Complementary and Alternative and Medicine for Asthma - PowerPoint PPT Presentation

Loading...

PPT – Complementary and Alternative and Medicine for Asthma PowerPoint presentation | free to view - id: 6bab7-ZDc1Z



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Complementary and Alternative and Medicine for Asthma

Description:

Complementary and Alternative and Medicine for Asthma – PowerPoint PPT presentation

Number of Views:195
Avg rating:5.0/5.0
Slides: 58
Provided by: kathi150
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Complementary and Alternative and Medicine for Asthma


1
Complementary and Alternative and Medicine for
Asthma
  • Kathi J. Kemper, MD, MPH
  • Caryl J Guth Chair for Holistic and Integrative
    Medicine
  • Professor, Pediatrics
  • Family and Community Medicine and
  • Public Health Sciences

2
By the end of this talk, participants will be
able to
  • Describe an integrative model of therapeutic
    options to treat asthma
  • Compare and contrast two models for testing
    treatment effectiveness
  • List three herbs or dietary supplements widely
    used to treat asthma/allergic conditions
  • List two evidence-based sources of information to
    learn more about CAM for asthma/allergies

3
Adolescent Asthma
  • Irene Wong is 15 yo with moderately severe
    asthma. She had 1 ER visit last year. She is
    tired of taking medications and would like to try
    Traditional Chinese Medicine. She admits she
    stopped using her steroid inhaler about a month
    ago.

4
Cultural cough remedy
  • A mother from the Dominican Republic tells you
    that she prefers home remedies to medications,
    but she values your opinion. What do you think of
    the bottle of Bronquila she brought you? Is it
    safe? Will it interfere with cromolyn?

5
Complementary, Alternative and Mainstream
Therapies
Alternative
Mainstream
Complementary
6
CAM - Adult Epidemiology,
  • In late 1990s, 42 of adult Americans had used
    CAM
  • Only 40 talked with docs about CAM same for
    peds
  • Numbers are increasing
  • Highest use in white, affluent, educated chronic
    illness
  • Eisenberg, JAMA, 1998

7
CAM in kids
  • ADHD 32 (Chan, 03)
  • IBD 41 (Heuschkel, 2002)
  • Cancer 65 (Friedman, 1997)
  • Cystic fibrosis 66 (Stern, 92)

8
Puerto Rican asthma remedies
  • Interviews of 118 Puerto Rican children with
    asthma in Connecticut
  • Maintain balance and harmony religious
    practices herbs
  • Siete Jarabes sweet almond oil, castor oil,
    tolu, wild cherry, licorice, cocillana, honey
  • Expectorants, emetics, cathartic, demulcents
  • Pachter LM, et al. Arch Pediatr Adolesc Med,
  • 1995149 982-88

9
CAM in Asthma
  • Asthma and allergies are both in top 10 ailments
    for which adults use CAM
  • UK kids 33 had used CAM homeopathy (15),
    breathing exercises (15) herbs (6)
  • Turkish asthmatics 49 used CAM quail eggs,
    herbs, wild honey (Orzhan, 2003)
  • Australian asthmatic kids 50-55 Vitamins,
    Herbs, Massage, Diet, Relaxation (Andrews. 1998
    Shenfield, 2002)
  • Brooklyn kids 80 diet (avoidance), massage,
    prayer (Dinkevich. Peds Res, 2003)
  • Bronx kids rubbing ointments (Vicks), prayer,
    massage, syrups, teas, foodsd (Reznik, Peds Res,
    2003)
  • Texas kids 81 used CAM prayer, herbal teas,
    vitamins, massage (Mazur. 2001)

10
Why do patients choose CAM?
  • Values (natural, organic, humanistic), cultural
    factors, and view of life (empowerment,
    egalitarian) MUCH MORE than
  • Dissatisfaction with mainstream care
  • Side effects from mainstream care
  • Astin, JAMA, 11/98

11
Does CAM work?
12
Goals of Medicine
  • Yang goals
  • Cure disease
  • Manage symptoms
  • Prevent specific disease
  • Yin goals
  • Promote well-being
  • Promote peace, harmony, meaning
  • Support, hope, trust

13
Goals of Asthma Therapy
  • YANG
  • Manage or relieve symptoms beta agonists
    steroids Mg
  • Prevention immunizations breathing exercises
    fish oil vitamin C Vitamin B6 yoga
  • Eliminate toxins fluids avoid ETS avoid
    allergens
  • YIN
  • Promote resilience/vitality diet, sleep,
    meditate, yoga
  • Support feeling of presence/connection
    reassurance, touch follow-up
  • Inner peace/harmony prayer, spiritual practice,
    meditation

14
Models for Rx/ Rsch
QOL Well-being
Disease in Organ or Tissue
Symptoms
Treatment
A
Secondary
Primary
Person
Symptoms or Disease
QOL Well-being
B
  • Treatment

Primary
Secondary
15
Holistic
  • Caring for whole person body, mind, emotions,
    spirit, relationships -- in the context of
    family, culture and community
  • Patient centered care

16
Dimensions of Well-Being
  • Physiologic, eg. normal PEF
  • Physical, eg. no cough uninterrupted sleep,
    sense of vitality
  • Functional, eg. attends school/work daily
  • Psychological, eg. competence, self-esteem
  • Emotional, eg. no anxiety, depression
  • Social, eg. friends, family
  • Spiritual, eg. meaning
  • Others..

17
Integrative Therapeutics
  • Considering a broad range of therapies, including
    the evidence of their benefits, risks,
    interactions, costs and selecting best in
    collaboration with patient/family.
  • Which therapy are we asking about? Or is it a
    combination (much harder to study!)

18
Integrative Approach to Therapeutic Options for
Asthma
  • Biochemical
  • Lifestyle
  • Biomechanical
  • Bioenergetic

19
Biochemical
  • Medications (not for this lecture!)
  • Dietary Supplements herbs, vitamins, minerals,
    bee propolis, fish oil

20
(No Transcript)
21
Coffee and Asthma
  • NHANESII survey of adults Regular coffee
    drinkers had 0.71 risk of asthma compared with
    non-drinkers
  • Italian studies showing significantly less asthma
    in 2 cup/day coffee drinkers
  • Dose effect observed

22
Herbs for Asthma
  • Xanthines coffee, tea. Epidemiology links higher
    intake to lower prevalence of asthma and wheeze
    (Schwartz. Ann Epid, 1992)
  • Adrenergic ephedra, coleus
  • Anti-inflammatory licorice, onions, fish oil,
    Shinpi-to, Saiboku-to (Japanese aka TJ-96,
    anti-inflammatory, inhibits LT synthesis. Urata.
    Respir Med, 2002) Onion (Allium cepa) improved
    PFTs (Amla. Ind J Pharmacol, 1980)
  • Ivy leaves (Hedera helix) in RCTs reduce airway
    resistance (Hofman. Phytomedicine, 2003)
  • Anti-oxidant Ginkgo
  • Solanum xanthocarpum acute improvement in PFTs
    for 6-8 hours (Govindan S. J Ethnopharm, 1999)

23
Ephedra- product variability
  • 20 products tested 10 evaluated for lot-lot
    variability
  • 5/20 contained norpseudoephedrine, a class IV
    controlled substance
  • Two contained 17 and 31 of listed alkaloids 6
    contained more than 100 of product label
  • Lot to lot variability 44-1000

24
Federal regulations food supplements
  • 1. Supplements can be marketed without testing
    efficacy.
  • 2. Safety need not be proved before marketing.
    Burden is on FDA to prove product is unsafe.
  • 3. Standards not required for manufacture.
  • 4. Structure/function product claims allowed.
  • 5. Label claims do not require extensive
    evidence.
  • 6. FDA approval not needed for marketing claims.

25
Do NOT use Patent Medicines
  • Heavy metals - lead, mercury, cadmium
  • Toxins - arsenic
  • Pharmaceuticals - steroids, antibiotics,
    hypoglycemic agents, antihistamines, etc.
  • In some studies, over 40 contaminated

26
(No Transcript)
27
Vitamin C
  • Antioxidant intake higher in non-asthmatics.
    (Bielory 1994 Fonastiere 2000) Daily use may
    decrease inflammation
  • EIB? (Cohen Arch Pediatr Adolesc Med, 1997)
  • Nigerian asthmatics, 1 gm daily helped. (Anah
    1980)
  • Reduces reactivity to methacholine, effect
    blocked by indomethacin. (Mohsenin 1983)
  • Block ozone-mediated exacerbations? (Grievink
    1999 Freed 1999)

28
Vitamin C
  • Intake (mg/day) saturation
  • 60 30
  • 100 72
  • 200 86
  • 400 91
  • 1000 100

29
Vitamin B6 (pyridoxine) and Asthma
  • db RCT of 76 asthmatic children
  • Vitamin B6 50 -200 mg/daily for one month
  • reduced frequency and severity of symptoms and
    need fewer meds
  • Possibly more important in kids on theophylline

30
Dietary supplements for asthma
  • Magnesium Fish oils
  • Bee propolis in RCT in patients on theophylline,
    marked reduction in nighttime symptoms and
    improved PFTs and decreased inflammatory
    cytokines (Khayyal. Fund Clin Pharmacol, 2003).
    BUT Bee pollen can cause anaphylaxis
  • Cordyceps sinensis (Chinese fungus) affects Th1
    and Th2 cells

31
(No Transcript)
32
Magnesium and Asthma
  • Dietary magnesium intake is independently
    related to lung function and the occurrence of
    airway hyper-reactivity and self-reported
    wheezing in the general population.
  • J Britton, et al. Lancet, 1994344357-62

33
Magnesium Sources
34
Lifestyle
  • Nutrition
  • Exercise
  • Mind-Body Therapies
  • Environment

35
Nutrition
  • Breastfeeding is protective
  • Onion extracts reduce bronchospasm in guinea pigs
    and reduce inflammation in vitro

36
FOOD and ASTHMA
37
Omega 3 fatty acids
  • Tend toward anti-inflammatory side of leukotriene
    production
  • Reduced asthma symptoms with chronic intake of
    high fish diet (twice weekly for at least 9
    months)

38
(No Transcript)
39
(No Transcript)
40
Environment
  • No smoking
  • Clean house
  • Minimize exposure to sick kids
  • Minimize exposure to allergens
  • Air filters? Yes (McDonald. Chest, 2002) bed
    covers? No? (Woodcock. NEJM 2003) Vacuums?
    De-humidifiers?
  • Minimize exposure to triggers such as sulfites,
    ozone, nitrogen dioxide, particulates (Tolbert PE
    Am J Epid, 2000 Gent, JAMA, 2003McConnell R. Am
    J Respir Crit Care Med, 2003)
  • Advocacy for clean air, less polluting vehicles

41
Exercise
  • Skiers and ice skaters have very high rates of
    EIB.
  • They can still compete successfully in Olympics
  • Keep moving!

42
(No Transcript)
43
Breathing exercises
  • Yoga. Pranayama. Inspiration to Expiration time
    12. Eg. count to 5 breathing in and count to 10
    breathing out.
  • Slow, deep breaths.
  • Daily, paying attention
  • Buteyko techniques? Reduce frequency and depth of
    breathing, record pulse and breath holding
    practice twice daily(Cooper. Thorax, 2003)

44
Asthma Mind-Body therapies
  • Hypnosis, yes
  • Autogenic training, yes
  • Biofeedback, yes
  • Meditation, yes, e.g., Sahaja yoga improves ARQL,
    POMS, methacholine challenge (Manocha. Thorax,
    2002)
  • STRESS MANAGEMENT YES or NO? Cost issues. Time.
    Self-efficacy (Frieri. Ann Allergy Asthma
    Immunol, 2003Huntley. Thorax, 2003 Hockemeyer
    J. Behav Med, 2002)

45
Biomechanical
  • Surgery
  • Massage
  • Cranial, spinal or joint adjustment

46
Massage for pulmonary problems
  • One of most common home remedies for asthmatics.
    Often combined with liniments (Vicks Vapo-Rub)
    (Reznick. APAM, 2002)
  • Asthma (Field. J Pediatr, 1998132(5)854-58)
  • Reduce stress?
  • Enhance social support
  • Relaxation immunomodulator (Th1 vs Th2 balance?)
  • CF (Hernandez-Rief, Soc Ped Psychol,199924(2)
    175-81)

47
Chiropractic and Asthma
  • Chiropractic is most common CAM therapy in US
  • DCs licensed in all 50 states
  • 2 RCTs show no benefit for asthma (Hondras.
    Cochrane Database Syst Rev, 2002)

48
Asthma - surgery
  • Early 20th century division of sympathetic and
    parasympathetic branches of pulmonary plexus
    abandoned with advent of better drugs

49
Bioenergetic
  • Acupuncture
  • Healing Touch/TT/Reiki/Qi Gung
  • Prayer/Spirituality
  • Homeopathy

50
Acupuncture for ASTHMA
  • Not sole therapy for asthma, even in China
  • Effective? Controversy
  • NOT for acute, rescue remedy
  • MAY help with subjective dyspnea, sleep, overall
    well-being
  • Safety
  • IS acceptable for sick kids (Kemper. Pediatrics,
    2000 Kemper, et al. Clinc Pulm Med, 2003 in
    press)

51
Therapeutic and Healing Touch
  • No research (yet)
  • Subjective improvement
  • Case histories
  • Not sole treatment!

52
Prayer
53
Homeopathy and ASTHMA
  • One RCT homeopathy and 96 asthmatic kids showed
    NSD, ceiling effect?(White. Thorax, 2003 Linde.
    Cochrane Database Syst Rev, 2000)
  • Benefits for allergies?
  • Very safe as long as not used as rescue medicine
    for acute attacks

54
Bioenergetic
Biochemical
Biomechanical
Lifestyle
55
Goals of Medicine
  • Yang goals
  • Cure disease
  • Manage symptoms
  • Prevent specific disease
  • Yin goals
  • Promote well-being
  • Promote peace, harmony, meaning
  • Support, hope, trust

56
Summary
  • Healthy lifestyle, including diet rich in omega
    three fatty acids, fish, onions, anti-oxidants,
    magnesium and possibly caffeine
  • Herbs may be useful, but not replacement for
    steroids
  • Comforting therapies and stress reducers
    (massage, meditation) probably underutilized
  • No evidence yet that chiropractic or homeopathy
    are worth professional intervention
  • More research needed! (e.g., Healing Touch)

57
Resources
  • Bielory L, et al. J Asthma, 200340S 47-53
  • Gardiner P and Kemper K. Herbs in Pediatric and
    Adolescent Medicine Peripheral Brain. Peds in
    Rev, 200021(2) 45-57
  • Kemper KJ and Lester M. Alternative asthma
    therapies an evidence based review. Contemp
    Peds, 199916(3) 162-95
  • Kemper KJ. ASTHMA chapter in The Holistic
    Pediatrician, 2nd edition. Quill, 2002
  • Ziment I and Tashkin DP. J Allergy Clin Immunol,
    2000106(4)603-14
About PowerShow.com