Full text of DOI:10.1089/107628003322017323

State-of-the-Art Complementary
Therapeutics for Asthma
Chris D. Meletis, N.D., and Jason Barker, N.D.
trophils, and epithelial cells. The recruitment and activation of
these cells and cellular components leads to recurrent symptoms,
such as wheezing, chest tightness, and coughing, more so at
night and early morning. Such episodes are associated with dif-
fuse airflow obstruction that is amenable to treatment-induced or
spontaneous reversal. Predisposition to this condition causes an
associated increase in the already established bronchial hyperre-
activity to various stimuli.
Asthma symptoms that appear in childhood are often associat-
ed with atopy, a susceptibility in which immunoglobulin E (IgE)
is produced in response to typically benign environmental anti-
gens (dust mite feces, animal dander proteins, fungi spores). Syn-
thesized IgE antibodies then bind to receptors on various
lymphocytes. Once the offending antigen binds to the Fab frag-
ment of the IgE antibody, proinflammatory cytokines are
released. Mast cell–released histamine and leukotrienes stimulate
bronchial smooth-muscle constriction, usually within 1 hour of
antigen exposure.
tatistics indicate increasing prevalence of asthma in indus-
trialized nations, particularly in the United States in the
last 20 years. The Centers for Disease Control and Preven-
S
tion has reported increasing asthma prevalence since 1980,
including increased mortality and racial and regional disparities
in asthma-related emergency department visits, hospitalizations,
1
and deaths.
According to the 1998 National Health Interview Survey, asth-
ma is one of the most widespread chronic disease conditions in
the United States, with 26.3 million Americans having been diag-
nosed with asthma by a physician within their lifetimes and with
an increased mortality rate of 55.6 percent while all-cause mortal-
2
ity rates have decreased 18 percent. (See Table 1.)
Various reasons for this increase in asthma cases have been
identified, ranging from air pollution to faulty genetics. The
mainstream focus on asthma has also changed in the last 20
years, with a shift in understanding—namely, that asthma is a
chronic inflammatory condition. With this new understanding,
treatment focus has changed from reactive to preventive, with
chronic long-term use of inhaled corticosteroids as the mainstay
of therapy. Despite this shift in treatment focus, increasingly neg-
ative statistics about asthma continue to be reported.
Eosinophils, in particular, release destructive elements, such as
major basic proteins that damage airway epithelial cells directly,
increase bronchial responsiveness, and promote degranulation
by mast cells and basophils. In addition, leukotrienes released
from eosinophils cause additional airway smooth-muscle con-
striction, increased vascular permeability, and further recruit-
ment of additional eosinophils.
With the advent of complementary medicine, physicians are
now more prepared than ever to treat asthma effectively. Asthma
is a disease process with numerous associated genetic, allergic,
environmental, and nutritional components, with varying symp-
tomatologies among individuals affected with this condition.
There is a vital need for today’s physician to develop an aware-
ness of asthma’s many precipitating factors and to learn about the
numerous complementary therapies available for treatment
because it is obvious that mainstream asthma treatment and pre-
vention are not capable of reversing the increasing morbidity of
this disease. Factors such as air quality may appear to be outside
of the physician’s realm of manageable patient comorbid compo-
nents, while other precipitating determinants may be addressed
via nutritional, botanical, and lifestyle supplementation allowing
for greater efficacy of pharmaceutical medications, when needed.
The Th2:Th1 Ratio Theory
It is a well-established fact that airway inflammation is the
mainstay of asthma pathophysiology. That being said, however,
inflammation is a nebulous descriptor in terms of the multiple
workings of the immune system in asthma. Newer theories of
pathologic inflammatory processes portray abnormally regulated
CD4+ T-cell responses to normally benign antigens as the instiga-
tors of asthma-related inflammatory processes.
More specifically, the Th2 subset cell grouping of CD4+ T cells is
implicated, producing interleukins (ILs)-4, -5, -6, -9, -10, and -13.
These cytokines establish the recruitment and differentiation of
mast cells, basophils, eosinophils, and B cells, where they play a
major role in humoral immunity and the generalized allergic
response.
Opposed to these functions, the Th1 subset of CD4 lympho-
g
cytes produce interferon- and IL-2, both of which are used to
Asthma Pathogenesis/Pathophysiology
create immunologic reactions that are specific to cellular defense,
as in the case of parasitic and viral invasions. Ideally, the
cytokines produced by Th2 and Th1 cells are mutually antagonis-
tic, establishing a relative balance in functions.
Asthma is a chronic inflammatory disorder of the airways in
which several cells and cellular elements play a role, particularly
mast cells, eosinophils, T-lymphocytes, macrophages, neu-
105

106
ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2003
ma. The Th2:Th1 ratio in patients with acute or stable asthma
was increased significantly compared to subjects in the control
(nonasthma) group, with Th2 levels significantly and positively
related to IL-4, total serum IgE, and total number of eosinophils.
Table 1. Asthma Facts
Prevalence
• Asthma has been increasing since the early 1980s across all age,
gender, and racial groups; asthma rates are higher among children
than adults and higher among blacks than whites.
• Approximately 17 million Americans have asthma; 5 million are
under age 18. Asthma is the most common chronic childhood
Forced expiratory volume 1 (FEV) level in the study subjects
1
had a significantly positive relation with Th1 levels and a nega-
5
tive relation with Th2 levels.
1
disease, affecting slightly more than child in 20.
The Hygiene Hypothesis
Recent analyses of risk-factor patterns for allergic disease in
Europe has lead to a causal theory for the increasing asthma epi-
demic; this theory is known as the hygiene hypothesis. It stipu-
lates that advances in hygiene have removed a protective
influence against atopy and asthma that was once provided by
infectious exposures in early childhood.
Deaths
• 14 Americans die each day from asthma.
• Between 1979 and 1992, asthma death rates increased 58 percent
overall.
• Asthma death rates for children under 19 increased 78 percent
between 1980 and 1993.
• More females die of asthma than males; more blacks die of asthma
than whites.
This hypothesis has been questioned in the United States,
where the largest sector of increasing asthma incidence since the
1970s occurs in the inner cities among minorities who are living
in poverty with suboptimal hygienic conditions. When viewed
from a historical perspective, the recent increasing trend in respi-
ratory allergies among the less-advantaged in the United States
may be explained as the consequence of several epiphenomena
linked to Westernization (including declining exposure to food-
borne and orofecal infections) that has moved downward from
the richest socioeconomic strata to the poorest in the last 150
Costs
• The total cost of treating asthma in 1998 was estimated to be
$11.3 billion, of which direct costs amounted to 7.5 billion dollars,
while indirect costs were 3.8 billion.
• Hospitalization accounted for the single largest portion of the cost.
• Among children ages 5–17, asthma is the leading cause of school
absences due to a chronic illness; this adds up to an annual loss of
more than 10 million school days per year and more hospitalizations
than any other childhood disease.
• Children with asthma spend an estimated 7.3 million days per year
restricted to bed.
6
years.
• For adults, asthma is the fourth leading cause of work loss, resulting
in nine million lost workdays each year.
In regard to this theory, it has been suggested that exposing
infants to factors that increase Th1 cells (infected siblings, day
care attendance during the first 6 months of life, and avoidance
of frequent antibiotic administration) may restore the T-helper
subset balance, resulting in fewer incidences later in life of asth-
ma and allergy. It appears that these exposures must occur prior
to the first year of life to make a difference.
• Asthma also accounts for about 1.8 million emergency room visits
and nearly 10 million doctor office visits each year.
• Asthma results in about a half million hospitalizationseach year;
more women are hospitalized for asthma than men, and blacks are
hospitalized from asthma three and one-half times more than
whites.
Experimental use of mycobacterial strains has demonstrated a
shift from Th2-immune responses to Th1-immune responses,
thereby preventing the allergy development in mice, as well as
ameliorating autoimmune diseases characterized by Th1 respons-
Ethnic Differences
• Blacks are three times as likely as whites to be hospitalized from
asthma and three times as likely to die from the disease.
• Racial differences in asthma prevalence, morbidity, and mortality
are closely related to poverty, urban air quality, indoor allergens,
and inadequate patient education and medical care.
7
es. It is interesting to note that both autoimmune and allergic
diseases share a parallel increasing prevalence. Rebalance of the
Th1- and Th2-subset cell ratios is a highly speculative theory
because it does not explain fully the complete immunologic etiol-
ogy of asthma and allergies.
Source: Adapted from the Asthma and Allergy Foundation of America (AAFA), 1233
20th Street, NW, Suite 402, Washington, D.C., 20036.
It is theorized that signature asthmatic inflammatory processes
are expressed as a result of unbalanced Th1 and Th2 cytokine
production, with a dominant polarization toward a Th2 pheno-
Gastroesophageal Reflux Disease
Various associations between asthma and gastroesophageal
reflux disease (GERD) have been elucidated in recent clinical
investigations: The prevalence of GERD in people with asthma is
generally higher than in people without asthma. Patients who
have asthma with GERD have a higher risk of hospitalization for
asthma symptoms. Asthma medications such as albuterol
decrease lower esophageal sphincter pressure and esophageal
contraction amplitude, while oral prednisone results in increased
esophageal acid contact times, and respiratory symptoms corre-
3
type, as asthma is a well-known Th2-mediated disease.
It is highly plausible that asthmatic inflammation is a result of
Th2-mediated mechanisms or an imbalance between Th1 and
Th2 cells. It has been observed that children born with a predom-
inance of Th2 cell subsets are predisposed to allergic disease and
4
asthma. In addition, it is thought that administering factors that
enhance Th1-mediated responses may restore the Th1:Th2 bal-
ance in susceptible individuals.
One study investigated the relationship between Th subsets
and their relationship to their relative cytokines, serum total IgE,
eosinophil count, and ventilatory function in patients with asth-
8
late with esophageal acid introduction events. These findings
suggest the possibility of asthma medications acting as promot-
ing factors in the development of GERD in patients with asthma.

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2003
107
It is estimated that incidence of GERD in children with asthma
reaches nearly 50–60 percent and is higher than in the general
population. This is not a newly discovered association; however
many studies are underway to determine the relationships
between asthma and GERD because it is not clearly known
which is the cause and which is the result.
Table 2. Doses of Supplements and
Botanicals for Treating Asthma
9
Supplements/Botanicals Doses
Pyridoxine (vitamin B )
25–50 mg, twice/day
6
Several hypotheses surrounding the GERD–asthma connection
focus on how GERD can lead to bronchial obstruction and how
obstruction can exacerbate GERD. The esophagus and lungs
interact by way of various mechanisms; esophageal acid-induced
bronchospasm may be provoked by a vagally mediated reflex in
which distal esophageal acid causes airway reactivity; by neural
enhancement of bronchial reactivity, whereby esophageal acid
augments airway hyperresponsiveness; and by microaspiration,
in which miniscule amounts of esophageal acid are inhaled, lead-
Ascorbic acid (vitamin C)
Magnesium
Essential fatty acids
(EPA + DHA)
Tylophora
(Tylophora asthmatica)
2000–3000 mg/day, in divided doses
250–300 mg, thrice/day
2000–3000 mg, in divided doses per day
Dried tylophora leaves: 200 mg, twice/day
Or, alcoholic extract: 40 mg, twice/day
Standardized extract containing 18%
Coleus (Coleus forskohlii)
forskolin: 50 mg, thrice/day
EPA = eicosapentaenoic acid; DHA = docosahexaenoic acid.
10
ing to airway reactivity. Possibilities that asthma may predis-
pose patients to GERD include autonomic dysregulation, an
increased pressure gradient between the thorax and abdomen,
bronchodilator medications, hiatal hernia, and abnormalities in
diaphragm function.
Vitamin and Mineral Therapy
Pyridoxine
Clinical trials utilizing antireflux medical therapy (e.g. his-
tamine-2 receptor antagonists) have been largely inconclusive,
producing no benefit to only modest reduction of only nocturnal
The active form of pyridoxine (vitamin B ) found in the human
6
¢
body, pyridoxal 5 -phosphate, has long been known to be deplet-
ed by theophylline, a now rarely used asthma medication.
Regardless of current or past theophylline use, patients who have
asthma tend to have lower circulating levels of this vitamin and,
in one study, supplementation with 50 mg of pyridoxine twice
per day for patients with asthma resulted in subjective reports of
dramatic decreases in frequency and severity of asthma attacks
11
asthma symptoms. Other studies that have investigated the use
of proton-pump inhibitors and antireflux surgery are currently in
progress. Despite the mixed results from these studies, the medi-
cal literature is flush with studies that demonstrate a definite link
between GERD and asthma. Treating asthma with H-2 blockers
and proton-pump inhibitor medications brings to light the possi-
bility of leaving patients with inadequate amounts of digestive
acid to properly break food proteins down, potentially leading to
increased allergenicity of foods, including decreased nutrient
16
while taking the supplement.
The study did not, however, indicate reasons for the apparent
beneficial effects of pyridoxine supplementation. Another study
placed 76 children with asthma on 200 mg of pyridoxine per day
for 5 months. These patients reported significant reduction of
12
absorption.
17
asthma symptoms and reduced usage of asthma medications.
Food Allergy
However, in another study, 9 weeks of treatment with 300 mg of
pyridoxine produced no difference in peak expiratory flow rate
Asthma can be one of the major symptoms of chronic food aller-
gy, contributing to the total overall antigenic load of a patient.
Food-mediated allergic reactions may become clinically apparent
immediately or even hours to days later in a patient with asthma,
manifested by specific production by mast cells of IgE antibodies
to food proteins.
18
(PEFR), FEV , or asthma symptom scores compared to controls.
1
Examples of studies such as these demonstrate the need for
increased research in the realm of vitamin B supplementation
6
for patients who have asthma.
From 20 to 60 percent of patients with bronchoconstrictive
symptoms are reported to develop these symptoms as a result of
food ingestion. One study demonstrated that the elimination of
Ascorbic Acid
Reactive oxygen species are implicated in the disease pro-
cess of asthma, as it has been previously demonstrated that
specific allergens were able to initiate a neutrophil-derived
respiratory burst in some allergen-sensitized patients with
13
previously determined food allergens early in life resulted in
decreased asthma symptomatology as well as inhibiting the pro-
gression of allergic tendencies (represented by decreased produc-
tion of total and specific IgE) compared to a control group that
19
asthma. Excessive exposure to reactive oxygen and nitrogen
species provides hallmark oxidative stress, propagating dam-
age in proteins, lipids, and DNA structures. Oxidative stress
in the lungs of patients with asthma is not only caused by
intrinsic inflammatory pathways; environmental exposures,
such as air pollution and cigarette smoke, also contribute.
Interventions designed to augment endogenous antioxidant
defenses are strongly indicated as adjuvant therapy for
p a ti e n ts w ho a r e s u ff e r i ng fr o m a l l e r gi c r e s p i ra to r y
14
did not undergo such eliminations. Increased gastrointestinal
(GI) permeability and GI symptomatology has been found in a
larger percentage of patients with asthma compared to controls
without asthma symptoms; this may partially explain the origins
15
of food-related allergy symptoms such as asthmatic wheezing.
Clinically, identification and removal of known and suspected
food allergens does provide some amelioration of asthma symp-
toms in certain individuals.
20
disorders.

108
ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2003
Ascorbic acid (vitamin C) is one of the key antioxidant vita-
showed that the majority of vitamin C–asthma investigations
were short-term and only addressed the immediate effects of
vitamin C supplementation on asthma symptoms.
mins that are abundant in the extracellular fluid that lines the
lungs, and low vitamin C intake has been associated with pul-
monary dysfunction. One study reported that patients with
asthma had significantly less ascorbic acid in both the cellular
and fluid-phase fraction of induced sputum, suggesting that
deficiency of ascorbic acid may be a result of airway inflam-
mation or may be a contributing
25
Magnesium
Magnesium and calcium play various roles in pulmonary struc-
ture and function. A magnesium deficiency leads to an enhanced
action of calcium being that excess
factor in the pathophysiology of
asthma.
magnesium acts as a calcium antag-
onist. This is notable in patients with
21
Antioxidant supplementation,
most notably vitamin C, can
Children with asthma who live
in Mexico City were given a daily
supplement combination of 50
international units of vitamin E
and 250 mg of vitamin C for 19
months. Pulmonary function tests
were performed twice per week,
with significant differences in
forced expiratory flow (25–75) and
peak expiratory flow between the
test and control groups. These
results suggest that antioxidant
supplementation, most notably
asthma as a result of an intracellular
influx of calcium causing bronchial
smooth-muscle contraction. Myo-
26
genically induced action potentials
and autonomic neurotransmitters
can alter cytosolic calcium concen-
tration. Increased action potentials
will lead to higher cytosolic calcium
concentrations, causing greater
cross-bridge activity. Likewise,
intracellular magnesium can modu-
late smooth-muscle contractions and
inhibit calcium uptake directly,
modulate the impact of air pollutants
to reduce their effects on patients,
including that of ozone on children
with moderate-to-severe asthma.
vitamin C, can modulate the impact of air pollutants to reduce
their effects on patients, including that of ozone on children
with moderate-to-severe asthma.
allowing for smooth-muscle relaxation. Magnesium works as a
smooth-muscle relaxant, of which the micromusculature sur-
rounding the bronchioles is comprised.
22
Consumption of antioxidants in foods as an asthma symp-
tom preventative method has also been studied. Intake of cit-
rus and/or kiwi fruit was a highly significant protective
measure for reducing wheezing among children who ate fruit
5–7 times per week compared to children who ate fruit less
than once per week. This protective effect was even evident
among the group whose fruit intake was only 1–2 times per
week compared to those who consumed fruit less than 1 time
per week, although no clear dose–response relationship was
Theoretically, inadequate magnesium levels may contribute
to asthma exacerbations. It is of interest to note that, while
27
overall calcium intake in the United States has increased in the
past 20 years, magnesium intake has remained unchanged,
while the asthma epidemic continues to grow. Magnesium is
an important contributor to prophylaxis of asthma symptoms
and intravenous magnesium is an accepted form of emergency
treatment for acute asthma attacks. Magnesium acts physiolog-
ically as a calcium antagonist, allowing muscle relaxation to
23
28
elucidated. It appears that even relatively low dietary doses
occur.
of vitamin C are protective against asthma symptomatology in
children.
Patients with chronic asthma were shown to be hypomagne-
semic, and this was associated with airway hyperreactivity,
wheezing, and general impairment of lung function in one study.
In addition, this investigation revealed that patients who have
chronic asthma and have lower stores of magnesium are hospi-
talized more often than other patients with asthma who have
normal levels of magnesium. Hypomagnesemia was also associ-
Prophylactic administration of ascorbic acid for prevention of
exercise-induced asthma is widely described in the medical liter-
ature, with most studies revealing that taking vitamin C pro-
duces moderately beneficial effects to reducing asthma
symptoms caused by exercise but results in little change in pul-
monary function tests. The main conclusions drawn from these
studies are that vitamin C demonstrates a slight-to-moderate pro-
tective effect on airway hyperreactivity in patients with exercise-
29
ated with more severe asthma symptoms. Erythrocyte magne-
sium concentration shared a significant inverse relationship with
inhaled metacholine challenge in relation to bronchial reactivity
and hypomagnesemia was prevalent in 40 percent of the patients
with asthma in this study compared to 11 percent of controls
24
induced asthma.
A wide review of studies that have investigated the use of
vitamin C for treating asthma and allergy found that, among
the significantly positive effects of this therapy, positive
effects on pulmonary function tests, metacholine, histamine,
or allergen broncho-provocation challenges, lymphocyte func-
tion and motility, and decreased respiratory infection inci-
dence were produced. No benefits were noted in these studies
regarding testing of cutaneous reactivity or more specific
immunologic parameter measurements. This main study also
30
who did not have asthma.
Based on this information, correction and stabilization of
magnesium levels in patients with asthma seems indicated. As
a medical therapy, magnesium has a good safety record.
Because magnesium is almost exclusively excreted by the kid-
neys, overdose levels of magnesium can only be anticipated in
patients with renal disease, intestinal hypomotility, and chron-
ic constipation.

ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2003
109
DHA range from 500 mg to 3 g per day. For people who are
allergic to fish or who have trouble digesting oils, capsules or
flax (Linum usitatissimum) seed oil may be substituted.
Omega-3 Fatty Acids
The end-product metabolism of arachidonic acid (AA), a compo-
nent of cellular membranes, produces proinflammatory 2-series
prostaglandins and 4-series leukotrienes, which are highly active
mediators of inflammation. AA is derived from the phospholipid
layer of immune-cell membranes via phospholipase A-2 in response
to immunologic stimuli. The cysteinyl leukotrienes C4, D4, and E4
are important mediators in asthma and are modulators of cytokine
function, and they have been implicated in the pathophysiology of
asthma via multiple mechanisms, while leukotriene B4 promotes
leukocyte chemotaxis and less-potent
Botanical Medicines
Coleus (Coleus forskohlii) is a member of the mint family that has
been used traditionally on the Indian subcontinent for treating
asthma. The active component of the plant, forskolin, has hypoten-
35
sive and spasmolytic properties. Forskolin’s mechanism of action
involves its ability to activate the enzyme adenylate cyclase. This
action increases the amount of cyclic
31
bronchoconstriction.
adenosine monophosphate (cAMP)
I m m u n e c e l ls th a t d ri v e th e
inflammatory process contain high
in cells, which produces various
physiologic and biochemical effects,
including inhibition of mast-cell
degranulation and histamine release
Coleus has been used
traditionally on the Indian
subcontinent for treating asthma.
proportions of the n-6 polyunsatu-
rated fatty acid (PUFA) AA in rela-
tion to low amounts of n-3 PUFA;
the two fatty acids are structurally
and functionally distinct.
as well as relaxing smooth mus-
36
cle.
Some pharmaceutical approach-
e s t o a s th m a a r e d e s i g n e d t o
increase cAMP levels by using an
The n-3 PUFAs eicosapentaenoic
acid (EPA) and docosahexaenoic
acid (DHA), found in high proportions in oily fish and fish oils,
produce anti-inflammatory activity and are indicated for pre-
venting asthma symptoms throughout the medical literature.
Supplementation with fish oil results in partial replacement of
AA in inflammatory-cell membranes with EPA, resulting in
decreased production of AA-derived inflammatory mediators.
However, this response alone is not totally indicative of the bene-
ficial anti-inflammatory effects of n-3 PUFAs. Both animal and
human studies have indicated that other anti-inflammatory
effects of n-3 PUFAs may occur downstream from cell-membrane
composition alteration, such as suppressed production of proin-
flammatory cytokines and inhibited adhesion molecule expres-
agent that binds to receptors that stimulate adenylate cyclase
(corticosteroids) and inhibits the enzyme phosphodiesterase,
which is responsible for the breakdown of cAMP. One example is
the methylxanthine-derived drug, theophylline, which has fallen
out of favor as an asthma therapy because of its narrow thera-
peutic window.
Forskolin’s effects on cAMP result in bronchial dilatation and
37
asthma symptom relief. In addition, forskolin may be of benefit
to patients with allergic asthma because this compound’s antial-
38
lergy qualities also include histamine release inhibition.
Tylophora (Tylophora asthmatica), another botanical medicine that
is native to India, has been shown to have antiasthmatic, anti-
32
39
sion occurring at the level of altered gene expression.
inflammatory and antianaphylactic properties. These effects have
In one study, dietary supplementation with fish oil for 10 months
in 29 children with bronchial asthma resulted in decreased asthma
symptom scores and response to an acetylcholine challenge in the
been attributed to the plant’s alkaloid constituents, tylophorine and
tylophorinine. For one study, 110 patients with asthma were
40
instructed to chew and swallow 1 tylophora leaf each day for 1
week. At the end of the week, 62 percent of the test subjects reported
moderate-to-complete relief of symptomatology and experienced a
continued reduction of symptoms for several weeks following the
33
treatment group with no changes in the control group. Subjects in
the treatment group received fish-oil capsules that contained 84 mg
of EPA and 36 mg of DHA. The daily dosages of EPA and DHA
were, respectively, 17.0–26.8 and 7.3–11.5 mg per kg of body weight
(–1), while control subjects received capsules containing 300 mg of
olive oil. No side-effects were noted.
41
study. Another study revealed improvements in lung function
and decreased nocturnal symptoms in patients with asthma, an
42
effect that, again, persisted past the 7-day trial duration.
Studies on fish oil consumption have revealed decreased lympho-
cyte proliferation, T-cell mediated cytotoxicity, natural–killer-cell
activity, macrophage-mediated cytotoxicity, monocyte and neu-
trophil chemotaxis, major histocompatibility (class II expression) and
antigen presentation, production of proinflammatory cytokines (ILs -
Conclusions
Asthma, like other chronic disease conditions, has increased in
incidence over the last 20 years. Mainstream therapy includes the
use of -adrenergic agonists to maintain bronchial patency, while
34
b
1 and -6, tumor necrosis factor), and adhesion molecule expression.
The studies described above demonstrate the ability of fish oil
supplementation to inhibit the inflammatory process of asthma.
Based on these findings, one would expect to see decreased asth-
ma symptomatology and improved lung function with addition
of fish oils to the diet. The majority of studies do not indicate an
optimal dose, however most doses of fish oils both EPA and
corticosteroids are used to prevent the now well-addressed inflam-
matory component of asthma. Relatively new outlooks on asthma
pathogenesis, such as Th2:Th1 balance theory and the hygiene
hypothesis, provide exciting new opportunities from which to
base new approaches to asthma therapy. Table 2 summarizes some
of these approaches.

110
ALTERNATIVE & COMPLEMENTARY THERAPIES—JUNE 2003
in induced sputum of mild asthmatics. Inhal Toxicol 2003;15:101–109.
22. Romieu I, Sienra-Monge JJ, Ramirez-Aguilar M, Tellez-Rojo MM,
Moreno-Macias H, Reyes-Ruiz NI, del Rio-Navarro BE, Ruiz-Navarro
MX, Hatch G, Slade R, Hernandez-Avila M. Antioxidant supplementa-
tion and lung functions among children with asthma exposed to high lev-
els of air pollutants. Am J Respir Crit Care Med 2002;166:703–709.
23. Forastiere F, Pistelli R, Sestini P, Fortes C, Renzoni E, Rusconi F,
Dell’Orco V, Ciccone G, Bisanti L. Consumption of fresh fruit rich in vita-
min C and wheezing symptoms in children. SIDRIA Collaborative
Group, Italy [Italian Studies on Respiratory Disorders in Children and the
Environment]. Thorax 2000;55(4):283–238.
24. Cohen HA, Neuman I, Nahum H. Blocking effect of vitamin C in exer-
cise-induced asthma. Arch Pediatr Adolesc Med 1997;151:367–370.
25. Bielory L, Gandhi R. Asthma and vitamin C. Ann Allergy 1994;73:89–96.
26. Landon RA, Young EA. Role of magnesium in regulation of lung
function. J Am Diet Assoc 1993;93:674–677.
27. Skotnicki AB, Jablonski MJ, Musial J, Swadzba J. The role of magne-
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28. Gulhas N, Durmus M, Demirbilek S, Togal T, Ozturk E, Ersoy MO.
The use of magnesium to prevent laryngospasm after tonsillectomy and
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Continued investigations of complementary therapies for asthma
are well-recommended, because many therapies are offering promis-
ing outcomes, based on preliminary research. Addressing asthma in
a preventative manner, using common supplemental interventions,
such as ascorbic acid, magnesium, and fish oils, as well as botanical
medicines, offers significant benefits for preventing bronchial hyper-
n
reactivity and inhibition of the damaging inflammatory response.
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