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Asthma

People who are having an asthma attack have real trouble taking a breath. Many people with stuffy noses from hay fever or colds say, "I can't breathe," but they retain the option of breathing through the mouth. Asthmatics, however, know what "I can't breathe" really means. Instead of their nasal passages, it is the bronchial tubes in their lungs that become swollen and clogged. Breathing can become frighteningly difficult.
Asthma involves two conditions: (1) contraction of the small muscles surrounding the bronchial tubes and (2) inflammation of the lining of those tubes. Traditionally, treatment primarily addressed the first aspect of asthma; in the past two decades, though, it has become 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 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). (Interestingly, Intal is derived from a Mediterranean herb named khella.) The newest drug treatment for asthma, omalizumab (Xolair), appears to be very safe and effective, but it is currently extremely expensive and, for this reason, it is seldom used.

Principal Proposed Natural Treatments

Warning: None of these treatments have been shown to be effective for severe asthma. Do not stop your standard asthma medication except on the advice of a physician.
The herb Tylophora indica (also called Tylophora 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 decades ago and fail to reach modern standards of design and reporting.
In a double-blind, placebo-controlled study of 195 individuals with asthma, the participants who were given 40 mg of a tylophora alcohol extract daily for 6 days showed significant improvement as compared to placebo. 1 Similar results were seen in two double-blind, placebo-controlled studies involving more than 200 individuals with asthma. 2,3 However, the design of these studies was a bit convoluted, and various pieces of information are missing from the reports, causing some difficulty in evaluating the validity of these trials.
Another double-blind study that enrolled 135 individuals and followed a more straightforward design found no benefit from tylophora. 4
The bottom line: Although tylophora is promising, larger and better studies are necessary to discover whether tylophora is truly effective.
For more information, including dosage and safety issues, see the full Tylophora article.
Boswellia: Possibly Helpful
The herb boswellia has shown promise as a treatment for rheumatoid arthritis . It is thought to work by inhibiting inflammation. Since asthma involves inflammation as well and can be treated by some of the same drugs that treat rheumatoid arthritis, boswellia has been tried for this purpose too.
One 6-week, double-blind, placebo-controlled study of 80 individuals with relatively mild asthma found that treatment with boswellia at a dose of 300 mg 3 times daily reduced the frequency of asthma attacks and improved objective measurements of breathing capacity. 9 However, further research needs to be performed to follow up this pilot study before boswellia can be described as a proven treatment for asthma.
For more information, including dosage and safety issues, see the full Boswellia article.
Coleus forskohlii : May Be Effective, But More Like a Drug Than an Herb
Another herb sometimes recommended for asthma also comes from India, Coleus forskohlii . While there is some preliminary evidence that it might have value, 10-12,66 this evidence is currently far too weak to be relied on. Furthermore, as presently sold, the herb is more like a drug than an herb. Natural Coleus 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: Effective, But Not Safe
The Chinese herb ma huang, also called ephedra , is definitely effective for mild asthma since it contains the drug ephedrine. However, we cannot recommend using it 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 at the turn of the twentieth century, and it soon became a primary treatment for asthma in the United States 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 today. 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. We recommend against using ma huang for asthma.

Other Proposed Natural Treatments

Other Herbs and Supplements

In a double-blind trial, 32 people with steroid-dependent asthma were given either placebo or essential oil of eucalyptus for 12 weeks. 47 The results showed that people using eucalyptus were more able to gradually reduce their steroid dosage than those taking placebo.
Two double-blind, placebo-controlled studies enrolling a total of over 80 people with asthma suggests that oligomeric proanthocyanidins (OPCs) from pine bark might reduce symptoms. 40,51
An extract made from ivy leaf has been advocated for the treatment of childhood asthma, but at present the meaningful supporting evidence is again limited to one placebo-controlled trial. 52
Another small double-blind, placebo-controlled study evaluated the effects of 4 weeks of treatment with a Japanese herbal mixture traditionally called Saiboku-To . 43 Researchers tested the tendency of the bronchial tubes to contract in response to an asthma-producing substance called methacholine. The results indicated that use of Saiboku-To helped prevent such contractions, and also reduced lung inflammation. Another study reportedly found benefit with a combination named Mai-Men-Dong-Tang. 67
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. 13,14,82
There is only weak and/or inconsistent evidence regarding whether two antioxidants in the carotenoid family, lycopene44,68 and beta-carotene , 45 might help prevent exercise-induced asthma.
One double-blind comparative study provides weak evidence that the Ayurvedic herbal combination called Astha 15 might be helpful for mild asthma. 69
Vitamin B 6 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 76 children with asthma found significant benefit from vitamin B 6 after the second month of usage. 16 Children in the treated group were able to reduce their doses of bronchodilators and steroids. However, a recent double-blind study of 31 adults who also used either inhaled or oral steroids did not show any benefit. 17
Supplementation with vitamin B 12 is also often said to be effective for asthma. 15 However, the scientific evidence in its favor consists almost entirely of open studies that did not attempt to eliminate the placebo effect.
Very preliminary evidence hints that the herb butterbur may be helpful for asthma. 18,19
One study found potential benefit with the spice Carum copticum . 81
Essential fatty acids, such as gamma-linolenic acid (GLA) 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, 21-29,41,46,96 and one study even found that fish oil can worsen aspirin-related asthma. 23 Nonetheless, there is some evidence from one research group that fish oil might be helpful for exercise-induced asthma. 55,72 There is also some interesting preliminary evidence that mothers who take fish-oil during late pregnancy may reduce the risk of asthma in their children up to 16 years later. 90
A study of 72 children with moderate, persistent asthma found that combined or single supplementation with omega-3 oils, zinc and/or vitamin C improved their symptoms and lung function. Combined supplementation was associated with greatest improvement. The reliability of these results should be questioned, however, since about 20% of children dropped out before the end of the 38-week study. 92
A preliminary double-blind, placebo-controlled trial suggests that green-lipped mussel extract might be helpful for allergic asthma. 42
One study suggests that the natural substance hyaluronic acid might be helpful for asthma when taken by inhalation. 73
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, no such evidence exists for quercetin taken in any manner; 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. When you take something by mouth, it's a very different matter from having it injected into your veins. Studies of oral magnesium for asthma have shown more negative than positive results. 53,70,76 However, some evidence exists that intravenous or inhaled magnesium may be beneficial. 31,32,54,71
Preliminary evidence, far too weak to be relied upon at all, has been used to suggest that the supplement coenzyme Q10 (CoQ 10 ) might be helpful for asthma. 77
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 , and yerba santa , as well as 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—a process we can hardly recommend. None of these treatments have any 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 10 days experienced a worsening of their symptoms, 89 there is no direct scientific evidence at this time that antioxidant supplementation improves asthma. A rather theoretical study found evidence that use of vitamin E might decrease the inflammatory response in children with asthma exposed to ozone. 59 However, a far more meaningful double-blind, placebo-controlled study found vitamin E (as 500 mg of natural vitamin E) ineffective for asthma. 60 Similarly, a large (almost 200-participant) study failed to find selenium helpful for asthma. 80
The herb picrorhiza has been advocated as a treatment for asthma, based primarily on two studies conducted in the 1970s. 83,84 However, neither of these studies reached modern scientific standards. Two subsequent, and better designed, studies of picrorhiza failed to find the herb more effective than placebo. 85,86
One study failed to find a mixture of probiotics (“friendly bacteria”) helpful for asthma in children. 87 But, another study found that a mixture of probiotic Bifidobacterium breve and prebiotic galacto/fructo-oligosaccharide may help reduce wheezing in infants with eczema. 94
Children with asthma may have reduced growth, possibly due to use of inhaled steroids. One study failed to find protective benefits with a multivitamin that contained vitamin D . 61 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). 62
Two exceedingly preliminary studies reported by one research group has led to publicized concerns that use of the insomnia supplement melatonin may worsen night-time asthma. 56,57 However, one double-blind study of melatonin in people with asthma found evidence of improved sleep without worsening of asthma symptoms. 58

Acupuncture

Although there have been numerous reports on acupuncture treatment for asthma, 33-37 the results have been contradictory.
A team of three researchers analyzed 13 trials on acupuncture in the treatment of asthma. 35 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, follow-up, and the like. 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."
A more recent review of acupuncture for asthma came to identical conclusions. 34

Other Alternative Therapies

Sublingual Immunotherapy , a form of "allergy shot" that involves drops under the tongue rather than injections, has shown promise for asthma. 78
Some people with asthma may also have food allergies . One way to discover if you are allergic to a certain food is through eliminating potentially allergenic foods from your diet, then systematically introducing them to see if a reaction occurs. This elimination diet should only be done under the care of your doctor because of the risk of severe allergic reaction. Other ways to diagnose a food allergy include the skin scratch test and blood tests (eg, RAST or ELISA). If you do have a food allergy, eliminating the offending food from your diet might reduce asthma symptoms. 20
A special breathing technique called Buteyko breathing may reduce medication use and subjective symptoms, though it does not appear to actually improve lung function. 63,64,88
Hypnosis , 48massage , 49yoga , 50,74,93 and some other forms of relaxation therapy39 may offer modest benefits for asthma. The same is true of standard aerobic exercise . 79
In two controlled studies, chiropractic spinal manipulation has failed to prove more effective than fake manipulation for treatment of asthma. 30,38 One study of osteopathic manipulation reportedly found benefits, but its design was flawed. 75
Researchers have also studied factors that may prevent the development of asthma . For example, by examining two large groups of children—6,963 children aged 6-13 and 9,668 children aged 6-12, researchers determined that those living on traditional farms in a rural environments were exposed to a wider range of microorganisms and had fewer cases of asthma compared to those living in suburban environments. 95 These findings help to confirm what has long been known as the hygiene hypothesis , which states that exposure to a large variety of germs early in life tends to make the immune system less susceptible to allergic conditions later in life, such as asthma. This would help explain why asthma seems to become more common as societies became wealthier and less rural.

References

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56 Sutherland ER, Ellison MC, Kraft M, et al. Elevated serum melatonin is associated with the nocturnal worsening of asthma. J Allergy Clin Immunol. 2003;112:513-517.

57 Sutherland ER, Martin RJ, Ellison MC, et al. Immunomodulatory effects of melatonin in asthma. Am J Respir Crit Care Med. 2002;166:1055-1061.

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60 Pearson PJ, Lewis SA, Britton J, et al. Vitamin E supplements in asthma: a parallel group randomised placebo controlled trial. Thorax. 2004;59:652-656.

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66 Gonzalez-Sanchez R, Trujillo X, Trujillo-Hernandez B, et al. Forskolin versus sodium cromoglycate for prevention of asthma attacks: a single-blinded clinical trial. J Int Med Res. 2006;34:200-207.

67 Hsu CH, Lu CM, Chang TT, et al. Efficacy and safety of modified Mai-Men-Dong-Tang for treatment of allergic asthma. Pediatr Allergy Immunol. 2005;16:76-81.

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