Asthma

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Asthma is a very common condition. Its typical symptoms are wheezing (a whistling noise in the chest), shortness of breath, coughing and a tight feeling in the chest caused by reversible obstruction of the airways as a result of inflammation or muscle spasm. Asthma may begin at any age and, if neglected, tends to recur and become chronic.

Asthma is a condition that affects the airways – the small tubes that carry air in and out of the lungs. Basically asthmatic attacks obstruct the flow of air to the lungs. People with asthma have airways that are almost always red and sensitive (inflamed). Their airways can react badly when they have a cold or other viral infection, or when they come into contact with an asthma trigger (something that sets off their symptoms). When this happens the muscles around the walls of the airways tighten and they become narrower. The lining of the airways swells and often produces a sticky mucus. As the airways narrow, the air has to squeeze in and out, and this is what causes the person with asthma to find it difficult to breathe.

Asthma may be allergic or non-allergic in origin. In allergic asthma, environmental allergens trigger the disease when inhaled or ingested. An asthma trigger is anything that irritates the airways and sets off the symptoms of asthma. Common triggers include colds or flu, cigarette smoke, exercise and allergies to things like pollen, furry or feathery animals or house-dust mite. Everyone’s asthma is different and you will probably have several triggers.

Most modern cities have problems with air quality outdoors, and indoor air is subject to pollution by furnishings, household chemicals, cosmetics and pet dander. Casual use of insecticides, pesticides and herbicides on lawns and food crops, as well as indoor exposures at work and at home, have also affected a number of patients.There is currently no evidence that traffic pollution causes asthma, although poor air quality can make your asthma worse. Asthma, like its related allergic conditions eczema and hay fever, often runs in the family and may be inherited.

Possible Symptoms

During asthmatic attacks breathing becomes difficult and forced breathing becomes necessary. A wheezing sound appears, due to the rush of air through the narrowed airways. At the same time, a troublesome cough can develop.

Symptoms of allergy and hypersensitivity may affect the body in the sinuses, the airways, the mucous membranes, the lungs or the skin. Some individuals develop problems in all of these areas. Sinus symptoms may include congestion, watery or sticky discharges, pain and pressure. Sinus inflammation can also trigger facial headaches as well as migraine headaches and vascular headaches.There is no hard and fast way of telling if you have asthma or not. This is partly because the symptoms can vary and may be similar to other respiratory conditions that are not asthma.

Asthma symptoms include shortness of breath, wheezing, cough and chest tightness. Not everybody will have all these symptoms. A history of asthma, eczema or hay fever in the family may mean that your chances of developing asthma are slightly higher than those without. If you suspect that you may have asthma, it is important to see your physician. He or she will discuss your medical history and your current symptoms. He or she also may want to measure your peak flow using a peak flow meter. A peak flow meter is a small hand-held device with a marker that slides up and down as you blow into it. The marker stops at the point when you blow hardest. Each time you use the meter (usually morning and evening) the result is marked on a chart. It can help along with keeping a record of your symptoms to give the doctor a better picture of how well controlled your asthma is. The doctor may decide to give you your own peak flow meter on prescription and ask you to keep a diary of readings before seeing him or her again.

Western Medicine Points of View

There is no cure for Asthma in Western medicine, so different types of medication and tablets have been developed to help sufferers manage the condition. Devices such as inhalers are commonly used. An inhaler ensures that very small amounts of medication are delivered directly into the lungs either to relax muscles or to calm inflammation in the airways and make them less likely to react badly to the environmental triggers of asthma. There are a variety of inhalers available. It is important that you use a device that you are comfortable with and can use properly. Your doctor or nurse will advise you on the most appropriate device and should demonstrate how to use it correctly.

There are two main types of asthma medication – relievers and preventers. Reliever inhalers are usually blue. They act by opening up the airways causing the muscles to relax and therefore allowing you to breathe more easily. The reliever should only be used when the symptoms of asthma appear or, if recommended, before exercise. They do not reduce the inflammation in the airways. If you need to use your reliever more than once a day or 3-4 times per week this suggests that there is a degree of inflammation in your airways that requires preventer treatment.

Preventers usually come in brown, red or orange inhalers. They work over a period of time to calm inflammation in the airways and make them less likely to react badly when you come across an asthma trigger. They need to be taken regularly. Most preventers are inhaled corticosteroids. It is important to understand that corticosteroids are not the same as anabolic steroids used by athletes to improve their performance. There are other types of medication that can be added to your reliever and preventer treatment if needed, such as preventer tablets and long-acting relievers.

TCM Points of View

Clinical trials have shown that acupuncture has a therapeutic effect on bronchial asthma.

In Traditional Chinese Medicine (TCM), asthma is caused by excessive phlegm resulting from weakened spleen and kidney, the two main organs responsible for the processing of body liquids. TCM distinguishes two general patterns of asthma, an Excess pattern and a Deficiency pattern. The former corresponds with acute asthma where one experiences a tight chest, severe shortness of breath, wheezing and often feels thirsty and feverish. The deficiency pattern occurs in chronic asthma, where patients complain of wheezing, sweating, general lassitude and cold hands and feet.

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. In Chinese medicine, asthma is called Xiao Chuan, which means wheezing and dyspnea (shortness of breath), respectively. TCM 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 shoulders, 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. It is very common for patients who have recurrent asthma attacks to have Kidney Deficiency. When under attack, such patients are said to have Upper Excess with Lower Deficiency.

Upper Excess refers to phlegm stagnation in the Lung and is characterizes by recurrent or continuous wheezing (which worsens after exertion), laboured inhalation and smooth exhalation, snoring sound in the throat, low-pitched rhonchi, audible wheezes, shortness of breath, a frail cough with scanty, thin, or frothy sputum, and a dry throat.

Lower Deficiency refers to a deficiency of Kidney Qi (the Kidney’s essential energy) or deficiency of Yang (the body’s hot energy) and is characterized by difficult inhalation as Kidney cannot grasp and hold the air down. In addition, the patients may also have deficiencies of the Lung and the Spleen.

Deficiency of the Lung is characterized by aversion to wind and spontaneous sweating while deficiency of the Spleen is characterized by increased production of phlegm and sputum. Patients may have red cheeks, red tongue with scanty coat. Pulse is thready and rapid. External pathogenic factors, such as cold or heat, commonly induce asthma attacks. Lung dominates the Qi (the body’s essential energy) 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 are 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 tends 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. Congenital weakness and chronic illness are also common causes of asthma. Children with asthma generally have congenital Kidney Qi deficiency, while patients with chronic illness such as chronic cough and recurrent cold/flu, are also likely to have Lung deficiency.

The fundamental cause of asthma is the presence of phlegm. In TCM, the passage of water is controlled by three organs, namely Lung, Spleen and Kidney.(Also Triple Warmer/SanJiao) The Lung regulates the water passages in the body’s Upper Burner section (Heart, Lungs, Pericardium, throat and head), the Spleen transports and transforms water in the Middle Burner section (Stomach, Spleen, Gall Bladder) and the Kidney dominates water metabolism in the Lower Burner (Liver, Kidneys, Instestines, Bladder). Imbalance of Yin and Yang (cooling bodily fluids and hot material energy, respectively) in any of these three organs may lead to stagnation of the water circulation, which then contributes to the production and storage of phlegm in the Lung.

Storage of phlegm in the Lung becomes the main cause for recurrent asthma attacks. Chronic asthma will lead to deficiency of Lung, Spleen and Kidney. Deficiency of the Lung means an inability of the Lung to inhale the air, and deficiency of the Kidney creates an inability of the Kidney to receive or grasp air. This will be complicated further if the Spleen is also deficient and there is an excess amount of phlegm that obstructs the airway. Overall, the condition becomes more and more complicated as the underlying syndrome represents a Deficient condition while the symptoms show an Excess condition.

Hot asthma occurs when heat attacks the Lung. In this case the Lung is no longer able to command Qi and control respiration. Patients generally experience a choking sensation, coughing spells and intercostal distention. Patients will also have phlegm as characterized by wheezing, crackling or moist rales and roaring sound in the throat from copious sputum that is thick and difficult to expectorate. Sputum is usually yellow but may be white in some cases where heat is not as prominent. It is common for patients to raise their shoulders to help breathing. Fever, irritability, perspiration, headache, thirst with desire to drink, flushed face and possible fever with aversion to cold are some of the symptoms of asthma due to heat. The tongue is red with yellow greasy coating. The pulse is superficial rapid or wiry.

The treatment principle for the Excess pattern is to dissolve Phlegm whereas for the Deficiency pattern the priority is to strengthen and tonify the weakened Qi (the body’s essential energy).Allergic conditions such as asthma and hay fever are due to a deficiency in the immune system. A weakened or over-sensitive immune system makes one more susceptible to external pathogenic factors like pollen and other allergens. Treatment for asthma, therefore, also focuses on strengthening the immune system. the treatment principle for the Excess pattern of asthma is to dissolve Phlegm whereas for the Deficiency pattern the priority is to strengthen and tonify the weakened Qi.

In TCM Points of view, allergic conditions such as asthma and hay fever are due to a deficiency in the immune system. A weakened or over-sensitive immune system makes one more susceptible to what TCM calls external pathogenic factors like pollen and other allergens. Treatment for asthma, therefore, also focuses on strengthening the immune system. For cold asthma acupuncture treatment should focus on sedating the Lung and eliminating the phlegm. In addition acupuncture may be used to treat stuffy or runny nose.

Treatments

Effects of acupuncture should be cumulative. After a series of treatments, one  should notice a reduction in the frequency and severity of attacks. Acupuncture has the effect of strengthening a person’s constitution and overall health so that their allergic response is reduced.

Herbal formulas can enhance the effect of acupuncture in relieving asthma. Many asthma formulas contain a herb which are meant to expand constricted bronchioles. Other herbs might have to be prescribed which, according to Chinese Medical theory, reduce phlegm production, combat infection, moisten the lungs and astringe coughing. There are many different types of asthma recognized in TCM. Different Herbal Formulation will be prescribed accordingly.

Liver and Asthma

Emotional stress can also be a factor in asthmatic episodes, and that can be used to address these issues as well. Asthma often is worse at certain seasons and at certain times of day. As with many chronic imbalances, treatment may require an ongoing effort from the patient and TCM doctor. Because there are different forms of asthma and each person may have a different imbalances, developing the correct, individualized, approach is important and often requires a number of appointments.

Prevention

In TCM, we say we treat winter disease in Summer and vice versa. For chronic asthma patients, we highly recommend to get Tonify or the prevention treatments during Summer. Taking certain preventative measures at home can lessen your chances of developing asthma, or reduce your symptoms. These steps include reducing the amount of dust in your home and can be achieved using simple measures like damp dusting and opening windows. Smoking during pregnancy increases the chance of a child developing asthma.