Monthly E-Newsletter December 2007
Dr. Sayeed Ahmad D. I. Hom. (London)
Asthma, disorder of the respiratory system in which the passages that enable air to pass into and out of the lungs periodically narrow, causing coughing, wheezing, and shortness of breath. This narrowing is typically temporary and reversible, but in severe attacks, asthma may result in death. Asthma most commonly refers to bronchial asthma, an inflammation of the airways, but the term is also used to refer to cardiac asthma, which develops when fluid builds up in the lungs as a complication of heart failure. This article focuses on bronchial asthma.
Every cell in the human body requires oxygen to function, and the lungs make that oxygen available. With every breath we take, air travels to the lungs through a series of tubes and airways. After passing through the mouth and throat, air moves through the larynx, commonly known as the voice box, and then through the trachea, or windpipe. The trachea divides into two branches, called the right bronchus and the left bronchus, that connect directly to the lungs. Air continues through the bronchi, which divide into smaller and smaller air passages in the lungs, called bronchioles. The bronchioles end in clusters of tiny air sacs, called alveoli, which are surrounded by tiny, thin-walled blood vessels called capillaries.
Here, deep in the lungs, oxygen diffuses through the alveoli walls and into the blood in the capillaries, and gaseous waste products in the blood mainly carbon dioxide diffuse through the capillary walls and into the alveoli. But if something prevents the oxygen from reaching the alveoli, the body's cells do not receive a constant supply of vital oxygen, and carbon dioxide builds up to harmful levels in the blood.
THE ASHTMA ATTACK
Asthma attacks occur when the bronchi and bronchioles become inflamed, reducing the space through which air can travel through the lungs. This causes the asthmatic to work harder to move air in and out of the lungs. Asthma attacks usually begin with mild chest pressure and a dry cough. As an attack intensifies, wheezing develops and increases in pitch; breathing becomes difficult; and coughing produces thick, stringy mucus. As the airway inflammation prevents some of the oxygen-rich air from reaching the alveoli, the cells of the body start to burn oxygen at a higher rate, actually increasing the body�s demand for oxygen. The frequency of asthma attacks varies considerably among asthma suffers. Some people have daily attacks, while others can go months or even years without having an attack.
Inflammation of the airway occurs when an irritant's such as pet hair or cigarette smoke comes into contact with the airway walls. Upon detecting the irritant as a harmful invader, the body's immune system sends special cells known as mast cells to the site of irritation, in this case the airway walls. The mast cells release histamine, a chemical that causes swelling and redness in a process called the inflammatory response. Histamine also causes bronchospasms, in which the muscles lining the airway walls contract repeatedly, causing the airways to narrow even more. In addition, cells that lubricate the airways with mucus called goblet cells overreact to the inflammatory response by secreting too much mucus. This mucus clogs the bronchioles, resulting in wheezing and coughing.
Asthma attacks are caused by airway hyper responsiveness that is, an overreaction of the bronchi and bronchioles to various environmental and physiological stimuli, known as triggers. The most common causes of asthma attacks are extremely small and lightweight particles transported through the air and inhaled into the lungs. When they enter the airways, these particles, known as environmental triggers, cause an inflammatory response in the airway walls, resulting in an asthma attack.
For some people the environmental triggers are allergens. Allergens are usually natural substances, such as plant pollen and mold spores, animal dander (tiny pieces of animal hair and skin), and fecal material from dust mites and cockroaches. Allergens produce an exaggerated response of the immune system in which a specific antibody, immunoglobulin E, initiates the inflammatory response. These same allergens may cause little or no reaction in nonallergic people.
Asthma also occurs in people who do not have allergies. In these people, chemical irritants trigger an inflammatory response that is initiated in a different way than in allergen-triggered asthma. For example, some people are sensitive to certain common chemical irritants, such as perfume, hairspray, cosmetics, and household cleaners. Other chemical irritants include industrial chemicals and plastics, as well as many forms of air pollution, such as exposure to high levels of ozone, car exhaust, wood smoke, and sulfur dioxide. Current research seeks to determine whether indoor pollutants also contribute to the development of asthma.
Not all triggers are environmental. Aggravations from within the body are known as physiological triggers and include exercise and infections, such as the common cold. Sometimes substances that asthmatics eat or drink bring on attacks. Chemicals found in food or medicines such as food sulfites found in beer and wine and medications such as aspirin and ibuprofen are especially problematic for many asthma sufferers. Intense emotion, such as crying, shouting, or laughing, may provoke hyperventilation, a rapid inhalation of oxygen that causes the airway to narrow. In asthmatics, hyperventilation often results in an attack. Many asthmatics are especially sensitive to physical exercise in cold weather.
Research suggests that genetic factors may increase the risk of developing the disorder. Children with a family history of asthma are more likely to develop asthma than other children. Despite this apparent genetic link, many people without a family history of asthma develop the disorder, and scientists continue to investigate additional causes.
Physicians typically diagnose asthma by looking for the classic symptoms: episodic problems with breathing that include wheezing, coughing, and shortness of breath. When symptoms alone fail to establish a diagnosis of asthma, doctors may use spirometry, a test that measures airflow. By comparing a patient's normal airflow, airflow during an attack, and airflow after the application of asthma medication, doctors determine whether the medicine improves the patient's breathing problems. If asthma medication helps, doctors usually diagnose the condition as asthma.
Identifying the specific trigger of a patient's asthma is usually more difficult than the initial diagnosis. Triggers may be easily recognizable and consistent; for example, a patient may always develop an asthma attack when using a particular cosmetic or household cleaning product. When the triggers are more difficult to identify, doctors perform a series of allergy skin tests to help determine whether allergy triggers are responsible. Skin tests are not conclusive, however, because patients may have skin reactions to substances that do not necessarily trigger an asthma attack. Doctors may also use spirometry to evaluate a patient's airflow before and after exposure to common triggers. Triggers that decrease airflow may be responsible for the patient's asthma.
Although there is no cure for asthma, effective treatment is available for preventing attacks and for controlling and ending attacks soon after they have begun. Asthma medications are taken orally or inhaled in vapor form using a metered-dose inhaler, a hand-held pump that delivers medication directly to the airways. There are two kinds of asthma medications: bronchodilators, which reduce bronchospasm; and anti-inflammatory medications, which reduce airway inflammation.
Bronchodilators are the most widely used medications for controlling sudden asthma attacks and for preventing attacks brought on by physical activity or exercise. They work directly on sites called beta-receptors that are attached to small muscle bands encircling the airways. When these drugs attach to the beta-receptors, the muscles relax and the airway dilates. Theophylline is a bronchodilator that works by relaxing the muscles surrounding the airways.
Anti-inflammatory medications work mainly by interfering with the activity and chemistry of immune cells, such as mast cells, that cause inflammation in the airway walls. Anti-inflammatory medications also help relax the airway muscles that constrict during bronchospasm. Corticosteroids reduce asthma symptoms by suppressing the immune response, and they often succeed when no other asthma treatment works. Over time they reduce the sensitivity of the airways to many common triggers. Long-term use of oral corticosteroids may have severe side effects, including weakening of the bones and the development of cataract, a clouding of the lens of the eye. Recent studies suggest that small doses of inhaled corticosteroids taken in combination with certain bronchodilators may work equally well while significantly reducing the side effects. Leukotriene modifiers, another type of anti-inflammatory medication, are taken orally as an alternative to corticosteroids for the long-term treatment of mild asthma.
Immunotherapy is a treatment option for asthma caused by allergens. This form of therapy modifies a person's allergic response by repeated exposure to small amounts of allergens. The asthmatic is injected periodically with known allergens, a procedure that trains the asthmatic's body to react to the allergens differently. Immunotherapy is especially effective in reducing allergic reactions to dust mites, animal dander, pollen, and fungi.
To control asthma attacks before they begin, asthmatics can measure their peak expository flow rate (PEFR), which is a gauge of how fast a person can exhale air from the lungs. By breathing into a small hand-held device called a flow meter, an asthmatic can learn when their airways are first starting to narrow. When the PEFR falls, asthma medication may be needed to prevent an attack. PEFR and medication should be used under a physician' s guidance.
Asthmatics can also prevent and control attacks by limiting their exposure to environmental triggers, especially allergens. Frequently cleaning carpeting, bedding, and household upholstery reduces levels of irritants and allergens in the home. To prevent asthma attacks, asthmatics should wear a mask while cleaning. Regularly bathing pets minimizes levels of animal dander in the air. Asthmatics should take care to avoid pollutants and irritants such as cleaning sprays and cigarette smoke whenever possible. Seasonal allergies to pollen and mold spores can be reduced by avoiding the outdoors during peak periods of activity.
Asthma is one of the distressing ailments which are not easy to cure. After using palliative medicines to overcome an acute attack, one should resort to constitutional treatment in order to give permanent relief to the patient. The main constitutional medicines are:
- Natrum Sulph.
The above medicines are to be given inter-currently in potency not below 200. No other medicine is to be given for 2 - 3 days before and after. If any of the above medicines have the desired effect, further drugging of the patient should be avoided.
Further, in Asthma the diet plays a very vital role. Thus, the use of white flour, eggs, white sugar, meat, fish, milk, curd and puddings should be avoided.
Difficult getting air into the lungs. ----- Brom., Iod.
Difficult getting air out of lungs. ----- Chlor., Sul.
In rapid short breaths. ----- Acon., Ant-t., Phos.
Shallow. ----- Acon., Ant-t., Nux-v., Phos.
Wheezy. ----- Ars-a., Cinch., Hep-s., Ipec., Phos.
Rattling. ----- Seneg., Sil.
Rattling and wheezing. ----- Ipec., Seneg., Sil., Squil.
As if air passages were full of smoke. ----- Brom.
With fear of suffocation. ----- Ars-a., Ipec., Sul., Ver.
Easy. ----- Cinch.
Cannot perspire. ----- Cham.
Profuse. ----- Hyper.
Chocking. ----- Hep-s.
Loose. ----- Dulc., Nat-s.
Dry. ----- Acon., Ars-a., Bry., Med., Nux-v., Psor.
Violent. ----- Kali-c.
Violent and incessant. ----- Ipec.
Spasmodic. ----- Aral., Cupr., Phos.
Paroxysmal. ----- Nux-v., Samb.
Deep sounding, hoarse. ----- Dros.
< After physical exercise. ----- Dulc.
With: desire but inability to cough. ----- Cham.
With: vomiting. ----- Kali-c., Ipec., Lob.
With: ending with vomiting. ----- Ipec.
With: pain in chest under short ribs. ----- Lob.
With: bleeding from the nose. ----- Dros.
With: must hold chest when coughing. ----- Nat-s.
With: caused by tickling in throat pit. ----- Rumex
Difficult. ----- Alumen, Dulc.
Profuse. ----- Blatta, Grind., Sul.
Worse from. ----- Hyper.
Bloody. ----- Nux-v.
None. ----- Cupr.
Rapid walking. ----- Lob.
Stool. ----- Poth.
From being at seaside. ----- Med.
< Change from warm to cold. ----- Dulc.
< Wet and damp. ----- Dulc., Nat-s., Sil.
< Dry cold air. ----- Hep-s., Rumex
< Foggy. ----- Hyper., Kali-c.
< Warm dry weather. ----- Syph.
< Damp weather. ----- Hep-s.
In right lower chest. ----- Kali-c
In left lower chest. ----- Nat-s.
In right and then in left lungs. ----- Lyc.
Through upper third of right lung. ----- Ars-a.
Through lung to back. ----- Kali-hyd.
In chest and mammae. ----- Med.
With burning feeling. ----- Ars-a.
With a constrictive feeling in the chest. ----- Ars-a., Cupr., Ipec., Lach.
With cramplike feeling in cardiac region. ----- Ptel.
Painful larynx. ----- Med., Phos.
Persistent nausea. ----- Ipec.
Dyspnoea (Shortness of breath). ----- Acon., Dulc., Euc., Ipec., Kali-p., Lach., Med., Psor., Sil., Sul.
Hands and face blue. ----- Squil.
Face pale. ----- Sil.
Liability to get colds. ----- Cinch.
11 p. m. to midnight. ----- Aral.
Midnight to 2 a. m. ----- Ars-a., Samb.
2 to 3 a. m. ----- Dros., Kali-ars., Samb.
2 to 4 a. m. ----- Kali-c.
3 a. m. ----- Samb.
4 to 5 a. m. ----- Nat-s.
< In morning. ----- Lach.
> Day time. ----- Med.
Always < at night. ----- Aral., Dros., Syph., Tub-bov.
On face in knee/chest position. ----- Med.
Must sit up. ----- Ant-t.
Must sit up as fears suffocation. ----- Ars-a.
Must lie with head high. ----- Ars-a., Cinch.
Must lie flat on back with arms outstretched. ----- Psor.
Sleepless. ----- Chlor.
< Lying down. ----- Grind., Kali-c., Sul.
> Lying down. ----- Psor., Ver.
> From stool. ----- Poth.
Awakes suddenly 3 a. m., nearly suffocated, has to sit up. ----- Samb.
TYPES OF PATIENTS
Fair haired, delicate-skinned. ----- Brom.
Corpulent. ----- Blatta
Easy perspiring. ----- Cinch.
Old people particularly. ----- Carb-v., Kali-c.
Sensitive, result of mental emotions. ----- Coff.
Dark haired. ----- Iod.
Better at seaside. ----- Med.
Better in open air. ----- Iod., Napth.
Worse for pressure on throat. ----- Lach., Rumex
Worse for motion. ----- Ars-a., Ver.
Worse for talking. ----- Arum-t., Dros.
Worse in warm room. ----- Iod.
Worse for food. ----- Kali-p.
Worse with annual hayfever. ----- Psor.
Worse due to exertion. ----- Aspido., Coca, Ars-a.
Worse due to dust. ----- Poth., Brom.
Worse going upstairs. ----- Kali-p.
Sailor gets asthma on going to shore. ----- Brom.
Attack of asthma due to mental or nervous emotions. ----- Coff., Kali-p., Succ-ac.
Eczema. ----- Ars. Stibiatum
Measles. ----- Carb-v.
Whooping cough. ----- Carb-v.
Any information given above is not intended to be taken as a replacement for medical advice. Therefore, it is very important that the patients should avoid self-treatment and rather consult the most abled and qualified classical homeopath and take the treatment under his proper guidance and advice.
MS Encarta Encylopedia.
Asthma by N. W. Jollyman
Copyright with Dr. Sayeed Ahmad 2004