Emphysema is a chronic
(long lasting) condition in which the walls between the alveoli (air sacs)
within the lung lose their ability to stretch and recoil, causing shortness of
Under normal conditions,
air enters the nose or mouth and travels down the air tube (trachea) to the
main air passages (bronchial tube). These passages allow air to go into the
right and left lungs. Each bronchial tube branches into smaller passages
(bronchioles) and eventually into tiny air sacs (alveoli). It is through the
alveoli that oxygen enters the bloodstream when we inhale and that carbon
dioxide is expelled when we exhale.
In emphysema, the air sacs
become weakened and can break apart. Elasticity of the lung tissue is lost,
causing air to be trapped in the air sacs and decreasing the amount of oxygen
that is available for the body, and also decreasing the amount of carbon
dioxide (CO2) expelled from the lungs. Also, it is easier for the airways to be
blocked, because normal respiratory function is lost.
In advanced emphysema, the
individual must work hard to expel air from the lungs. Breathing can consume up
to 20% of the individuals energy while at rest, making exertion very difficult.
emphysema develops gradually over many years, the individual may not experience
symptoms such as shortness of breath until irreversible damage has already
Emphysema develops very
slowly, usually after years of cigarette smoking. As the disease becomes worse,
any amount of activity may cause difficulty breathing. Shortness of breath
during activity or exercise is usually the reason that prompts a person with emphysema
to see a doctor.
According to the American
Lung Association, over 3.1 million Americans have emphysema, of which 91% are
45 years of age or older.
Smoking is the major cause,
but with ever increasing air pollution and other environmental factors that
negatively affect pulmonary patients, those numbers are on the rise.
pulmonary disease (COPD), also known as chronic obstructive lung disease, is a
general term for diseases that damage the lungs and includes emphysema and
bronchitis (inflammation of the lungs). It is estimated that more than 16
million Americans have some form of COPD. COPD is the fourth leading cause of
death in the U.S, claiming the lives of more than 120,000 Americans.
Smoking: The single greatest risk factor for emphysema is
smoking. Emphysema is most likely to develop in cigarette smokers, but cigar
and pipe smokers and marijuana smokers also are susceptible, and the risk for
all types of smokers increases with the number of years and amount smoked. Men
are affected more often than women are, but this statistic is changing as more
women take up smoking.
Age: Although the lung damage that occurs in emphysema
develops gradually, most people with tobacco-related emphysema begin to
experience symptoms of the disease between the ages of 50-60.
Exposure to secondhand smoke: Secondhand smoke, also known
as passive or environmental tobacco smoke, is smoke that is inadvertently
inhaled from someone else's cigarette, pipe or cigar.
Pollution and chemical exposure: An individual breathing
fumes from certain chemicals such as chlorine or pesticides, dust from grain,
cotton, wood, or working around toxic fumes, is more likely to develop
emphysema. The risk is even greater if the person smokes. Breathing indoor
pollutants such as fumes from heating fuel as well as outdoor pollutants such
as car exhaust, increases the risk of emphysema.
Heredity: A rare, inherited deficiency of the protein,
alpha-1-antitrypsin (AAt), can cause emphysema, especially before age 50, and
even earlier if the individual smokes.
Connective tissue disorders: Some conditions that affect
connective tissue (provides body framework and support) are associated with
emphysema. These conditions include cutis laxa (a rare disease that causes
premature aging) and Marfan syndrome (a disorder that affects many different
organs, especially the heart, eyes, skeleton and lungs).
Smoking: Cigarette smoke is by far the most common cause of
emphysema. The damage begins when tobacco smoke temporarily paralyzes the
microscopic hairs (cilia) that line the bronchial tubes. Normally, these hairs
sweep irritants and germs out of the airways. But when smoke interferes with
this sweeping movement, irritants remain in the bronchial tubes and infiltrate
the alveoli, inflaming the tissue and eventually breaking down elastic fibers.
Shortness of breath (dyspnea) is caused by the lungs being over inflated trying
to get more oxygen to the tissues.
Genetic protein deficiency: In a small percentage of people,
emphysema results from low levels of a protein called alpha-1-antitrypsin
(AAt), which protects the elastic structures in the lungs from the destructive
effects of certain enzymes. A lack of AAt can lead to progressive lung damage
that eventually results in emphysema.
SIGNS AND SYMPTOMS
Shortness of breath: Shortness of breath (dyspnea),
especially during activity, is one of the earliest symptoms of emphysema. As
the disease progresses, shortness of breath becomes constant, even during rest.
Fatigue: Shortness of breath causes a reduced capacity for
physical activity, becoming worse as the disease progresses. An individual is
likely to feel tired both because it is more difficult to breathe and because
the body is getting less oxygen.
Lowered immunity: In addition, individuals may suffer from
frequent colds accompanied by coughing.
Others: Other symptoms include distress resulting from the
inability to get enough air, wheezing, chronic mucus production, weight loss,
exhaling through pursed (puckered) lips or grunting before exhaling, needing to
lean forward to breathe while sitting, and anxiety (nervousness) and/or
depression. Individuals with emphysema are often thin and have very pink skin.
Individuals with advanced disease may have the characteristic barrel chests
from the increase in lung size.
Individuals with emphysema have a higher death rate than
those with normal lung function. Causes of death include cancer, stroke (lack
of blood flow and oxygen to the brain), respiratory failure, lung infections
such as pneumonia and influenza, and heart attack. Eventually, severe shortness
of breath will limit the person's normal daily activities.
Individuals who continue to smoke will have worsening
shortness of breath. They may have panic attacks when they are unable to get
enough air in and out. People with advanced emphysema are often incapacitated.
They are short of breath even when confined to a chair or bed.
Pulmonary function tests (PFTs): These noninvasive tests can
detect emphysema before symptoms are seen. They measure how much air the lungs
can hold and the flow of air in and out of the lungs. They can also measure the
amount of oxygen and carbon dioxide exchanged in the lungs. They include a
spirometry test and lung volume test.
In a spirometry test, a person breathes into mouthpiece that
is connected to an instrument called a spirometer. The spirometer records the
amount and the rate of air that is breathed in and out over a specified time.
Some of the test measurements are obtained by normal, quiet breathing, and
other tests require forced inhalation or exhalation after a deep breath.
Lung volume measurement detects restrictive lung diseases.
In this set of diseases, a person cannot inhale a normal volume of air.
Restrictive lung diseases may be caused by inflammation or scarring of the lung
tissue (interstitial lung disease) or by abnormalities of the muscles or
skeleton of the chest wall.
Lung volume measurement can be performed in two ways. The
most accurate way is for an individual to sit in a body plethysmograph (a
sealed, transparent box that resembles a telephone booth) while breathing in
and out a mouthpiece. Changes in pressure inside the box allow determination of
the lung volume. Lung volume can also be measured when a individual breathes
nitrogen or helium gas through a tube for a specified period of time. The
concentration of the gas in a chamber attached to the tube is measured,
allowing estimation of the lung volume.
Chest X-ray: A chest X-ray can help rule out other lung
problems (such as lung cancer) rather than to diagnose emphysema. Even in the
advanced stages of emphysema, chest X-rays are often normal.
Blood tests: Arterial blood gases (ABGs) measure how well
the lungs transfer oxygen to the bloodstream and how effectively they remove
carbon dioxide from the bloodstream. A blood test for the alpha-1-antitrypsin
(AAt) gene, which is found in some individuals with emphysema, may also be
Pulse oximetry: This test involves use of a small device
that attaches to the fingertip to measure the amount of oxygen in the blood. To
help determine whether the individual needs supplemental oxygen, the test may
be performed at rest, during exercise and overnight.
Sputum examination: Analysis of cells in sputum (matter
coughed up from the respiratory tract) can help determine the cause of some
lung problems. If bacteria are present, there is infection. Blood may also be
present in sputum.
Computerized tomography (CT) scan: A CT scan allows a
healthcare professional to see the organs in two-dimensional images or
"slices." Split-second computer processing creates these images as a
series of very thin X-ray beams are passed through the body. A CT scan can
detect emphysema sooner than an X-ray can, but it cannot assess the severity of
emphysema as accurately as a pulmonary function test.
Smoking cessation: The most important step in any treatment
plan for those with emphysema is stopping smoking. Nicotine replacement
products, including the patch (Habitrol©, Nicoderm CQ©, Nicotrol©), chewing gum
(Nicorette©), lozenges (Commit©), inhaler (Nicotrol Inhaler©), nasal spray
(Nicotrol NS©), and the antidepressant bupropion (Zyban©), can help with
smoking cessation. These drugs work, in part, by continuing to release low
levels of dopamine (a brain chemical) in the brain. In this way, these smoking
cessation medications decrease the craving for nicotine and reduce the signs
and symptoms of withdrawal. Varenicline (Chantix©) is a new drug that works in
this way, too. Chantix© stimulates the release of low levels of dopamine in the
brain to help reduce the signs and symptoms of withdrawal. In addition, Chantix
blocks nicotine receptors in the brain. The U.S. Food and Drug Administration
(FDA) has approved the course of Chantix© treatment for 12 weeks. Individuals
who successfully quit smoking during Chantix© treatment may continue with an
additional 12 weeks of Chantix© treatment to further increase the likelihood of
long-term smoking cessation. Side effects of Chantix© include changes in taste,
nausea, vomiting, gas, and insomnia (inability to sleep).
Bronchodilators: These drugs can help relieve coughing,
shortness of breath and trouble breathing by opening constricted airways, but
they are not as effective in treating emphysema as they are in treating asthma.
Drugs that dilate constricted airways (beta-agonists) include albuterol
(Ventolin©, Proventil©), metaproterenol (Alupent©), terbutaline (Brethine©),
theophylline (Theo-Dur© or Slo-bid©, and perbuterol (Maxair©). They may be used
to decrease acute symptoms such as wheezing and shortness of breath (dyspnea)
that happen quickly.
Steroids: Corticosteroid (or just steroid) drugs are used to
prevent and reduce airway swelling, as well as decrease the amount of mucus in
the lungs. Steroids may either be inhaled (using an inhaler) or taken orally
(tablet). Inhaled steroids include beclomethasone (Beclovent© and Vanceril©),
budesonide (Pulmicort Respules©), flunisolide (Aerobid©), fluticasone
(Flovent©), and triamcinolone (Azmacort©). The inhaled steroids seem to have
fewer side effects than oral steroids do, prolonged use can weaken the bones
and increase the risk of heart disease (including high blood pressure, high
cholesterol levels, chest pain, and heart attack), cataracts, and diabetes.
Oral corticosteroids include Aristocort©, Celestone©,
Decadron©, Medrol©, Prednisone© or Sterapred©. Liquid corticosteroids (like
Pediapred© or Prelone©) are available for children. These medications can be
used short-term for severe symptoms such as extreme shortness of breath. Oral
steroids can cause side effects including many drug interactions and severe
swelling (edema) that can lead to dangerously high blood pressure.
Leukotriene modifiers: Leukotriene modifiers such as
zafirlukast (Accolate©) or montelukast (Singulair©) are a new type of long-term
control medication. They help prevent airway inflammation and swelling, as well
as decrease the amount of mucus in the lungs.
Supplemental oxygen: If severe emphysema with low blood
oxygen levels is present, using oxygen at home may provide some relief. Various
forms of oxygen are available as well as different devices to deliver them to
the lungs. A doctor will help with setting up oxygen for home use.
Antibiotics: In general, antibiotics are not effective for
emphysema or chronic (long term) bronchitis. However, they are used if a true
respiratory infection is present along with the emphysema, such as pneumonia or
influenza. If infection is present, the mucus might be yellow or dark green
along with a fever and shortness of breath. Broad-spectrum antibiotics may help
relieve these symptoms, but should be used with caution to avoid the serious
and growing problem of antibiotic-resistant bacteria.
Vaccines: If an individual has emphysema, healthcare
professionals recommend an influenza (flu) shot annually and a pneumonia shot
every five to seven years.
Gene therapy: Infusions of alpha-1-antitrypsin (AAt) gene
may help slow lung damage in people with an inherited deficiency of the
Surgery: In a procedure called lung volume reduction surgery
(LVRS), surgeons remove small wedges of damaged lung tissue. Although it may
seem inappropriate to remove lung tissue in shortness of breath, the extra
space that is created in the chest cavity after removing some of the lung
appears to help the remaining lung tissue and diaphragm work more efficiently.
For those who are helped by this surgery, improvement is the greatest the first
six months after the procedure. After that, lung function gradually declined.
People may begin to have more difficulty breathing, and performance in the
pulmonary function tests, such as spirometry, may decrease. By the two-year
mark, the lung function in many people is about the same as it was before
Transplant: Lung transplantation is an option if the
individual has severe emphysema and other options have failed. Usually just one
lung is transplanted because the survival rate has been proven to be higher for
individuals with single-lung transplants than for individuals with double-lung
Pulmonary rehabilitation program: A key part of treatment
involves a pulmonary rehabilitation program, which combines education, exercise
training and behavioral intervention to help restore the individual with
emphysema to the highest possible level of independent living.
TYPES OF INHALERS
Dry powder-inhaler: Dry-powder inhalers are the most common
inhalers used today. This type of inhaler does not need a propellant. Instead,
the individual inhales the medicine so it can reach the lung. Children, people
with severe emphysema and asthma and people suffering from acute (immediate)
attacks may be unable to produce enough airflow to use these inhalers
Metered-dose inhaler: The most efficient way to get asthma
medication into the airways is with a metered-dose inhaler (MDI). When used
properly, about 12-14% of the medication is inhaled deep into the lungs with
each puff of the MDI. They are especially important for delivering quick relief
medication - short-acting beta agonists - that relieve an acute attack of
emphysema. MDIs are also used to deliver some long-term control medications,
including anti-inflammatories and long-acting bronchodilators, which are taken
routinely to manage asthma and emphysema symptoms. An MDI is especially
recommended for use with inhaled steroids because it reduces the amount of drug
dispersed into the mouth, which reduces the risk of side effects.
Metered-dose inhalers are designed to release a pre-measured
amount of medication into the lungs. There are several different types, but in
general, they all have a chamber that holds the medication and a propellant
that turns the medication into a fine mist. A button is pushed to force the
medication out through the mouthpiece.
Medication that is inhaled acts more quickly than medication
taken by mouth. It also causes few adverse effects because the medication goes
directly to the lungs and not to other parts of the body.
If an MDI is not used correctly, symptoms may persist or
worsen. Individuals who have trouble using the device correctly may use a
spacer to help them get the medication they need. Spacers are attached to the
mouthpiece, and they hold the discharged, pre-measured medication in a chamber
until the patient breathes in. Spacers are recommended for young children and
older adults who have trouble coordinating breathing and activating the MDI.
Nebulizer: A nebulizer is an electrical device that sends
medicine directly into the mouth by a tube (or mask in children). This method
does not require hand-breath coordination. The patient puts the prescribed
amount of medication into the tube, and then places the tube in the mouth (or
places the mask over the child's nose and mouth). Then the patient breathes
normally until all of the medication is gone.
Good scientific evidence:
Boswellia: Boswellia has been proposed as a potential
therapy for asthma. Future studies are needed to assess the long-term efficacy
and safety of boswellia and to compare the efficacy of boswellia to standard
therapies. Boswellia should not be used for the relief of acute asthma
exacerbations. Boswellia is generally believed to be safe when used as directed,
although safety and toxicity have not been well studied in humans. Avoid if
allergic to boswellia. Avoid with a history of stomach ulcers or stomach acid
reflux disease (GERD). Use cautiously if taking lipid-soluble medications,
agents metabolized by the liver's cytochrome P450 enzymes, or sedatives. Use
cautiously with impaired liver function or liver damage or lung disorders. Use
cautiously in children. Avoid if pregnant due to potential abortifacient
effects or if breastfeeding.
Buteyko breathing technique: The Buteyko breathing technique
(BBT) consists of breathing techniques, relaxation exercises, and asthma
education. The technique aims to reduce hyperventilation. Studies have shown
reduced use of rescue inhalers among patients receiving BBT. Improvements in
other measures of asthma severity have not been shown. Additional study is
BBT is generally considered safe. Avoid with asthma that
changes suddenly ("brittle asthma"). BBT may interact with asthma
medications and should be used with caution when decreasing asthma medication.
Asthma should be treated by a qualified healthcare professional and patients
should always carry a rescue inhaler. Avoid if pregnant or breastfeeding.
Choline: Choline is possibly effective when taken orally for
asthma. Choline supplements seem to decrease the severity of symptoms, number
of symptomatic days and the need to use bronchodilators in asthma patients.
There is some evidence that higher doses of 3 grams daily might be more
effective than lower doses of 1.5 grams daily. Choline is generally regarded as
safe and appears to be well-tolerated. Avoid if allergic/hypersensitive to
choline, lecithin, or phosphatidylcholine. Use cautiously with kidney or liver
disorders or trimethylaminuria. Use cautiously with a history of depression. If
pregnant or breastfeeding it seems generally safe to consume choline within the
recommended adequate intake (AI) parameters; supplementation outside of dietary
intake is usually not necessary if a healthy diet is consumed.
Coleus: There is a lack of sufficient data to recommend for
or against the use of coleus in the treatment of bronchial asthma. Preliminary
data appears to be promising. However, larger, randomized, controlled trials
are needed to confirm the safety and efficacy of coleus in bronchial asthma.
Coleus is generally regarded as safe, as very few reports have documented
adverse effects. However, only a few short-term trials have assessed its safety
in a small sample size of patients. Avoid if allergic to Coleus forskohlii and
related species or with bleeding disorders. Avoid if pregnant or breastfeeding.
Ephedra: Ephedra contains the chemicals ephedrine and
pseudoephedrine, which are bronchodilators (expand the airways to assist in
easier breathing). It has been used and studied to treat asthma and chronic
obstructive pulmonary disease, such as asthmatic bronchoconstriction, in both
children and adults. Other treatments such as beta-agonist inhalers (for
example, albuterol) are more commonly recommended due to safety concerns with
ephedra or ephedrine. However, the U.S. Food and Drug Administration (FDA) has
collected thousands of reports of serious toxicity linked to ephedra (including
over 100 deaths). Ephedra products are banned from dietary supplements because
of serious health risks, including heart attack, heart damage, breathing
difficulties and fluid retention in the lungs. Avoid ephedra if pregnant or
Psychotherapy: Family psychotherapy may slightly improve
wheezing and thoracic gas volume for asthma in children, according to several
Psychotherapy is not always sufficient to resolve mental or
emotional conditions. Psychiatric medication is sometimes needed. The
reluctance to seek and use appropriate medication may contribute to worsening
of symptoms or increased risk for poor outcomes. In order to be successful,
psychotherapy requires considerable personal motivation and investment in the
process. This includes consistent attendance and attention to treatment
recommendations provided by the practitioner. Not all therapists are
sufficiently qualified to work with all problems. The client or patient should
seek referrals from trusted sources and should also inquire of the
practitioner's training and background before committing to work with a particular
therapist. Some forms of psychotherapy evoke strong emotional feelings and
expression. This can be disturbing for people with serious mental illness or
some medical conditions. Psychotherapy may help with post-partum depression,
but is not a substitute for medication, which may be needed in severe cases.
Pycnogenol: Pycnogenol© is the patented trade name for a
water extract of the bark of the French maritime pine (Pinus pinaster spp.
atlantica), which is grown in coastal south-west France. Pycnogenol may offer
clinical benefit to both children and adults with asthma. Additional study is
needed before a conclusion can be made. Avoid if allergic/hypersensitive to
pycnogenol, its components, or members of the Pinaceae family. Use cautiously
with diabetes, hypoglycemia, or bleeding disorders. Use cautiously if taking
hypolipidemics, medications that may increase the risk of bleeding,
hypertensive medications, or immune stimulating or inhibiting drugs. Avoid if
pregnant or breastfeeding.
Yoga: Multiple human studies report benefits of yoga (such
as breathing exercises), when added to other treatments for mild-to-moderate
asthma (such as standard drug therapy, diet, or massage). Better research is
needed before a firm conclusion can be drawn.
Yoga is generally considered to be safe in healthy
individuals when practiced appropriately. Avoid some inverted poses with disc
disease of the spine, fragile or atherosclerotic neck arteries, risk for blood
clots, extremely high or low blood pressure, glaucoma, detachment of the
retina, ear problems, severe osteoporosis, or cervical spondylitis. Certain
yoga breathing techniques should be avoided in people with heart or lung
disease. Use cautiously with a history of psychotic disorders. Yoga techniques
are believed to be safe during pregnancy and breastfeeding when practiced under
the guidance of expert instruction (the popular Lamaze techniques are based on
yogic breathing). However, poses that put pressure on the uterus, such as
abdominal twists, should be avoided in pregnancy.
Unclear or conflicting scientific evidence:
Acupressure, shiatsu: Preliminary research suggests that
acupressure may be of benefit in improving quality of life in asthma. Further
well-designed studies are needed before firm conclusions can be drawn. A
combination of acupressure and massage may reduce dyspnea (labored breathing)
and anxiety in patients with chronic obstructive pulmonary disease (COPD) who
use prolonged mechanical ventilatory support. Further study of acupressure
alone is needed before a recommendation can be made. A small study of patients
undergoing pulmonary rehabilitation reported acupressure to be beneficial for
decreasing dyspnea. Larger, well-designed studies are needed before clear
conclusions can be drawn.
With proper training, acupressure appears to be safe if
self-administered or administered by an experienced therapist. No serious
long-term complications have been reported, according to scientific data. Hand
nerve injury and herpes zoster ("shingles") cases have been reported
after shiatsu massage. Forceful acupressure may cause bruising.
Acupuncture: Some research suggests acupuncture may help
prevent exercise-induced asthma and that it may reduce the perceived level of
breathlessness associated with asthma or emphysema. However, reviewers agree
that the available studies are small, poorly designed, and insufficient for
making recommendations. A few studies have found no support for the use of
acupuncture for asthma. Overall there is insufficient evidence on which to base
recommendations for acupuncture to treat breathlessness in chronic obstructive
pulmonary disease (COPD).
Needles must be sterile in order to avoid disease
transmission. Avoid with valvular heart disease, infections, bleeding disorders
or with drugs that increase the risk of bleeding (anticoagulants), medical
conditions of unknown origin, neurological disorders. Avoid on areas that have
received radiation therapy and during pregnancy. Use cautiously with pulmonary
disease (like asthma or emphysema). Use cautiously in elderly or medically
compromised patients, diabetics, or with history of seizures. Avoid
electroacupuncture with arrhythmia (irregular heartbeat) or in patients with
Alexander technique: The Alexander technique is an
educational program that teaches movement patterns and postures, with an aim to
improve coordination and balance, reduce tension, relieve pain, alleviate
fatigue, improve various medical conditions, and promote well-being. There is
currently not enough scientific evidence to make a strong recommendation for
the use of the Alexander technique in chronic asthma patients. More study is
needed in this area. There is a lack of high-quality research describing the
effect of the Alexander technique on respiration. No serious side effects have
been reported with use of the Alexander technique. It has been suggested that
the technique may be less effective with learning disabilities or mental
illnesses. The Alexander technique has been used safely in pregnant women.
Applied kinesiology: Applied Kinesiology (AK) is an
assessment technique that uses muscle strength testing with the aim to identify
nutritional deficiencies and health problems. It is based on the concept that
weakness in certain muscles corresponds to specific disease states or body
imbalances. Study results are mixed in regards to bronchial asthma. Further
research is needed before conclusions can be drawn. Applied kinesiology
techniques in themselves are harmless. However, medical conditions should not
be treated with AK alone, and should not delay appropriate medical treatment.
Aromatherapy: Early evidence suggests that aromatherapy may
aid mucus clearance in chronic obstructive pulmonary disease (COPD). More
studies are needed before conclusions about this application of aromatherapy
can be made. Essential oils should be administered in a carrier oil to avoid
toxicity. Avoid if history of allergic dermatitis. Use cautiously if
driving/operating heavy machinery. Avoid consuming essential oils. Avoid direct
contact of undiluted oils with mucous membranes. Use cautiously if pregnant.
Ayurveda: There is early evidence that daily supplementation
with gum resin of Boswellia serrata, known in Ayurveda as Salai guggal, may
reduce dyspnea (shortness of breath), rhonchi, and the number of attacks in
bronchial asthma. Another herb, Devadaru (Cedrus deodara), may have
antispasmodic effects and reduce symptoms in bronchial asthma, particularly for
patients with shorter histories of asthma and lower frequencies of attacks.
Further research is needed in this area before a recommendation can be made.
Ayurvedic herbs should be used cautiously because they are
potent and some constituents can be potentially toxic if taken in large amounts
or for a long time. Some herbs imported from India have been reported to
contain high levels of toxic metals. Ayurvedic herbs can interact with other
herbs, foods and drugs. A qualified healthcare professional should be consulted
before use of any herbs or supplements. Use guggul cautiously with peptic ulcer
disease. Avoid sour food, alcohol, and heavy exercise. Mahayograj guggul should
not be taken for long periods of time. Pippali (Piper longum) should be taken
with milk and avoided with asthma. Avoid sweet flag, and avoid amlaki (Emblica
officinalis) at bedtime. Avoid Terminalia hebula (harda) if pregnant. Avoid Ayurveda
with traumatic injuries, acute pain, advanced disease stages and medical
conditions that require surgery.
Belladonna: Belladonna may improve the prevention of airway
obstruction and reduce the amount of mucus produced. However, due to a lack of
high-quality human research in this area, there is not enough evidence to form
a clear conclusion.
Avoid if allergic to belladonna or plants of the Solanaceae
(nightshade) family (bell peppers, potatoes, eggplants). Avoid with history of
heart disease, high blood pressure, heart attack, abnormal heartbeat
(arrhythmia), congestive heart failure, stomach ulcer, constipation, stomach
acid reflux (serious heartburn), hiatal hernia, gastrointestinal disease,
ileostomy, colostomy, fever, bowel obstruction, benign prostatic hypertrophy,
urinary retention, glaucoma (narrow angle), psychotic illness, Sj©gren's
syndrome, dry mouth (xerostomia or salivary gland disorders), neuromuscular
disorders such as myasthenia gravis, and Down's syndrome. Avoid if pregnant or
Beta-carotene: The prevalence of bronchitis and shortness of
breath in male smokers with chronic obstructive pulmonary disorder (COPD) seems
to be lower in those patients who consume a diet containing high amounts of
beta-carotene. However, beta-carotene supplements have not been proven to
benefit COPD and may actually increase cancer rates in smokers. Based on
preliminary evidence, taking a mixture of beta-carotene isomers orally may
prevent exercise-induced asthma. However, because synthetic beta-carotene has
not been well tested for this indication, the difference between the activities
of the two supplements cannot be deduced. Further research is needed before a
strong recommendation can be made. Avoid if sensitive to beta-carotene, vitamin
A or any other ingredients in beta-carotene products.
Black tea: Research has shown caffeine to cause improvements
in airflow to the lungs (bronchodilation). However, it is not clear if caffeine
or tea use has significant clinical benefits in people with asthma. Better
research is needed in this area before a conclusion can be drawn.
Avoid if allergic or hypersensitive to caffeine or tannins.
Skin rash and hives have been reported with caffeine ingestion. Use caution
with diabetes. Use caution if pregnant. Heavy caffeine intake during pregnancy
may increase the risk of SIDS (sudden infant death syndrome). Very high doses
of caffeine have been linked with birth defects. Caffeine is transferred into
breast milk. Caffeine ingestion by infants can lead to sleep disturbances/insomnia.
Infants nursing from mothers consuming greater than 500 milligrams of caffeine
daily have been reported to experience tremors and heart rhythm abnormalities.
Tea consumption by infants has been linked to anemia, decreased iron metabolism,
Borage seed oil: The flowers and leaves of borage (Borago
officinalis) are often pressed to produce oil very high in gamma-linolenic acid
(GLA). Preliminary evidence suggests that gamma linolenic acid (GLA) may have
some immunosuppressant activity that may be helpful in reducing asthma
symptoms. Avoid if allergic or hypersensitive to borage, its constituents, or
members of the Boraginaceae family. Use cautiously in patients with bleeding
disorders or taking warfarin or other anticoagulant or antiplatelet (blood
thinning) agents. Use cautiously in patients with epilepsy or taking
anticonvulsants. Avoid in patients with compromised immune systems or similar
immunological conditions. Avoid in pregnant patients as borage oil may be
contraindicated in pregnancy given the teratogenic and labor-inducing effects
of prostaglandin E agonists, such as borage oil's GLA. Avoid if breastfeeding.
Bromelain: Bromelain is a digestive enzyme extracted from
the stem and the fruit of the pineapple plant (Ananas comosus, family
Bromeliaceae). There is currently not enough information to recommend for or
against the use of bromelain in chronic obstructive pulmonary disorder (COPD).
Avoid if allergic to bromelain, pineapple, honeybee, venom, latex, birch
pollen, carrots, celery, fennel, cypress pollen, grass pollen, papain, rye
flour, wheat flour, or other members of the Bromeliaceae family. Use cautiously
with a history of bleeding disorders, stomach ulcers, heart disease, liver, or
kidney disease. Use caution before dental or surgical procedures or while
driving or operating machinery. Avoid if pregnant or breastfeeding.
Butterbur: Historically, butterbur has been used to treat
asthma. Pre-clinical studies report anti-inflammatory and leukotriene
inhibitory properties, which may lead to clinical effects. Initial human
research suggests possible benefits. However, controlled trials with adequate
sample sizes are necessary in order to clarify whether there are true benefits
in humans. Use caution if allergic or sensitive to Petasites hybridus or other
plants from the Asteraceae/Compositae family (like ragweed, marigolds, daisies,
and chrysanthemums). Raw, unprocessed butterbur plant should not be eaten due
to the risk of liver or kidney damage or cancer. Avoid if pregnant or
Chiropractic: Several studies report the effects of
chiropractic spinal manipulative therapy on breathing indices and quality of
life in children and adults with asthma. Results are variable, and in the
studies with positive results, mostly subjective but not objective (lung
function test) changes are reported. Due to methodological problems and
variable results, no clear conclusions can be drawn in this area. There is not
enough reliable scientific evidence to conclude the effects of chiropractic
techniques in the management of chronic obstructive pulmonary disorder (COPD).
Use extra caution during cervical adjustments. Use
cautiously with acute arthritis, conditions that cause decreased bone
mineralization, brittle bone disease, bone softening conditions, bleeding
disorders, or migraines. Use cautiously with the risk of tumors or cancers.
Avoid with symptoms of vertebrobasilar vascular insufficiency, aneurysms,
unstable spondylolisthesis, or arthritis. Avoid with agents that increase the
risk of bleeding. Avoid in areas of para-spinal tissue after surgery. Avoid if
pregnant or breastfeeding due to a lack of scientific data.
Coenzyme Q10: CoQ10 may benefit asthma patients when added
to other therapies. Further research is needed. Asthma should be treated by a
qualified healthcare provider. Allergy has not been associated with Coenzyme
Q10 supplements, although rash and itching have been reported rarely. Stop use
two weeks before surgery/dental/diagnostic procedures with bleeding risk and do
not use immediately after these procedures. Use caution with a history of blood
clots, diabetes, high blood pressure, heart attack, or stroke, or with
anticoagulants (blood thinners) or antiplatelet drugs, or blood pressure, blood
sugar, cholesterol, or thyroid drugs. Avoid if pregnant or breastfeeding.
Coleus: Coleus species have been used in the Asian
traditional medicine to treat angina, asthma, bronchitis, epilepsy, insomnia,
skin rashes, and a wide range of digestive problems. Pretreatment with coleus
may be beneficial as a breathing aid for intubation, especially for middle-aged
smokers. More research is needed.
Coleus is generally regarded as safe, as very few reports
have documented adverse effects. However, only a few short-term trials have
assessed its safety in a small sample size of patients. Avoid if allergic to
Coleus forskohlii and related species or with bleeding disorders. Avoid if
pregnant or breastfeeding.
Cordyceps: Cordyceps may reduce some asthma symptoms.
Additional studies are needed to make a firm recommendation. There is currently
insufficient evidence from clinical study to draw a conclusion on the use of
cordyceps for other respiratory disorders.
Avoid if allergic or hypersensitive to cordyceps, mold, or
fungi. Use cautiously with diabetes or bleeding disorders or if taking
anticoagulant medications. Use cautiously with prostate conditions, if taking
immunosuppressive medications, or if on hormonal replacement therapy or oral
contraceptives. Avoid with myelogenous-type cancers. Avoid if pregnant or
Creatine: It is unclear if creatine may help treat chronic
obstructive pulmonary disease (COPD). Study results are mixed. More clinical
trials are needed before a conclusion can be made. Avoid if allergic to
creatine or with diuretics (like hydrochlorothiazide, furosemide (Lasix©)). Use
caution in asthma, diabetes, gout, kidney, liver or muscle problems, stroke or
a history of these conditions. Avoid dehydration. Avoid if pregnant or
Danshen: Danshen (Salvia miltiorrhiza) is widely used in
traditional Chinese medicine (TCM), often in combination with other herbs.
Better studies are needed in which danshen is compared with more proven
treatments for asthmatic bronchitis before a clear conclusion can be drawn.
Avoid if allergic or hypersensitive to danshen. Use
cautiously with altered immune states, arrhythmia, compromised liver function
or a history of glaucoma, stroke, or ulcers. Stop use two weeks before
surgery/dental/diagnostic procedures with bleeding risk, and do not use
immediately after these procedures. Use cautiously if driving or operating
heavy machinery. Avoid if taking blood thinners (anticoagulants), digoxin or
hypotensives including ACE inhibitors such as captopri, or Sophora subprostrata
root or herba serissae. Avoid with bleeding disorders, low blood pressure and
following cerebal ischemia. Avoid if pregnant or breastfeeding.
English ivy: Currently, there is insufficient available
information to recommend for or against the use of English ivy in treating
asthma in children or in treating chronic obstructive pulmonary disease COPD).
Additional study is needed.
Avoid if allergic or hypersensitive to English ivy (Hedera
helix), its constituents, or members of the Araliaceae family. In addition,
crossreaction or cross-senstivity has been noted between Hedera helix and
Dendropanax trifidus, Schefflera arboricola, dandelion (Taraxacum officinale),
false ragweed (Ambrosia acanthicarpa), giant ragweed (Ambrosia trifida), short
ragweed (Ambrosia artemisifolia), sagebrush (Artemisia tridentata), wild
feverfew (Parthenium hysterophorus), yarrow (Achillea millifolium), and tansy
(Tanacetum vulgare), and some Dahlia species. Use cautiously with cancer or
taking antineoplastic (anticancer) agents. Avoid if pregnant or breastfeeding.
Eucalyptus oil: Further research is needed to confirm
anti-inflammatory and mucolytic activity of eucalyptus oil before it can be
recommended in upper and lower airway diseases, such as asthma. Avoid if
allergic to eucalyptus oil or with a history of seizure, diabetes, asthma,
heart disease, abnormal heart rhythms, intestinal disorders, liver disease,
kidney disease, or lung disease. Use caution if driving or operating machinery.
Avoid with a history of acute intermittent porphyria. Avoid if pregnant or
breastfeeding. A strain of bacteria found on eucalyptus may cause infection.
Toxicity has been reported with oral and inhaled use.
Gingko: Ginkgo biloba has been used medicinally for
thousands of years and is currently one of the top selling herbs in the United
States. Ginkgo may reduce symptoms in patients with asthma. More study is
needed to make a conclusion. Avoid if allergic or hypersensitive to members of
the Ginkgoaceae family. If allergy to mango rind, sumac, poison ivy or oak or cashews
exists, then allergy to ginkgo is possible. Avoid with blood-thinners (like
aspirin or warfarin (Coumadin©)) due to an increased risk of bleeding. Ginkgo
should be stopped two weeks before surgical procedures. Ginkgo seeds are
dangerous and should be avoided. Skin irritation and itching may also occur due
to ginkgo allergies. Do not use ginkgo in supplemental doses if pregnant or
Ginseng: Limited research suggests that ginseng has positive
effects on breathing, such as its proposed role as a bronchodilator. Ginseng
was reported to improve lung function and exercise capacity in patients with
chronic obstructive pulmonary disease COPD). Several studies have also looked
at the effects of ginseng in a variety of lung conditions. Early results are
promising, but many studies have used combination products, making it difficult
to evaluate the effect of ginseng. More research using ginseng alone is needed
in this area. Avoid ginseng with a known allergy to plants in the Araliaceae
family. There has been a report of a serious life-threatening skin reaction,
possibly caused by contaminants in ginseng formulations.
Goji: In traditional Chinese medicine (TCM), herbs are
almost always administered in combination formulas consisting of several herbs
that balance each other's effects and enhance the success of the treatment. A
case study provides some initial objective data on the formula
"Invigorating Kidney," which includes wolfberry together with six
other herbs. This herbal decoction showed that it may be possible to reverse
airway obstruction for patients convalescing from asthma.
Use cautiously in patients who are taking blood-thinning
medications, such as warfarin. Use cautiously in asthma patients and in
patients with sulfite sensitivities. The New York Department of Agriculture has
detected the presence of undeclared sulfites, a food additive, in two dried
goji berry products from China. Avoid in patients who are allergic to goji, any
of its constituents, or to members of the Solanaceae family.
Green tea: Research has shown caffeine to cause improvements
in airflow to the lungs (bronchodilation). However, it is not clear if caffeine
or tea use has significant benefits in people with asthma. Better research is
needed in this area before a conclusion can be drawn. Avoid if allergic or
hypersensitive to caffeine or tannins. Use cautiously with diabetes or liver
Green-lipped mussel: Limited evidence suggests that
green-lipped mussel supplementation may help allergic diseases, such as atopic
asthma. Additional research is needed before a recommendation can be made.
Green-lipped mussel is generally considered safe. Use cautiously with
anti-inflammatory agents. Use cautiously with asthma. Avoid in patients with
liver disease. Avoid with allergy or sensitivity to green-lipped mussel or
other shellfish. Avoid if pregnant or breastfeeding.
Guided imagery: A small study reports increased outcomes of
relaxation in chronic obstructive pulmonary disease (COPD) with use of guided
imagery techniques. Additional research is needed to confirm these results.
Guided imagery is usually intended to supplement medical care, not to replace
it, and guided imagery should not be relied on as the sole therapy for a
medical problem. Contact a qualified health care provider if mental or physical
health is unstable or fragile. Never use guided imagery techniques while
driving or doing any other activity that requires strict attention. Use
cautiously with physical symptoms that can be brought about by stress, anxiety,
or emotional upset because imagery may trigger these symptoms. If feeling
unusually anxious while practicing guided imagery, or with a history of trauma
or abuse, speak with a qualified health care provider before practicing guided
Hydrotherapy: There is preliminary evidence that daily
breathing exercises in a warm pool may improve lung function measurements in
patients with chronic obstructive pulmonary disease (COPD). It is not clear if
this technique is superior to breathing exercises alone. Evidence from
controlled trials is necessary before a clear conclusion can be drawn.
Avoid sudden or prolonged exposure to extreme temperatures
in baths, wraps, saunas, or other forms of hydrotherapy, particularly with
heart disease, lung disease, or if pregnant. Avoid with implanted medical
devices like pacemakers, defibrillators, or hepatic (liver) infusion pumps.
Vigorous use of water jets should be avoided with fractures, known blood clots,
bleeding disorders, severe osteoporosis, open wounds, or during pregnancy. Use
cautiously with Raynaud's disease, chilblains, acrocyanosis, erythrocyanosis, and
impaired temperature sensitivity, such as neuropathy. Use cautiously if
pregnant or breastfeeding. Hydrotherapy should not delay the time to diagnosis
or treatment with more proven techniques or therapies, and should not be used
as the sole approach to illnesses. Patients with known illnesses should consult
their physician(s) before starting hydrotherapy.
Hypnotherapy, hypnosis: Preliminary research for the use of
hypnosis for the management of asthma symptoms does not provide clear answers.
Anxiety associated with asthma may be relieved with hypnosis. Additional
research is needed before a firm conclusion can be drawn. Use cautiously with
mental illnesses like psychosis/schizophrenia, manic depression, multiple
personality disorder or dissociative disorders. Use cautiously with seizure
Kiwi: Currently data on the therapeutic benefit of kiwi as a
preventative for lung conditions is lacking. A survey study suggests that kiwi
and other fruits high in vitamin C may be effective for the prevention of
respiratory problems in children, especially wheezing. However, properly
controlled studies are lacking at this time. More research is warranted before
a recommendation can be made.
Avoid if allergic or hypersensitive to kiwi, latex, birch
pollen, banana, chestnut, fig, flour, melon, poppy seeds, rye grain, sesame
seeds and related substances. Kiwi is generally considered safe when taken in
amounts naturally found in foods. Use cautiously with anti-platelet drugs like
aspirin, cilostazol or clopidogrel. Use cautiously with hormone therapies or
serotonergic drugs. Avoid if pregnant or breastfeeding because there are no
clinical trials that have tested its safety in supplemental doses. The amount
found in foods appears to be safe in most people.
Lactobacillus acidophilus: Lactobacillus acidophilus has
been suggested as a possible treatment for asthma. However, further research is
necessary before a firm conclusion can be made. Acidophilus may be difficult to
tolerate if allergic to dairy products containing L. acidophilus. Avoid with a
history of an injury or illness of the intestinal wall, immune-disease, or
heart valve surgery. Avoid with prescription drugs, like corticosteroids,
because of the risk of infection. Use cautiously with heart murmurs. Antibiotics
or alcohol may destroy Lactobacillus acidophilus. Therefore, it is recommended
that Lactobacillus acidophilus be taken three hours after taking antibiotics or
drinking alcohol. Some individuals can use antacids (like famotidine (Pepcid©),
esomeprazole (Nexium©)) to decrease the amount of acid in the stomach one hour
before taking Lactobacillus acidophilus.
L-Carnitine: Currently there is insufficient evidence to
support the use of carnitine for respiratory distress in adults. Avoid with
known allergy or hypersensitivity to carnitine. Use cautiously with peripheral
vascular disease, hypertension (high blood pressure), alcohol-induced liver
cirrhosis, and diabetes. Use cautiously in low birth weight infants and
individuals on hemodialysis. Use cautiously if taking anticoagulants (blood
thinners), beta-blockers, or calcium channel blockers. Avoid if pregnant or
Lutein: There is early evidence of a role of carotenoids in
lung function and severity of respiratory infections. However, there is no association
between levels of lutein in the blood and illness severity in the elderly or in
lung function in adults. More information is required in this field before a
strong recommendation can be made. Avoid if allergic or hypersensitive to
lutein or zeaxanthin. Use cautiously if at risk for cardiovascular disease or
cancer. Avoid if pregnant or breastfeeding.
Lycopene: Laboratory research suggests that lycopene, like
other carotenoids, may have antioxidant properties and may be helpful in the
prevention of exercise-induced asthma. There is limited, poor-quality research
in this area, and further evidence is needed before a firm conclusion can be
made. Avoid if allergic to tomatoes or to lycopene. Due to a lack of conclusive
data, avoid if pregnant or breastfeeding.
Massage: Promising initial evidence suggests that massage
therapy may improve lung function in children with asthma. Additional research
is necessary before a firm conclusion can be drawn. Avoid with bleeding
disorders, low platelet counts, or if on blood-thinning medications (such as
heparin or warfarin/Coumadin©). Areas should not be massaged where there are
fractures, weakened bones from osteoporosis or cancer, open/healing skin
wounds, skin infections, recent surgery, or blood clots. Use cautiously if
history of physical abuse or if pregnant or breastfeeding. Massage should not
be used as a substitute for more proven therapies for medical conditions.
Massage should not cause pain to the client.
Meditation: Preliminary research of transcendental
meditation© for asthma reports benefits. However, due to unclear design or
study description, these results cannot be considered definitive.
Sahaja yoga, which incorporates meditation techniques, may
have some benefit in the management of moderate to severe asthma. Further
studies of meditation alone are needed before any a firm conclusion can be
Use cautiously with underlying mental illnesses. People with
psychiatric disorders should consult with their primary mental healthcare
professional(s) before starting a program of meditation, and should explore how
meditation may or may not fit in with their current treatment plan. Avoid with
risk of seizures. The practice of meditation should not delay the time to
diagnosis or treatment with more proven techniques or therapies, and should not
be used as the sole approach to illnesses.
Melatonin: Based on preliminary research, melatonin may
improve sleep in asthma. Further studies that evaluate the long-term effects of
melatonin on airway inflammation and bronchial hyper-responsiveness are needed
before a firm conclusion can be made. Based on available studies and clinical
use, melatonin is generally regarded as safe in recommended doses for
short-term use. Available trials report that overall adverse effects are not
significantly more common with melatonin than placebo. However, case reports
raise concerns about risks of blood clotting abnormalities (particularly in
patients taking warfarin), increased risk of seizure, and disorientation with
Mistletoe: Studies of Iscador© document improved clinical
symptoms and markers of immune function in children with recurrent respiratory
disease (RRD) exposed to the Chernobyl nuclear accident. There is currently
insufficient evidence to recommend for or against mistletoe therapy for RDD in
general. Avoid if allergic or hypersensitive to mistletoe or to any of its
constituents. Anaphylactic reactions (life threatening, shock) have been
described after injections of mistletoe. Avoid with acute, highly febrile, inflammatory
disease, thyroid disorders, seizure disorders or heart disease. Use caution
with diabetes, glaucoma or with cholinergics.
Nasal irrigation: Early research suggests that hypertonic
saline aerosol may benefit chronic obstructive pulmonary disease (COPD), by
enhancing the clearance of lung secretions. More studies are needed. Nasal
irrigation is generally well tolerated. Use cautiously with history of frequent
nosebleeds. If the irrigation liquid is hot, the nose may become irritated.
Omega-3 fatty acids, fish oil, alpha linolenic acid: Several
studies do not provide enough reliable evidence to form a clear conclusion on
the use of fish oil for asthma. Because most studies have been small without
clear descriptions of design or results, the results cannot be considered
Avoid if allergic or hypersensitive to fish, omega-3 fatty
acid products that come from fish, nuts, linolenic acid or omega-3 fatty acid
products that come from nuts. Avoid during active bleeding. Use cautiously with
bleeding disorders, diabetes, low blood pressure or drugs, herbs or supplements
that treat any such conditions. Use cautiously before surgery. The
Environmental Protection Agency (EPA) recommends that intake be limited in
pregnant/nursing women to a single 6-ounce meal per week, and in young children
to less than 2 ounces per week. For farm-raised, imported, or marine fish, the
U.S. Food and Drug Administration recommends that pregnant/nursing women and
young children avoid eating types with higher levels of methylmercury and less
than 12 ounces per week of other fish types. Women who might become pregnant
are advised to eat 7 ounces or less per week of fish with higher levels of
methylmercury or up to 14 ounces per week of fish types with about 0.5 parts
per million (such as marlin, orange roughy, red snapper, or fresh tuna).
Smoking cessation: This is the most important measure for an
individual to take to prevent developing emphysema.
Avoidance of respiratory irritants: The lungs can be
protected by avoiding fumes from paint and automobile exhaust, perfumes,
burning candles, and incense. The humidity level in the home should be at
40-50%. Filters to the furnace and air conditioner are changed regularly to
Regular exercise: Regular exercise can significantly
increase the capacity for physical activity. Simple breathing techniques (deep
breathing) also can help.
Fluids: With emphysema, mucus tends to collect in the air passages
and can be difficult to clear. Drinking plenty of fluids, such as water or 100%
fruit juices, help to keep secretions thin and easy to bring up.
Minimization of exposure to allergens: Keep known allergens,
such as dog dander and dust, to a minimum.
Avoidance of respiratory infections: Avoid being around
crowds during cold and flu season (colder months). Washing the hands
frequently, along with carrying a small bottle of hand sanitizer, keeps viruses
and bacteria away. Touching the nose or rubbing the eyes increases virus and
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Natural Standard (www.naturalstandard.com)