Asthma is not normally found in children under 2 years of age, although other respiratory disturbances cause wheezing, both in infants and older children: bronchiolitis in infants causes wheezing and trouble with breathing in and out when the bronchioles become inflamed and blocked. Children with croup wheeze, but it is characterized by trouble breathing in and not out as in asthma.
Asthmatic bronchitis affects children mostly between the ages of two and six years. Wheezing is accompanied by a fever, dry cough and some difficulty breathing, and it is caused by constriction of bronchi and bronchioles, as a result of an allergic response to infection in the bronchi or to the mucus it produces. It normally occurs in children younger than those who normally develop classic asthma, it tends to develop in allergic children and always occurs as a result of infection. Thus it requires treatment for the infection as well as the accompanying allergic response.
Obstruction of the airways by either spasm, hyper-responsiveness of the bronchial tubes, inflammation or swelling of the respiratory mucosa is certainly on the increase and can be triggered by a variety of different factors, which may act separately or in combination. Many asthmatics are allergic to pollen, house dust, animal fur and a variety of foods, and may also be prone to other allergic reactions, such as eczema and hayfever. A recent review suggests that “food allergy should be considered in any child with asthma” (for background causes of allergic asthma see Allergies).
Asthma can be set off by a smoky or cold, foggy atmosphere. Certain household chemicals can also cause irritation of the bronchial mucosa and predispose to spasm. Any respiratory infection (cough, cold or influenza, for example) can irritate the bronchial tubes and cause them to constrict.
An asthmatic child may well have a tendency to chronic catarrh or repeated respiratory infections, which weaken the lungs. Emotional factors can often play a part. Children with asthma may be being “suffocated” by an over-protective parent, or there may be nervousness, hypersensitivity, disharmony in the family or the surroundings, particularly insecurity, causing constriction in the chest. When asthma has been set off, the anxiety that this may cause, and distress, if the attack is severe, may serve as an aggravating factor in itself. Recent research confirms the link between anxiety, depressive symptoms and asthma, also suggesting the use of inhaled corticosteroids is associated with a negative effect on patients’ mental health.
Inheritance can be another factor, predisposing the child to asthma or eczema. Digestive disturbances may also be implicated as they can cause irritation of the vagus nerve, which feeds the stomach and the bronchial tubes, causing the constriction of muscles in the chest.
The most important line of treatment is to prevent attacks and, preferably, to resolve the chronic problem. This necessitates constitutional treatment of the child. In an allergic child it is important to attempt to discover which substances the child is allergic to or irritated by and the background causes of allergy. Although there may be a variety of possible allergens: foods, pollen, animal dander, feathers, plants, moulds or the housedust mite, for example, it is an uphill struggle to prevent contact with these, and food is by far the easiest area to work with. If the offending foods can be found and omitted from the diet, it takes a considerable strain off a debilitated immune system, which then has a greater ability to resist sensitivity to other substances, such as animal dander or the house-dust mite.
The most common food allergens implicated are milk produce, wheat, eggs, oranges and artificial colourings, flavourings and preservatives (particularly sulphur). While examining the diet for possible allergens and making necessary changes, the child can be treated with herbs, combining herbs to improve the function of the digestive and immune system and to decrease the allergic tendency, with herbs specifically to relax the bronchial tubes and expel the mucus. It is not enough simply to remove the offending allergic substances, even if the asthma improves, for the allergic tendency will remain, only to focus its attention later on some other food that is eaten regularly. Research has suggested that a low salt diet can ease the severity and frequency of asthma attacks and that yoga, swimming and singing can encourage the use of respiratory muscles, which can be trained to overcome moderate restriction in the width of the air passages in chronic asthma. Other research has shown swimming to decrease the severity of asthma symptoms.
It may take a few months or even a year to treat asthma effectively with herbs, so it is important to be patient and not give up too easily. During this time, if the child already uses inhalers or other medication, herbs can be used in conjunction with these. As the condition improves, the child should be able to use inhalers or steroids less and hopefully they can gradually be withdrawn.
• Herbs for the digestive and immune systems, such as chamomile, garlic, liquorice, yarrow and propolis can be combined with herbs to relax the bronchi and expel the mucus, such as coltsfoot, grindelia (Grindelia camporum), hyssop (Hyssopus off.), lungwort (Pulmonaria off.), mullein, sundew and thyme, and soothing herbs to relieve irritation in the chest like comfrey leaf (Symphytum off.), marshmallow (Althea off.), mullein and plantain.
• Research on patients with chronic airways obstruction has indicated that essential oil inhalations have a positive effect on mucus clearance but this is not advised during acute attacks.
• When asthma is aggravated by a respiratory infection, thyme, garlic, echinacea, liquorice, balm of gilead (Populus gileadensis) and hyssop, with their antimicrobial, antispasmodic and expectorant properties, will help resolve infection as well as relax the airways.
• Ginkgo (Ginkgo biloba) leaf extracts have been shown to benefit children’s asthma. A small trial with Ginkgo shows promising results in improving the clinical symptoms of asthma. The herb appears to work by a number of mechanisms, notably as a platelet-activating factor antagonist. Liquorice is a very interesting herb in this context. It has soothing and expectorant properties, and helps to support the adrenal glands, providing a natural counterpart to cortisone and helping to reduce the effects of stress and allergic reactions. This is particularly useful for children using cortisone inhalers or oral steroids when seeking to find a herbal alternative. It may be possible to withdraw the use of steroid medicines / inhalers gradually over a period of time.
Herbs that support the nervous system, help to relax the child and counter stress and tension can be added. These include chamomile, hops (Humulus lupulus), lemon balm, limeflowers (Tilia europea), skullcap (Scutellaria laterifolia) and vervain (Verbena off.). During an asthma attack, hot foot baths can be made using infusions of these herbs. Hot compresses can also be applied frequently to the chest.
• A useful remedy for asthma, which may be used in these different ways, is an infusion of equal parts of chamomile, coltsfoot, elecampane and thyme. Add two parts of this infusion to one part ginger and liquorice decoction. Give ½ tsp (2-3 ml) every 15-60 minutes, depending on the severity of the attack.
• There are several powerful herbs for asthma, such as the schedule three herbs ephedra (Ephedra sinica), lobelia (Lobelia inflata), and jimson weed (Datura stramonium). These are frequently used by professional herbalists, although I do not use them in my practice. Lobelia, also known as Indian tobacco or asthma weed, has antispasmodic properties and has long been used in the treatment of bronchial asthma. It contains lobeline, an alkaloid that has a nicotine-like effect on the central nervous system. Ephedra, a herb native to China where it is known as Ma Huang, is another specific for asthma. It contains the alkaloid ephedrine, well known for its slimming effects and frequently used for increasing metabolism in slimming preparations. It also acts as a bronchodilator and an expectorant.
General advice in the treatment of asthma
Herbal teas can be sipped during an asthma attack, but food is best avoided until the chest has settled down. The following foods are useful preventatively however to counter the problem generally: pure, unrefined sunflower seed oil (which contains inulin helpful in the treatment of asthma); foods rich in vitamin A – carrots, spinach, peas, beetroot, fish liver oils, watercress, apricots; foods rich in calcium; garlic for the immune system; vitamin C containing foods to stimulate the expulsion of mucus from the chest and enhance the immune system; drinks of lemon and honey to help clear the mucus.
Asthma can be aggravated by faulty breathing. Breathing exercises taught properly and practised regularly by the child can improve lung function, as well as help calm emotional stress – breathing has a direct connection to feelings and state of mind.
Abdominal breathing is easily learned and is simple to practise with an asthmatic child. As one slowly breathes in, the abdomen should expand outwards and, as one breathes out, it relaxes down again. If one uses the abdomen instead of the top part of the lungs, breathing will be more relaxed, and, if one counts while breathing, control over the breath can be gained. Begin by breathing in for three seconds and out for three seconds. If the child finds this easy, gradually increase the time it takes to breathe in and out. Because the difficulty with asthmatics is with breathing out, shape the mouth as if to whistle and blow the breath out as slowly as possible. Research has shown that Buteyko breathing technique (mimics pranayama) can improve symptoms and reduce bronchodilator use. Both meditation and hypnotherapy have also shown positive effects in small trials.
The fact that coughs and colds often bring on an attack and, if frequent, can actually weaken the lungs and predispose to asthma, means they need to be treated at their onset. If a child has frequent colds or other respiratory infections, this will require further investigation and remedial measures taken to enhance their immunity (see Immune System). The child’s diet should be analysed and potential allergens like milk, wheat and eggs should be kept to a minimum. If there is a history of asthma or allergies in the family, or if there is a tendency to wheezing during respiratory infections or to frequent coughs and colds, herbal teas can be given regularly as a preventative. Chamomile, coltsfoot, elecampane and thyme in hot infusions can be given sweetened with honey, two or three times daily.
If a child suffers from other allergies, it is important that they are treated constitutionally (see Allergies). Plenty of fresh air and gentle outdoor exercise should be part of the child’s daily routine. All exercise should be gentle; vigorous exercise, especially in cold air, can bring on an attack. An asthmatic child needs to be encouraged to take plenty of rest and relaxation. Over-stimulation and frightening or over-exciting games or television programmes are best kept to a minimum. Emotional stresses and strains within the family may be better discussed openly, so that any exaggerated fears may be dispelled and there is an opportunity for mutual support.
Ayurvedic approach to asthma
The Sanskrit term used in Ayurvedic medicine for asthma is shvasa meaning difficult breathing. It is caused by Kapha blocking Vata. Kapha forms first and therefore is the primary dosha that requires treatment. As in other health problems, a child’s constitutional dosha can predispose them to asthma. Vata type children who tend to be nervous, shy, fearful and insecure may be more prone to asthma while the influence of the Kapha stage of life may contribute to the accumulation of mucus in the chest which serves to block the bronchii.
Bronchial asthma (tamaka shvasa) is classified predominantly as being caused by a disturbance of Vata which causes bronchospasms. Coughing, fever, allergies, diarrhoea owing to indigestion, vomiting, cold, dry weather, smoke, breeze, drinking very cold water, and a high Vata diet, can all lead to Vata derangement. Aggravated Vata begins to move upwards in the pranavaha srotas, the respiratory channel, aggravating Kapha and making it difficult to breathe. Eating abishyandhi food (wet, viscous and sticky food like yoghurt, pork and salt) and low digestive fire lead to the accumulation of ama (toxins) in the body. Vata is also obstructed by Kapha accumulating in the stomach (the origin site of Kapha), rising up into the chest and causing breathing difficulties. Kapha becomes sama (i.e. mixed with ama) sticky, and thick and creates congestion. When movement of Vata is obstructed by Sama Kapha, it spreads in all directions and disturbs the channels of respiration and prana.
Prodromal signs (Purvarupa rupa)
These include pain or heaviness in the throat and chest, poor appetite, astringent taste in the mouth and abdominal rumbling. Once symptoms manifest there may be a crackly cough, loss of taste or appetite, runny nose, dry mouth and thirst and difficulty breathing, particularly lying down. The child may desire warm things. Breathing tends to be worse on cloudy days, after drinking cold water, from cold breezes or direct wind and when eating Kapha increasing foods. Another form of asthma is associated with Pitta and involves fever and infection and tends to improve with cool drinks, cool foods and cool air.
Specific dosha symptoms
• Pitta: wheezing, coughing with yellow phlegm, sweating, irritability, fever, the child desires cold air. Attacks occur mainly at noon or midnight.
• Kapha: wheezing and coughing with excess clear or white phlegm, rattling chest sounds. Attacks occur mainly in morning and evening.
Low digestive fire causes accumulation of ama and affects Kapha in the chest area causing Sama Kapha and creating congestion. Prana and Udana Vayu become aggravated by high Vata diet, etc., leading to dryness, and constriction in the bronchi and bronchioles, in the channels that carry Prana in the body. There is no place for Prana to go down and Udana to go up. Constipation disturbs Apana Vayu which controls the movement of all the other Vayus.
Ayurvedic approach to treatment of asthma
The aim of treatment is to clear Kapha from the lungs through therapeutic emesis, or expectorants, then to treat the Vata derangement. Treatment of Kapha: Kapha Shamana
• Pippali churna and honey
• Boswellia (Boswellia serrata).
A randomized controlled trial using boswellia gum was carried out on 40 patients who had bronchial asthma for between 3 and 15 years. They were given 300 mg three times daily over a period of 6 weeks and it was reported that 70% of them showed significant improvement indicated by “disappearance of physical symptoms and signs such as dyspnoea, rochi, number of attacks … as well as decrease in eosinophilic count”.
Tylophora asthmatica or Tylophora indica are used to treat accumulation of mucus in the chest. Several studies have been done on the treatment of asthma using Tylophora asthmatica (). Other research has been carried out into the anti-asthmatic effects of anthrapachaka leaf (Tylophora indica) and its anti-allergic properties, 10-15 drops of the tincture can be given once a day for no more than 7-10 days per month for effects lasting up to a month after stopping. He states that excessive amounts can cause nausea and vomiting but it is certainly a herb that deserves more attention.
• Vasasva contains: vasak (Adhatoda vasica), jaggery, dhataki (Woodfordia fructicosa), cinnamon, cardamom, kankola (Piper cubebs), ginger, long and black pepper, and tagar (Valeriana wallichii). Clears phlegm in coughs and asthma.
Garlic is also used for its antimicrobial, decongestant properties, and to reduce Kapha. It is active against Staphylococcus, Candida, E. coli, influenza type B and herpes simplex 1. Cinnamon also helps to clear Kapha from the stomach and lungs.
For asthma associated with Pitta, ghee, vasak, vamsha lochana, ginger, pippali and brahmi are used.
For Vata ghee and pippali, vamsha lochana, guggul (Commiphora mukul) lemon or lime juice and ashwagandha are commonly prescribed. Castor oil purgation is used to clear Vata from the bowels. Narayan oil is applied to the chest. Enemas are considered the quickest way to relieve Vata.
Treatment for all doshas
• Tridoshic herbs include haritaki, bala and saffron.
• After attacks it is advisable to strengthen lungs with tonics like Chyawan prash (which is a jam prepared mainly from amalaki (Emblica officinalis)), ashwagandha, bala haritaki and brahmi, to prevent further attacks.
• A Kapha reducing diet is recommended to help reduce mucus production, followed by Vata pacifying diet.
• Yoga is recommended, particularly the fish, bow, plough, half wheel, cobra and palm tree postures. Those who practise yoga postures in combination with relaxation and breathing exercises have been shown to have less asthma attacks probably because of the calming effect that yoga has on mind and body and this helps to balance Vata and reduce constriction in the bronchi.
• Pranayama (breathing exercises) may also be helpful. According to Ayurveda, Pitta types should do left nostril breathing, inhaling through the left nostril and exhaling through the right. Kapha children should do right nostril breathing and Vata types alternate nostril breathing. Research has demonstrated that pranayama may help asthma sufferers if practised regularly.