Conventional treatments for asthma, when properly carried out, are usually effective at controlling symptoms, but they do not address the underlying causes of the disease. Commonly used drugs carry considerable risk of adverse effects, and conventional thinking about this disorder gives little attention to antibiotic exposure in utero and in infancy, immunizations, food sensitivities, and IgG-mediated food allergy in the etiology of the condition.

Naturopathic physicians take a more comprehensive approach to asthma, utilizing evidence-based therapies targeting the patient's environment, lifestyle, and diet. It is not necessary to forego conventional therapy when undertaking naturopathic treatments, but many patients can gradually discontinue conventional medications under physician supervision as the condition improves.

Shortcomings of Conventional Treatment

Antibiotics are often used to treat respiratory infections that accompany asthma. In some cases they are necessary. However, overuse leads not only to development of resistant bacteria but, in the case of infants, actually increases the risk of asthma. Researchers at the University of Nottingham, UK, found that women who took antibiotics during pregnancy increased their children's risk of asthma by 68% (McKeever TM et al. Am J Resp Crit Care Med2002, Sept 15; 166(6):827–832). Antibiotic exposure prenatally and in the first two years of life destroys beneficial gut flora and drives the maturing immune system toward the Th2 response. Likewise, immunization with whole-cell pertussis and live attenuated mumps and rubella virus, bottle-feeding, diets heavy in omega 6 fatty acids and saturated fats (including maternal diet during pregnancy), insufficient dietary antioxidants, and exposure to environmental toxins all push T-helper cell function to the Th2 limb.

Beta 2-adrenergic agonists (bronchodilators) are reasonably safe, but stimulate the autonomic nervous system and may produce rapid or irregular heartbeat, insomnia, shakiness and nervousness. Overuse of bronchodilators can result in an overall worsening of asthma. This, and the cardiovascular adverse effects, may partially explain the rising mortality from asthma in recent years.

Overuse of systemic corticosteroids leads to increased appetite, weight gain, hyperglycemia, fluid retention, mood changes, and gastrointestinal upset. Long-term steroid use leads to immune suppression, adrenal suppression, osteoporosis, myasthenia, cataracts, skin changes, and peptic ulcers.

Naturopathic Approach to Asthma

An appropriate naturopathic treatment plan includes the following:

• Determination of specific underlying defects that allow development of sensitization and excessive inflammatory response.
• Identification of allergens, and implementation of dietary and environmental strategies for avoiding them.
• Modulation of the inflammatory process.
• Effective treatment of bronchoconstriction.

For infants with a family history of atopy, consider delaying or avoiding certain immunizations. The relative risk of developing asthma is 1% in children receiving no immunizations, 3% in those receiving vaccinations other than pertussis, and 11% for those receiving pertussis (Odent MR et al. JAMA 1994; 272:592–593).

Inflammatory leukotrienes from arachidonic acid in meat and dairy contribute significantly to asthma. This explains some of the benefit of vegan and fish-based diets in reducing asthma (Lindahl O et al. J Asthma 1985; 22:45–55). The diet should include foods rich in flavonoids and carotenoids, and garlic (unless the patient is allergic to it) as it inhibits leukotrienes. Hydrogenated oils and fried foods should be avoided. Food allergies play an important role in asthma (Bock SA. J Asthma 1983; 20:377–381; Businco L et al. Ped Pulm Suppl1995; 11:59–60), and elimination diets are often successful in identifying allergens, particularly in infants (Hodge L et al. Thorax 1996; 51:805–809). Avoidance of common allergens during infancy reduces allergic tendencies in atopic children (Hide DW et al. J Allergy Clin Immunol 1994; 93:842–846).

An overgrowth of Candida albicans has been implicated in asthma. The acid protease produced by Candida is the responsible allergen (Akiyama K et al.Allergy 1994; 49:778–781). Food allergies, Candida, and other unfriendly intestinal organisms are responsible for asthmatics having intestinal hyper-permeability or "leaky gut" (Benard A et al. J All Imm 1996; 97:1173–1178). This can often be repaired by identifying and eliminating causative agents and supplying nutrients such as L-glutamine, zinc, vitamins A, C and E, and probiotics. Vitamins A and C, as well as zinc, thymus extracts, and herbs such as Echinacea, Lomatium and Larix can bolster immunity and reduce the need for antibiotics.

Magnesium and pyridoxine (vitamin B6) are the most important nutrients in managing asthma; they help promote bronchodilation. Incidentally, commonly used bronchodilators can cause magnesium and B6 depletion. For patients who find that sulfites trigger symptoms, vitamin B12 and molybdenum are beneficial (Stevenson DD, Simon RA. J All Clin Imm 1981; 68:26–32). Hydrochloric acid, vitamins C and E, selenium, glutathione, and n-acetyl cysteine may also be helpful. Some herbs with bronchodilating and/or anti-inflammatory actions include Ginkgo biloba, Tylophora asthmatica, Coleus forskholii, Boswellia serrata, Ephedra sinensis, Lobelia inflata and Glycyrrhiza glabra. These all have a scientific as well as historical basis for their use.

In conclusion, conventional medication may be preferable for symptomatic treatment of moderate to severe asthma attacks. But naturopathic approaches, for informed and compliant patients, may lead to better overall outcomes in mild asthma. They also hold great potential for long-term prevention and symptom control.

Michael Traub, ND, is currently president of the American Association of Naturopathic Physicians. He practices in Kailua-Kona, Hawaii, and is on staff at North Hawaii Community Hospital.