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The world record for holding a breath is 6 minutes, 2 seconds. However, during normal breathing, the time between breaths averages a few seconds. In those with asthma, allergic rhinitis (hay fever) and other respiratory problems, breathing does not come so easily and is fought for on a day-to-day basis.

Currently, respiratory health is on the front pages of newspapers as Severe Acute Respiratory Syndrome (SARS)--a pneumonia linked with troubled breathing and a high fever--continues to affect the world's population. At press time, the virus had infected 2,700 people and claimed the lives of more than 100. For most people, the greater concern is not contracting SARS, but rather ways to live with the more common ailments of asthma and allergies.

What is the cycle of a breath? It starts with the nose and mouth, as air is sucked in and taken through the trachea and into the lungs via two large passageways, known as bronchi. Smaller tubes, known as the bronchioles, carry oxygen to the millions of air sacs (alveoli) that make up the lungs. Folded like tiny balloons, alveoli have very thin walls filled with blood. The thinness of the walls is so that oxygen taken in through a breath can pass through the alveoli and into the bloodstream, where the gas can then travel to the body's cells. In a healthy, functioning lung, these alveoli expand and contract like millions of tiny balloons. Carbon dioxide, the main component in "used air" that is exhaled, is created after the alveoli use the oxygen to burn food.

Asthma, a chronic lung disease, occurs when the lining of the bronchi is inflamed and swollen, creating large amounts of mucus and clogging the bronchi's airways. According to the American Lung Association (ALA), the prevalence of asthma has increased in the United States over the past two decades. Based on results from the 2001 National Health Interview Survey (NHIS), 31.3 million Americans have been diagnosed with asthma, with females being 10-percent more likely to be diagnosed than males. In addition, 12 million Americans, 4 million of whom were 18 and younger, had an asthma attack in 2001. Interestingly, those between the ages of 5 and 17 had the highest attack prevalence rates. In 2000, 4,500 people died of asthma, most of them women.

Asthma comes in various forms and subcategories. Occupational asthma is related to workplace exposure to asthmatic triggers and affects 5 percent to 10 percent of adult asthmatics. Exercise-induced asthma (EIA) is affects 11 percent of Americans, 4 percent of whom are not otherwise asthmatic. There are also the subcategories of adult-onset and childhood (about 5 million Americans under the age of 18) asthma. The causes of asthma are numerous, from environmental to metabolic to genetic, and the number of potential triggers is in the thousands, ranging from chemical pollutants to foods.

According to the ALA, 2002 estimates indicated asthma costs to be $9.4 billion in direct expenses and another $4.6 billion in indirect costs (lost productivity). In fact, the association estimated that 14.5 million lost work days and 14 million lost school days were racked up annually among asthma sufferers.

Breathing-related allergies affect approximately 40 million Americans, many of whom are also among those who suffer from asthma each year. In fact, allergic diseases are the sixth leading cause of chronic disease in the United States, according to the American Academy of Allergy, Asthma and Immunology.

Allergists have found that IgE antibodies trigger both asthma and allergies, high levels of which characterize both conditions. IgE antibodies attach to the immune system's mast cells, causing histamines and leukotrienes to be released from cells--in turn causing allergies. According to Lorna R. Vanderhaeghe and Patrick J.D. Bouic, Ph.D., in their book, The Immune System Cure (Kensington, 1999), IgE production is under the control of T-cell cytokines. In turn, the Th1-type helper T-cells secrete gamma interferon. "In a normal immune response, gamma interferon is responsible for stopping the release of interleukin-4, thereby reducing the production of IgE antibodies," they wrote.

Having allergies or asthma is not necessarily predestined. According to respiratory health researchers from Bulgaria's National Center of Hygiene, Medical Ecology and Nutrition, "The wide variations in the prevalence of respiratory diseases and asthma in different countries are probably due to environmental and not genetic factors."¹

How does complementary and alternative medicine (CAM) play a role in asthma, allergies and overall respiratory health? Vitamins and minerals attack the oxidative stress that contribute to these conditions, and botanicals and essential fatty acids (EFAs) have been found to modulate the inflammation that accompanies respiratory distress.

Vitamins & Minerals

"The contribution of free oxygen radicals in the pathogenesis of bronchial asthma is generally accepted," said researchers from the Institute of Preventive and Clinical Medicine in Bratislava, Slovakia.² "The modulation of antioxidative defense by supplementation with antioxidants represents an additive approach in the complex management of the disease." Specifically, the antioxidant effects of various vitamins and minerals may be of benefit in respiratory health.

The most well-known antioxidant vitamin is vitamin E. The alveolar surfactant (a specific complex produced by Type 2 alveolar epithelial cells) is the first area in the pulmonary system that oxidants bombard. Researchers from Berlin postulated that vitamin E could serve an important role in protecting surfactant lipids against oxidation and subsequent lung injury.³ They added that a temporary vitamin E deficiency induced a reversible change in the expression of pro- and anti-inflammatory markers.

Other German researchers reported vitamin E in high doses was correlated with low IgE concentrations and a reduced prevalence for allergic reactions.⁴ They hypothesized that the vitamin's inherent antioxidant properties suppressed interleukin-4 protein levels in T-cells. Researchers from the University of Nottingham, England, and Harvard had similar findings: Higher concentrations of vitamin E intake were associated with lower serum IgE concentrations and a lower frequency of allergen sensitization.⁵

Researchers in Cuernavaca, Mexico, reported that vitamin supplementation may counteract the detrimental effects of pollution--a top reason for oxidative stress in the body.⁶ Asthmatic children given a daily supplement of 50 mg of vitamin E and 250 mg of vitamin C or a placebo were followed over 1.5 years. Researchers found that there was no association between ozone and lung function in the supplement group, leading them to conclude that antioxidants may modulate the impact of ozone exposure on the small airways of children with moderate to severe asthma.

Since ozone aggravates asthma, researchers from the University of Washington, Seattle, evaluated the effects of antioxidants such as vitamin E (400 IU/d) and vitamin C (500 mg/d) on ozone-induced bronchial hyper-responsiveness in adult asthmatics.⁷ Subjects on the antioxidants were seen to respond less severely to the sulfur dioxide challenge, which mimicked ozone.

High dietary intake of vitamin C, or foods rich in the vitamin, may reduce the rate of loss in lung function for adults, which may ultimately prevent chronic obstructive pulmonary disease.⁸ vitamin C is abundant in the extracellular fluid lining the lung, and low status has been associated with pulmonary dysfunction, according to English researchers.⁹ However, after conducting a meta-analysis of 65 studies, they found that, at present, evidence from randomized trials is insufficient to recommend vitamin C for asthma relief.

Vitamin A deficiency may play a hand in childhood asthma. Children with severe, persistent asthma were seen to have markedly low serum vitamin A levels; however, more trials were needed to see if vitamin supplementation would be of benefit.¹⁰ Researchers at the University of Iowa reported that vitamin A and its retinoids may aid respiratory health by regulating bronchial responsiveness and maintaining a normal bronchial epithelium.¹¹ Conversely, research out of Des Moines University, Iowa, indicated that that children who have been free of infectious illness may disturb the natural balance of vitamin A and Th1-type helper T-cells.¹² In turn, vitamin A accumulation may occur in the lungs by producing retinoid metabolites, which could lead to an acute, localized form of retinoid intoxication, recognized as asthma.

The provitamin A precursor, beta-carotene, as well as vitamins C and E, work in tandem to promote respiratory health.¹³ In particular, they may help with forced expiratory volume.

Suboptimal levels of coenzyme Q10, a vitamin-like nutrient occurring naturally within the body, may lead to antioxidant imbalance in asthmatics, according to Slovakian researchers.¹⁴ Concentrations were decreased significantly in asthmatics' plasma and whole blood.

Vitamins may also help those with cystic fibrosis. This genetic disease affects approximately 30,000 U.S. children and adults, and causes the body to produce an abnormally thick, sticky mucus that leads to a variety of symptoms, including persistent coughing, wheezing or pneumonia. Australian researchers reported a high-dose supplement containing 200 mg of vitamin E, 300 mg of vitamin C, 25 mg of beta-carotene and 500 mcg of vitamin A decreased oxidative stress, a possible factor in clinical outcomes in cystic fibrosis patients.¹⁵

Vitamins are not the only nutritional helpers in respiratory health--there are also minerals. For example, researchers out of Athens, Greece, reported magnesium levels in asthmatics' red blood cells were low, even though plasma levels remained unchanged during asthmatic episodes.¹⁶ In a hospital setting, 2 g of intravenous magnesium sulfate improved pulmonary function as an adjunct to standard therapy in patients with very severe, acute asthma.¹⁷ According to the Natural Marketing Institute's (NMI) Health & Wellness Trends Database, four years of trended data from more than 2,000 consumer respondents, allergy sufferers are 24-percent more likely than non-sufferers to use a magnesium supplement.

Selenium is reported to have antioxidant benefits in the fight to breathe. Researchers in Slovakia reported selenium eliminates hydroperoxides produced at the site of respiratory inflammation and intake increased the mineral's presence in plasma and red blood cells.¹⁸ In particular, asthmatics dependent on corticosteroids were seen to have a reduced dependency on their medication during a 96-week supplementation at 200 mcg/d.

Complementary Natural Products

Vitamins and minerals have their place in respiratory health, but so do botanicals, EFAs and sulfur compounds.

On the asthma front, there are plant extracts that can make a world of difference in the everyday process of breathing. Boswellic acids from Boswellia serrata help various inflammatory diseases, including bronchial asthma. Research out of Germany reported that compounds from the gum inhibited leukotriene biosynthesis and elastase in white blood cells.¹⁹

Even though it is making the news these days in terms of weight loss and possible harmful side effects, ephedra has a long history steeped in respiratory health. Chinese researchers have investigated the herb's clinical uses for asthma, chronic bronchitis, pneumonia and whooping cough. In the oldest comprehensive material medica, Shen Nong Ben Cao Jing, ephedra is listed among the "middle class" herbs as an anti-allergy agent.²⁰

Ginkgo biloba, as Ginkgolide B, has been seen in vitro to have inhibitory effects on peripheral blood mononuclear cells in asthmatic patients, leading researchers from Kuwait to conclude that it may be a useful modality for asthma treatment.²¹

The acute effect of lycopene (as Beer-Sheva Israel-based LycoRed/Biodar's Lyc-O-Mato®) on airway hyper-reactivity was assessed in patients with exercise-induced asthma by researchers out of Israel.²² In a double blind test using 30 mg/d of lycopene or a placebo, patients on the supplement for a week were more protected against exercise-induced asthma, most likely through the supplement's antioxidant effects.

Flavonoids may also impart health benefits for asthmatics. Researchers from King's College in London reported intake of red wine--and its flavonoids--was negatively associated with asthma severity.²³

Other flavonoids, such as quercetin, also appear beneficial for those with compromised respiratory health. In an evaluation of dietary intakes of 10,000 men and women, researchers from the National Public Health Institute in Finland reported asthma incidence was lower for those in the highest quartile of quercetin intake.²⁴ Luteolin, found in foods such as bee propolis and tea, has been indicated to inhibit the IgE-mediated reaction by blocking histamine and cytokine release from mast cells.²⁵

Flavonoids may also be a winner in terms of general respiratory health. In research out of Dublin, French maritime pine bark (as Pycnogenol® from Hillside, N.J.-based Natural Health Science) was investigated regarding its antioxidant effects on histamine.²⁶ Scientists researched the flavonoid's effects on rat mast cells in comparison with sodium cromoglycate, a known inhibitor of histamine release from the mast cell; they found Pycnogenol's inhibitory effect was on par with sodium cromoglycate's.

Plant extracts in the form of isoflavones also appear promising in respiratory function. In animals treated with the soy isoflavone genistein, the compound was seen to inhibit tyrosine kinase signaling, a factor in the activation of inflammatory cells.²⁷ Researchers from the National University of Singapore reported lung tissue was protected by genistein, which may have therapeutic potential for allergic airway inflammation. Research out of the University of Minnesota, Duluth, also reported phytoestrogens were beneficial for asthma.²⁸ Animals consuming an isoflavone-rich diet were protected against pulmonary challenges inflicted in the lab. The researchers concluded isoflavones reduced antigen-induced eosinophilia (a systemic respiratory disease) in the animal model of asthma.

Sterols and sterolins may attenuate the inflammatory response in respiratory problems. "Sterols and sterolins stimulate the release of Th1-type cytokines from helper T-cells and, as a result, control the allergic condition by decreasing the manufacture of IgE," Vanderhaeghe and Bouic wrote. "Sterols and sterolins also reduce the synthesis of interleukin-6, the inflammation factor. It is known that during the late phase of an asthma episode, interleukin-6 perpetuates the inflammatory response, which causes bronchial tissue damage."

In a study over a 12-week period, allergic (predominantly pollen sensitive) persons were given either placebo or sterol/sterolin capsules (as Eugene, Ore.-based Essential Phytosterolin Inc.'s Moducare™).²⁹ The sterol/sterolin mixture was found to reduce interleukin-4 in both allergic and control groups, leading to a reduction in symptoms, including post-nasal drip.

Even a chemical found in chocolate may give rise to a natural cough treatment. In a study presented in December 2001 at the British Thoracic Society's (BTS) winter meeting, volunteers were given theobromine, a chocolate constituent, and capsaicin, a cough stimulant. Theobromine was found to be more effective than placebo and codeine (used in traditional cough medicines) in treating the resulting cough. The researchers, who were from the National Health and Lung Institute in London, said more research needed to be done based on this promising data. "It is too early to advise people suffering from coughs to treat themselves with chocolate," said John Harvey, M.D., chairman of the BTS Communications Committee.

EFAs are also integral for maintaining respiratory health. In a published paper out of the University of Southampton, England, Philip Calder, Ph.D., reported that human inflammatory cells contain high proportions of the omega-6 polyunsaturated fatty acid arachidonic acid (AA), a precursor to 2-series prostaglandins and 4-series leukotrienes--both of which are highly active mediators of inflammation.³⁰ These inflammatory cells, however, also contain low levels of omega-3s. "Animal and human studies have shown that dietary fish oil results in suppressed production of pro-inflammatory cytokines and can decrease adhesion molecule expression," Calder wrote, adding that clinical studies have reported that oral fish oil supplementation has been found to benefit asthma.

Omega-3s such as eicosapentaenoic acid (EPA) may down-regulate the T-helper 1-type response associated with inflammatory diseases like asthma.³¹ Researchers concluded fatty acids also counteract the inflammatory effects of AA.

In a meta-analysis of asthma and fish oil studies, Australian researchers highlighted one study that showed fish oil supplementation improved peak flow rate and reduced asthma medication in asthmatic children; also, there were no adverse events associated with the supplements.³² In a study of asthmatic children, it was found that over the course of 10 months, 84 mg/d of EPA and 36 mg/d of docosahexaenoic acid (DHA, another omega-3) decreased asthma symptoms.³³ In a rat model, DHA (as tridocosahexaenoyl-glycerol) was also shown to reduce bronchial hyper-responsiveness.³⁴

In the area of marine nutraceuticals, green-lipped mussel extract may improve lung function in asthmatics, according to researchers from Russia.³⁵ Patients taking the extract (Hong Kong-based Pharmalink's Lyprinol®) twice per day for eight weeks experienced a decrease in daytime wheezing, as well as improved peak expiratory flow rate. Scientists proposed that the extract's eicosatetraenoic acid (ETA), a metabolite of AA, was the main factor in this improvement.

Methylsulfonylmethane (MSM), a naturally occurring sulfur compound, may also be a respiratory aid. In research out of the GENESIS Center for Integrative Medicine in Washington state, 2,600 mg/d of MSM (as OptiMSM™ supplied by Vancouver, Wash.-based Cardinal Nutrition) over 30 days was found to improve decreased energy levels and other symptoms related to hay fever.³⁶

Whether it is magnesium for asthma or isoflavones for allergies, the respiratory landscape is rife with natural products backed by sound research. While taking these supplements may not be able to help people hold their breath for over six minutes, at least their day-to-day breathing may be improved.

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by Susan Colebank 2004

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