Although medications often do have a place for asthmatics, in our usual zeal to reach for the pill first we have neglected other interventions that may play an equal or even greater role in the treatment and prevention of asthma. Inhalers are not as invasive as many oral asthma medications, and steroids, over the short term, can be helpful during a severe attack.
Drugs are often pushed while lifestyle interventions like exercise (which are equally effective based on scientific studies) are ignored and in some cases discouraged. As proof of this the website of the Asthma and Allergy Foundation of America (www.aafa.org) states that, "Exercise-frequently in cold air-is a frequent asthma trigger." Although the site notes that children can exercise with appropriate management, nowhere does it mention the beneficial effects of exercise. All of the treatments listed are medications, and under prevention it lists "take your medication as prescribed" and "identify and minimize contact with your asthma triggers" (one of which is "running, playing, or exercising"!) Why such an emphasis on drugs instead of viable alternatives? The fact that 72% of this particular non-profit foundation's revenue comes from pharmaceutical companies might have something to do with it.
Sean Lucas MD MPH and Thomas Platts-Mills MD PhD from the University of Virginia Asthma and Allergic Diseases Center wrote "...the overwhelming majority of studies demonstrated the capacity for asthmatic subjects to exercise safely and significantly improve their cardiovascular fitness and quality of life...the allergy community has placed emphasis on medical therapy and allergen avoidance...It is our belief that an exercise prescription should be part of the treatment for all cases of asthma."
I believe it is important to encourage outdoor play in children as a preventive measure for asthma. As Lucas and Platts-Mills write, "The real question is whether prolonged physical activity and, in particular, outdoor play of children plays a role in prophylaxis against persistent wheezing. If so the decrease in physical activity might have played a major role in recent increases in asthma prevalence and severity."
Allergic asthma can also be treated via avoidance of triggers in the home and environment such as pet dander, mold, dust mites, cockroaches, tree and plant pollen in spring, second hand smoke, perfumes, and chemicals, including those found in standard household cleaning products. Wash bedding on a regular basis, decrease humidity, check air conditioning units for mold, minimize dust, keep pets outside (or don't have one), use an air conditioner (but clean its filter on a regular basis), shower before bed to remove pollen, keep food sealed to decrease insects, and change filters in blown air cooling and heating systems.
Your doctor can test you and identify your triggers. This involves exposure to a number of potential allergens and then measuring the inflammatory response. Once you have identified the plants, foods, molds, chemicals or animals you are allergic to you can avoid them. In addition, your doctor can perform tests to determine how much of the immunoglobulin IgE you have that is specifically oriented to different potential allergens. These tests are low risk and can provide useful information for deciding on treatment and lifestyle changes.
A number of studies have shown a relationship between psychological stress and asthma. Using relaxation techniques, like deep breath, progressive muscle relaxation, and meditation, can be useful in preventing asthma attacks. Still, for many individuals with chronic asthma, medication is a requirement.
Lucas SR, Platts-Mills TAE (2005): Physical activity and exercise in asthma: Relevance to etiology and treatment. Journal of Allergy and Clinical Immunology 115:928-934.
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