EVERY BREATH YOU TAKE
DR. ANATOLY BELILOVSKY, MD, ANSWERS YOUR ASTHMA FAQS AND TALKS
OUTDOOR POLLUTION, ALTERNATIVE TREATMENT AND STRESS
Q: What is asthma, really?
A: Asthma is the reversible narrowing of bronchi,
the pipes through which air reaches your lungs.
Look at it this way: Imagine breathing through
your eyes. Have you heard of bronchospasm?
Thatâ€™d be like your eye was closed. Bronchial
inflammation? Thatâ€™d be like your eye was swollen
shut and filled with gunk. Reversible obstruction? Thatâ€™d be like your eye was shut one minute (a trigger response) and wide open the next.
Q: Why is there so much asthma lately?
A: The theory that makes the most sense, and is best backed up by evidence, is the hygiene hypothesis. In several studies, it was found that in developing countries, people who were infested by intestinal parasites had less allergy and asthma than those who were not, and in a German study, less asthma was found in children who survived a life-threatening infection. The immune system is constantly on the lookout for infections and parasites and, lacking real targets for the immune cells to attack, sometimes attacks healthy tissues or overreacts to minor infections. There are a number of infectious agents such as respiratory syncytial virus or mycoplasma that have been identified as commonly associated with asthma, and, of course, pollutants can trigger attacks. Blaming all asthma on outdoor pollution is probably incorrect, as the air is cleaner now than it has been for hundreds of years because of stricter environmental controls.
Q: How is asthma treated?
A: There are medications like albuterol, which relaxes the muscles holding the airway closed; steroids, which decrease the swelling; and antibiotics, which treat the infections that may either trigger or complicate asthma episodes. A common mistake is to assume that, if shortness of breath is absent, all is well. This error is best avoided with the use of a little toy called a peak flow meter. It measures how fast you can breathe out, compared with both your personal best and the ideal calculated for your age and height. Peak flow numbers will drop long before actual shortness of breath appears, allowing you to adjust your treatment or seek help early. Another dangerous mistake is to treat with beta-agonists (like albuterol) alone. They work quickly, but in the worst attacks, they fail without warning; dependence on beta-agonists has caused many deaths in asthmatics. Think of them as fire extinguishers; if you use one daily, there is something wrong in your kitchen, and they are useless against a big fire. There are a number of preventive medications that keep attacks from happening, and a number of rescue medications that stop breakthrough attacks, but the old â€œcanâ€™t breathe, take a puffâ€ routine is not only useless, but potentially deadly.
Q: What are alternative treatments for asthma?
A: First of all, emotional distress is a well-known asthma trigger. The lungs and the brain are connected by the vagus nerve, and vagus activity is known to produce asthma attacks, so whatever makes you feel less anxiety will probably have an effect against asthma. Secondly, a number of plants produce toxins that, in small quantities, have an asthma-blocking activity. Unfortunately, as these toxins are needed by the plants to keep them from being eaten by animals, they tend to have serious side effects. Ephedrine in ma huang, theophylline in tea, and scopolamine in deadly nightshade are examples of such poisons. Many currently used medications are â€œdeclawed,â€ less toxic derivatives of natural plant poisons. Thirdly, human and animal adrenal glands produce steroid hormones, some of which fight the inflammation that is part of an asthmatic event. Both natural versions of these hormones and synthetic derivatives are used sparingly, as they produce their effect by suppression of immunity. â€œDeclawedâ€ versions of these hormones are easily destroyed in the bloodstream; they are given as inhalations directly into the airways and do not produce measurable effects anywhere else in the body.
Physical activity appears to help more often than not; exercise-induced asthma appears to be less common than asthma that gets better with consistent exercise. In any case, asthma should never serve as an excuse for reduced activity. Finally, anything that controls heartburn will probably reduce asthma severity as wellâ€”and since caffeine, fat, overeating, spicy foods, alcohol, smoking and tight clothing can all induce heartburn, avoiding them might be worth a try.
Dr. Anatoly Belilovsky is a New York pediatrician whose 365-day practice, Belilovsky Pediatrics, won an AmeriChoice award for Center of Excellence in asthma care. He is a graduate of Princeton University and served as a clinical instructor in pediatrics at Cornellâ€™s Weill Medical College. For more information, visit his website and blog www.babydr.us.