ASTHMA OVERVIEW
more and more a problem
more stuff in the air
emergency visits to hospital increase with incr in air pollution: linear correlation
PHYSIOLOGY
hypersensitivity of bronchial airways-->release of inflam mediators from mast cells
inflam-->AA-->5-lipoxygenase makes HPETE-->LK4-->mucus and bronchoconstriction
lipox makes HPETE from AA
things that block lipoxygenase help asthma: ginger, quercetin, boswellia, tumeric, carotenoids
glutathione peroxidase makes HETE instead of HPETE, helps asthma, nebulize glutathione, NAC
Leukotriene 4 series incr edema, mucus, sm m constrx, etc
decr beta andrenergic stim dt less cortisol and epi, dt decr methylation, adrenal fatigue
Calcium potentiates phospholipase A2 which gets arachidonic acid out of cell membranes (inflam)
PGE1-->incr cAMP
guanylate cyclase (which makes cGMP) incr by polyamines, decr by cysteine, antiox, bitter melon
SX: recurrent attacks of dyspnea, wheezing, coughing
expectoration of tenacious mucoid sputum
prolonged expiration, musical rales
eosinophilia, incr serum IgE
INCIDENCE
more in kids with 2:1 male:female ratioo
over 12 million pts with asthma in US
incidence incr 42% btw 1982 and 1992
MINIMIZE TRIGGERS
foods that cause immediate response are usu fixed allergies not seasonal
most allergens are cyclical, allergenicity will reduce with avoidance
diary (high in AA and also very antigenic)
soy, gluten, pork, beef, GMO ingredients
eliminate from sleep area: molds, feathers, dirty filters, rugs, drapes, cats
good vacuums: rainbow, princess brands
clean bedding, get dust mite cover for mattress
consider formaldehyde bomb, consider ionizer, ozone generator
toothpaste: sodium lauryl sulfate mb a trigger, so can silicates
SULFITES in sandwich meats, wine, only listed if over 10ppm concentration, some pts very sensitive, in most distilled liquors, wine coolers, drinks with corn syrup, all fruit juices, bread with dough conditioners, most processed wheat products, chips, frostings, all processed cheese foods, most dried veg and fruit, all fish and shellfish, soy products, shredded coconut, all jams and jellies
DX
listen to lungs
can have spirometer in office
intrinsic dt bronchial rxn to phys irrit
ie chem, cold, exercise, infx, agents that activate alt complement pathway, emotional
extrinsic dt immunologically mediated condition with incr IgE
ACUTE ASTHMA TX
if you're in a pinch, a strong cup of coffee is effective
IV Mg+ (max he's used was 7-8 grams for a migraine in a big guy, 1-3 grams in push or drip is usu enough, he prefers the drip, with 21 gauge needle you can put it in too fast, flush rxn coincides with abatement of asthma attack)
PROPHYLAXIS FOR CHALLENGE
Vit B6 100mg helps prevent MSG or nitrate sensitivity
quercetin 1 gram
Vit E 8 hours prior to exposure
NAC
Molybdenum for sulfite sensitivity
spray sodium cromolyn in back of throat, intol is inhaled form, 3 sprays 15 mins before trial
sodium cromolyn comes as eyedrops and nasocrom nose drops for hay fever
this stuff can work for gluten sensitivity too
LONGTERM TX FOR ASTHMA
DECREASE INFLAMMATORY PATHWAYS
block lipoxygenase: ginger, quercetin, boswellia, tumeric, carotenoids
divert AA-->HETE (instead of HPETE): glutathione nebulizer, NAC
fasting
SUPPORT METHYLATION
N-acetyl cysteine to provide methyl groups, mucolytic, antiox
mucomist
daily B-12 shots at first, helps all young kids some dramatically
methyl cobalamin hurts more when give as shot so add some procaine
B12 shots can be weekly once stabilized
B6 50mg bid, takes about a week to work, prevents peripheral neuropathy
potent cofactor for delta 6 desaturase
book: Doctor's Guide to Vitamin B6
DIET
decr red meats and dairy (high in AA)
eat red colored: onions, grapes, rose hips, very berry drink (flavonoids)
above with alc helps extract flavonoids
avoid excessive calcium
avoid bananas to avoid phospholipase A2 potentiation
ginger tea highly recommended, with raw honey
try vegan diet
incr foods w flavonoids and carotenes: apple, cherry
SUPPLEMENTS
EPA 3gm/day
Flax or fish oi 1-2 TBS/day
incr EPA and linolenic acid (flax, fish is fastest, EPO, DHA from algae for vegetarians)
Mg+ 500-900mg/day, SR is desirable, constant supply plus weekly IV
he uses MgCl, less concentrated and less problems than with sulfate
carotenoids:
B carotene 100,000-300,000 IU/day
he uses betaplex from scientific botanicals for prevention of sunburn, 2-3000 units for asthma
alcoholic tinctures: curcumin, pisidia, glycyrrhiza, lobelia, ginger
quercetin 500mg 30 mins before meals, available as inhalant form thorne
can mix quercetin in vanilla extract to solubilize, won't dissolve in water/juice
selenium start at 200mcg and gradually incr to 800mcg longterm no higher
(precursor to glutathoine peroxidase)
vit E 800 IU/day
avoid tryptophan which is converted to serotonin, a bronchoconstrictor
vitamin C 1-2 grams/day
staphage lysate is extract of staphylococcus, comes as liquid, try very small dose at first
use only w/ supervision: from delmart labs may cause anaphylaxis
ephedra tincture, standard homeopathics, very effective, mixes with lobelia
ginkgo biloba
strong phosphodiesterase inhibitor, just as coffee does
breaks down cAMP, and you want to increase it
he uses 24% standardized extract, you can put it in your tincture
HCl
esp for children, asthmatics have very low acid
Dr Donovans herbal bitters from herb pharm
molybdenum IV stims sulfite metabolism
not very effective orally
if oral take picolinate
TX FOR ASTHMA PER MILNER 2010 BELOW HERE
hypoallergenic diet, desensitization
garlic, onions, ginger, cumin, coriander
vegan diet
EFAs: fish, EPA 4-12g daily, EPO too: omega 6 500mgx2 tid
avoid bananas, salicylates
B6 150-200qd or P5P 10-20mg tid btw meals
B12 1000mcg SL or injx weekly
vit c 1-4g
vit e 400 iu
sel 200 mcg
beta carotene 25-100,000 iu
HERBS:
decongestant: ephedra, NAXC, glycyrrhiza, SSKI
antihist: quercetin, hesperitin methyl chalcone, urtica, mixed bioflavonoids
bronchodilators: ephedra, belladonna, capsicum, lobelia
ACUTE TINCTURE FORMULA
lobelia (1)
ephedra (1)
capsicum (1/2)
1 tsp chased with a glass of warm water every 15 mins until breathing normalized
will get better or will vomit and then be better
combine with local hot compress and hot water bottle (local heat)
consider mustard or ginger compress
diathermy, hot herbal poultice, hot pack
EPI PROTOCOL
ACLS 1:10,000 IV
1:1,000 SC or IM
kids: .05-.2ml dose
adults: 0.3-0.5ml SC or IM (IM 1st), repeat as indicated each 20-30 mins
-->ER, Milner sounds like "if" it fails but my understanding is epi means going to hospital
check pulse ox
PHARM
Rxs: prednisone, albuterol (alpha and beta andrenergic stim), flonase (nebulized steroid), theophylline (xanthine), etc
Better know well how to taper from steroids.
CAUTIONS
arginine-->high nitrous oxide can agg cough
gamma toco may reduce this effect
iron mb used to block NO synthetase
ACE inhib can agg
FARTHER OUT THERE
B12 INJX TO INFRASPINATUS TRIGGER POINT
B12 an dlidocaine HCl 2ml injx
a study supports this use (what study?)
MOA: numbs a nerve to the bronchial tree??
CHINESE MED
cupping, rolling of cups
plum blossom needling
ADRENAL TX PER DR MILNER 2010
indicated for asthma
support cortex and medulla
vitamin B complex
pantothenic acid added to 1000mg daily
extra B6
vitamin C
tyrosine 3,000-5,000mg (between meals)
dopamine from mucuna or compounded 120-250mg L-dopa (between meals)
DHEA if deficient (dehydroepiandrosterone)
pregnenolone if deficient
cortisol if deficient
(I have come almost entirely to this tx plan for myself over the last year)
HOMEOPATHIC
mc: arsenicum
r/o: phos, kali-c, ars-iod, sulph, silica
**there's a section in the Milner asthma notes on cystic fibrosis, no file for that yet