers

• Anti-allergic prophylactic inhalers, such as sodium cromoglycate prevent mediator release from airway mast cells. The dose is dependent on severity and it may cause coughing.
• Corticosteroids are used acutely for severe attacks. It aims to prevent migration and activation of inflammatory cells.

Preventers

Preventer medicines make the airways less sensitive, reduce redness and swelling and help to dry up mucus. Preventers are recommended to be taken every day to reduce symptoms and asthma attacks.

Common Preventers

• Corticosteroid inhalers are prescribed in conventional medicine for enhanced protection. Examples are beclomethasone (e.g. Qvar) or fluticasone (e.g. Flixotide). Side effects of this drug include cough, hoarseness and oral thrush.
• Some asthma products contain a combination of a corticosteroid (preventer) and a long-acting beta2agonist (to help keep the airways open for up to 12 hours), to help keep asthma under control. Examples include Seretide (fluticasone plus salmeterol).

A Note on Bronchodilators:

• Beta2-adrenergic agonists are administered by metered dose inhaler. Studies have shown that increased use more than 3-4 times a week provides inadequate control of bronchodilation. Alternative dosing is via a nebuliser in the hospital (every one to two hours). This medicine stimulate adrenaline receptors and side effects include rapid or irregular heartbeat, insomnia, shakiness and nervousness.
• Anticholinergic agents, such as ipratropium bromide is dosed via inhaler. It inhibits the parasympathetic nervous system and side effects include dry mouth, cough, headaches, urinary retention and worsening of glaucoma.
• Methylxanthines are now used only intravenously for severe acute attacks or for night-time or severe persistent asthma. It has considerable side effects which include nausea, vomiting, headaches, insomnia, tremor, seizures, abnormal heart rhythms and possibly death.

Stopping preventer medications suddenly can sometimes be dangerous for people with asthma, as it may result in more frequent severe asthma attacks.

All changes in dosing should be supervised in conjunction with the prescribing specialist.

Asthma always requires medical management, but there are steps you can take to minimise the frequency and severity of attacks.

Diet

• All people with asthma should be on an anti inflammatory and low allergy diet. Try to avoid pro-inflammatory and allergenic foods like wheat, gluten, dairy, sugar and refined carbohydrates as these will increase inflammation and mucus production in the body.
• Reduce pro-inflammatory foods in the diet including saturated fats (meats and poultry). Patients sensitive to antibiotics should eat only organic meats to avoid potential antibiotic residues.
• Avoid foods with a high content of mould or leftover food, yeasts, pickles, vinegars, etc.
• Eat a minimally processed diet that is rich in antioxidants, phytonutrients and bioflavonoids.

Lifestyle

• Maintain an allergen-free environment.
• Cover pillows and mattresses with plastic/allergy covers.
• Use synthetic materials (foam mattresses, acrylics) instead of animal products (wool, horsehair).
• Minimise dust-collecting household items (i.e. carpets, curtains).
• Regularly wash soft toys.
• Use of an air purifier/dust filter may help.
• Avoid exposure to environmental tobacco smoke.
• Reduce chemical, irritant and pollution exposure.
• Avoid damp or mouldy housing conditions.
• Reduce exposure to pets and animal dander.
• Reduce exposure to dust mites and cockroaches – clean and vacuum regularly, wash bedclothes in very hot water, use mattress covers.
• Aim to breast feed exclusively until 6 months of age.

Useful Supplements

Vitamin D

Increased vitamin D levels are associated with greater lung function to reduce asthma severity and improve treatment response. Adequate Vitamin D may also reduce the incidence of infections, and increase the response to steroid medications.

Zinc

Zinc has been shown to support immune function.

Probiotics

Probiotics are essential for maintaining and improving gut flora. Seretide  – an inhaler drug may increase susceptibility to oral thrush, and in the long term corticosteroid use can lead to weight gain, metabolic dysfunction and reduced bone mineral density. By maintaining and restoring the balance of good bacteria in the gut, this helps to balance immune function and enhances digestive health.

LGG

LGG is a probiotic strain (Lactobacillus rhamnosus GG), a human probiotic strain that is one of the most extensively studied and best characterised therapeutic probiotics available. LGG can help balance beneficial bacteria in the gut, improve nutrient absorption, and may reduce the incidence of allergic conditions like asthma.

Vitamin C

Vitamin C deficiency has been found to exacerbate asthma symptoms, so keeping vitamin C levels up is crucial to help support immune function.

Fish Oil

Research shows that people with chronic inflammatory disorders, like asthma have been found to be low in omega 3 fats.

Magnesium

Magnesium is essential in reducing bronchospasm/ bronchoconstriction in asthmatic patients as well as reducing stress and inflammatory activity.

Mushroom

Medicinal mushrooms play an important role in immune modulation, help to improve overall immune resistance and have congestion clearing effects to help with asthma and bronchitis management.

Other Herbs

Anti-allergy herbs perilla and albizia with quercetin provide effective acute relief of allergy, with mucus clearing properties, especially indicated for asthma and allergic rhinitis.

The Role of Stress and Anxiety 

Hypersensitivity reactions may be associated with stress and anxiety. Counselling and/or stress management may help reduce reactivity.

Exercise Therapy

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