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Health Protocols


Lifestyle Management for Asthma

Asthma needs to be managed even when symptoms are not present. According to the 2007 guidelines issued by the National Heart, Lung and Blood Institute (NHLBI 2007), people with asthma should educate themselves and have a clear action plan (regardless of severity) for the management of their asthma symptoms.

To effectively control and manage asthma in the long-term, patients must be able to self-monitor their symptoms and recognize the warning sign(s) of an attack. They must also be able to respond quickly through timely use of medication(s) and/or other intervention(s). In addition, the patient must recognize and minimize contact with the specific asthma trigger(s) as well as manage other medical/health conditions that can exacerbate symptoms.

Managing Asthma Triggers

People with persistent or seasonal asthma as well as a family history of allergies should have testing for airborne and food allergens. Because asthma and allergies frequently co-exist, treating the allergy symptoms may improve asthma (Boulet 2011). If possible, patients should reduce their exposure to known allergens at home, school, work, or daycare. The patient’s allergist can suggest specific ways to remove the offending allergen(s) and keep the area(s) allergy-free. More information is available in the Allergies protocol.

Patients with asthma are advised to exercise with caution because it can trigger an attack (NHLBI guidelines). They are also advised to avoid exertion when the level of air pollution is high as it can exacerbate exercise-induced asthma. Studies have shown, however, that supervised exercise and leisure-time physical activity reduced symptoms and improved the quality of life in some people with asthma (Kosti 2012). Brief warm-ups and use of short-acting beta-2 agonist medications before exercise or vigorous activity may help prevent or alleviate asthma (Wood 2009).

Preliminary evidence shows that yoga and breathing exercises may also help manage asthma. However, more rigorous trials are needed to validate the evidence (Vempati 2009; Mekonnen 2010).

Managing Conditions Associated with Asthma

Treating conditions associated with asthma can help a patient manage and control the disease. Some evidence suggests that treating GERD may reduce asthma exacerbations and improve the quality of life for some asthma patients (Littner 2005). More information is available in the GERD protocol.

Proper rest and stress management are also important in reducing asthma attacks. Persistent asthma, especially if uncontrolled and severe, can bring about worry and anxiety in the patient. Likewise, evidence indicates that stress in general can precipitate and increase the risk of asthma attacks in children and adults (Wright 2011). More information is available in the Stress Management protocol.

Dietary Considerations

It has been observed that people (regardless of health state) who eat fewer fruits and vegetables have weaker lungs. Also, asthma patients who ate less fruits and vegetables had more frequent attacks (Gilliland 2003).

Obesity is also associated with asthma (Boulet 2011). Obese asthma patients who lost weight observed improvements in their respiratory symptoms and lung function (Maniscalco 2008).

Also, evidence has revealed that a healthy, antioxidant rich diet may be protective against asthma. For instance, three studies found that children who followed a strictly Mediterranean diet (emphasizing plant-based foods such as fruits, vegetables, whole grains, legumes and nuts, with limited intake of red meat) had lower risk of wheezing, diagnosis of asthma, and allergic rhinitis (Chatzi 2009; Arvaniti 2011; Grigoropoulou 2011). Adults who consumed Mediterranean style foods were also seen to have improved control over asthma symptoms (Barros 2008). Also, apples may be protective against asthma. Several population studies have found that greater consumption of apples is associated with lower asthma incidence; polyphenols and other compounds present in apples are thought to convey the protection (Boyer 2004; Hyson 2011).