Asthma is a complicated and complex physiological disease which can result in tragic, sudden death. People who have other related lung diseases, such as chronic obstructive pulmonary disease (COPD), have higher mortality rates from asthma than do people with no history of lung disease, and mortality from all causes can be increased among asthmatic adults.1 Rates of asthmatic deaths are higher in the black population; in the white population, the rates have increased more in females than in males.2 The death rate from asthma in the United States has been increasing over the last 10 years. People suffering a near-fatal asthmatic episode have poor prognoses, with 10 percent of them dying after one year of having the first episode.3
Fatal asthma is the result of the complete loss of the body's homeostatic countermeasures to naturally balance the systems that control the flow of oxygen to the tissues. When this phenomenon occurs, immediate treatment with extreme measures must follow to prevent a possible unfortunate event. These emergency cases are managed using such courses of treatment as inhaled epinephrine and forced ventilation. The usual finding on post expiration is that mucous blocks or plugs the constricted bronchi and bronchioles causing hypoxia, which may lead to suffocation.
For the chiropractor, these cases are to be taken seriously and should be treated aggressively by emergency medical professionals until the condition is stabilized. Once the severe attack has relinquished its grip and the patient is again stabilized, the chiropractor may be the only hope of restoring normal homeostasis of all involved systems.
Not all forms of asthma are associated with fatalities. Individuals can have mild forms of asthma which are restrictive enough to interfere with performing the normal activities of daily living. In its mildest form, asthma can be simply a nuisance when varying degrees of exertion or allergic reactions are involved. For children especially, asthma can become a living psychological incarceration pressed upon them by both their parents and the suffocating nature of the disease.
Chiropractic providers have long touted their ability to help those who suffer with this lung disease by performing adjustments to various levels of the spine. However, a holistic or alternative approach for treatment of patients with asthma may be warranted.
With this additional approach, the chiropractic provider will have another treatment protocol that may better suit the current patient who suffers from this restrictive disease.
By focusing on two prevalent conditions (viscous mucous production and adrenal gland insufficiency), which are directly associated with asthma, a holistic or alternative approach for treatment by using specific recommendations for nutritional supplementation can be derived. The treatment of both will entail traditional chiropractic care along with using a recommendation of pantothenic acid and adrenal gland tissue concentrate as a supplement.
After a comprehensive examination, the chiropractor should address the first danger (which is not the cause of the disease, but the cause of death). The difference between a disease that is deadly and one that is a severe nuisance, as in the case of asthma, is mucous.
Mucous is a viscous fluid that coats the lining of all nasal and oral passages throughout the intestinal tract to its end. For the lungs, the lining secretes mucous as a protective mechanism to reduce drying, trap solid particles, and help prevent infection through immunoglobulins. When the mucous becomes thickened, the cilia that are responsible for removing the debris become fatigued or otherwise inhibited from functioning correctly. To treat mucous viscosity, the practitioner should investigate dietary deficiencies or excesses and alter the diet as needed to reduce a possible inflammatory (tissue congestion) response due to allergic reaction or hypersensitivities.
To help reduce the viscosity of the mucous, pantothenic acid seems to be a viable natural way. Dosages of 200mg of pantothenic acid (B5) per day for adults and lesser dosages for children per day will be sufficient to help reduce the viscosity. Single dosages per day are allowable; however, to achieve an optimum physiological effect of the supplementation, smaller dosages divided evenly throughout the day are encouraged. As with all supplements that are used above normal recommendation, there are caveats.
The initial reaction of pantothenic acid is usually to reduce the viscosity of the mucous. This is often demonstrated by a slight "runny nose effect" approximately 15 minutes after ingestion. This allows for greater mucous clearance to occur, but patients who take the supplementation while concurrently having an upper respiratory infection may exhibit an exacerbation of the infection, possibly because of a decrease in the concentration of immunoglobulins. This subsequent decrease may tend to perpetuate bacterial infection secondary to any upper respiratory virus. However, pantothenic acid may be a valuable tool to stop the buildup of thickened mucous in the lungs and move the asthmatic patient to a safer realm.
The second condition to be addressed is adrenal insufficiency. As stated previously, common medical treatments for bronchial constrictions are medications such as oral steroids and epinephrine to decrease inflammation and cause dilation of the bronchioles and bronchi allowing for better gas exchange in the alveoli.
Under normal circumstances, one function of normal lung physiology is achieved via the adrenal glands by secreting minute amounts of epinephrine, which regulates the diameter of the bronchial tree for maintaining normal airway flow. However, it could be said that during normal physiological function, the nervous system is the actual mechanism that controls or regulates the proper adrenal function, thereby regulating adequate diameters of the bronchial tree.4 Sometimes, due to unusual stress levels placed on the body (allergies, injuries, sicknesses, etc.), adrenal insufficiency occurs because of adaptation (a common neurological occurrence to long-term sustained stimulation).5-7 This adaptation of both the medulla and the cortex causes loss of function to the major anti-inflammatory reducing chemicals of the body and the anti-bronchi spasm chemicals, whereas the response to chronic stress in otherwise normal individuals will result in a shift to increased glucocorticoids.5 Glucocorticoids are the primary mechanism for conversion of protein to glucose, therefore diminishing the body's store of protein.
A study done in New Zealand found that adrenal insufficiency may be an important cause of death in acute severe asthma. A contributing factor to adrenal insufficiency in this study was the use of oral and inhaled steroids on an intermittent and daily schedule. Individuals using oral steroids in divided daily dosages had the greatest suppression of adrenal function and greatest complications from acute asthma.10 Unfortunately, this is a common approach for the treatment of bronchial constrictions. This methodology of treatment may demonstrate that the prolonged use of these medications may be a contributing catalyst for the condition instead of a viable treatment for it.
Another interesting article depicted a patient with sudden hypertensive episodes. After an evaluation was performed, it was determined that she had developed a pheochromocytoma (the adrenal gland and several other tissues are composed of chromic material). As this condition progressed, her asthma eventually subsided. However, the bronchial spasms returned immediately after the tumor was removed.11 This article demonstrated that elevated levels of adrenergic chemicals can affect bronchial activity in a positive way.
To raise the level of epinephrine chiropractically, one resorts to the old philosophy of "consume the organ that is malfunctioning." Therefore, for adrenal gland insufficiency, it is suggested to supplement the gland with adrenal gland tissue concentrate. Therefore, supplements for the adrenals will have adrenal tissue concentrate. Additionally, there are other synergistic elements such as vitamin C, pantothenic acid (small dosages), magnesium8 and others which may include some helpful herbs. Normally, the adult dosage would be 200+ mg per day (80mg for children) when no stressors are in effect. This can be increased in adults to 400mg three times a day when stressors (allergies, illnesses, etc.) are high. This helps supplement the adrenal gland function for the purposes of preventing gland fatigue and metabolic dysfunction by supporting the adrenal gland while proper healing occurs.
Other supportive supplements that may be useful include ginkgo biloba, other various herbs, niacin and B6. The need of these may depend on other conditions that the patient may have concurrently.
The chiropractic philosophy of nerve function out of time with need is paramount in this case. For the body to move out of homeostasis, there must be a driving force that shifts this balance out of the normal range. A possible contributing factor may be from a dysfunction of the sympathetic/parasympathetic relationship from abnormal pressures applied to the spinal nerves by the vertebral column.
Chiropractic's health care philosophy states that the body can maintain homeostasis by reducing biomechanical dysfunctions that may be contributing to aberrant function of the nervous system. Through many years of practice, chiropractors have found associations of biomechanical vertebral dysfunctions of the upper cervicals, mid to lower thoracics, sacrum, and pelvis involved with upper airway disturbances. For example, the osteopaths have documented that manipulation of the upper cervical and thoracic spine can be an effective treatment against such conditions as upper respiratory infections.9
In addition to vertebral dysfunctions, aberrant rib motion and restricted motion of the cranial sutures during respiration have also been associated with upper airway disturbances. Often in young children in the chiropractic office, C1, the sacrum and sometimes the mid-thoracics (which corresponds to the parasympathetic/sympathetics) are checked for subluxation. We recommend that when parents bring their children in for exam and treatment of asthma, the chiropractor should pay special attention to these areas and T 8-9 vertebral levels due to their direct neurological influence on the adrenal glands.
Chronic vertebral segmental dysfunction could also indicate a predisposition for future episodes of upper airway disturbances like asthma. However, a provider who uses the aforementioned supplementation along with the adjustment may find that the patient will not require the same frequency of adjustments as before the supplementation began.
References
- Huovinen E, Kaprio J, Vesterinen E, Koskenvuo M. Mortality of adults with asthma: a prospective cohort study. Thorax 1997;52(1):49-54.
- Sly RM, O'Donnell R. Stabilization of asthma mortality. Ann Allergy Asthma Immunology 1997;78(4):347-54.
- McFadden ER Jr., Warren EL. Observations on asthma mortality. Ann Internal Medicine 1997;127(2):142-7.
- Gray's Anatomy, 4th edition.
- Pignatelli D, Magalhaes MM, Magalhaes MC. Direct effects of stress on adrenocortical function. Horm Metab Res 1998;30(607):464-74.
- Pike JL, Smith TL, Hauger RL, Nicassio PM, Patterson TL, McClintick J, Costlow C, Irwin MR. Chronic life stress alters sympathetic, neuroendocrine and immune responsitivity to an acute psychological stressor in humans. Psychosomatic Medicine 1997;59(4):447-57.
- Hellriegel ET, D'Mello AP. The effect of acute, chronic and chronic intermittent stress on the central noradrenergic system. Pharmacol Biochem Behav 1997;57(1-2):207-14.
- Bar Dayan Y, Shoenfeld Y. Magnesium fortification of water. A possible step forward in preventive medicine? Ann Med Interne (Paris) 1997;148(6):440-44.
- Purse FM. Manipulation therapy of upper respiratory infections in children. JAOA 1966;65(9):964-972.
- Karalus NC, Mahood CB, Dunn PJ, Speed JF. Adrenal function in acute severe asthma. NZ Med Journal 1985;98(788):843-6.
- Harvey JN, Dean HG, Lee MR. Recurrence of asthma following removal of a noradrenaline-secreting pheochromocytoma. Postgrad Med Journal 1984;60(703):364-5.
