According to Asthma UK, between 2011 and 2015, the UK’s average asthma death rate was almost 50% higher than the average across the EU. Asthma UK also stated that around 1,400 people died from an asthma attack in the UK in 2015 and the UK’s death rate was higher than countries including Greece, Italy and the Netherlands. Releasing the figures on World Asthma Day on 1 May, the charity said the situation was “truly shocking”, but did not know “for sure” why Britain was performing so badly.
What is asthma
Asthma is a type of chronic obstructive pulmonary disease (COPD). A characteristic of asthma is that symptoms tend to occur suddenly in response to stimuli that irritate the immune system and air passageways, which is described as having an asthma attack.
When a person with asthma comes into contact with something that irritates their sensitive airways (an asthma trigger), it causes their body to react in three ways:
- The muscles around the walls of the airways tighten causing them to narrow
- The lining of the airways becomes inflamed and start to swell
- Phlegm or sticky mucus sometimes builds up, which can narrow the airways even more
These reactions cause the airways to become narrower and irritated – making it difficult to breathe, leading to asthma symptoms.
A trigger is anything that sets off the asthma symptoms, such as:
- house dust mites
- pet dander
- colds and flu
- cigarette smoke
- cold air
- mould spores
- hormonal changes
Common symptoms of asthma include:
- tightness in the chest
- feeling short of breath
The symptoms of asthma can range from mild to more serious. Not everyone will get all of the symptoms. Some people experience them from time to time, but otherwise live ‘normal’ lives doing everything they want to do with very few symptoms. Unfortunately, about 5% of people with the condition have what is known as severe asthma and they require specialist care and support to manage symptoms.
Medications and inhalers (bronchodilators) help control asthma attacks and prevent emergencies or complications. Most of these drugs can help open up the airways very quickly, preventing further complications.
Medications used to treat asthma include:
Mild intermittent asthma
Inhaled short-acting beta 2 agonists (normally blue) such as salbutamol or terbutaline. These work by stimulating receptors in the lungs called beta 2 receptors. This causes the muscles in the airways to relax and allows the airways to open.
Regular preventer therapy
Inhaled standard-dose corticosteroid medicine (normally brown), such as Beclometasone. It reduces inflammation in the lungs that can act as a trigger for an asthma attack, and so should reduce the number of attacks. Alternatives to inhaled corticosteroids are leukotriene receptor antagonists (LTRAs), theophylline, inhaled sodium cromoglicate, or inhaled nedocromil sodium. During an allergic reaction the body releases leukotrienes. These chemicals cause the airways to become inflamed. If someone has hay fever as well as asthma, they may be prescribed LTRAs too. In addition, LTRAs can help people who have ‘exercise-induced asthma’ as they help cut down how sensitive the airways are to cold air etc.
Initial add-on therapy
A regular inhaled long-acting beta 2 agonist (LABA) such as formoterol fumarate or salmeterol may be used in conjunction with an inhaled corticosteroid.
However, medication long-term is not very effective for treating the underlying causes of asthma or other respiratory problems.
Risk factors for asthma
Unhealthy Gut Microbiome
The human gut microbiome and its role in both health and disease has been the subject of extensive research, establishing its involvement in human metabolism, nutrition, physiology, and immune function. For example, over 70% of the immune system resides in the gut. Microbial communities provide defence against pathogens from ingested foods. They crowd out pathogenic bacteria, produce toxins that are poisonous to these pathogens, and prevent adhesion and proliferation of such pathogens, protecting us from disease.(1)
Dysregulated gut flora has been linked to specific diseases including gastrointestinal disorders, mental health issues, allergies, and autoimmune conditions. Antibiotics destroy supportive as well as causative bacteria throughout the whole body, leading to a loss of diversity and density, both of which are essential for a healthy microbiome.(2)
A number of studies suggest that the use of antibiotics, particularly when taken by the mother during pregnancy or during early life, can increase the risk and severity of asthma in children.(3-5)
In a paediatric population with asthma, children who had been breastfed had a statistically significantly lower risk of asthma severity later in life compared to children who had not been breastfed. (6,7)
The Hygiene Hypothesis and Spending More Time Indoors
The ‘hygiene hypothesis’ suggests that our insistence on cleanliness and lack of exposure to a wide range of microbes in the developed world, deprives our bodies of immune stimulation, disrupting normal immune development and thus increasing the risk for allergic disease. In addition, children and adults both spend more time than ever inside clean, very hygienic homes and this can actually reduce someone’s ability to effectively build the immune system. In addition, being inside more increases exposure to certain allergens or irritants that can accumulate indoors, including dust mites, mould spurs, pet hair and other microbes.
Having hay fever, and/or eczema in childhood is a strong predictor of asthma onset later in life.(8-10) For many people with asthma, the release of histamine when they have hay fever makes asthma symptoms worse.
Allergic reactions triggered by antibodies in the blood often lead to the airway inflammation that is associated with asthma. Additionally, pollution, sulphur dioxide, nitrogen oxide, ozone, cold temperatures, and high humidity have all been shown to trigger asthma in some individuals. More information can be found here.
Researchers have found that obese asthmatics have more chronic low-grade systemic inflammation and it is recognised that airway swelling and inflammation help to trigger asthma attacks.(11)
One study found that obese asthmatics had a higher (Asthma Control Questionnaire) score, more activity limitation and wheezing compared to non-obese asthmatics.(12)
Compression of the lungs caused by poor posture may also contribute to symptoms.
A sedentary lifestyle and our addiction to technology has become standard in the Western population. The obsession with smartphones has led to the development of forward head posture, often referred to as “Text Neck”, “iHunch” or “Reading Neck.”
The Consequences of Forward Head Posture
In regard to respiratory dysfunction in chronic neck pain patients, a recent study “demonstrated a strong association between an increased forward head posture and decreased respiratory muscle strength in neck patients.”(13)
According to Rene Cailliet MD, director of the Department of Physical Medicine and Rehabilitation at the University of Southern California, forward head posture can add up to 30 pounds of abnormal leverage on the cervical spine. This can pull the entire spine out of alignment. Forward head posture results in loss of vital capacity of the lungs by as much as 30%. This shortness of breath can lead to heart and blood vascular disease. The entire gastrointestinal system is affected; particularly the large intestine. Loss of good bowel peristaltic function and evacuation is a common effect of forward head posture as well as reduced endorphin production.
Observational studies have reported associations between asthma and low intake of dietary antioxidants (vitamin E, vitamin C, carotenoids, selenium, polyphenols), omega-3 fatty acids and vitamin D.(14) Interestingly, there is growing research suggesting the possibility that childhood asthma is influenced by maternal diet during pregnancy, with studies highlighting associations between childhood asthma and maternal intake of some nutrients (vitamin E, vitamin D, selenium, omega-3 fatty acids). It has been suggested that maternal diet during pregnancy influences foetal airways and/or immune development.(15)
Honey Bee Propolis
Honey bee propolis extract has been studied extensively and found to be helpful in asthma management.
A study in 2003 found honey bee propolis potentially effective as an adjuvant to therapy in asthmatic patients. It concluded that the benefits may be related to the presence of caffeic acid derivatives and other active constituents.(17)
In the pathophysiology of asthma, structural cell dysfunction and concomitant micro-environment changes in airways are crucial to pathological progression, which involves oxidative stress.
Caffeic acid phenethyl ester (CAPE) is an antioxidant obtained from propolis which has been shown to have beneficial effects on several respiratory disorders, such as chronic obstructive pulmonary disease. In summary the study concluded that CAPE alleviates airway inflammation and remodelling in chronic asthma by balancing the airway micro-environment.(18)
Vitamin C has multiple benefits for supporting immunity: it stimulates neutrophils, increases lymphocyte and interferon production, has antioxidant and anti-histamine properties. Vitamin C is found in most fruits, particularly berries and vegetables such as dark leafy greens.
Zinc improves cell mediated immunity by increasing production of T-lymphocytes and regulating the function of white blood cells. Zinc can be found in eggs, wholegrains and pumpkin seeds.
Children with vitamin D deficiency are more likely to develop asthma, a 10-year study of children in Perth, Australia, has discovered. The findings showed repeated bouts of vitamin D deficiency in early childhood were linked to higher rates of asthma at aged 10, as well as allergy and eczema.(19)
Vitamin D can be manufactured in the skin during exposure to sunlight. To obtain adequate vitamin D, 30% of the body should be exposed daily for 10-15 minutes in peak sunlight 10am-2pm April-October. However, many people are not achieving this and it is not possible to get enough from the diet; vitamin D is found in oily fish, butter and eggs. Therefore, the government now recommends supplementing with 10µg of vitamin D daily, through the year. This amount should be considered a minimum, most people will need more than this to achieve optimal blood levels of vitamin D.
Optimising gut health is of importance to reduce the risk of atopic conditions such as eczema and asthma.
You can support the health of the gut by:
- Obtaining adequate fibre from vegetables, fruits and moderate intake of wholegrains (if tolerated)
- Consuming prebiotic foods such as apples, Jerusalem artichoke, garlic, onions and asparagus
- Consuming probiotic foods sauerkraut, kimchi, kefir and miso
- Taking a live bacteria supplement
Omega-3 fatty acids
In a paper published in the Journal of Clinical Investigation, researchers using cell cultures from local asthma patients, found that omega-3 fatty acid products reduced the production of IgE, the antibodies that cause allergic reactions and asthma symptoms in people with milder cases of asthma(20)
Omega-3 fatty acids are found in oily fish, algae, walnuts, flax and chia seeds.
- Asthma is a common long-term inflammatory disease of the airways of the lungs.
- Risk factors for asthma include having an unhealthy gut microbiome, suffering hay fever and/or eczema in childhood, obesity and poor posture.
- Forward head posture, often referred to as “Text Neck”, “iHunch” or “Reading Neck”, results in loss of vital capacity of the lungs by as much as 30%.
- Observational studies have reported associations between asthma and low intake of dietary antioxidants (vitamin E, vitamin C, carotenoids, selenium, polyphenols), and omega-3 fatty acids and vitamin D.
- Honey bee propolis extract has been studied extensively and found to be helpful in asthma management.
- Vitamin C has multiple benefits for supporting immunity and has antioxidant and anti-histamine properties.
- Optimising gut health is of importance to reduce the risk of atopic conditions such as eczema and asthma.
If you have any questions regarding the topics that have been raised, or any other health matters please do contact me (Jackie) by phone or email at any time.
firstname.lastname@example.org, 01684 310099
Jack Tarling and the Cytoplan Editorial Team
Honey Bee Propolis – Propolis is a complex food, and over 180 natural compounds have been identified including vitamins, minerals, fatty acids and amino acids. Propolis is one of nature’s richest sources of bioflavonoids and this is one of the reasons that it is considered to be an excellent and natural antioxidant.
Cherry C – Cherry C capsules are rich in vitamin C and carotenoids, with the cherry-like fruits being one of the richest-known natural sources of vitamin C.
Acidophilus Plus – Acidophilus Plus contains Lactobacillus acidophilus and a further 8 live native bacterial strains, plus a small amount of fructo-oligosaccharides (FOS).
High Potency Fish Oil – High potency fish oil capsules give you 550mg of the essential fatty acids EPA/DHA per 1000mg. Our fish oils are guaranteed to be clean, stable & free from pollutants. Fatty acids (EPA and DHA) contribute to the normal function of the heart (the beneficial effect is obtained with a daily intake of 250mg of EPA and DHA).
Krill, CoQ10 + K2 – This unique formula combines vitamins and natural nutrients contributing to a range of functions. This supplement comprises Krill Oil, Vitamin K, Vitamin D3, CoQ10, Resveratrol and Lycopene.
High Potency Vitamin D – A wholefood supplement from lichen ideal for vegetarians and vegans. One tablet provides 62.5µg (2500i.u.) Vitamin D3 (Cholecalciferol) at 1250% of NRV. Vitamin D3 is the most bioavailable form of this nutrient.
CoQ10 Multi – This is an adult only formula. The composition includes CoQ10, Beta 1-3, 1-6 Glucan and vitamins B12 and D3. It is also an excellent additional multi formula for those people taking our Red Rice Yeast Plus supplement (for cholesterol support).
- Vyas, U. and Ranganathan, N. (2012) ‘Probiotics, Prebiotics, and Synbiotics: Gut and Beyond’, Gastroenterology Research and Practice. Hindawi Publishing Corporation, 2012, pp. 1–16.
- Blaser, M. J. (2014) ‘Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues’, Henry Holt and Company LLC, New York, 35(9), p. 261.
- Ahmadizar, F. et al. (2017) ‘Early life antibiotic use and the risk of asthma and asthma exacerbations in children’, Pediatric Allergy and Immunology, 28(5), pp. 430–437.
- Feldman, M. F. and Bird, J. A. (2013) ‘Use of Antibiotics During Pregnancy Increases the Risk of Asthma in Early Childhood’, PEDIATRICS. American Academy of Pediatrics, 132(Supplement), pp. S5–S6.
- Zhao, D. et al. (2015) ‘Prenatal antibiotic use and risk of childhood wheeze/asthma: A meta-analysis’, Pediatric Allergy and Immunology, 26(8), pp. 756–764.
- Ahmadizar, F. et al. (2017) ‘Breastfeeding is associated with a decreased risk of childhood asthma exacerbations later in life’, Pediatric Allergy and Immunology, 28(7), pp. 649–654.
- Dogaru, C. M. et al. (2014) ‘Breastfeeding and Childhood Asthma: Systematic Review and Meta-Analysis’, American Journal of Epidemiology. Oxford University Press, 179(10), pp. 1153–1167.
- Jarvis, D. et al (2009) Allergy frontiers: epigenetics, allergens and risk factors. Springer; pp. 49–78.
- Leynaert, B. et al (2004) Association between asthma and rhinitis according to atopic sensitization in a population-based study. J Allergy Clin Immun. 113:86–93.
- Rzehak, P. et al. (2008) ‘A prospective study on the association between hay fever among children and incidence of asthma in East Germany’, European Journal of Epidemiology, 23(1), pp. 17–22
- Liang, Z. et al. (2016) ‘A Systemic Inflammatory Endotype of Asthma With More Severe Disease Identified by Unbiased Clustering of the Serum Cytokine Profile.’, Medicine. Wolters Kluwer Health, 95(25), p. e3774.
- Mosen, D.M. et al (2008) The relationship between obesity and asthma severity and control in adults. J Allergy Clin Immunol;122:507–11.
- Kapreli, E. et al. (2009) ‘Respiratory Dysfunction in Chronic Neck Pain Patients. A Pilot Study’, Cephalalgia, 29(7), pp. 701–710.
- Allan, K. and Devereux, G. (2011) ‘Diet and Asthma: Nutrition Implications from Prevention to Treatment’, Journal of the American Dietetic Association, 111(2), pp. 258–268.
- Devereux, G. (2010) ‘Session 1: Allergic disease Nutrition as a potential determinant of asthma’, Proceedings of the Nutrition Society, 69(1), p. 1.
- Hollams, E.M. et al. (2016). “Vitamin D over the first decade and susceptibility to childhood allergy and asthma.” The Journal of allergy and clinical immunology
- Khayyal, M. T. et al. (2003) ‘A clinical pharmacological study of the potential beneficial effects of a propolis food product as an adjuvant in asthmatic patients.’, Fundamental & clinical pharmacology, 17(1), pp. 93–102.
- Ma, Y. et al. (2016) ‘Caffeic acid phenethyl ester alleviates asthma by regulating the airway microenvironment via the ROS-responsive MAPK/Akt pathway’, Free Radical Biology and Medicine, 101, pp. 163–175.
- Hollams, E. M. et al. (2017) ‘Vitamin D over the first decade and susceptibility to childhood allergy and asthma.’, The Journal of allergy and clinical immunology. Elsevier, 139(2), p. 472–481.e9.
- Kim, N. et al. (2017) ‘Corticosteroids inhibit anti-IgE activities of specialized proresolving mediators on B cells from asthma patients.’, JCI insight. American Society for Clinical Investigation, 2(3), p. e88588.