Asthma

• Introduction
• Research
• TCM Clinical Trials
• Patient Form

Introduction

Asthma is a serious chronic lung disease affecting 21 per cent of children 2 to 15 years of age. Asthma is the most common chronic disease of childhood. This disorder is typically episodic and remittent in nature. Asthma is characterized by the narrowing of the large and small airways due to a spasm of the smooth muscles of the bronchi, edema, inflammation of the bronchial mucosa and production of tenacious mucus. Asthma can begin at any age, but most people with this condition develop it before the age of five.

Main Symptoms of Asthma

• Shortness of breath
• Tightness in the chest
• Coughing
• Wheezing

The frequency and severity of symptoms differs from person to person. There are four types of asthma: allergic, exercise-induced bronchospasm (EIB), reactive airway disease (i.e. asthma that only occurs during colds) and miscellaneous types. Included in the miscellaneous group are heartburn or reflux asthma and stress induced asthma. Children sometimes outgrow their asthma and half of these children will see a lessening of their symptoms as they move into adolescence. Unfortunately, fifty percent of this group will see their asthma return, often when they are in their 30s and 40’s.

Does Modern Medicine Treat Pediatric Asthma Effectively?

The majority of children’s asthma is NOT under control! Fifty-two percent of children currently receiving treatment from a modern medical doctor have poorly controlled asthma (according to the Asthma in Canada survey – the largest and most comprehensive survey to be done on the status or state of asthma in Canada). Poorly controlled asthma leads to an increase in asthmatic symptoms during the day and night, absenteeism (i.e. school or social engagements), exacerbations (i.e. more frequent acute attacks), an increased need for ‘rescue’ medication and a lower tolerance for physical activity. Poorly controlled asthma is a burden to the child and their family as well as healthcare systems as these patients are more likely to require urgent care and hospitalization. Although statistics show that more than 50% of these children are suffering with poorly controlled asthma, 88% of parents continue to believe their child’s asthma is controlled ‘very well’. Moreover, 77% of general physicians and 90% of specialists surveyed also believe their asthma patients are optimally controlled even though statistics demonstrate otherwise. Ultimately, improperly treated asthma may lead to a lifetime of asthma.

Asthma and TCM

The current TCM approach to the treating asthma was first discussed in great detail by a famous TCM doctor named Zhu Dan-xi (approximately 600 years ago). Since this time, the treatment of this disease has been refined and improved upon by many generations of Chinese doctors. Paediatrics is a distinct specialty within Traditional Chinese Medicine. The majority of parents seeking an effective treatment for their child’s asthma should see a TCM doctor who specializes in paediatrics. The most important modality utilized in the treatment of paediatric asthma is Chinese Herbal Medicine. The herbal formula is usually a culmination of 10 to 15 ingredients, which are chosen based on the child’s clinical presentation. Upon return visits, the herbal formula is adjusted or modified as the patient’s condition improves.

Success Stories

Britney

Britney's asthma has improved immensely since receiving acupuncture and herbal medicine. Within the past 8 months my daughter has used her puffers approximately 5 to 6 times. Prior to treatment, Briney was using her puffers 5-6 times per week depending on the weather and her activities. Now she plays soccer outside in the summer and basketball in the winter with no puffers!



Christina

I have been ill alot over the years because of my asthma. I was also often ill with alot of sinus infections and viral infections which would make my asthma worse. When I was ill because of these problems it would cause me to miss alot of school sometimes 30 to 40 days a year. When my mother started taking me to Dr. Helmer, he started me on a action plan on how I could overcome my health problems. Dr. Helmer made me feel comfortable about taking Chinese herbs and made me feel confident about myself that there was hope for me to feel "normal" and be like others and participate in sports. Although the herbs are not the best tasting, their success in helping me are worth it. I thank Dr. Helmer for believing in me.

Lotta

Prior to seeing Robert Helmer, Lotta often suffered from severe bronchitis (once a month for over a year) and even suffered from pneumonia one time. She was coughing, sneezing and wheezing nearly all the time and her immune system was very weak and eventually she developed asthma. Since treatment with Robert Helmer her immune system has become much more stable. The herbs helped her to stay healthier for a longer period of time and to recover faster when she got sick. Since she was diagnosed with asthma we have been using a combination of TCM and modern medicine and she is doing very well with this approach. Lotta is now full of energy, her appetite is good and she is feeling strong and healthy. She has not been seriously sick for several months now, which was unthinkable before.


Research

• Antibiotics in Relationship to Asthma, Allergies and Eczema
• Diet and Asthma
• Breastfeeding
• Pollution
• Genetics, Cigerette Smoke and Asthma
• Different Symptoms, Same Treatment
• Asthma and Reflux
• Flu Shot May Not Be As Protective for Children with Asthma as Previously Thought

Antibiotics in Relationship to Asthma, Allergies and Eczema

70% of children will receive antibiotics in the first six months of life. According to a Henry Ford Hospital study in USA children who receive antibiotics within their first six months of life more than double their risk of developing allergies by age 7. More specifically, the study also found that babies who received one round of broad-spectrum antibiotics were also 8.9 times more likely to acquire asthma. There is also a link between antibiotics and eczema. According to Chinese medicine, antibiotics weaken the digestion (spleen/stomach) or the source of qi (i.e. energy in the body) which often leads to a weakened immune system. When the immune system is weakened it leads to an increased likelihood of allergies. Moreover, a weak digestion easily leads to phlegm production and the coughing and wheezing associated with asthma.

Promising news though, this same study carried out by Henry Ford Hospital demonstrated the same participants were less susceptible to these effects if they live with at least two pets, namely dogs or cats, during their first year of life. Other factors including a mother’s diet during breast-feeding and history of allergies increase the risks of allergy for a child taking antibiotics. The allergies included pets, ragweed, grass and dust mites.

Diet and Asthma

Article 1

According the Daily News (London) a rather large study of 1000 children reported that British children are twice as likely to suffer from asthma when compared to those in other European countries.

The culprit? Poor diet. The explanation given was that British children have a tendency not to eat many foods rich in vitamin E (such as oily fish and vegetables), which can guard against asthma.

Article 2

A large study in the February 1, 2004 American Journal of Respiratory and Critical Care Medicine studied the relationship between asthma and the blood levels of antioxidant nutrients. The study looked at over 6,000 children aged 4 to 16 years and demonstrated that the higher level of these nutrients in the body the less likely the child would develop asthma. Those individuals according to the blood tests in the top 16 percent of vitamin C, beta carotene, and selenium were 10 to 20 percent less likely to develop asthma than their peers. More significant, was the finding that high selenium levels cut the risk of asthma in half among children exposed to tobacco smoke. Selenium is found in many foods, including meat, seafood, eggs, bran, whole wheat, oats, walnuts, garlic, and brown rice. Selenium is (often) destroyed in food processing. This illustrates the importance of eating fresh food and home-cooked meals. Walnuts are a Chinese herb and medicinal food. This food has been used empirically for the treatment of asthma. Beta carotene is abundant in yellow and orange fruits and vegetables and green leafy vegetables. Vitamin C is abundant in many foods, including citrus fruits, greens, broccoli, sweet potatoes, bell peppers, tomatoes, cantaloupe, and strawberries. This study is another good example of the importance of encouraging our children to enjoy eating a wide variety of delicious whole foods - fruits, vegetables, grains, nuts, and lean sources of protein.

Article 3

A study published in the September 2000 issue of Thorax produced more supportive evidence of the importance of a child’s diet in the treatment and prevention of asthma. Not surprising, researchers found that the risk of developing asthma was decreased by the children who consumed more vegetables, fiber, and other nutrients (including vitamin E, calcium, and magnesium). On the other hand, a poor diet (eating more often at fast food restaurants) increased the incidence of wheezing.

Article 4

A recent study in the UK revealed that people who ate at least two apples per week had a 30% lower chance of asthma versus people who ate less than 2 per week. In addition, people who ate more selenium (an anti-oxidant mineral) in their diet were about half as likely to suffer from asthma. The RDA for selenium is 55 micrograms. The study showed that people who ate 50 to 90 micrograms were protected most from asthma. The theory behind this is the anti-oxidants in apples and many other fruits can help protect people from chronic diseases. Foods rich in selenium include walnuts, Brazil nuts, tuna, beef, enriched grains and pasta.

Breastfeeding

Breast milk is the best food for babies and supports the development of a healthy immune system. Moreover, modern medicine is only beginning to delve into the many amazing qualities of this naturally baby food.

Among many of breast milk’s qualities is its ability to lower the risk of developing asthma, eczema and allergies. If a mother suffers with any of the above conditions, their child is at a greater risk of developing them as well. However, breast milk can reduce the risk of their children developing asthma, eczema or allergies if they are breast fed for at least 4-6 months.

Study 1: A study of over 2500 children published in the July 2002 issue of the Journal of Allergy and Clinical Immunology supported the above fact that breastfeeding reduces the risk of asthma regardless of the mother’s asthma history.

Study 2: Another study (October 2003 Journal of Allergy and Clinical Immunology), came to the conclusion that children who are breastfed are less likely to wheeze before their first birthday. In this study, the researchers followed 243 mother-baby pairs for 12 months.

Study 3: A research study of 2600 infants with asthma showed that if any formula was introduced before 4 months of age, the infant's risk of asthma increased by 28%.

Pollution

Pollution can trigger asthma and changes in commuting practices as well as automobile designs must take place. Environmental changes that take place today are likely to have a huge impact on the incidence and severity of asthma in the children of tomorrow.

Article 1

According to a 2001 study performed by the American Medical Association, the 1996 Summer Olympic Games in Atlanta provided valuable insight on the effects of automobile traffic and air quality on asthma. To minimize traffic, the city of Atlanta introduced environmentally friendly means of transportation including closing streets to private cars, adding more public transportation and encouraging working from home. With these modifications the air quality improved and peak morning traffic decreased by 22.5%. Particulate matter, carbon monoxide, and ozone levels were reduced by 16% to 28% during the Olympics.

As well, the number of asthma related emergency room visits recorded for children ages 1 to 16 dropped by more than 40%. In comparison, non-asthma related visits were reduced by no more than 3.1% during the same time period.

Article 2

It is well known that children who live in areas with excess air pollution have higher rates of asthma and other lung diseases. A study presented at the November 2001 annual meeting of the Radiological Society of North America suggests that permanent lung damage that is a result of pollution can go virtually unnoticed in an apparently perfectly healthy child. The study involved Mexico City and a seaside Mexican town. In Mexico city where air quality is below national standards for four hours per day, over 63% of apparently healthy children breathing city air had signs of obstruction on x-ray, over 50% had signs of inflammation, and 18% had signs of more advanced damage. In comparison, only 5% of children living in the seaside town where the air is cleaner had mild obstruction, and none had inflammation or more advanced damage.

Genetics, Cigerette Smoke and Asthma

Just as every child’s personality is unique, so is their physical reaction to second hand cigarette smoke according to a study in July 2004’s issue of Thorax. Repeated exposure to the 4000 chemicals in second hand cigarette smoke will cause asthma in some children because 50% of them have large amounts of glutathione S transferases (GST), which naturally detoxify the chemicals in the smoke. Researchers in Germany did genetic testing on over 3,000 schoolchildren, aged 9 to 11. The bottom line - secondhand smoke is not good for any child, especially children with a genetic tendency towards allergic conditions (asthma, eczema and hayfever).

Different Symptoms, Same Treatment

According to Chinese medicine, disease is divided according to pattern discrimination and not according to modern medical disease. Pattern discrimination is based on various symptoms collected by the four examinations of TCM. Below are some abstracts of three articles that discuss various symptoms (i.e. snoring, cough, obesity and clearing the throat) related to asthma. These symptoms correlate to phlegm (-heat) in TCM.

Study 1

According to modern medicine, a child’s occasional snoring is very common especially during times of respiratory infections. A study from Australia published in the August 2003 issue of Chest concluded that there is a link between consistent snoring, asthma and nighttime coughs in preschool children. Nighttime coughs have often been associated with asthma and children who snore are more likely to have nighttime coughs. Moreover, children who snore are far more likely to have asthma than children who do not snore. Decreasing the exposure to tobacco smoke in the house can improve all three co-related symptoms. According to Chinese medo the disease mechanism of phlegm (-heat).

Study 2

Children who are overweight are more likely to have asthma than children who are not overweight. An article in Pediatric News reports that children (9-14 years old) that are obese are twice as likely as their peers to develop asthma. These children watch more TV and exercise less, eat an unhealthier diet and weigh more. Yet again we have another great reason to encourage children to eat healthy, delicious foods and to get sufficient exercise.

Study 3

The authors (of a study found in the April 10, 2003 issue of the New England Journal of Medicine) surveyed the parents of more than 2500 children (3-5 years old) attending daycare on the island of Crete. Among other questions these researchers asked "does your child have a habit of clearing his or her throat often?" More than 100 parents answered yes to this question. Many of those children had already been diagnosed with asthma, but most had not. When pulmonary function testing was performed on the other children (who cleared their throat often) they found they all had mild asthma that had not yet been detected. These children’s lung function and throat clearing improved with asthma medicines. The study suggests that throat clearing may be the first sign of asthma in some children. In both Chinese and Western medicine it is well known that children with asthma fare better with early diagnosis and early treatment.

Asthma and Reflux

Doctors of TCM have known for some time that there is a connection (especially in children) between the digestion and respiratory problems such as asthma. Modern medicine now also recognizes this and estimates that 34 to 89 percent of reflux sufferers also have asthma. This percentage is too high to be considered coincidence. The evidence is mixed (in Western medicine) about whether reflux triggers asthma, asthma (or asthma medicine) triggers reflux, both, or neither. Modern medicine is beginning to realize what Chinese medicine has known for centuries - that effective treatment of reflux (i.e. digestion problems in TCM) can dramatically improve asthma. A study presented in the April 2002 issue of The Journal of Asthma unveils increasing evidence that there is a relationship between gastroesophageal reflux, noting that the severity of reflux was directly proportionate to the severity of the asthma.

Flu Shot May Not Be As Protective for Children with Asthma as Previously Thought

Many parents of asthmatic children believe that their child must get the flu shot in order to prevent any potential asthmatic related symptoms resulting from the flu. However, a Dutch study of 700 kids, did not show a benefit of this popular assumption and raises many questions that hopefully future studies will answer. Overall, 42 asthma flare-ups occurred during the flu season. Those who did NOT get the shot actually had fewer asthma flare-ups, but those that DID get the shot had shorter flare-ups. Both groups had an equal number of flare-ups total.


TCM Clinical Trials

Study 1 - Asthma (Acute)

A summary of data collected in a clinical audit using Chinese Herbal Medicine to treat children with acute asthma appeared in the 4th edition of the Zhejiang Journal of Integrated Chinese-Western Medicine in 1998. The acute episode was either triggered by an upper respiratory tract infection, exposure to an allergic substance or emotions. Participants were divided into different sub-categories based on their signs and symptoms. Based on this differentiation 17 cases were classified in TCM as phlegm heat congesting the lung pattern , 36 cases had external cold & lung heat pattern and 14 cases had a mixed vacuity-repletion pattern. Ma Xing Shi Gan Tang Jia Jian (Ephedra, Armeniaca, Gypsum & Licorice Decoction with Additions & Subtractions) was the base formula used by the doctor in this study. Seven days equaled one course of treatment. Using this classic Chinese herbal medicine formula, 49 cases (73.1%) were judged cured, 14 cases (20.1%) were improved, and four cases (6.8%) had no improvement. Therefore, the total amelioration rate was 93.2%. Using this method, the wheezing disappeared in 1-6 days, with the average being 3.2 days. The rapid breathing disappeared in 1-4 days, with the average being 1.5 days. The coughing disappeared in 3-7 days, and the average time till disappearance was 4.6 days.

Study 2 - Asthma (Remission Stage)

In issue #4, 2004 of the Shandong Journal of Chinese Medicine, the results were reported of a clinical trial using Chinese herbal medicine as a treatment for children during the remission stage of asthma. All the patients in this study were seen as out-patients at the Chinese authors’ hospital. Altogether, there were 145 patients who were randomly divided into two groups, a treatment group and a comparison group. The treatment group were orally administered Huang Qi Liu Jun Zi Tang (Astraguls Four Gentleman Decoction) which consisted of fifteen different Chinese herbs. This formula which was decocted was administered two times per day, and one month of treatment equaled one course. The comparison group were administered a simplified Chinese formula called Yu Ping Feng San (Jade Windscreen Powder) in liquid form, one ampule each time, three times per day. Results were analyzed after three courses for both groups with follow-up after one year.

Marked effect was defined as complete disappearance of all symptoms and one or less acute attacks within one year on follow-up. Before the study each patient suffered from 3-5 asthma attacks per year. Some effect was defined as basic disappearance of symptoms and two recurrent attacks on follow-up within one year. Based on these criteria, within the treatment group, 53 patients were judged to have gotten a marked effect, 23 got some effect, and nine got no effect, for a total effectiveness rate of 89.41%. In the comparison group of 60 patients, 21 got a marked effect, 25 got some effect, and 14 got no effect, for a total effectiveness rate of only 76.67%. Therefore, the treatment group got a better effect (P + 0.05). There were no side effects in either group.

Study 3 - Asthma (Remission Stage)

In issue # 2, 2005 in the journal Chinese Medical Research, Chen Ming et al. from the Fujian Chinese Medical Research Academy published an article titled, " Clinical Observations on the Relationship Between Three Hidings Moxibustion, ET, IgE, and Lung Function." ET stands for endothelins which are some of the most powerful vasoconstrictors in the body. In particular, ET-1 is found widely disseminated in the respiratory tract and is believed to play a major role in asthma and inflammation of the respiratory tract. The three hidings are three particular days during the extreme heat of summer. Three hidings moxibustion is a treatment method in Traditional Chinese Medicine based on the principle, "For winter disease, treat in the summer." A summary of this article is presented below.

Altogether, there were 90 patients enrolled in this study and these individuals were randomly divided into two groups at a 1:2 ratio. This meant that there were 30 patients who were assigned to the comparison group who did not receive three hidings moxibustion. The following table shows the relative sex, age, and disease duration between these two groups.

The treatment groups were treated with indirect ginger moxibustion on two acupuncture points on the back. In TCM these points are referred to as Da Zhui (GV 14) and bilateral Fei Shu (Bl 13). In addition, a Chinese medicinal paste was applied to the points after moxibustion in this group.

Both groups were examined 15 days before the treatment group was treated for the first time and 15 days after treatment for the last time.

Marked effect was defined as marked improvement in the symptoms of asthma as well as other symptoms associated with each patient’s pattern discrimination with basically no recurrence of asthma. Improvement meant that the symptoms of asthma as well as the symptoms of the patient’s pattern all decreased. The following table shows these outcomes in the two groups, keeping in mind that the comparison group, in fact, received no treatment.

Group	Number	No Effect	Improvement	Marked Effect	Total Effect
Treatment	60	9	34	17	85%
Comparison	30	28	2	0	6%

In addition, mean ET (ng/L) decreased by 7.31 "12.56 in the treatment group, but only decreased 1.78" 5.14 in the comparison group. Likewise, mean IgE (mg/L) decreased by 0.1899 "0.5739 in the treatment group but only 0.0321" 0.1471 in the comparison group. There were also statistically significant changes in the treatment group in other measures of respiratory tract health, such as forced vital capacity (FVC), forced expired volume (FEV), maximum midexpiratory flow (MMEF), peak expiratory flow (PEF), and forced expiratory flow 25%, 50%, and 75%. Thus three hidings moxibustion was deemed as being definitely effective for the treatment of chronic bronchial asthma.


Patient Form

This printable handout is to inform current patients how they can assist in the healing process by offering helpful tips and suggestions.