Understanding Asthma and Its Treatments

Ophelia Gherman, M.D.
December 7, 2017
What is asthma? What are its conventional treatments? Are there any natural treatments?

Asthma affects 334 million people globally with the highest number of patients living in developed countries. Although only 10% of these are classified as severe asthmatics, asthma still imposes an unacceptable burden on health care systems, on society through loss of productivity and, especially for pediatric asthma, on the family.


Asthma is a complex immune disorder involving an interplay between genetics, environmental exposure, and inflamed hyper-responsive bronchioles. Asthma and allergies often occur simultaneously in the same patient or within a family. The two are linked genetically. 


The main root of illnesses such as asthma, allergic rhinitis, and food allergies is inflammation. Other childhood exposures such as viral respiratory tract infections, the composition of microflora within the gut and the airway, fetal smoke exposure, and maternal diet during pregnancy increase the risk of asthma. Bacterial communities within the intestines and airway are modifiable and have important effects on early immune development and susceptibility to allergy or asthma. A child’s gut flora is affected by maternal gut flora during pregnancy, medications, illnesses, and microbial exposure within the child's environment.


An asthma attack occurs when the smooth muscle of the airway constricts in response to a stimulus. This rapid constriction causes a decrease in airway diameter by a factor of 4, which is like trying to breathe through a miniature straw versus a regular size straw. This leads to wheezing, coughing, breathlessness, and a sense of anxiety. Due to the inflammation, constriction, mucus production, and immune response, the lung bronchioles undergo structural changes after each asthma attack. Multiple uncontrolled asthma attacks then lead to scarring and overall reduced lung function. It is imperative to understand one’s triggers and eliminate all possible factors that could lead to an asthma attack in order to preserve the lungs.


For most, seasonal allergies are a prime triggering factor for internal inflammation. The first symptoms are watery and itchy eyes, a runny nose, post-nasal drip, a scratchy throat, and coughing. Regardless of whether you experience symptoms or not, all asthma patients should include an allergy treatment in their asthma protocol.


Asthma patients should also avoid external environmental triggers such as air fresheners, commercial laundry detergents, caustic cleaning products, and commercial lotions and perfumes. The most common dietary triggers that asthma patients should eliminate are dairy, eggs, gluten, and any other food substance they may be allergic to.


Despite changes to our understanding of underlying causes and the treatment of asthma, we have seen an increase in asthma cases and complications. Conventional medical treatment may help mild to moderate cases of asthma but the rise in cases and complications begs the question whether these pharmaceutics are enough to address the complex diversity and severity in many cases.


Conventional Asthma Treatment 

Below is a quick checklist of commonly used medications in the treatment and prevention of asthma:


Albuterol is a rescue inhaler that is used for quick-relief. It works by rapidly dilating constricted lung airways and wheezing. Albuterol helps to reduce lung damage and helps maintain lung function in the long run.


Steroid inhalers are used by patients whose asthma is not stable and who experience multiple asthma flare-ups. These steroid based inhalers reduce swelling and irritation of the airways. It is prescribed as a way to reduce the number of times one needs to use their rescue inhaler (albuterol).


Antihistamines block the histamine cascade from triggering excess swelling, inflammation, and mucus production in the nasal and oral passages. This helps to reduce post nasal drip and congestion which are both key triggers in asthma patients.


Mast cell stabilizers or Montelukast (Singulair) reduces lung airway constriction and inflammation and thereby reduces asthma flare-ups.


Frequent or chronic use of steroids can cause weight gain, increase in sugar levels, diabetes, osteoporosis, bone fractures, glaucoma, friable skin, depression, and growth disturbance or hindrance of bone development in children. 


A stepwise approach is needed for asthma treatment to work. Asthmatics should have a thorough work up to check for elevated eosinophils. Blood eosinophilia greater than 4% or 300-400/μL supports the diagnosis of asthma, but an absence of this finding is not exclusionary.  Additionally, a pulmonary function test may detect asthma is poorly responding to current treatment or reveal lost lung function. If your asthma frequently flares up, additional imaging tests, such as a chest x-ray, may be revelatory. Chest CT or MRI could identify the degree of pulmonary inflammation, infection, or other co-morbidities. Skin and blood allergy testing is also recommended. This will help patients mitigate their environmental and dietary triggers and aid in overall wellness and health. In the long run, if asthma symptoms such as coughing and/or excess mucus production persist despite asthma treatment, allergen elimination, and negative testing, one should consider gastro-esophageal reflux as a possible alternative diagnosis.


Integrative supplements


Elimination of irritants

There is a time and a place for the use of pharmaceutical treatments, but most people experience unwanted side effects and compounded influence of toxicity on the body. The most judicious approach would be to naturally decrease inflammation (the source of reactions) and strengthen the two key systems in our bodies—the digestive and the immune system—in order to reduce asthma attacks as well as allergy attacks.



Elderberry fruits grow on a species of trees called Sambucus. The flowers and fruits are commonly used for medicinal purposes. The leaves, root, and bark are toxic due to the cyanide content and are not to be used. Due to its rich source of flavonoids, including anthocyanins, minerals, and vitamins such as potassium, Vitamin C, A, and B6, elderberry is well known for its pharmacological effects. It has been shown to inhibit viral replication, and act as an immunoprotective agent by increasing the production of inflammatory and anti-inflammatory cytokines. It is fairly safe to use during pregnancy and while breastfeeding. There are no known drug interactions and have little side effects unless using fresh Sambuca juice of the American elder (S. canadensis) and Mexican elder (S. mexicana). (Recommendations are to use 3.8 g standardized liquid extract (2:1) per 10 ml syrup: For intensive use: Adults: 2 teaspoons 4 times daily | Children: 1 teaspoon 4 times daily)


Black cumin oil  

Black cumin (Nigella sativa, Ranunculaceae) seeds have anti-inflammatory, immunomodulatory, and antioxidant effects. A recent study on partly controlled asthmatics taking 1-2 grams of black cumin oil for 12 weeks showed lower inflammation levels and greater pulmonary function. It also reduced asthma severity as compared to the placebo. By thus decreasing pulmonary inflammation, black cumin decreases remodeling of lung tissue and thereby helps to preserve lung tissue and function.



Studies by Harvard University have linked a strong immune system to a healthy and diverse group of intestinal flora. Re-populating the gut with healthy bacteria may be done through food and supplemental sources, such as probiotics. Food sources rich in probiotics are yogurts, pickled vegetables such as cabbage (sauerkraut or kimchi) and a diet rich in fresh organic vegetables. There are multiple types of probiotic supplements to choose from, but I highly suggest getting something that will be affordable so that it can be a sustainable part of your diet.



Staying well hydrated cannot be overemphasized for patients with asthma and chronic allergies. When the body is dehydrated its drought management system produces more histamines, which aggravates asthma and allergic attacks.


Note: It is important to understand that herbal supplements are not regulated by the FDA and have not been tested. However, unlike drugs, herbal supplements are considered safe unless proven to be unsafe. Efficacy of each supplement can vary depending on different harvest seasons, locations, and due to the different extraction solvents and methods used to prepare them.






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