Austin Asthma Treatments
What is Asthma?
Asthma isn’t a disease. It is a condition of restricted airwayscharacterized by wheezing, coughing, chest tightness, and shortness of breath. Sometimes the only symptom is coughing. At its most mild, we see the patient who wheezes once in a great while, perhaps when they have a “cold” or a chest infection. At its most severe, we see life threatening shortness of breath, and even death, as a result of severe asthma.
Recent studies indicate about 15 million Americans haveasthma. The incidence is rising year by year. There are about 500,000 hospital admissions for asthma each year. And there are about 5,000 deaths attributed to asthma annually It is estimated that 100 million workdays are lost each year due to asthma. Asthma causes 10 million days of school absences each year. Direct expenses related to asthma care are estimated at $3.8 BILLION annually. Then there is also an additional $2.6 billion in indirect medical expenses, including lost workdays for adults with asthma, or from caring for children with asthma.
Asthma has long been thought to be a “emotional” disorder, in that it was observed in children subjected to stress or anxious situations (…”clean up your room right this minute or I’ll blister your bottom”…), who would promptly begin wheezing. So is it emotional? Not really. Since our “emergency” hormone ADRENALIN is such a powerful stimulus for muscle contraction, it stands to reason that emotional change (good or bad) is surely one of the many causative factors. Adrenalin can lead to bronchoconstriction, one of the two main culprits in the causation of asthma. We have finally reached some agreement that the other culprit is inflammation. Moreover, most physicians would agree, now, that this is about inflammation of the total respiratory system: nose, sinus, lungs and all. Some of the shortness of breath (SOB) is due to swelling of the soft tissue lining the airways. Some is due to muscle spasms in the smooth muscles that surround the airways. Some is due to mechanical obstruction from mucus.
In my office, I address a wheezing patient by immediately beginning intradermal “neutralization” of the airborne and hormonal causes of the swelling. In females, from adolescents to the elderly, I first attempt to reverse whatever part of their symptoms might be caused by an allergic reaction to their own hormones, particularly progesterone.
This has even greater significance if they have signs of hormone imbalance.
Asthma and Hormones
The signs and symptoms of hormone imbalance most often include weight gain, fat production, loss of short-term memory, fatigue, mood swings, skin problems, and diminished sex drive. In young ladies (from pre-puberty to age 18 or so), a hormone imbalance is often evident from the first moment of the initial interview. The most common signs include skin problems, thin and fine scalp hair, increased facial and body hair, slender figures, small breasts, thin lips and an anxious or nervous demeanor. Typical skin problems include oiliness from the neck up, especially between the eyebrows and across the bridge of the nose. Often the scalp is oily with fine scalp hair. The eyebrows are frequently dense with coarse hair. Lip and cheek hair is increased. Less frequently, I see “acne” or red, irritated spots on the chest and sometimes across the upper back. Some ladies will find one or more coarse, dark, curly hairs growing around the edge of nipple tissue. Some see a few hairs of this type growing up from the pubic area toward the navel along the midline of the belly. What does this sound like? A sixteen year old boy! This clinical picture demonstrates a significant hormone imbalance. These patients exhibit varying degrees of masculinization. In extreme cases, I’ve seen teenage girls who shaved daily and had very thin scalp hair. These are not disease states. They are varying degrees of hormone “imbalance.”
I order a standard panel of laboratory tests on my female patients who have begun menstruation. The panel includes estrogen, progesterone, testosterone, DHEA (dehydroepiandrosterone), cortisol and thyroid. The typical pattern I see is slightly low estrogen, low progesterone and testosterone, and dramatically low DHEA and cortisol (especially as ladies enter their 30′s and almost always by their early 40′s).
The significance of this hormone imbalance relates to soft tissue swelling (STS). Swelling leads to all the common symptoms of allergy. In the case of asthma, swelling in the cortex results in increased levels of adrenalin secretion. Adrenalin causes tightening of smooth muscle in the airways of asthmatics, resulting in asthma “attacks” or shortness of breath. Adrenalin also causes very rapid acidosis throughout the body. One of the many consequences of this state of acidosis is a reduction in our ability to extract oxygen from the air we breathe, which further aggravates the asthma “attack” or SOB. (See oxygen dissociation curve, Harrison, etc.)
If, for the moment, we suspend disbelief and accept my hypothesis that STS (Soft Tissue Swelling) is the direct cause of asthma, then hormone imbalance becomes a critical element in-so-far-as hormone imbalance results in such swelling. This occurs in my select population of allergy patients because they have an allergic reaction to one or more of their own hormones, usually the androgenic (male) hormone progesterone.
The hormone imbalance causes STS in two ways. The first is a result of diminished cortisol production. And the second is a result of the elevated level of progesterone (or the hyper-sensitivity reaction of the patient to it, which has the effect of heightening the effect of even a very low level).
If the patient has an allergic reaction to his or her own progesterone, their body releases adrenalin, this in itself can cause spasms and result in asthma symptoms.
We can only make a limited amount of hormones and nature places different priorities on different hormones. If we look at the graph below, we can imagine we are looking down into the body and viewing the TOTAL FLOOR SPACE of our hormone factory.
The Hormone Factory
- Metabolic (thyroid)
- Progesterone (or “boy” hormone)
Nature’s TOP priority is adrenalin. Anyone who didn’t have enough adrenalin didn’t make it… they were eaten by the bears.
dilutions of Progesterone are either injected intradermally or administered using sublingual drops. I usually start with a dilution of Progesterone diluted with 10-1 to 10-3 parts water. That is a unit of water with twelve zeros after it. Then, further injections or drops are administered to try toeliminate the wheezing or shortness of breath as completely as possible. These reactions usually occur within fifteen to thirty seconds after the antigen is injected. And if the Progesterone makes the patient’s condition worse, it can be reversed immediately with an even weaker dilution of Progesterone.
This methodology is fast, economical and very effective.
What Are The Causes of Asthma?
For many years there has been a “turf war” between physicians over who might be best qualified to treat asthma. It still seems to be “up for grabs.”
The pediatricians, of course, feel they should take care of the kids. And the “Adult Allergists” and the Pulmonologists compete between each other and the Primary Care physicians.
So what are the causes for asthma? I think the causes include the air we breathe (and the pollen, mold and chemicals in it), the food we eat, the substances, chemicals, toxins we come in contact with, hormone imbalances and hormone allergies, stress, infections and acidosis. I think that about covers it.
If I am correct, then our different specialists are missing the big picture. Some may even be blinded by the bias of their training or, heaven forbid, economic considerations.
For example, in the last year I have seen the first studies showing the inter-relationship of allergy, sinusitis and asthma. Allergic rhinitis is found in 80% of patients with asthma. Sinusitis is found in 80% of patients with asthma also. So how do you deal with that? Do you see an E.N.T. for the sinusitis, an allergist for the allergic rhinitis and a pulmonologist for the asthma?
And of course you need a neurologist for the headaches, a rheumatologist for the joint pain, an ophthalmologist for the transient blurred vision, a gastroenterologist for the irritable bowel, (or the “hiatal hernia” that only seems to occur when your allergies flare up)…. And eventually a psychiatrist to help you figure out if it really is…”all in your head.”
Anyway, you see what I mean. The pediatricians tell me “you can’t treat a child’s allergies until he is at least one year old (or “two,” or “three,” etc.). They also tell us with complete assurance… “it could NOT have anything to do with food allergy, which exists only rarely, if at all…try these antibiotics.”
Or the pulmonologist who SEEMS to feel asthma sufferers are experiencing a systemic deficiency of oral Prednisone! Prednisone certainly helps, but why on earth would we want Prednisone in your feet, legs, arms, head, etc., with all of the well-known, horrendous side effects of Prednisone (including Diabetes and Death) when the lungs are the only place we need it?
The ENT physicians and the Primary Care physicians continue to prescribe antibiotics for the sinus infection. I say “the sinus infection,” because I think it’s always the same one. You cannot get rid of a sinus infection with antibiotics. Antibiotics are carried around the body in the bloodstream. The sinus doesn’t have any blood running through it. It’s a “cave” in your head. So how can the antibiotic get to the infection on the surface of the sinus cavity? It cannot. Why do antibiotics seem to help? Because, as in the case of ear infections, the antibiotic has a mild anti-inflammatory effect thereby reducing the swelling. This allows the sinus to drain once again, the pressure is reduced and the infection goes back to sleep…until the next time the allergic swelling causes the sinus to become “blocked.” When the pressure builds up the vascular interface is pushed back, the dormant bacteria wake up, look around and say…”the cops are gone, lets have lunch”…and your old friend the sinus infection is back.
I think asthma is simply one of the more severe degrees of allergy and NOT a separate disorder. Almost everybody with allergy experiences stuffy noses, itchy eyes and mucus drainage. If this continues they may get more soft tissue swelling in adjacent areas, sort of a “DOMINO EFFECT.”
After the typical eye, nose and throat symptoms, you begin to get swelling of the ear tubes (otitis media), or the sinus passages (sinusitis). Finally, if the swelling gets bad enough, you reach what I consider to be the three worst symptoms of allergy: asthma, brain allergy (fatigue, depression, or Attention Deficit Disorder) and SKIN problems. I believe it is most effective to treat the underlying causes of the allergic swelling, not just the asthma, or brain allergy or skin problems.
If I can stop all the allergy swelling and prevent its return, I don’t have to worry about the asthma…it will disappear. NO SWELLING… NO ASTHMA.
The following is a report from the A.C.A.A.I., a conference sponsored by the National Institute of Health focused on allergy and asthma.
The Bronchoconstriction Factor
Sometimes the airways just snap shut. This can be slow or lightening fast. Many factors can precipitate such a spasm but there is one primary hormone involved… adrenalin. This hormone can cause powerful spasms of the smooth muscles that affect the respiratory system and the throat and chest.
Adrenalin comes mainly from the Adrenal Gland sitting on top of your kidneys. In various form it is also found throughout the body as the triggering chemical for many muscles. Adrenalin is basically an emergency hormone designed to allow you to avoid life-threatening emergencies. If a car careens off the street toward you and your baby, adrenalin squirts out and gives you the instant strength and speed to snatch your 100 pound baby and leap in a single bound to safety… on the roof of your house. Okay, you get the picture.
Section 3. Treatment
Part 1. Neutralization
Neuro-Humoral Reactions Everything we know about immunology proposes the existence of a “humoral” mechanism of action. All of our current scientific principles of immunology are based on this premise. In most instances, Neutralization by Titration with dilutions of antigen bears these principles out. When the antigen is injected intradermally, the reaction (an increase or decrease of subjective symptoms) usually occurs within fifteen to thirty seconds. This is what one would expect if a humoral reaction were taking place as these times correspond to “circulation time.”
However, sometimes the patient reports a “reaction” (i.e. an increase or decrease in the symptom) in much less time than “circulation” time. In one example, a sixty-year-old female patient, S.V., was seen with arthritic pain in her knees of “10″ (ten being the worst pain she had ever experienced with the condition, and “0″ being no pain at all). She had been taking large doses of Prednisone (a corticosteroid) for several years and was frankly “Cushingoid” (extremely swollen, a common side effect). Progesterone was administered intradermally. In less than ten seconds she reported the pain was, “Gone. Zero.”
I have seen this phenomenon repeatedly during the last several years. I am forced to conclude that in addition to the humoral mechanism of immune reactions there must also exist a NEURO-HUMORAL mechanism of action that is sometimes elicited. In many instances, the reaction takes place so fast (less than 10 seconds) that it would be impossible for a humoral reaction to take place.
How can this happen so fast? How can this happen at all?
In the case of asthmatics, a part of the problem always seems to involve “swelling” in the airways caused by a “reaction” to the airborne antigens. If airborne antigens are causing swelling because of antibody response in the “soft tissue” of the airways, a certain number of antibodies or “defender” cells are in “equilibrium.”
That is to say, if one thinks of mold spores (these cause nighttime symptoms) as “robbers” and our antibody or “defender” cells as “cops,” then the reactions of the two (cops and robbers) together cause the swelling in the airways.
So if a normal airway has lots of defenders or “cops” available and if mold spore antigens or “robber” cells cause the “cops” to grab them, swelling results from the congregation of massive amounts of “cops and robbers” complexes in the soft-tissue of the airways.
If “R” = “robber” (mold spores, for examples) and “C” = “cop” (defender cells), the complexes might appear like this: “R”+”C” = RC or CR or cR. In any event, the result is the same. The soft-tissue “swells” reducing the air passages.
Some of the “cops” get tired and break “loose” from the complex and fresh “cops” enter from the vascular system to replace them.
How Neutralization Works
If mold spore (“robbers”) “R” cells are injected intradermally into the very dense tissue of skin where highly reactive histamine cells reside, the circulating (“cops”) “C” cells attack the injected “R” cells and a shift in the equilibrium takes place. The result is the immediate reaction at the injection site with an accompanying release of histamines causing redness and swelling. Because this is such “dense” or “tight” tissue, the reaction is “locked” in for two to three hours. The reaction is initiated when the easily dislodged “C” (“cop”) cells are instantly shifted from the soft tissue of the airways and immediate relief of the “swelling” and shortness of breath is possible.
Once the acute swelling is reduced, medication becomes much more effective providing long term relief. Now we can begin the serious work of prevention of the asthma. In the next sections, we will discuss various Medications, and their uses, and tactics for avoiding foods that may be causing some of the problems.
Part 2. Medication A. “Rescue” or reliever drugs A respected allergy journal estimated the cost of testing “moderate or severe chronic asthma” for one year. Consider the following “average” expenses of moderate persistent asthma:
|Doctor Visits||(4 @ $200)||$800|
|Steroid Inhalers||(12 @ $50)||$240|
|Albuterol Inhalers||(6 @ $40)||$240|
|Emergency Room Visits||(2 @ $1000)||$2,000|
If a hospital admission occurs, add $4,200 to $10,000. Of course, it’s difficult to measure the cost of lost school or work days to say nothing of the cost of the reduced quality of life. Of the medications available, I find the Beta-Agonists (albuterol) useful in gaining initial relief of symptoms. I find these helpful, during the fist days of treatment, simply to open the lungs enough to allow me to load the patient with a sufficient amount of inhaled steroids to prevent a reoccurrence of theattack. I will give the patient a single metered-dose inhaler (MDI) of albuterol with the specific instructions that they use it no more than four times per day during the first 2-3 days. This is difficult for some patients, particularly teenagers, because they want FAST relief.
However, I spend a great deal of time explaining that these QUICK FIXES are just that… Quick Fixes.
The problem with these gases (and oral forms as well) is that they simply treat the SYMPTOMS and they’re pretty hard on the patient. They only last a few hours, and then the problem returns. The side effects can be quite uncomfortable as well. The side effects include tachycardia (increased heart rate) and “jitteriness.” In cases where the patient may have had co-existing cardiac problems, there have even been deaths. I routinely require pharmacists to call me when a patient requests a refill for albuterol. I allow it, but I then call the patient to find out where we have “gone wrong.” I believe, if I do my job correctly, there should be no need for Beta Agonists, except on rare occasions, after the first month of treatment. I also have no need for emergency rooms orhospitals because my patients don’t have crises. I believe I get some of the worst asthmatics in a five-state area and I can count on one hand the number admitted to the hospital (for asthma) in the last twenty years. The reason for this has to do with first controlling the asthma (neutralization, MDIs for Beta-Agonists, steroids, environmental control and dietary restrictions) then preventingits reoccurrence. Initial control is attempted with:
- Neutralization (described previously)
- Fast relief (Beta Blocker)
- Fast-acting steroid (oral or injectable)
If patients use their MDIs effectively, there is relief of symptoms in almost every instance. This is more the case with inhaled steroids than the Beta Agonists because even a small amount of albuterol inhaled into the lungs seems to have a dramatic effect in most cases. Once the patient can get a moderate amount of air into their lungs, I want them to begin LOADING UP with inhaled steroids.
1. Inhaled Steroids
Inhaled steroids are the mainstay of my prevention tactics during the first few weeks of treatment. These marvelous medications are almost always effective if we can get them into the lungs in high enough concentrations. Most patients simply cannot inhale enough steroid gas for effective treatment. One has to be an Olympic class-breathing expert to use one of these “MDIs”. Most patients are given an MDI and told to use “use this four times a day” (or “two times,” or “three,” or whatever). But, few are instructed in how to use inhalers. One patient I saw was a 70 year old lady on constant oxygen. She removed her nasal oxygen cannula to show me how she used her inhaler. She took a deep breath (as deep as she could), exhaled, squirted the gas into her mouth… and swallowed. In a few moments, she took the canister from her lips, inhaled softly and muttered….”The damn thing doesn’t do a bit of good.” Well, yes, I can see where it wouldn’t!
Many of my patients come in with all the correct medicines. But, only rarely (and only recently) do they know how to use their medicines.
The quick relief of the Beta Agonists is a tender trap. Yes, they open the lungs, but it is like opening a stuck door with a hand-grenade. The door opens, but the method is pretty hard on the equipment. AND, when the door closes back (four or five hours later) you just have to do it all over again. This is like cutting off dandelion flowers in your yard with a machete… effective, but tedious and tomorrow the problem is right back.
Wouldn’t it be better to “Oil The Hinges?” or “Dig out the dandelion roots?” Steroids oil the hinges. Even my friends the pulmonologists acknowledge that. We’re in complete agreement about the effectiveness of steroids in controlling asthma and even preventing it. We simply disagree on How To Deliver The Steroids. They know about inhaled steroids, but they are frustrated with the huge number of patients who don’t (or won’t) use the inhaled steroids because…”The damn thing doesn’t do a bit of good.” So, they fall back on their mainstay…Prednisone.
At this point I am in complete and total disagreement with the treatment plan. I take almost every patient I see off PREDNISONE just as fast as possible. Why would I treat the person with asystemic steroid to address a problem that exists almost entirely in the lungs? I won’t. I don’t. I don’t need to. Prednisone has horrendous side effects well known to the most naive patient and certainly well known to all physicians. Side effects include diabetes, liver and organ disease, and death. No one would use it if they had a reasonable alternative. Certainly one would NEVER use systemic steroids on children… If There Was An Alternative
Why don’t the inhaled steroids work? Because no one stopped to examine how the patient uses them. I was so excited when the first nasal steroids came out. It was such a great breakthrough.But in no time at all, I began to hear patients complain that the nose sprays “Don’t Work!” I couldn’t imagine why they wouldn’t, so I asked the patient to show me how he used it. The patient dutifully stuck the end of the nasal gas canister in his nostril, grimaced, triggered the gas discharge and at the same time, gave an enormous Snort and snuffed the gas vigorously up his nose. “Well, yes,” I explained, “I can see where that gas isn’t going to do much good.” So we began to try to figure out some means of getting the gas where we wanted it (the nasal mucus membrane) and how we could keep it there long enough for the gas to be absorbed.
In retrospect I am amazed at how many patients reported good results. Even when Snuffing the Gas Vigorously! Apparently, the steroids are so effective that, in some mild cases, the miniscule amount absorbed en passant was enough to give some patients some relief of their symptoms. This is rarely the case.
What to do? When the patient snuffs vigorously (as we usually do when we’re trying to clear something through the nose, a “sniffle in force,” if you will), a wind is created, a 50 mile an hour wind which whips the gas, through the nose, down the throat and into the lungs. Into the lungs, where it does no harm but it certainly does no good for the nose.
I ask the patient, “Where do you think that gas goes when you snuff it up your nose?” Most reply…”into my head.” So, I next explain how terribly effective this gas can be if it gets to the right place.
If we suppose a contest, where we each get one “spray” from a can of black spray paint in a white room, where the winner is the one who gets the most paint to stick on the walls, this becomes easier to understand.
Patients who “snuff” the nasal spray with vigor and force would be like contestants who open doors wide at either end of the room, spray the paint once and blow a 50 mile an hour wind through the room. Out of any 100 paint particles (bear with me) only 10 paint particles would “stick” to the walls. The rest would blow on out of the room.
I, on the other hand, (clever fellow that I am) wouldclose the room up TIGHT and spray the paint once. I would move not a hair for ten seconds. By then, a great deal of the 100 paint particles would have stuck to the walls, probably 90 or so out of the 100!
We next stand in front of a mirror and I explain “gas law” to the patient. Gas will instantly expandto fill all of the space it occupies.
I then have the patient “squirt” a dose of the gas into one nostril, leaving his mouth open while watching himself in the mirror. He sees the gas come rushing out of his mouth and the other nostril. So, even without “snuffing,” he will lose most of the gas.
Next, I have him close his mouth, hold his breath and raise the back of his tongue up to the roof of his mouth. This blocks the nasopharynx and keeps all the gas in his nose. Right?… Wrong!
He still has that other nostril open. It’s better, but still no cigar! Next step. Repeat step one (mouth closed, nasopharynx blocked), now, hold the other nostril shut.
Perfect?? Not quite yet, almost… only one thing remains. Having done all this, I noticed that the moment he discharged the gas, he lowered the canister from his nose… and a lot still leaked out(50 paint particles).
So, here’s PERFECT:
- Hold your breath
- Lift your tongue to block your nose in the back of your mouth
- Hold one nostril shut
- Firmly plug the other with the canister
- Release gas and hold everything closed while you slowly count to ten.
If you do this absolutely perfectly, you are:
- An alien being, or
- Sure to discover the joy of a completely clear nose within 48 hours.
These gases cannot miss. They invariably work if the problem is allergy. If this doesn’t work, you either have a virus (rhinovirus… count the days… nothing will open your nose until the virus does its thing… usually five days); or, you have some mechanical blockage (polyp, deviated septum, crayons stuck in your nose). Now it’s just a matter of how much does it take to do the job?
I usually load up the patient with a large amount during the first two days. It often takes up to two days for the steroid to soak down through the tissue (like “oil into dry wood”) to get to the bottom layer of cells that cause the problem. So, I start the patient with this highly effective method, using one “squirt” in each nostril (then “holding it in” for ten seconds) six times each day for the first two days. Since it isn’t necessary to “space” the doses (as we might need to in order to achieve a fairly constant “blood level”), the patient can do one set after another and I usually suggest three “sets” in the morning and three in the evening.
Remember, these steroid gases and aqueous “mists” act like “oil into dry wood.” As soon as one coat of oil soaks in, you can immediately add another, and another. We are trying to achievecomplete control with a large loading dose of this very effective drug. Once the nose is comfortably clear, I have the patient reduce the dose by 50%, to, say, three “sets” of one “squirt” on each side (holding for ten seconds) for two more days. If they remain open and clear on this dosage, we reduce it once again, to one “set.” If they continue “clear,” I usually stop the gas entirely and try to maintain control with antihistamines as much as possible.
Now, what has all this nose spray stuff got to do with ASTHMA?
I’m glad you asked. I was just about to explain that. The problem in asthma is inflammation of the airways. The solution to asthma is the prevention of the inflammation of the airways. There are many medications that help prevent inflammation. For the short term, the best of these are steroids. Inhaled steroids. But like the nasal problem, I have to find a way to get enough steroids into the lungs.
Steroids are my first choice of initial anti-inflammatory medications. They work almost every time. The problem is getting them where you want them… and nowhere else. Why would anybody use a 50-year-old oral medication (prednisone) that invariably causes adverse side effects when used for any significant period? Why would one prescribe systemic steroids for a problem confined to the lungs? I understand the problem. Many physicians have not found inhaled steroids to be effective. Why not? The current corticosteroid gases are always superior to any amount of systemic steroids. The trick is to get an adequate amount of the gas in the patient.
Manufacturers, typically, do not offer much help. They suggest that the MDI canister be held near the open mouth, “squirt” the gas, inhale, and hold your breath.
Now let me ask you, have you ever seen anyone jogging down the trail sucking in a “gulp” of air and squirting the gas? The lungs do not absorb much gas when they are hyper-inflated. They work like “sponges,” as they empty and fill. As we breathe air in and out, oxygen is extracted. If the lungs are hyper-inflated (as when one takes a deep breath and holds it) not much of the steroid is going to be absorbed and most of it will come right back out when the patient exhales. Furthermore, most asthmatics cannot get a deep enough breath to get much gas in to begin with. So, what is the solution?
Now you see the connection with the long discourse on nasal steroids. Like the nasal steroid, the inhaled steroid can’t miss, if we get an adequate amount in the lungs and keep it there.
HOW? By getting enough steroid gas in the lungs to do the job.
One might ask if I am not worried about side effects from excessive steroid levels. I have never seen any systemic side effects from these large doses of inhaled steroids. Using the methods described here, I find most of my patients are off all inhaled steroids within a few days or weeks. None are kept on “loading” doses over one or two weeks. There are usually no side effects probably because I use a large enough loading dose in the first 48 to 72 hours to completely prevent reoccurrence of the asthma attack. And how can I get enough gas in to do the job? By using a RE-BREATHER.
A new tool in the asthma prevention category is the anti-leukotrienne class of drugs. Three new drugs of this type have been introduced. They are Accolate, Zyflow and Singulaire. They block an enzyme reaction that stimulates smooth muscle spasms leading to constriction of airways.
In some of my patients, these drugs have been completely successful in preventing asthma symptoms. In a few patients, they have been the only medication necessary to do this. It is typical of humans to react differently to medications and these medications are no exception to the rule. Some do better on Zyflow than Accolate, some on Singulaire and so forth. If one of these doesn’t help, be sure you try the other two before you give up this marvelous possibility.
It is interesting to note that the handful of patients who responded best to these drugs were my worst cases. In two cases in particular, I had been treating men who had continuous problems with asthma for over 20 years. We could maintain control but only by using every modality we had available. They needed constant environmental control, allergy neutralization and desensitization, food restriction and all the medication I could get in them. They used large amounts of inhaled steroid and frequent “blockers” like albuterol.
In recent months, I noticed I hadn’t heard from them so I called to see how they were doing. J.F. said he was having, “No trouble with asthma at all, so long as I take my Accolate twice a day.” The second patient, R.P., has had a history of crisis after crisis but now has been almost completely symptom-free for the several months he has been on Singulaire once a day.
These were the two most difficult patients I have had and both have had surprising relief using this new class of drugs. Interestingly, each was begun on a different drug than the one they ended up on. When they saw no improvement after a four week trial, I switched them to a different drug in the same group and then they experienced this outstanding result.
Both are still very allergic and we still deal with their airborne and food reactions in the usual fashion, but the only asthma drug they are using is an anti-leukotrienne.
I treat asthma as though the underlying cause was allergy. If I control the asthma and ignore the underlying upper airway allergy, then it is only going to be a matter of time until the asthma returns.
Once I have acute asthma symptoms in control, I begin to address the underlying allergy problems. The approach is traditional in that I use allergy testing and desensitization. I also advocate all the usual environmental controls including air filters, mold lights and ozone generators. I encourage all my patients to explore the impact of food sensitivity on their allergy symptoms. I encourage all my patients to “pray for the willingness to change your lifestyle” (or adopt a positive attitude if you don’t relate to prayer). I think movement is critical for the best results.
I use the word movement to distinguish it from the negative feeling many have about exercise.Exercise is terrific and absolutely effective in combating allergy symptoms and swelling. However, most of my patients are what I call “recovering athletes.” They still think of “exercise” as those old seven minute miles they used to run for fun, for an hour or more. Since they don’t have either the time or the conditioning to do that anymore, they don’t do anything. So I urge them to move a little each day. You will be amazed. Thirty minutes of walking will really help relieve allergy swelling.
I encourage vitamins and minerals and filtered water. I prescribe nose sprays, skin creams and everything else that will relieve the allergy symptoms. But, the mainstay of my treatment of allergy symptoms is almost always… ANTIHISTAMINES.
The most basic problem in allergy patients is swelling of soft tissue. This swelling is usually caused by histamine release. The simplest, cheapest, safest way to control this swelling is by using antihistamines.
There are so many antihistamines available that there is almost never a case where I cannot find at least one that will be effective and free of side effects. I use them as the foundation of allergy treatment and in most cases of asthma as well.
Basically, if there is no swelling there is no allergy. If there is no mucus there will be no viral infections, no sinusitis, and no ear infections. There will be fewer upper respiratory infections and less asthma as well.
Almost all of the antihistamines everyone could ever need are available over the counter. Ask your pharmacist or physician for advice on where to start using these effective and inexpensive medications to control your allergy symptoms and thereby reduce your risk for asthma.
1. Re-breathers An inexpensive device ($15.00) is available, called an “InspirEase.” It is great for kids from about four to fourteen. It only holds 750cc of air, so it is of limited use in adults. For them, we use a “zip-lock baggy,” in either half gallon or one gallon size, whichever they can comfortably inflate.
Using InspirEase We place any of the steroidal gases in this device, and, while the Mom holds the child’s nose, the child sucks in the 750cc of air in the air chamber. As the patient inhales, a “puff” of the gas is added to the 750cc of air in the chamber. This gas is inhaled along with air. The patient then exhales (at a normal rate) back into the chamber and then inhales again, followed by another exhale and so on.
Thus, the patient is re-breathing the medication. Inhaling the full dose of the medication or gas repeatedly, will result in faster diminishment of the inflammation. After each use, the patient is instructed to sip and spit a large amount of water to rinse any residual steroid out of their mouth and throat. This will help minimize any systemic absorption of the medication.
I have little ones, from four years of age, to teenagers using this device. The dose for small patients (four to eight) would be about one puff and six breaths (one episode) eight times initially, all at one sitting. No need to “space” gas doses, as we are trying to achieve tissue saturation rather than blood levels. If the patient has any restriction of the airway that prevents a full and deep inspiration, then I precede the steroid gas with a dose of Atrovent (an oral inhaler) used with an InspirEase device. I recommend one or two puffs per six breaths. This will usually open the patient enough (3 points or better on a scale of 10) to allow adequate inspiration of the steroidal gas which is given as soon as the patient is “open” enough. If Atrovent does not do the trick (in conjunction with the neutralization injections), then we try Proventil (a bronchial dilator, “Albuterol”) with InspirEase, one or two puffs per six breaths. I never use Proventil or Albuterol if any other choices are available, as they are hard on the patient. They can cause shakiness and irritability and only treat the “symptoms” of the condition.
In larger kids, (eight to fourteen) I begin on an inhaled steroid with an InspirEase using two “puffs” with six breaths per episode and using eight to twelve episodes initially. I usually keep the patient at this high level until they are asthma-free for forty-eight hours. This almost always occurs within three to four days of initializing treatment.
Once the patient is asthma-free for forty-eight hours the dosage is cut in half. For example: eight episodes of “one puff and six breathes” per day is reduced to four episodes. If the patient remains asthma free for two days more, the dose is again reduced by 50% percent. And so on.
None of my patients are out-of-control asthmatics. We have no one in Status Asthmaticus and I do NOT have one patient on Prednisone. In fact, I stop Prednisone within the first few days of treatment.
The Cheapest, Most Effective ADULT RE-BREATHER:
The one gallon ZIP lock baggy.
If the patient cannot inflate this baggy completely, we drop down to a half gallon baggy.
These cost about $3.00 for twenty, and that is enough to conclude your asthma treatment with nearly 100% success for at least one year.
The gas apparatus is placed inside the bag. The patient then zips the bag to fit snugly over their mouth and nose and inflates the bag, holding it in place with one hand while with the other hand triggers one, two or three “puffs” of the gas into the bag and breathes in-and-out in this “closed system,” five or six times.
This provides a huge increase in the amount of absorbed gas into the lungs. “Saturation” by these methods is almost invariably achieved within three to four days. The asthma is now blocked 90% or more, and the dosage is reduced by 50% every forty-eight hours if the patient remains “symptom-free.” If symptoms return at reduced doses, the initial high dose is resumed and subsequently reduced once again, in the same fashion as the patient regains control.
In particularly difficult cases, one is occasionally required to use a “maintenance” dose of the inhaled steroid for a small amount of time, until other contributing causes can be better controlled (i.e., pollens or molds, hormone reactions, viral or bacterial infections, etc.).
2. PULMICORT and ADVAIR
The newest and best inhaled steroid isn’t a gas. It’s a fine powder called Pulmicort. This dispenses an extremely fine dust of steroid medication. Now, you don’t have the problem with absorption like you might have had with a gas. This marvelous device is user friendly and practically “goof-proof.” If the patient cannot get a deep breath then I may have them use a rapid-acting blocker to get them open enough to get the maximum benefit from the Pulmicort. If the patient can take in a deep breath then one simply “sucks” in the powder of the Pulmicort along with the breath of air and holds their breath for a count of three or four seconds and then exhales. Almost all of the steroid powder will stick and be absorbed. Like the re-breather doses, I start people on loading doses of six to eight inhalations, usually divided into two parts, half in the morning and the other half at night. The results have been just as good as the re-breather techniques with no technical skill or instruction required. It is critically important to gargle with water after each use to minimize systemic absorption of the steroid.
Another new medication, called Advair, is a combination of the mild “blocker” SereVent (salmeterol) and the marvelous powdered steroid Fluticasone. The combination has been shown to be more effective than the sum of the parts. In other words, if SereVent were considered to be one unit of effectiveness and fluticasone were considered to be one unit of effectiveness, then it would follow that the total effectiveness of the two combined would be two units of relief. But this is not the case. The combination has been demonstrated to give four units of relief, not just the two units that a person would expect.
As a result, I no longer have to use re-breathing devices like the InspirEase or the zip-lock baggies. Now we have powders like Pulmicort and Advair.
These are far superior to any gas as all the medication sticks to the lung tissue guaranteeing a high level right where we want it. Using these powdered steroids in adequate amounts will prevent asthma in almost every case.
In the next section, we will explore food avoidance.
Section 4. Food Avoidance The “quickest” measure one can take to prevent problems is to drastically limit food choices and neutralize any metabolic acidosis (over production of acid in the stomach) which also affects breathing. It is difficult for anyone to extract oxygen from the air in the face of respiratory or metabolic acidosis (Oxygen Dissociation Curve which explains the negative effects of acidosis on our ability to extract oxygen from inspired air). I test my patients for reactions to a few foods initially, in an effort to find a “safe” diet to use for the critical few days. It is important to find foods the patient does not react to, lest they deteriorate, meal-by-meal, from the outset. Usually chicken (organically grown), brown rice, water and salt comprise the entire diet of an adult (breakfast, lunch, supper, and snacks) for the first three to four days. Modifications to this strict diet have to be made for kids. For one thing, they simply won’t do it. At least, not willingly. Little ones (under four) are pretty much limited to what Mom gives them, so we have less trouble here. I suggest at the very least, eliminating several food groups (just for a few days, NOT forever):AVOID:
- All diary: NO cows milk, cheese, yogurt, ice cream. Rice or soy milk is usually OK for this short period.
- Tomatoes and tomato products: NO tomatoes, ketchup, pizza, lasagna, spaghetti, hot sauce, etc.
- Pineapple and citrus fruits and juices: These are already very acidic and will usually aggravate the condition by causing or contributing to acidosis.
- Chocolate: Remember, this isn’t forever, just a few days.
- Sugar: Candy, corn syrup, etc. This is why kids “crash” in the ER when an IV is begun. It is usually “D5W” which is Dextrose 5% in water, i.e., corn sugar.
- All grains except brown rice: NO Bread, cereal, cookies, chips, cake, pasta, etc.
- Brown things to drink: NO chocolate drinks or colas, diet or otherwise, and only minimal amounts of coffee or tea.
- Anything the patient eats “addictively,” or “craves” or eats on a daily basis:Especially if it is something the patient wants or “needs” when they do not feel good.
Each day that we don’t eat a food that causes a reaction, we accumulate more reactivity. This goes on for five to seven days and then rapidly diminishes. So, I suggest you avoid all these foods from Monday to Friday night. Then, on Friday night pick EVERYTHING that YOU MISS THE MOST and EAT IT. You will naturally select the foods to which you are most allergic. And so you will learn what foods to avoid.
There is more information on asthma under hormones.
* This treatment is not approved by the FDA