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By Dr. Alex Chen, L.Ac., O.M.D., Ph.D.
and Dr. John Chen,
L.Ac., O.M.D., Ph.D., Pharm.D
 WESTERN MEDICINE
DEFINITION:
Asthma affects approximately 15 million Americans today. It's
a pulmonary disorder characterized by wheezing and dyspnea due
to obstruction and inflammation of the airways. Asthma may be
triggered by allergy, exertion, irritant particles, weather,
psychological stress, etc.
ETIOLOGY:
There are many causes of asthma. Allergens such as pollens,
smoke, alcohol, house dust and animal hair may trigger an asthma
attack. Asthma may also be induced by non-allergy related factors
such as exertion, cold air, stress, anxiety, crying, hearty
laughing, and viral infection. Common morbidity associated with
asthma include sinusitis, allergic rhinitis, gastroesophageal
reflux, cardiovascular disease, diabetes, obesity, and hyperthyroidism.
CLINICAL MANIFESTATION:
In an asthma attack, there will be a combination of spasm of
the bronchi, inflammation of the airways, and increased mucous
secretion. In mild to moderate cases, the patients will experience
shortness of breath, wheezing, hyperpnea, and use of accessory
muscles (such as neck and chest muscles) to facilitate breathing.
Anxiety and sweating are commonly seen in asthmatics as they
struggle for air. In severe cases, the patients will experience
marked respiratory distress, cyanosis, use of accessory muscles,
wheezes, lethargy and possibly confusion. Patients with severe
asthma may not have any wheezing as there is very little air
moving in and out of the lungs.
DIAGNOSIS:
Asthma is diagnosed based on the characteristic episodes of
wheezing, coughing, dyspnea or chest tightness interspersed
with asymptomatic intervals. Objective confirmation is made
with repeated spirometry tests performed over symptomatic and
asymptomatic periods. Spirometry is a device that measures the
breathing capacity of the lungs and is helpful in making the
diagnosis, assessing the severity of the illness, and monitoring
the effectiveness of the treatment.
If the asthma is
allergy-induced, identification of the allergen is very important.
Skin test for allergen, blood test for antibodies, and Inhalation
Bronchial Challenge Test may assist in identifying the correct
culprit. Allergic skin test helps to identify the allergen,
but an allergen that causes an allergic reaction on the skin
may not necessarily induce an asthma attack. Blood test for
antibodies helps to determine the degree of sensitivity to that
specific allergen. Additionally, an Inhalation Bronchial Challenge
Test can be done to confirm the direct correlation between an
allergen and an initiation of asthma attack. Since the patient
will have to inhale a diluted solution of the allergen in the
challenge test, there is a slight risk of a severe asthma attack.
TREATMENT:
Drug treatments of asthma include management of an acute attack
and maintenance on a daily basis. Five groups of drugs are commonly
used for treating asthma.
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Beta-adrenergic
Drugs: Beta-adrenergic drugs are bronchodilators that
relax smooth muscle and widen the airways. They are commonly
used for relieving sudden attacks of asthma and preventing
exercise-induced asthma. Common examples of Beta-adrenergic
drugs includes epinephrine (Primatene Mist or AsthmaHaler),
isoproterenol (Isuprel), metaproterenol (Alupent), pirbuterol
(Maxair), terbutaline (Brethaire) and albuterol (Proventil
or Ventolin). Common side-effects of Beta-adrenergic drugs
include increased Heart rate, nervousness, restlessness,
headache and muscle tremors.
-
Theophylline:
Theophylline also relaxes bronchial smooth muscle and is
commonly used to treat and/or prevent bronchial asthma.
Common trade names of theophylline include Theo-Dur, Theo-24,
Uniphyl and Slo-bid. Common side-effects of theophylline
include nausea, vomiting, nervousness, restlessness, insomnia,
and in severe cases, seizures and arrhythmia.
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Corticosteroids:
Corticosteroids block the inflammatory response and reduce
the asthma symptoms. Systemic corticosteroids (such as prednisone)
may be used to treat acute asthma attack and inhalation
of corticosteroids (such as Azmacort) may reduce the likelihood
of asthma attack through desensitization to allergens. Though
effective, long-term use of corticosteroids has a wide range
of side-effects including but not limited to poor wound
healing, decreased immunity, retarded growth in children,
GI bleeding, hunger and weight gain.
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Cromolyn
(Intal): Cromolyn (Intal) inhibits the release of
inflammatory substances from mast cells and is used to prevent
but not treat asthma. When taken regularly, cromolyn (Intal)
is especially helpful in patients who have exercise-induced
asthma. Cromolyn (Intal) is relatively safe but has occasional
side-effects such as cough and hoarseness.
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Anticholinergic
Drugs: Anticholinergic drugs produce bronchodilation
by preventing smooth muscle contraction. Anticholinergic
drugs are less potent and have a slower onset of action
in comparison with beta-adrenergic drugs. Examples of anticholinergic
drugs include atropine and ipratropium (Atrovent).
ORIENTAL MEDICINE
DEFINITION:
In Chinese medicine, asthma is called "xiao chuan, " which means
wheezing and dyspnea, respectively. Chinese medicine 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 shoulder, 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.
ETIOLOGY:
In Oriental Medicine, 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.
External pathogenic
factors, such as cold or heat, commonly induce asthma attacks.
Lung dominates the Qi 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
is 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 tend 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 as well.
Congenital weakness
and chronic illness are also common causes of asthma. Children
with asthma generally have congenital Kidney Qi deficiency.
On the other hand, chronic illness, such as patients with chronic
cough and recurrent cold/flu, are likely to have Lung deficiency.
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