Asthma and COPD

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


Asthma, and chronic obstructive pulmonary disease (COPD), which includes chronic asthma and bronchitis, or airway inflammation, are a spectrum of syndromes that include diseases of the lung which lead to a variety of symptoms, such as chest tightness, shortness of breath, dyspnea, wheezing and cough. Wheezing is type of breathing difficulty where the narrowed trachea and bronchioles produce a whistling, squeaking, puffing or musical sound as the air passes. Dyspnea is the subjective shortness of breath perceived when airway narrowing creates distress or alarm, and may occur with exertion, on either inspiration or expiration of breath, and may be purely subjective, without apparent physical cause. This feeling of respiratory distress is perhaps the most problematic part of asthma and COPD, and sometimes the airway is so narrowed that it is life threatening. There are over 5000 asthma-related deaths per year in the United States, and the disease affects approximately 25.7 million people with asthma, one-third under the age of 18. Asthma-related deaths, or mortality, are among the lowest in the world, and continue to decrease in the United States, thanks to the use of emergency asthma inhalers and hospital emergency services, but the rates of prevalence of asthma have continued to increase since 2001, although not as dramatically as the period between 1980 and 2001, where the U.S. saw a 79 percent increase in incidence of asthma!

Chronic asthma is part of the degenerative lung disease called Chronic Obstructive Pulmonary Disease, or COPD, along with chronic bronchitis, and emphysema, and it is estimated that over 120,000 COPD-related deaths occur per year in the United States, yet there is little awareness of this threat! COPD is usually a slowly developing disease and timely restorative care could greatly reduce this alarming mortality. To gain perspective, in 2011 the U.S. Centers for Disease Control and Prevention (CDC) reported that 31,374 patients died of breast cancer. The prevalence of chronic bronchitis has increased dramatically in the black population in the United States from 1999 to 2011, as well as the aging baby boomer generation. Despite a remarkable decrease in cigarette smoking, and heavy cigarette smoking, the overall rates in chronic bronchitis and COPD have not diminished dramatically overall in the last decade. A number of factors are tied to this persistent prevalence of the disease, including air pollution (see separate articles on this website devoted to the health aspects of air pollution and lead, mercury and heavy metal toxins), diet, lifestyle, and persistent use of medications that impair immune function, such as corticosteroids and NSAIDS, and overuse of antibiotics. Ironically, corticosteroids are very successful at treating acute COPD exacerbations, yet chronic use of corticosteroids has been shown to contribute to the progression of the disease. A systematic protocol of restoring lung health and function has been left out of the treatment strategy in standard medicine, and this is proven to be a big mistake. Integration of Complementary Medicine, in the form of the Licensed Acupuncturist and herbalist, fills this gap in treatment strategy, working to restore healthy respiratory health and function. The scientific data accumulated in the last decade has greatly elucidated this devastating spectrum of diseases, whose incidence has increased steadily in the U.S. population, and has led to a rethinking of the strategies for both treatment and prevention of asthma and COPD. Patient education and integration of Complementary Medicine will bring us from just managing these respiratory diseases to finally curing them.

The United States Centers for Disease Control and Prevention (CDC) reports that incidence of asthma in the U.S. rose from about 19 percent to about 21 percent of the population between 2001 and 2010, increasing about 2.9 percent per year in the number of persons affected. This reflects a problem with the overall treatment strategy, especially as the incidence of cigarette smoking dramatically declined, and the CDC reports that in this time period the percentage of Americans that took at least one pharmaceutical medication regularly rose by 4 percent to almost half of the population, with asthma medications, especially for children, among the most commonly used type of drugs. The time to get serious with preventive medicine, environmental concerns, and expansion of the treatment options to integrate Complementary Medicine has arrived. The current drug strategy of emergency relief and palliative care has not addressed the actual health problems, has not stopped the progression of the diseases, and has not prevented the rising incidence of this serious threat to public health, and the health of future generations. When the status quo has not worked well enough, we should fix it. Incidence of asthma has increased dramatically in children and often results in recurrence in early adulthood if the underlying health issues are not resolved. Incidence of COPD has increased dramatically in the aging population and is usually ignored until the symptoms become more severe, yet is a slowly progressing disease, often a result of insufficient treatment of the underlying health factors related to asthma. Simply managing acute symptoms in asthma, instead of actually correcting the health problem, has led us to this alarming and devastating public health outcome.

Asthma usually onsets in childhood or early adult life, while COPD (chronic bronchitis, emphysema, chronic asthma, types of pulmonary fibrosis, and other lung diseases) usually onsets in later adult life. A history of asthma increases the risk of acquiring COPD by 10-fold or more, though, and improving the respiratory and overall health with asthma is perhaps the most important aspect of prevention of COPD, besides quitting smoking. While it has been widely assumed that most COPD cases have been caused by or strongly related to cigarette smoking in the past, statistics in the United States show that there has been a slight rise in COPD mortality for women between 1999 and 2010, despite dramatic decreases in the the incidence of heavy cigarette smoking. National per capita cigarette sales decreased 35 percent between 1999 and 2010, with the proportion of heavy smokers also decreasing steadily, from about 15 percent of smokers to about 6 percent, yet the prevalence of COPD has not dropped dramatically, remaining at between 3 and 9 percent in the United States depending on geographic location. Yes, prevalence of COPD in the United States has been tied to geographical demographics, much more than cigarette smoking prevalence, with about twice the incidence in the Midwest and South compared to most of the Western and Northern United States. Maps of the areas of high incidence of COPD largely overlap maps of the density of dirty coal-fired power plants in the United States, and despite the insistence that COPD has been a self-inflicted disease of lifestyle choice with heavy cigarette smoking, this is now proven wrong. The global BOLD study has also shown that while age and smoking are strong contributors to COPD, they do not explain variations in disease prevalence, showing that other health factors have long been overlooked. COPD is the third leading cause of death in the United States, with more than 120,000 COPD-related deaths per year, and the disease causes enormous disability as well. Often, chronic obstructive lung disease and interstitial lung disease overlap, and a 2009 study at Chiba University in Japan found that these diseases were strong risk factors for lung cancer as well. It appears that too much emphasis has been applied to cigarette smoking, however admirable that has been, and a host of health issues related to these diseases and respiratory health have been largely overlooked.

COPD develops slowly, and worsens over time, unless the patient learns how to create a comprehensive protocol to slow or reverse the disease mechanisms. Standard medicine has found no treatment that successfully reverses the underlying health problems driving COPD, and has resorted to merely managing the disease. Managing the disease has not stopped the progression of the disease, though. While this protocol is very important, there is much more that can be accomplished by the patient with asthma or COPD. In the early stages of chronic bronchitis, a persistent cough and increasing difficulty with mucus flow occurs, as well as chest tightness and shortness of breath. When the disease progresses to later stages, the unseen damage to the lung tissues creates poor exchange of oxygen and carbon dioxide into and from the blood, labored breathing, and cor pulmonale (right ventricle heart failure due to chronic pulmonary hypertension). The blood oxygen levels are normal in the early years of chronic bronchitis, but are part of the cause of death in latter stages, as the patient is not able to get enough oxygen or expel enough carbon dioxide, leading to bloating, swelling, and a blue complexion, and eventually serious dysfunction throughout the body. In COPD, gradual degeneration of the deep lung tissues eventually leads to hardening of arterioles and veins, and the right ventricle of the heart struggles to pump enough blood into the lung to maintain blood oxygen levels. Helping the body to maintain and repair lung tissues, and regulate inflammatory processes, is essential in this disease, and Complementary Medicine can provide these essential therapeutic aids. Much research in the last decade has also shown that inhalation of high concentrations of fine particulate matter (PM10) in air pollution immediately causes stiffening of peripheral blood vessel and hypertension, particularly in patients with COPD and asthma, and chronic exposure to heavy air pollution contributes much to this disease process.

Prevention of asthma and COPD is perhaps the most important aspect of these respiratory disease syndromes, as well as prevention of progression of the disease. The U.S. National Institutes of Health (NIH) states that most people at risk for COPD are not even aware of the disease, and that this slowly developing disease occurs most often after the age of 40. Although a history of smoking cigarettes is highly associated, about 1 in 6 patients diagnosed with COPD never smoked. Cigarette smoking has been linked to as many as 90 percent of COPD deaths by experts, though, and the stubborn insistence on ignoring the other causes and contributors to COPD has now become an issue in this arena of medicine. Environmental exposure to smoke, dust, fumes and chemicals is the primary cause of almost all cases of COPD, with only one significant genetic factor known, alpha-1 antitrypsin (AAT) deficiency, although it is estimated that only about 100,000 Americans have this genetic trait. The U.S. NIH states that prevention involves awareness of exposure to these airway irritants, testing with spirometry (lung capacity), quitting or severely restricting cigarette smoking, avoiding airborne pollution, and seeing your healthcare provider regularly. There is obviously much more that can be done to prevent COPD, and asthma.

In 2001, the European-based Global Initiative for Chronic Obstructive Lung Diseases (GOLD) revealed that in 1990, COPD ranked 12th as a cause of disability-adjusted life years lost globally, but that by 2020 is expected to rank fifth, and be the third leading cause of all deaths in the world. GOLD stated: "A nihilistic attitude toward COPD has arisen among some healthcare providers, due to the relatively limited success of primary and secondary prevention (i.e. avoidance of factors that cause COPD or its progression), the prevailing notion that COPD is largely a self-inflicted disease, and disappointment with available treatment options". There is much that can be done to prevent asthma and COPD, and their progression to a more threatening and disabling syndrome of disease symptoms, but this involves attention to the whole health and the underlying physiological aspects of the disease, patient education and awareness, and integration of Complementary Medicine, our chief medical specialty in preventive medicine and holistic care. There is no choice between standard medicine and Complementary Medicine, but integration of this medical specialty provides a realistic, proactive, and hopeful means of slowing or even reversing the disease mechanisms, and achieving less dependency on problematic drugs that have been created merely to manage symptoms.

Current medical management of asthma and COPD involves use of medications that combine corticosteroid with beta-2-adrenergic agonists (e.g. Advair), along with medications that inhibit inflammatory mediators, such as the leukotriene receptor antagonists (e.g. Singulair). Many patients are paying attention to the FDA warnings and the warnings from medical researchers concerning chronic use of these medications and are seeking healthy alternatives and Complementary Medicine strategies to decrease the use of these medications and perhaps, like many patients have discovered, be able to live without asthma and/or COPD. The treatment protocol in Complementary Medicine should address the maintenance and repair of lung tissues and cardiovascular health, inflammatory regulation, and related health problems, as well as help with managing symptoms, though. Every patient with asthma and COPD sees that symptoms are much less frequent when one's health improves, yet specific information on improving the immune system and health of the bronchioles, respiratory membranes, and the neurohormonal system responses is not easy to come by. Once one understands what needs to be done, choices in a healthy therapeutic routine are clear. Not only symptom relief, but persistent therapy to reverse the degeneration of the respiratory system is important. Even when symptoms are mild the disease may progress.

The choices with treatment in Complementary Medicine are not concerned with choosing between the asthma drugs and acupuncture/herbal medicine. These therapies can be used together to both manage symptoms and correct the underlying causes of asthma and COPD. Asthma medications insure that the patient avoids sometimes frightening episodes of breathlessness. The goal is to improve health and manage symptoms with an array of proven therapies so that the patient is confident that drug dependance can be reduced without problems, and then to improve health further so that the asthma or COPD is cured.

The notion that asthma medications are entirely benign and can be used as often as you want without consequences is totally false. When the need for asthma inhalers and oral medications increases, this is the time to explore a more holistic approach to treatment, and Complementary Medicine, in the form of the advice and care of a competent Licensed Acupuncturist and herbalist, is especially important in this more proactive treatment plan. This course of therapy is not undertaken lightly, and depends upon a good understanding of the disease, therapies, and issues involved. Patient education and understanding is the key to effective management of asthma and COPD, and the time to incorporate this more proactive approach to care is before you are debilitated by the disease. Early intervention with a more holistic and thorough treatment strategy is the key to success.

With the numerous warnings of (1) medication side effects with chronic use of asthma medictions, (2) adverse effects on the airway membranes with chronic and constant use, (3) acquired tolerance and decreased effectiveness of asthma medications with chronic and constant use, and (4) the risk of eventually stimulating a severe asthma episode with increased use, the public is becoming aware that they cannot simply and solely depend on drugs that control asthma symptoms, which do not stop the progression of the disease, but must also search for ways to correct the ill health of the airway membranes, dysfunction of the membrane immune responses and neurohormonal reactions, and chronic inflammatory imbalances that perpetuate this threatening disease. Many patients are also realizing that television, media and print ads telling them that there is no cure for COPD are meant to discourage the use of Complementary Medicine to improve respiratory health and related health problems, which is not helpful. As scientific study reveals the serious comorbid health problems associated with asthma and COPD, intelligent patients are realizing that they must work on their overall health as well as control asthma symptoms. There is no actual binary choice between either pharmacological treatment or holistic care with Complementary Medicine, only an integrative strategy to improve success and prevent progression. There is perhaps no health problem that requires integration of Complementary Medicine more than asthma and COPD.

Examining the Risk vs Benefit of Standard Medication

The following information is not meant to alarm or to suggest that asthma medications are unsafe, but awareness of the risk facts are needed when looking at your overall health and making the decision to decrease risk and adverse effects by adopting healthy strategies of Complementary Medicine. The effects of long-term use of these medications are not always apparent. A story in the Money and Policy section of the New York Times, Dec. 5, 2008, illustrates the current debate and is available by clicking on the link at the end of this article.

Many medical groups and businesses have downplayed the risks of asthma medications, and pharmaceutical companies have produced new studies that downplay the risks. The fact that patients feel no immediate ill effects of these medications when starting use serves to help promote this downplaying of risk, but many researchers have become alarmed in recent years. The usual advice when faced with the recent proof of increased risk is that there is no alternative to these medications and so the risk is worth it, but when the facts are examined about alternative and complementary treatment, many M.D.'s say that this may be worth trying. Many patients, too, have doubts about pharmaceutical manipulation of studies today and are increasingly wary of long-term risks.

Warnings and risks of chronic use of asthma medications have increased in recent years. In November of 2005, the FDA requested that a warning be included on products with beta-2-adrenergic agonists stating "may increase the chance of severe asthma episodes and death when these episodes occur". Researchers at Stanford and Cornell universities concluded that 80% of asthma deaths were caused by the combo-inhalers Advair, Serevent and Foradil, a combination of steroid and adrenergic agonist, although this was disputed by the manufacturer. Researchers found that these drugs may worsen bronchial inflammation and hyper-responsiveness. In 2004, the FDA issued a warning the albuterol sulfate contained in many asthma medications can produce "clinically significant cardiovascular effects" such as high blood pressure, racing pulse, and ECG changes affecting arrhythmias, and warned that beta-adrenergic agonists may "produce significant hypokalemia (potassium deficiency) which has the potential to produce adverse cardiovascular effects". FDA black box warnings have been required for Advair, Serevent, Symbicort, Foradil, Brovana and others. Clinical study of Brovana, a beta-adrenergic agonist, showed that increases in blood sugar of up to 1.2 mg/dL were seen at both 2 and 6 hours after eating. A 2 year study showed a dose-related increase in uterine and cervical cancer and polyps in mice with high dose. In March of 2008, the FDA issued a stronger warning that recent clinical studies showed more serious risk for pediatric patients taking beta-adrenergic agonists, or bronchodilators. The FDA has issued warnings on asthma/CPOD medications that labeling makes unsubstantiated effectiveness claims and omits material facts.

Side effects in clinical study of these common asthma medication combinations include headaches, muscle and bone pain, soreness of the sinus and throat membranes, increased incidence of fungal infections in the mouth and ears, stomach ache, insomnia, tiredness, dizziness, increased blood acidity, etc. In 2008, Merck updated its labeling information of Singulair (anti-leukotrienic drugs) to include warnings of depression, anxiousness, tremor and suicidial thinking and behavior because of an FDA warning that resarch was strong linking these problems with chronic use of Singulair and investigation was ongoing.

The key question in evaluating long-term risk versus benefit is not whether we may be one of the unlucky few who face serious consequences, but rather, if these medications can cause such significant harm, what are they doing to my general health. To improve your general health and prevent future health problems, you can start understanding how asthma and COPD works and what healthy measures you can start taking to decrease chemical dependancy and to give your body the best shot at a cure.

Many medications may trigger, worsen or even contribute to the cause of asthma and COPD, and Complementary Medicine may reduce the need

Some common medications that may trigger or worsen asthma include aspirin, NSAIDS (ibuprofen, advil, naprosen etc.) acetaminophen, and beta-blockers such as atenolol, propranolol and metoprolol. Chronic use of antihistamines, steroids and medications for controlling stomach acidity may also worsen your condition. As described above, various antibiotics may cause or contribute to eosinophilia and eosinophil migration to the bronchioles, lung and esophagus, with common allergens, low-grade parasitic infections, and environmental toxins triggering an eosinophil activation that injures cells with the release of major basic proteins that attack the organ cells. Complementary medicine may help reduce chronic drug dependency, or overuse, in these cases.

Acetaminophen (paracetamol), a too common pain reliever that is found in hundreds of pain medications with different names, both prescription and non-prescription, and is now finally being regulated to decrease the toxic overdosing that is so common in the United States. Acetaminophen is the non-steroidal anti-inflammatory (NSAID) medication most associated with asthma. Both asthma and allergic sinusitis (rhinitis), which is heavily associated with asthma in concurrent morbidity, especially in young patients, have shown a significant association with acetaminophen use in large studies. A large study in 2010 by the University of Auckland, New Zealand, part of The International Study of Asthma and Allergies in Childhood (ISAAC), found that the most prevalent associations with prevalence of asthmatic symptoms worldwide were sales of acetaminophen (paracetamol), trans fats in food, and smoking prevalence in women (PMID: 20092649). Even air pollution, as measured by ambient particulate matter (PM), or soot, which has been blamed in recent years for increase in asthmatic symptoms, and generated bans on the use of fireplaces and wood stoves in cities such as San Francisco, was found to have little or no association with the prevalence of childhood asthma by the ISAAC study (PMID: 19819866). The increase in sales of acetaminophen were highly associated.

A 2011 report by the Akron Children's Hospital Department of Pediatrics, in Akron, Ohio, and published in the medical journal Pediatrics (2011 Dec:1181-5), stated that: "The epidemiologic association between acetaminophen use and asthma prevalence and severity in children and adults is well established. A variety of observations suggest that acetaminophen use has contributed to the recent increase in asthma prevalence in children: (1) the strength of association; (2) the consistency of association across age; (3) the dose-response relationship; (4) the timing of increased acetaminophen use and the asthma epidemic; (5) the relationship between per-capita sales of acetaminophen and asthma prevalence across countries; (6) the results of a double-blind trial of ibuprofen and acetaminophen for treatment of fever in asthmatic children; and (7) the biologically plausible mechanism of glutathione depletion in airway mucosa. Until future studies document the safety of this drug, children with asthma or at risk for asthma should avoid the use of acetaminophen." There can be no more certain statement than this.

One particular aspect of the link between acetaminophen use and asthma, as well as chronic allergic sinusitis and eczema, is the depletion of our most important cellular detoxification pathway, the glutathione depletion in airway mucosa. The subject of glutathione may be further explored on a separate article on this website, entitled Glutathione Metabolism, restoration and balance. Acetaminophen has had warnings by the FDA ignored by prescribing doctors and patients since 1977, when the FDA Advisory Review Panel recommended that strong warnings of liver damage from excessive acetaminophen dosage and use of acetaminophen for more than 10 days be placed on all medications containing acetaminophen. The FDA failed to follow these expert recommendations, and by 1999, the National Hospital Discharge Survey found that over 26,000 hospitalizations per year in the United States were related to acetaminophen toxicity. The National Hospital Ambulatory Care Survey reported that nearly 57,000 emergency room visits per year were related to acetaminophen injury in 1999, and the American Association of Poison Control Centers recorded 108,000 calls regarding acetaminophen poisoning in 1999, resulting in 141 deaths. Since 1999, the sales of acetaminophen have increased dramatically, and these red flags concerning the liver toxicity and damage to the detoxification pathway resulting from acetaminophen use were ignored, as the increase in asthma, COPD, allergic sinusitis and eczema have now reached epidemic proportions, according to health experts.

What these findings also should tell physicians and patients is that the healthy function of the liver, glutathione detox pathway, and regulation of inflammatory metabolism is a very important subject in relation to asthma and COPD. Complementary Medicine not only provides effective and safe treatment for asthma and COPD, but also alternatives to chronic acetaminophen use to relieve pain, and methods of increasing the healthy function of the glutathione metabolism, liver function, and immune health related to inflammatory regulation. In fact, the treatments with Traditional Chinese Medicine, acupuncture, hebal and nutrient medicine, and the direct physiotherapies in TCM, called Tui na, provide all of these benefits in a single treatment. In addition, the injury from medications such as acetaminophen can be ameliorated with the use of TCM therapies. The benefits are great, and the risks are nonexistent with this type of Complementary Medicine.

A growing concern with COPD, and the alarming rise in COPD in women, is the subject of sleep disorders and nocturnal hypoxia. Nocturnal hypoxia in COPD is found to be worse during REM phases of the sleep cycle, and restoration of a healthy sleep cycle is needed. Insomnia medication is thought to worsen the sleep cycle and may also contribute to increased nocturnal hypoxia. As the situation with nocturnal hypoxia and insomnia worsens, standard medicine now utilizes oxygen therapy at night, and take patients off of beta-blockers (beta-adrenergic antagonists) that are routinely prescribed for even mild hypertension, and often switch to anticholinergics. Pharmaceutical anticholinergics come with considerable side effects, though, and herbal anticholinergics, such as Huperzine A and Vinpocetine, have been recognized as effective and without side effects, even by the U.S. FDA. About half of all patients with with severe COPD experience sleep disorders, and common COPD and asthma medications may worsen insomnia, but some health organizations have warned that various insomnia medications, such as benzodiazepines, as well as alcohol, could worsen nocturnal hypoxia, and are contraindicated. To learn more about insomnia, nocturnal bruxism, sleep apnea, and restless leg syndrome, and what you can do with a proactive approach and a comprehensive therapeutic routine, utilizing sleep hygiene, lifestyle changes, dietary changes, and Complementary Medicine, go to various articles on this website that elucidate these complex disorders.