by Dr. Gary Farr on 13 February 2002
What is it?/Characteristics/Cause
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Asthma is a narrowing of airways in the lungs that causes coughing, wheezing and gasping for breath. It has probably been around since cave dwellers slept on furs coated with dust mites and cockroach crud. But why is it on a rampage today when, ironically, we know more than ever about its causes and treatment? "It's a paradox," says N. Franklin Adkinson, professor of medicine at the Johns Hopkins Medical Institutions. "After over a decade of spending large amounts of money investigating this disease, and finding more powerful, less toxic drugs, all of which should benefit patients, the prevalence has doubled" and the death rate has soared. Consider the 300 million air sacs in the human lungs: Small, fragile, exquisitely designed, they are a critical place where body meets world. The goal, naturally, is to exchange gases: Oxygen from incoming air is transferred to the bloodstream.
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Asthma is definitely not a do-it-yourself illness. Nor is it something that should be treated only in emergency rooms. If you suspect you have asthma, don't call The Why Files. Call your doc.
In a normal bronchial tube, relaxed muscles and thin walls allow good airflow. In an inflamed tube, tightened muscles, thickened walls, and abundant mucus inhibit air flow. And carbon dioxide and other waste gases in the blood leave with the exhaled air. This gas exchange is the kind of thing you take for granted until it goes bad. In asthma, that deterioration starts when the lung becomes what doctors call "hyper-reactive." Essentially, that means the airways respond too strongly to a stimulus by narrowing. Breathing becomes more difficult; in severe cases, it becomes impossible, and the disease claims another victim.
Typically, asthma occurs in episodes. The sequence starts with an inflammation, often caused by an allergic response to dust mites, animal dandruff, mold or pollen. That inflammation sets the stage for further irritation. "If your airway is provoked by an allergen, then any other allergen will have a greater effect," says Norman Edelman, a lung specialist who is a consultant to the American Lung Association and dean of the Medical School at State University of New York at Stony Brook.
How bad is asthma?
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Asthma - Statistics |
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The passage lining swells. More mucus is secreted. Muscles around the airway tighten Combined, this narrowing makes breathing, particularly exhaling, more difficult. In more severe attacks, wheezing and whistling are heard. To the asthmatic, it can feel like breathing through a straw. |
Bad and getting worse. Don't believe us? Then check these numbers:
Doctor and hospital visits due to asthma are up 50 percent in a decade to 14 million per year. That included 1.6 million visits to emergency rooms, the doctor-of-last-resort to many people without health insurance.
Worldwide, the prevalence of asthma ranges from 1.9 percent to 36.7 percent in various countries, according to the International Study of Asthma and Allergy in Children.
What's behind the radical rise in this disease?
Too many causes, too much disease
In their search for the causes of asthma, scientists have blamed lots of disgusting stuff, like roach parts and mite scats. They've also found a few asthma triggers that aren't so disgusting, like cold, dry air.
And even a few that should be healthy, like exercise.
Many, indeed most, cases of asthma, particularly among children, have allergies as a major component. Allergies to what? Dust mites, pollen, animal dander (shed skin), cockroaches, and
certain foods. Different people have different allergies, obviously. Intriguingly, an allergen that sets off a sneezing fit may or may not set off an asthma attack -- even in the same person.
Let's stick with this el-grosso train of thought by looking at some of the more revolting asthma triggers.
Disgusting:
- Infection: Viral infections of the respiratory apparatus irritate the tissues and seem to set up asthma attacks. Similarly, bacterial sinus infections can aggravate asthma by causing mucus to drain into the lungs.
- Irritants: Chemicals such as strong perfumes, household cleansers, or industrial dusts and vapors can all irritate the lungs.
Tobacco smoke: to the smoker or nearby victims, can irritate the airways.- Gastroesophageal reflux: a "burping up" of acid stomach contents is irritating (and not just to the lungs).
- Roaches: A recent study of asthmatic children in eight inner-city neighborhoods found that similar numbers of children were allergic to roaches (37 percent) and dust mites (35 percent). Yet roach-parts seemed much more potent in triggering asthma: 50 percent of the kids' rooms contained roach allergen, compared to 10 percent containing dust-mite allergen. And the roach-allergic kids who lived in roach-infested houses were admitted to hospitals three times as often as other asthmatic kids in the study. "The combination of cockroach allergy and exposure to high levels of this allergen may help explain the frequency of asthma-related health problems in inner-city children," the researchers concluded.
Are all asthma triggers so disgusting?
Not so disgusting
- Lots of funky stuff -- roach parts, dust mites, even ragweed pollen -- can trigger asthma attacks. But other things can also cause the airways to constrict:
- Drugs and food: As many as 20 percent of adult asthmatics have attacks after exposure to aspirin, non-steroidal anti-inflammatory medicines, or sulfites in food and drink.
- Exercise: An estimated 85 percent of allergic asthmatics wheeze after exercise, with long-distance running and serious cycling being the worst offenders. (Swimming seems particularly benign to asthmatics.)
- Emotions: Stress and fatigue can affect the immune system in ways that start or exacerbate an attack. "Any chronic disease," says Marcus Cohen, an allergist in private practice in Madison, Wis., "is precipitated and made worse by psychosomatic factors."
- Violence: A study by Rosalind Wright of Brigham and Women's Hospital in Boston suggests that children exposed to violence in their neighborhoods (through hearing gunshots or witnessing physical violence) were twice as likely as other children to experience wheezing and to use emergency medicine to dilate their bronchial tubes. "Researchers have been studying the psychological impact of violence on children, but we also need to be looking at the impact of violence on physical disease," Wright said.
Here's more detail on these triggers -- revolting and otherwise.
An industrial disease?
To some experts, this laundry list of triggers point to the general condition of living in an industrial society as the overarching cause of asthma. "We live in houses that are closed, work in businesses that are closed, the windows don't open, and any pollutant is recirculated," says Cohen. "There's a tremendous amount of volatile organic compounds from synthetic carpet and vinyl upholstery that are off-gassing all the time. Almost everything is carpeted, and that's a place for dust mites to multiply." And many energy-efficient houses have moisture problems that promote the growth of mold and mites. "There are a lot of things going on," Cohen concludes.
Edelman agrees that indoor air pollution is a factor, pointing out that people are spending more time inside. There are dust mites, smoke and mold in houses that are closed for energy efficiency. And kids are spending more time in day care, and are getting more viral infections, which predispose them to asthma."
Outdoor air pollution is also an important cause of asthma, he says, "but it's hard to attribute the increase to that, since it's not been increasing for the last 10 years. At the same time, he adds, the Lung Association says the relationship between asthma and air pollution -- particularly fine particles and ground-level ozone -- is clear enough to require federal passage of the proposed air pollution standards. Air that meets the current EPA standards "precipitate asthma attacks," he states.
Deadly statistics
With each 10 microgram increase in airborne fine particles, reports of asthma attacks go up by 3 percent, according to Douglas Dockery of the Harvard School of Public Health.
Overall death and hospitalization rates rise in lockstep with air pollution levels. For example, an increase in airborne fine particles of 100 micrograms per cubic meter increased the death rate by 13 percent in Sao Paolo, Brazil (see "Air Pollution and Mortality..." in the bibliography). Breathing nitrogen oxide, a key component in auto exhaust, exacerbates the lung's allergic reaction to dust mites. The Why Files covered the air pollution standards dispute.
So exactly what is causing the increase in asthma? "The honest answer is that we don't know" the full story, Edelman concludes. "Speaking for the American Lung Association, I'd say it's urgent that we find out what the true cause is."
{find_doctor} Locate a practitioner to find the cause of your asthma.
{fre_test_resp}
Symptoms/Medical Dx/Medical Tx
The symptoms of asthma vary among people and can
include wheezing, shortness of breath and tightness of the chest. Other
asthma symptoms can include: trouble controlling a cough; a persistent cough
at night; difficulty breathing during, or soon after, physical exertion or
exercise; or waking up at night because of one or more of these symptoms.
Episodes of asthma symptoms (also called asthma attacks, flare-ups or
exacerbations) occur when airways narrow, making it difficult - sometimes
impossible - to breathe.
Warning signs of an impending asthma attack may include chest tightness,
light wheezing, coughing, restlessness when trying to sleep, irritability,
itchy throat and watery eyes.
Diagnosis of allergies begins with a history and
physical exam. The person may report symptoms after a specific exposure,
such as being around cats.
Sometimes, the individual will have symptoms during particular seasons. For
those with ongoing symptoms such as nasal stuffiness, other tests can be
performed. The healthcare provider may order a test that looks for
eosinophils in the nasal mucus. Allergy testing may be done to determine the
particular triggers that cause the individual's symptoms.
Right or wrong: Do We Know All We Need to Control Asthma?
Always treatable, not curable
If
you know what triggers allergic asthma, the obvious strategy is to reduce
exposure to those allergens. To pinpoint what causes hyper-reactivity in the
lung in allergic asthma, allergists use skin tests, then suggest that the
patient reduce or eliminate contact with the allergens. Vacuum the floor.
Rip up the carpet. Jettison dusty crud. Nuke the roaches.
This is almost starting to sound like fun, until you remember that pet cats
are a potent cause of allergies. Bummer. Ciao, Gato.
Double bummer: The sad part is that these measures doesn't always control
allergic asthma. Some dust mites will plague the cleanest houses, and roach
control can be problematic -- to say the least -- in poor neighborhoods.
And even good allergen control still leaves patients with symptoms. That
disturbing news came from a recent test of immune therapy for allergic
asthmatics. In fact, the study contained a double whammy. The goal was to to
control allergic asthma with the same kind of allergy shots that relieve
sneezing and itching allergies. (Allergies are essentially an overreaction
of the immune system to foreign proteins, and these tiny doses of allergens
were supposed to "teach" the immune system to tolerate the allergen.)
Although such "immunotherapy" has been used for years in asthmatics, the
recent study of 121 children with severe asthma found that it just did not
work: Allergy shots reduced neither the number of emergency-room visits nor
the need for medication.
Unexpected
The
results were a bit of a shock, says lead researcher N. Franklin Adkinson,
professor of medicine at the Johns Hopkins Medical Institutions.
"We were surprised at the unequivocal, across-the-board finding, that we
could not find any aspect of asthma care that was influenced." Adkinson's
allergist colleagues quickly responded that the study did not reflect the
real world. For one thing, patients actually evicted their pets, which many
patients refuse to do.
For another, the patients saw their doctors every two or three weeks, while
most patients are lucky to see their asthma doctors twice a year. Finally,
the "astounding 90 percent compliance rate" among patients did not reflect
clinical reality. That's according to Michael Kaliner, who spoke to The
Lancet (2/8/97) on behalf of the American Academy of Allergy, Asthma and
Immunology.
Adkinson admits that the subject population was inevitably tilted toward
patients who would obey the rules for the required two to three years. And
he adds that while immunotherapy did not help the severe cases who he'd
hoped would benefit, there were indications that it might help milder cases,
and/or patients with more recent diagnoses.
Norman Edelman, a consultant to the American Lung Association, says the
study should be seen in context. "If allergy shots were dramatically
successful, we'd know it by now. And if they didn't work at all, we'd know
that by now too. So it may work in some selected cases."
As we mentioned previously, there's another lesson in the results: a missing
piece of the asthma picture. These patients cleaned out their environments,
they saw their doctors, they took their meds, and they still had symptoms.
Why? Probably, Adkinson says, "due to an unknown or complicating factor."
There are any number of candidates for unknown asthma factors, but the one
that intrigued The Why Files is the personal history of infection. In a
recent Japanese study of 867 children, asthma symptoms correlated with
reactions to tuberculosis skin tests.
A positive skin test signals "exposure" to TB, meaning the person has either
had the disease or been vaccinated against it. The study found that asthma
symptoms were one-half to one-third as common among those who were exposed
to TB as those who had not been exposed. That indicates, but does not prove,
that having TB, or getting the vaccination, somehow protects against
allergic asthma.
Enough speculation. What's new on the asthma drug front?
Hot airways, tight airways
Twenty-five years ago, asthma was treated as an
acute disease, with drugs designed to dilate, or enlarge, the bronchial
tubes that carry air inside the lung. But the biggest advance in recent
years stems from the recognition that inflammation -- the process that
prepares tissue to combat foreign bodies -- plays a crucial role in the
disease, because it sets up the lungs for acute attacks.
With the knowledge that asthma is a chronic, inflammatory disease, doctors
have begun to rely on drugs that calm the inflammation and reduce the excess
reactivity of the airways.
The
most common of these drugs are inhaled versions of corticosteroids --
synthetic hormones that are unrelated to the anabolic steroids used by body
builders. The inhaled drugs ensure that more of the active ingredient
reaches the lungs -- although as much as 80 percent of the dose does get
ingested through the stomach.
How effective are inhaled corticosteroids? In the March 19, 1997 issue of
JAMA (the Journal of the American Medical Association), James Donohue of
Brigham and Women's Hospital in Boston reported that patients with moderate
to severe asthma who took them had half as many hospitalizations for asthma
as other patients. But does lack of hospitalizations mean asthma is
effectively treated? I think not.
New federal guidelines on asthma treatment emphasize using steroid drugs to
calm inflammation and halt the asthma process at the beginning.
In 1997, U.S. asthma doctors gained access to a new category of drugs that
affect an inflammatory mechanism involving molecules called leukotrienes.
Two so-called leukotriene inhibitors have recently been approved, and
several more are close to approval.
At first, the new drugs will be used when existing anti-inflammatories don't
work, says Marcus Cohen, an allergist in Madison, Wis. "We have to see where
they fit in; we don't know yet what population they'll best affect." In the
future, he says, other inflammatory mechanisms that have already been
identified will also become targets for drug therapy.
Furthermore, a series of experimental drugs are about to enter clinical
trials. These drugs also exploit a new understanding of how the inflammation
actually begins. Two drug companies are looking at antibodies -- think of
them as neutralizing agents -- to interleukin-5, a messenger molecule in the
inflammatory process. Tests with animals have shown that the antibodies
prevent interleukin-5 from activating eosinophils -- immune cells that play
a major role in inflammation. Clinical trials are imminent.
Breathing lessons
But better drugs and better patient advice are not
enough -- patients obviously need access to them. Part of the problem is
cost. Inner-city asthmatics who have poor access to health care tend to rely
on emergency rooms where the necessary follow-up is problematic at best. In
other cases, patients don't want to fix what doesn't seem broke: They don't
see a reason to take preventative medicine on days when they have no
symptoms, not understanding that inhaled steroids are a long-term treatment
for the inflammation that causes most asthma.
Norman Edelman, of the American Lung Association, sees the issue of patient
education as "both a problem and an opportunity. Asthma is an illness where
the active cooperation by the patient is critically important -- it leads to
better control. You send the patient home with instructions on what to watch
for, how to change medicines, about the triggers, how to deal with school,
work and home environments. It's a complicated illness, and it requires a
lot of patient know-how and activism."
{find_doctor} Locate a practitioner to find the cause of your asthma.
{fre_test_resp}
CRA Dx/Nutritional Tx
{cra_tx}
The following reflexes should be tested for the cause and treated accordingly:
- {blood_quality_reflex} Blood Quality Reflex
- {circulation_reflex} Circulation Reflex
- {hemoglobin_reflex} Hemoglobin Reflex
- {lma_sub_lung} Left Master Allergy Lung Sub-Reflex
- {lma_sub_parasite} Left Master Allergy Parasite and-or Flu Sub-Reflex
- {lma_sub_spleen} Left Master Allergy Spleen Sub-Reflex
- {lma_sub_staph} Left Master Allergy Staph Sub-Reflex
- {lma_sub_strep} Left Master Allergy Strep Sub-Reflex
- {rma_reflex} Right Master Allergy Reflex
- {rma_sub_bile_duct} Right Master Allergy Bile Duct Sub-Reflex
- {rma_sub_gallbladder} Right Master Allergy Gallbladder Sub-Reflex
- {rma_sub_liver} Right Master Allergy Liver Sub-Reflex
- {towers_meridian} Towers Meridian Reflex
- {virus_reflex} Virus Reflex
- {yeast_reflex} Yeast Reflex
- {infec_noninfect_pus_gut} Gut Reflex
- {infec_noninfect_pus} Pus Reflex
- {infec_noninfect_pus_chr_fatigue} Chronic Fatigue Syndrome Sub-Reflex
- {infec_noninfect_pus_int_flora} Intestinal Flora Pus Sub-Reflex
- {infec_noninfect_pus_liver} Liver-Metal Overlad Pus Sub-Reflex
- {infec_noninfect_pus_parasite} Parasite Pus Sub-Reflex
- {arth_lf_coronary} Left Coronary Artery Reflex
These reflexes should be tested and treated with the proper supplementation.
{fre_test_resp}You may also locate a {find_doctor} competent health care practitioner for testing.
{nut_tx}The following supplements are indicated:
Children 0-5 years: follow the following supplementation per day for 12 weeks to 1 year:
- 1-10 {allerplex} to normalize breathing
- 1-3 {antronex} to control coughing
- 1 {cal_amo} to eliminate possible parasites
- 1-3 {multizyme} to digest mucus
- 1-6 {vasculin} to balance heart rhythm and electrical pulse
- 1-3 {zymex_ii}to eliminate possible parasites
Children 6-12 years: follow the following supplementation per day for 12 weeks to 1 year:
- 6-20 {allerplex}
- 5-20 {antronex}
- 6-12 {cardioplus} or {vasculin}
- 5-10 {multizyme}
- 6 {zymex_ii}
Adults: follow the following supplementation per day for 12 weeks to 1 year:
- 6 {allerplex}
- 2 {cal_amo}
- 12 {vasculin}
- 2 {cat_d}
- 3 {drenamin}
- 2 {b6_naicinamide}
{fre_test_resp}
Diet/Chiropractic Tx/Exercise & Prevention
The asthma epidemic among children may have been triggered by youngsters not
eating their greens. Increasing affluence has led to many consuming a diet
that has more processed food than fresh vegetables.
Now researchers claim that a lack of key vitamins and minerals in the diet
may be responsible for the rising levels of asthma in Britain and other
Western countries.
In Britain a million children have the condition which is more common among
youngsters here than almost anywhere else in the world, affecting up to one
in three teenagers.
The scientists studied communities in Saudi Arabia where there are striking
differences in lifestyle and the rate of allergies across the country.
More than 100 children aged around 12 with asthma symptoms, who lived in the
city of Jeddah and several villages, were compared with 200 non-asthmatic
children.
Diet was significantly linked to wheeziness in the children with asthma.
Those children with most symptoms had the lowest intakes of vegetables, milk
and fibre, vitamin E, calcium, magnesium, sodium and potassium.
Children whose diets were relatively low in vegetables and vitamin E intake
were around three times more likely to wheeze.
The researchers, from Aberdeen University and King Abdulaziz University in
Jeddah, said the Saudi diet was traditionally based on Arabic foods that
bore little resemblance to the Western diet.
'However, with increasing prosperity and commercial exposure, there has been
an influx over some three decades of Western-type frozen and prepared foods
in supermarkets and restaurants,' they added.
In recent years experts have claimed that the explosion in asthma has
happened because children's lives are 'too clean'. They say previous
generations were exposed to more dirt - and the microorganisms in it - which
helped their immune systems develop resistance to allergies and related
conditions.
But the researchers said there was no link between numbers of infections
children suffered and levels of wheeziness.
Dr Martyn Partridge, chief medical adviser to the National Asthma Campaign,
said: 'This study is consistent with others that suggest that taking fresh
fruit and a balanced diet protects against asthma and some other lung
diseases. 'It is yet another pointer towards lifestyle as the cause of the
increase in prevalence of asthma.'
Dr Neil Barnes, a specialist at the London Chest Hospital, said there was
stronger evidence for infections rather than diet being responsible for
rising asthma levels. 'But it may turn out that different factors are
responsible in different communities,' he added.
A study published in the November / December 2000
issue of Today's Chiropractic gives some insight into the use of
chiropractic in combating asthma. Forty seven patients were observed for a
two year period. They had been medically diagnosed with persistent asthma
ranging from mild persistent in 11 cases, moderate persistent in 28 cases,
to severe persistent in 8 cases. The care rendered consisted of specific
{chiro_adj} chiropractic adjustments. The range of visits was from 14 to
44, with the average being 26 during the study period.
All 47 of the study patients showed "a marked improvement ranging from 87 to
100 percent." Their symptoms improved as well as a decrease in their usage
of acute asthma attack medication. Even more impressive was the fact that
all of the patients in the study reported maintaining their improvement
after a two-year follow up.
Childhood Asthma and Chiropractic
Chiropractors suggest that there is a strong link
between people who suffer from childhood asthma and nerve interference from
subluxation. {chiro_subl} Subluxations are when bones in the spine
pressure or irritate nerves causing abnormal nerve function.
An article published in the Journal of Vertebral Subluxation Research (Vol.
1 No. 4) showed positive effects of chiropractic care on 81 children with
asthma. It concluded that "Based upon information currently available,
chiropractic care represents a safe non-pharmacological health care
approach, that may be associated with a decrease in asthma-related
impairment, reduced respiratory effort, and a decrease incidence of asthma
attacks. The correction of vertebral subluxation could reduce or eliminate
the need for medication, and potentially ease the severity of the asthmatic
condition."
This was verified in another study. In a study conducted in 1996 by the
Michigan Chiropractic Council (MCC), a panel of doctors performed an
out-come assessment study to test the qualitative and quantitative
effectiveness of chiropractic care on children with asthma. There was an
overwhelming interest in the study. More than 500 parents called the MCC
seeking to get their child involved in the chiropractic study.
The study, which took place during May and June of 1996, examined the
chiropractic effectiveness in correcting the cause of asthma in patients
from birth to age 17. The average age of the participant was 10 years. After
30 days of chiropractic health care, patients averaged only one attack,
whereas prior to the study they were experiencing more than four attacks.
Medications were decreased by nearly 70 percent. Patient satisfaction was
rated 8.5 on a scale of 10. More than 70 chiropractors from 62 cities in
Michigan participated in the study involving more than 80 children suffering
from asthma.
The International Chiropractic Pediatric Association cites several studies
when coming to the following conclusion discussing the benefits of
chiropractic for children with asthma:
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76.5% of patients with bronchial asthma said they benefited from chiropractic treatment. Peak flow rate and vital capacity increased after the third treatment. Significantly lower quality of life impairment rating scores were reported for 90.1% of children after 60 days of chiropractic care. During this same time period the average number of asthma attacks decreased an average of 44.9%, and asthma medication usage was decreased an average of 66.5%. Among parents of asthmatic children who had received chiropractic treatment, 92% considered this treatment beneficial. |
Go
here for additional information regarding chiropractic treatment.
There are several facts to be realized about asthma and exercise.
- Asthma is in fact a common but serious condition.
- If asthma is well controlled with appropriate treatment, exercise does not need to be avoided or limited.
- Having asthma does not mean you cannot exercise. Many well-known athletes have managed their asthma to successfully compete in their chosen sports.
Exercise-Induced Bronchospasm (EIB)
Definition: a temporary narrowing of the
airways, or bronchospasm, which is induced by strenuous exercise.
Most children with asthma have acute asthma episodes from time to time.
These episodes vary greatly in how quickly they start, how severe they are,
and how long they last. Episodes brought on by allergens or by exercise
develop quickly, whereas episodes caused by viral infections (colds) usually
begin slowly over a few days. Severe asthma episodes can be life
threatening.
Children's airways are small to begin with, and therefore any changes in the
airways can cause significant symptoms in a child. These changes (airway
inflammation and bronchoconstriction) cause any combination of four major
signs and symptoms:
- Cough
- Wheeze
- Shortness of breath
- Tightness in the chest
Each child's asthma is different, meaning that
different factors may be responsible for provoking the asthma.
Exercise may cause airways to tighten.
Mechanism of Exercise-Induced Bronchospasm
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vigorous exercise
increased oxygen demand
increased breathing rate
airway cooling and drying |
EIB is a very common symptom for persons with
asthma. Eighty to ninety percent of asthmatics have difficulty breathing
with vigorous exercise.
There are a number of people who have not been diagnosed with asthma and who
develop breathing problems with vigorous exercise. For example, 50% of
people with hay fever or allergic rhinitis (allergic runny nose) and 10% of
normal athletes have been found to develop EIB. As these individuals have
hyperresponsive airways, a diagnosis of asthma is probable. For this reason
it is preferable to refer to breathing difficulties that develop with
vigorous exercise as exercise-induced bronchospasm rather than
exercise-induced asthma.
Why does exercise create breathing difficulty? There is no simple answer to explain why EIB develops. There has been much debate and controversy over this the past few years. People with asthma begin with hypersensitive airways (or twitchy airways). When exposed to certain stimuli, these airways react by contracting or tightening. When we exercise vigorously, we tend to breathe in and out of our mouth, and our breathing becomes deeper and quicker. The EIB is most likely due to:
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cooling of the airways
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drying of the airways or loss of water from the airways
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involvement of the nervous system; there is promising evidence that chiropractic care can normalize messages sent to the lungs so that bronchspasm can be controled. see the section above on chiropractic
Breathing warm, humidified air (i.e. during swimming) can completely or partially prevent EIB. Breathing cold, dry air seems to make EIB symptoms worse for many people. People who suffer from asthma have certain cells called mast cells in their large bronchi and lungs. The cooling and drying of the airways stimulate the mast cells to produce a chemical substance called a mediator, which causes spasms of the muscles surrounding the airways.
Symptoms of EIB
Obvious Symptoms
With some children, the signs of EIB are very obvious:
- Wheezing
- Shortness of breath on exertion
- Chest tightness
For example, these children are generally identified as having asthma in your class; they take medications regularly and they generally have symptoms with other stimuli in addition to exercise.
Subtle Symptoms
There is another group of children who exhibit more subtle signs:
- Cough (a child may consistently cough after jogging or playing basketball or soccer)
- Chest congestion
- Chest discomfort or pain
- Shortness of breath (children may complain that their chest is too small)
- Susceptibility to cold air (a child consistently coughs after coming in from playing outside)
- Feels out of shape or winded
- Tires easily
- Displays lack of energy (especially in children)
- Problems occur while running but not while swimming
- The child is unable to keep up with their friends when running and playing
- The child is unable to run five minutes without stopping
- Dizziness
- Stomach-ache
- Frequent colds
- Frequent throat clearing sounds
EIB is often overlooked by parents, physicians, teachers, and even the children themselves; if not properly diagnosed, appropriate management is not possible. The child continues to have symptoms and soon learns to limit his or her exercise so that these symptoms or uncomfortable sensations are avoided.
Ways to Reduce EIB
1. Avoid Exercise if Symptoms are Present Prior to Exercise
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if a student has obvious wheeze or breathing difficulty prior to exercise, it should be avoided
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exercise will be hazardous
2. Supplementation
The following supplements are indicated:
Children 0-5 years: follow the following supplementation per day for 12 weeks to 1 year:
- 1-10 {allerplex} to normalize breathing
- 1-3 {antronex} to control coughing
- 1 {cal_amo} to eliminate possible parasites
- 1-3 {multizyme} to digest mucus
- 1-6 {vasculin} to balance heart rhythm and electrical pulse
- 1-3 {zymex_ii}to eliminate possible parasites
Children 6-12 years: follow the following supplementation per day for 12 weeks to 1 year:
- 6-20 {allerplex}
- 5-20 {antronex}
- 6-12 {cardioplus} or {vasculin}
- 5-10 {multizyme}
- 6 {zymex_ii}
Adults: follow the following supplementation per day for 12 weeks to 1 year:
- 6 {allerplex}
- 2 {cal_amo}
- 12 {vasculin}
- 2 {cat_d}
- 3 {dermamin}
- 2 {b6_naicinamide}
3. Adequate Warm-Up
a period of submaximal exercise before exertion is encouraged i.e. walking and other low level activities, and flexibility exercises should be done; this can be followed by running rapidly on the spot for 30 seconds, followed by a 60 second rest; repeat this 2 or 3 times
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warm-up period may need to be longer than usual
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subsequent exercise should then be less symptom provoking than usual
4. Modified Exercise
There is no such thing as the perfect exercise for
people with EIB. The key is to select a sport or exercise the child enjoys
and feels good about doing. Very light or nonaerobic exercise (such as
walking or weight training) rarely results in EIB. Exercise intensity should
begin at low levels and gradually increase as the child's fitness level
improves. Running tends to produce symptoms more easily than do bicycling or
walking. Indoor swimming very rarely causes EIB because it is performed in a
humid and often warm environment; it is a sport often chosen by people with
asthma.
Other sports relatively well tolerated include:
- football
- downhill skiing
- tennis
- baseball
- volleyball
- wrestling
- short distance track and field events
- golfing
- gymnastics
5. Avoid Environmental Factors
- inhaled allergens
- dust (outside or inside)
- pollens (grasses, weeds, trees)
- animals
- air pollutants such as sulfur dioxide and ozone
are known to aggravate EIB. People with inhaled allergies may find exercise more difficult in this type of environment; there may be a need to increase anti-inflammatory medication during the seasons.
- cold, dry air
- wearing a scarf or cold air mask warms and humidifies the air before it reaches the airways. Minimize exercising in cold, dry air. EIB has been shown to be eliminated if exercise is done in warm, moist environments.
6. Adequate Cool-Down
Avoid stopping exercise abruptly. To avoid sudden changes in the airway temperature, a warm-down period of 10 minutes is suggested. This warm-down period, however, may need to be longer.
7. Avoidance of Certain Foods
Avoiding certain foods several hours prior to strenuous exercise may be important for some people. The following foods may increase EIB, and in some cases cause anaphylaxis:
- shrimp
- celery
- peanuts
- egg whites
- almonds
- bananas
Signs include:
- flushing
- hives
- rash
- swelling of the larynx
- bronchospasms
- faintness
7. Chiropractic Care
Consult a licensed practitioner and go through a trial of chiropractic care. Locate a licensed practitioner {find_doctor} here.
Exercise-induced anaphylaxis
This is a rare but frightening and potentially fatal physical allergy. Food ingestion before vigorous activity has been associated with exercise-induced anaphylaxis; exercise-induced anaphylaxis occurs more commonly in hot, humid weather conditions and may also be related to severity of exertion. The teacher should be aware of emergency treatment for this.
Other Suggestions:
Students should exercise for as long as the rest of the class, or until coughing, wheezing or chest tightness develops, which may range from a few minutes to the full lesson. Exercise tolerance will vary greatly among students with asthma, and even from day to day in the same student. Should a student become wheezy or have difficulty breathing during exercise and develop an asthma episode, implement emergency treatment.
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