Childhood Asthma by Douglas C. Burr M.S., L.Ac., RCP Douglas Burr is a Licensed Acupuncturist, with a Masters of Science in Traditional Oriental Medicine. He was a Respiratory Therapist for 20 years before studying Oriental Medicine. He practices in San Diego, CA at the West Coast Center for Integrative Medicine.

Luckily the medications available are many times able to reverse an attack. Still some patients experience frequent trips to the ER, which is frustrating and disheartening.

Acupuncture can minimize and sometimes eliminate asthma attacks and those "middle of the night" trips to the ER. Painless and needle free treatment is common for children. What you can expect when talking to an acupuncturist about treatment for your child will be discussed but first let us cover important information concerning allopathic treatment.

The most important aspect of Western treatment is to understand terms and have clear, up-to-date knowledge of the drugs commonly used.

· Asthma- a reversible, obstructive lung disease, resulting from bronchial (airway) spasms and inflammation of the airway lining.

· Status asthmaticus- the state of an asthmatic patient not responding to repeated doses of bronchodilators and in progressive respiratory failure. Requires aggressive treatment in an emergency room setting.

· Triggers- sensitivity to an irritant or an event that can set off or "trigger" an asthma attack.

Dealing with Asthma Triggers

It is important to be able to identify and attempt to avoid your child's asthma triggers. These could be one or more of the following:

· Allergens- pollen, grass, dust, pet dander, foods, etc.

· Environmental irritants- chemicals, household cleaners, fresh paint, new carpets, new cars, exhaust, second-hand smoke (even residual smoke in clothes and car interiors).

· Exercise and emotional triggers

These triggers may induce different levels of severity of asthma; mild intermittent, mild persistent, moderate persistent and severe.
Some triggers may induce a mild asthma attack while another may cause a severe or status attack. Here are some tips:

• First line treatment is the avoidance of allergens and irritants in the home.
• Using bed and pillow covers can significantly reduce dust mites.
• Eliminate chemical cleaners; natural citrus-based cleaners are widely available.
• Regular cleaning of carpets or removal of carpets is recommended if possible.
• Using air purifiers can also be beneficial.
• Check for mold in any area where water damage is suspected.

Foods may play a roll in inducing an asthma attack or preventing an attack by boosting the immune system. So monitoring your child's diet is very important.

Try eliminating certain foods one at a time for a few weeks, and then slowly add that food back into the diet and watch for any reactions. Dairy products, wheat or wheat gluten, nuts and highly processed foods are potential offenders. It's always a good idea to restrict or eliminate over used food additives such as high fructose corn syrup and artificial sweeteners.

Teach your child good hand washing habits! Reducing the chance of colds, flu and any bacteria related illnesses would decrease asthma attacks and maintain a healthy immune system.

Medications for Asthma Attacks

In case of an asthma attack, both parent and child must be absolutely clear on which medications treat acute attacks and which are used for maintenance. Today most asthma sufferers have 2 or 3 medications to take at different times, which may be confusing especially during a crisis.
Some of the most common medications in use are:

1. Albuterol Sulfate- brand names: Proventil, Ventolin
Bronchodilator- for acute or sudden episodes of asthma (inhaler only)
- Daily maintenance and taken before exercise
- comes in inhaler, syrup and tablets

Effectiveness of inhaler is dependant upon proper usage, instructions should be given when prescription is written and periodically thereafter. Rinse mouth after use to reduce mouth and throat dryness.
Repeated use may cause paradoxical or rebound bronchospasm, if breathing problems persist or worsen your contact health care provider immediately!

2. Ipratropium Bromide- brand name: Atrovent
bronchodilator- has delayed onset, not for acute asthma!
- comes in inhaler only

Commonly used with albuterol, a 5-minute interval is recommended between uses. Contraindicated for patients with a hypersensitivity to soybeans or peanuts. Safety and efficacy in children under 12 have not been established. The herbs jaborandi tree and pill-bearing spurge may decrease the therapeutic effect. Effectiveness of inhaler is dependant upon proper use.

3. Budesonide- brand name: Pulmocort, and fluticasone propionate- brand name: Flovent
- corticosteroids, anti-inflammatory- not for acute asthma!, maintenance treatment only

A reduction of growth in children and teenagers may occur as a result of the use of corticosteroids. Instructions must be given for proper use. Rinse mouth after use. Avoid exposure to chicken pox or measles and report immediately any exposure to your health care provider.

4. Salmeterol Xinafoate- brand name: Serevent
bronchodilator- long-term maintenance treatment of asthma
May cause bronchospasm in some patients. Safety and efficacy has not been established in children under 12. Patient must be instructed on proper use

5. Advair- combination of Flovent and Serevent, use is currently under review by the FDA due to its potential to cause bronchospasm.

The Chinese Medicine Perspective on Asthma

In Chinese medicine asthma is not only a problem with the Lungs but can also be related to a problem or deficiency with the Spleen and/ or the Kidneys. The Organs in Chinese medicine have much similar functions as Western medicine but also take on roles that are much broader and interact with each other to create balance in a completely healthy state of both body and mind.

The Lungs are considered the most exterior organ because of their direct connection to the outside. They can be easily influenced by exterior "pathogens." The Lungs govern and control the dispersal of "Qi" and regulate the opening and closing of skin pores. The skin is considered the exterior Lung. Like the Lungs, the skin "breathes" to control body temperature and sweat. This relationship between Lungs and skin is betrayed by the common occurrence of both eczema and asthma in the same patient. Many patients find their eczema clears up as the asthma resolves. The balance between Lungs and skin promotes Protective Qi or Wei Qi. This ancient idea of a protective and defense mechanism of the body is today called our immune system.

The Spleen is where food and fluids are transformed and then the refined material is transported to the appropriate areas of the body. If the Spleen is deficient and unable to do its job, then the proper transformation of food and fluids cannot take place. This is when phlegm and dampness can collect in the Lungs instead of the refined "mist" that is normally transported to the Lungs to keep them moist.

In Western medicine the lungs and kidneys have a relationship in maintaining pH (acid-base) balance in blood. Similarly a relationship in Chinese medicine is essential between the Lungs and Kidneys in order to maintain the proper movement of air into and out of the lungs. If his relationship is out of balance then wheezing occurs.

Acupuncture and Asthma

When the underlying problem is addressed, acupuncture treatment can minimize severity and frequency of asthma attacks in children and adults. In some cases treatment can resolve asthma altogether. Acupuncture can treat not only the symptoms of asthma (coughing, wheezing, increased work of breathing), but also the root of the problem. This is why the problem exists in the first place. The root problem is usually an underlying deficiency or a lingering pathogenic factor. Lingering pathogens result from unresolved illness and result in a chronic cough, getting sick easily, becoming tired easily, decreased appetite, etc. Lingering pathogens can become deeply ingrained in the body if they aren't treated. This is sometimes where asthma starts. Many parents have had their child diagnosed with asthma after a bout with bronchitis that never seems to be completely resolved. Acupuncture is effective in treating asthma from emotional triggers as well.

Your Child's Acupuncture Visits

What your child can expect at an acupuncture clinic is first an in-depth history is taken by the practitioner including: frequency and severity of attacks, what triggers set off attacks, and questions about overall health. The treatment depends on the age of the child but may consist of using shoni shin, small instruments used for rubbing or pressing the skin along acupuncture channels and points, and Electric stim or E-stim. This creates a tapping sensation on selected acupuncture points. In our clinic we refer to it as the "tickle machine". Most children enjoy treatment and tolerate it very well. Treatments may last 30-45 minutes on average.

The number of treatments required depends on your child's constitution, age and severity of condition. A weekly treatment for 6-8 weeks and then spacing treatments every 2-4 weeks depending on results is common. In severe cases, 2 or 3 treatments may be recommended in the first week or so depending on results. It is common to see results of decreasing frequency or severity of attacks after the first couple to treatments.

Emergencies

It is important to remember that Western treatment can be lifesaving and any asthma attack is not to be taken lightly. Always watch for signs of increasing asthma severity and keep medications available for emergencies. Our goal is to minimize or eliminate the need for medications and the multiple side affects associated with each of them. Find an acupuncturist who can work with your family medical doctor to answer questions and be an integrative resource for your child's health and well being.