Research Database -
International Updates

Asthma / Lung Function / Respiratory Function / Allergies

Issue 74

RITZ, Department of Psychiatry and Behavioral Sciences, Stanford University, Veteran’s Administration, Palo Alto Health Care System, CA, USA, identified and reviewed (80 references) studies on relaxation training for the treatment/management of asthma in adults.
Methods: The author evaluated six controlled and three uncontrolled studies on relaxation training in adult asthma patients carried out between 1980 and 2000. Methods used in the studies included progressive relaxation, functional relaxation, autogenic training or yoga.
Results: Most studies included only small numbers of subjects and had one or more methodological short-comings: e.g. suboptimal data analysis, high drop-out rate, problems with measurement procedures, inadequate descriptions of methods and/or results. Few or no overall effects were found on lung function, symptoms, medication consumption and healthcare use. The author discusses problems with the rationale for using relaxation therapy in asthma from a psychophysiological perspective, and gives examples of possible beneficial and detrimental effects of these techniques on lung function when relaxation interventions target emotional processes, musculoskeletal function and/or breathing.
Conclusion: It has yet to be confirmed whether relaxation training can be of significant benefit to adult asthma patients.
Ritz T. Relaxation therapy in adult asthma. Is there new evidence for its effectiveness? Behavior Modification 25 (4): 640-66. Sep 2001.

RAKHOV and REBROV [no affiliation provided] assessed whether acupuncture added to conventional medical treatment could have an additional beneficial effect in bronchial asthma patients with autonomic dysfunction.
Methods: The study included 192 patients with bronchial asthma and autonomic dysfunction being treated with conventional anti-asthma medication. A programme of corporal acupuncture treatment was added to that of the medical treatment. Changes in rhythmogram, external respiratory function and psychological status were assessed.
Results: The addition of acupuncture improved bronchial permeability and was also reported to improve ‘psychovegetative’ disorders. The investigators reported that the effect of acupuncture was not related to that of placebo.
Rakhov DA, Rebrov AP. (Acupuncture correction of autonomic nervous system disorders in patients with bronchial asthma.) Klinicheskaia Meditsina 79 (3): 38-40. 2001.

Issue 54

HACKMAN and colleagues, University of California, Davis 95616 USA write that asthma, one of the most common chronic diseases of the western world, has significant effects upon patients' quality of life.
Background: Although asthma is usually treated with drugs, there is considerable interest to find effective non-drug therapies. Hypnosis has been used to treat numerous disorders including asthma; however hypnosis has not been used as a standard treatment for asthma The authors review the literature (54 references) regarding hypnosis in the treatment of asthma.
Results: There is significant data to suggest that hypnosis may be an effective treatment for asthma; however it is too soon to conclude that hypnosis is always effective. Research studies conducted have consistently demonstrated that hypnosis has a clinical effect in asthma treatment. Larger randomized, controlled studies are required. Existing data suggest that hypnosis efficacy is enhanced in individuals who are susceptible to the treatment modality, when used by experienced practitioners and when administered over several sessions, and when reinforced by patient autohypnosis. Children appear to respond particularly well to hypnosis as a tool for the improvement of symptoms of asthma.
Hackman RM et al. Hypnosis and asthma: a critical review. The Journal of Asthma 37(1): 1-15. Feb 2000.

KALAYCI and colleagues, Department of Pediatrics, Hacettepe University Faculty of Medicine, Ankara, Turkey studied serum levels of antioxidants in children with bronchial asthma.
Methods: The authors determined serum levels of alpha tocopherol (vitamin E), beta-carotene and ascorbic acid (vitamin C) and lipid peroxidation products (thiobarbituric acid reactive substances (TBARS) in 14 children during an asthma attack and remission. Twelve healthy children served as controls.
Results: All antioxidant vitamins were significantly lower in the asthmatic children at remission compared to controls. Comparisons between attack and remission periods in asthmatic children did not reveal any difference apart from beta-carotene. Levels of all three vitamins correlated highly significantly with each other. TBARS levels were significantly higher during an asthma attack compared to remission periods. There was no correlation observed between the antioxidant vitamins and lipid peroxidation products.
Conclusions: These data demonstrate that antioxidant vitamins are decreased in the serum of asthmatic patents even during the asymptomatic periods of this disease, and that this decrease is not totally dependent upon the increased oxidative stress, as reflected by lipid peroxidation products. The role of antioxidant vitamins in the prevention and/or treatment of asthma remains to be determined.
Kalayci O et al. Serum levels of antioxidant vitamins (alpha tocopherol, beta carotene, and ascorbic acid) in children with bronchial asthma. The Turkish Journal of Pediatrics 42(1): 17-21. Jan-Mar 2000.

OKAMOTO and colleagues, Department of Medicine, Misasa Medical Branch, Okayama University Medical School, Tohaku-gun, Tottori Japan compared the effects of n-3 and n-6 fatty acids on bronchial asthma.
Methods: The authors measured the effects of perilla seed oil (n-3) and corn oil (n-6) in relation to pulmonary function and generation of leukotriene B4 (LTB4) and C4 (LTC4) by leukocytes. 14 patients with asthma were randomized into one of two groups: 1) 7 patients consumed perilla seed oil-rich supplementation; and 2) 7 subjects consumed corn oil-rich supplementation. The groups consumed the oils for a duration of 4 weeks. The generation of LTs by leukocytes and respiratory function were compared between the two groups.
Results: Generation of LTB4 and LTC4 by leukocytes tended to increase in the corn oil-rich supplement group, and decrease in the perilla seed oil-rich supplementation. There were significant differences between the two groups regarding the generation of LTB4 and LTC4 at 2 weeks following dietary supplementation. There were significant increases in PEF, FVC, FEV and V25 pulmonary function values in the perilla seed oil group, as well as significant differences in FVC values and FEV between the two groups after 4 weeks of dietary supplementation.
Conclusions: The results of this study suggest that perilla seed oil-rich supplementation is useful in the treatment of asthma in terms of suppression of LTB4 and LTC4 generation by leukocytes and improvement of pulmonary function.
Okamoto M et al. Effects of dietary supplementation with n-3 fatty acids compared with n-6 fatty acids on bronchial asthma. Internal Medicine 39(2): 107-11. Feb 2000.

FORASTIERE and colleagues, Department of Epidemiology, regional Health Authority, Lazio, Rome, Italy. oer.f.forastiere@agora.stm.it studied the consumption of fruit rich in vitamin C in relation to wheezing and other respiratory symptoms in Italian children.
Methods: The authors write that although a beneficial effect of fresh fruit consumption on lung function has been observed, the epidemiological evidence regarding the effect on respiratory symptoms and asthma is limited. The authors conducted cross sectional and follow-up studies of Italian children. Parents of 18,737 children aged 6-7 years living in northern and central Italy completed respiratory questionnaires. Winter consumption of citrus fruit and kiwi fruit by the children was categorized as less than once per week, 1-2 per week, 3-4 per week and 5-7 per week. A subset of 4104 children from two areas was reinvestigated after one year using a second parental questionnaire to record occurrence of wheezing symptoms over the intervening period.
Results: After controlling for confounders (sex, study area, paternal education, household density, maternal and paternal smoking, dampness or mould in the child's bedroom, parental asthma), intake of citrus fruit or kiwi fruit was a highly significant protective factor for wheeze in the last 12 months (odds ratio (OR) = 0.66) for those eating fruit 5-7 times per week compared with less than once per week, shortness of breath with wheeze (OR = 0.68), severe wheeze (OR - 0.59), nocturnal cough (OR = 0.73), chronic cough (OR = 0.75) and non-coryzal rhinitis (OR = 0.72). the follow-up study indicated that fruit intake recorded at baseline was a strong and independent predictor of all symptoms investigated except non-coryzal rhinitis. In most cases the protective effect was evident even among children whose intake of fruit was only 1-2 times per week and no clear dose-response relationship was found. The effect was stronger (but not significantly) in children with a history of asthma; those eating fresh fruit at least once per week experienced a lower one year occurrence of wheeze than those eating fruit less than once per week.
Conclusions: Although the effect of other dietary components cannot be excluded, it is concluded that consumption of fruit rich in vitamin C, even at a low level of intake, may reduce wheezing symptoms in childhood, especially among already susceptible individuals.
Forastiere F et al. Consumption of fresh fruit rich in vitamin C and wheezing symptoms in children. SIDRIA Collaborative Group, Italy (Italian Studies on Respiratory Disorders in Children and the Environment). Thorax 55(4): 283-8. Apr 2000.

Comments: The take-home message from this research is as clear-cut as can be - children eating fruit even only 1-2 times per week are at significantly less risk of developing respiratory and asthmatic symptoms. And we all thought that Italians ate loads of fruits and vegetables.

Issue 34

HODGE and colleagues, Institute of Respiratory Medicine, Royal Prince Alfred Hospital, Sydney, Australia studied in asthmatic children the clinical and biochemical effects of fish oil and increased omega-3 and reduced omega-6 fatty acids.
Methods: The authors conducted a double-blind, randomised, controlled trial with 39 asthmatic children aged 8-12 years over a 6 month period. The children in the omega-3 group received fish oil capsules plus canola oil and margarine; those in the omega-6 group safflower oil capsules plus sunflower oil and margarine. The authors measured plasma fatty acids, stimulated tumour necrosis factor alpha (TNFalpha) production, circulating eosinophil numbers and lung function at baseline and following 3 and 6 months of dietary modification. Day and night symptoms, peak flow rates and medication use were recorded for 1 week prior to laboratory visits.
Results: Compared to the omega-6 group, plasma phospholipid omega-3 fatty acids were significantly greater at 3 and 6 months. In the omega-3 group TNFalpha production decreased significantly from baseline;
however the magnitude of change between groups was not significant. There were no significant changes in the clinical outcome measures.
Conclusions: Dietary enrichment of omega-3 fatty acids over a 6-month period increased plasma levels of these fatty acids, reduced stimulated tumour necrosis factor alpha production, but did not affect the clinical severity of asthma in children.
Hodge L et al. Effect of dietary intake of omega-3 and omega-6 fatty acids on severity of asthma in children. Eur Respir J 11(2): 361-5. Feb 1998.

Issue 33

VEDANTHAN and colleagues, Northern Colorado Allergy Asthma Clinic, Fort Collins 80524, USA studied the therapeutic effects of yoga upon asthma.
Methods: 17 adult asthmatics, university students from 19-52 years were randomly assigned into 2 groups: 1) yoga (n = 9) and 2) control (n = 8) groups. Breathing and relaxation techniques including breath-slowing exercises (pranayama), postures (yogasanas) and meditation were taught to the yoga group 3 times per week for a total of 16 weeks. All participants in each group kept daily symptom and medication diaries, performed AM and PM peak flow readings, completed weekly questionnaires and underwent weekly spirometry.
Results: The yoga group reported significantly enhanced relaxation, positive attitude and better yoga exercise tolerance, with a tendency toward decreased use of beta adrenergic inhalers. There was no significant variation in pulmonary functions between the yoga and control groups.
Conclusions: Yoga techniques are a beneficial adjunct to the medical management of asthma.
Vedanthan PK et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc 19(1): 3-9. Jan-Feb 1998.

Comments: As detailed in Yoga and Breathing Exercises for Asthma, Issue 25 (February 1998), yoga and breathing techniques have been shown to be extremely effective in preventing asthma attacks, as well as improving pulmonary function parameters.

CHAN and colleagues, Graduate Institute of Pharmaceutical Chemistry, China Medical College, Taichung, Taiwan, Republic of China isolated three new flavonoids, together with twenty-two known compounds, from the heartwood of Dalbergia odorifera T. Chen (Leguminosae).
Methods: These flavonoids were evaluated in antiallergic and anti- inflammatory tests.
Results: The results indicated that (S)-4-methoxydalbergione (1) and cearoin (2) exhibited antiallergic activity and that (S)-4-methoxydalbergione (1), cearoin (2), butein (13), koparin (15), bowdichione (16), 3’-O-methylviolanone (23), and xenognosin B (24) demonstrated significant anti-inflammatory activity.
Chan SC et al. Three new flavonoids and antiallergic, anti-inflammatory constituents from the heartwood of Dalbergia odorifera. Planta Med 64(2): 153-8. Mar 1998.

Issue 30

LUDTKE and WIESENAUER, Institut fur Medizinische Informations-
verarbeitung, Tubingen, Deutschland.rainer.luedtke @uni-tuebingen.de compared the efficacy of homoeopathically prepared Galphimia glauca with that of placebo in the treatment of pollinosis and estimated the overall success rate of Galphimia glauca in a meta-analysis of clinical trials. METHODS: The authors analysed 7 randomised double-blind placebo-controlled trials and 4 non placebo-controlled trials (1 randomised and controlled, 1 prospective uncontrolled, 2 retrospective uncontrolled) conducted by their study group between 1980 and 1989. A further Medline search revealed no other trials on this topic. A total of 1038 ambulatory patients, suffering from acute pollinosis (752 in placebo-controlled trials) were entered into the analysis. The main outcome measures included the relative frequency and relative risk for showing noticeable and soothing relief in eye symptoms as assessed by the patient. METHODS: The overall rate of improved eye-symptoms was about 1.25 times higher in the treatment compared to the placebo group. The success rate of the treatment was estimated as being 79.3%. Across single studies results were highly comparable except for the 1985 study. CONCLUSIONS: There was a significant superiority of Galphimia glauca compared to placebo, with success rates comparable with those of conventional antihistaminics, with no side effects.
Ludtke R and Wiesenauer M. A meta-analysis of homeopathic treatment of pollinosis with Galphimia glauca. Wien Med Wochenschr 147(14): 323-7. 1997.

COMMENTS: Despite a considerable literature now accumulating regarding the effective treatment of allergies such as hayfever using homoeopathy, there is still considerable skepticism within the conventional, as well as the unconventional healthcare communities. However, if homoeopathic treatment is superior to drugs such as antihistamines which have undesirable side effects, then surely physicians ought to sit up and take notice. The public certainly are voting for homoeopathy, with over-the-counter homoeopathic remedies now being sold in most chemists.

Issue 26

XU and colleagues, Visceral Manifestation Laboratory, Huashan Hospital, Shanghai Medical University China studied the effect of strengthening body resistance Chinese method upon asthmatic attacks. METHODS: Asthma patients of Cold and Heat types were divided into control and treatment groups. Control group patients were symptomatically treated, whereas the test group were treated both on the principal and secondary aspects. RESULTS: Test results in the treatment group were markedly higher than in the control group. The 1 second forced expiratory volume (FEV1) and maximal expiratory flow increased markedly, the human leukocyte antigen carrying (HLA-DR+) T cell ratio, basophilic cell releasing capacity (HBR) and T cell hyperplasia response to specific allergen were reduced. These criteria were not significantly changed in the control group. CONCLUSIONS: These results suggest that the strengthening body resistance method displayed a prominent regulating action in relieving asthma attacks.
Xu DS et al. Study on effect of strengthening body resistance method on asthmatic attack. Chung Kuo Chung Hsi I Chieh Ho Tsa Chih 16(4): 198-200. April 1996.

WIGAL and colleagues, Department of Psychology, Ohio University, Athens Georgia USA assessed the effects of experimenter expectancy upon resistance to respiratory air flow in healthy individuals. METHODS: Resistance to respiratory air flow was measured as total respiratory resistance (Rt). 3 naive experimental assistants collected air flow resistance responses from 30 people who, they had been advised, were either likely or unlikely to respond to the suggestion of breathing difficulty. RESULTS: The individuals were randomised to the 2 test conditions. Those people who were described to the experimenters as being likely to respond exhibited greater Rt increases to bronchoconstriction suggestion than those who had been described as unlikely to respond. CONCLUSIONS: These results confirm the presence of a source of variance which has not been considered previously in suggestion studies.
Wigal JK et al. Experimenter expectancy in resistance to respiratory air flow. Psychosom Med 59(3): 318-22. May-Jun 1997.

ROSS, Environmental Health Center, Dallas, Texas 75231 USA jross@ehcd.com illustrates several characteristic feature of multiple chemical sensitivity (MCS) with a case history. METHODS: This case study concerns the induction of asthma and chemical sensitivity in a 42-year old registered nurse, whose problems started after moving into a new home under construction, with associated chemical exposures. RESULTS: MCS patients often report the onset of their condition with chemical exposures such as those encountered at their work places or following the use of pesticides at their homes. Patients describe a spreading phenomenon of increasing intolerance to commonly encountered chemicals at concentrations tolerated by other people. Symptoms often wax and wane and are more likely to occur in individuals or families with history of migraine or classical allergies. Idiosyncratic drug reactions are common, as are symptoms such as vascular instability and poor temperature regulation. Also common are myalgia, joint pains and food intolerance. When tested these patients are found to have contamination with xenobiotic chemicals. A recently identified condition which exhibits features of both asthma and chemical sensitivity is reactive airways dysfunction syndrome. MCS patients often show patterns of neurotoxic brain metabolism which can be confirmed using single photo emission computed tomography (CT) imaging.
Ross GH. Clinical characteristics of chemical sensitivity: An illustrative case history of asthma and MCS. Environ Health Perspect. 105 (Suppl 2): 437-41. Mar 1997.

COMMENTS: Asthma and allergies are extremely prevalent and appear to becoming even more so. Sources of exposure can be found everywhere – foods eaten, environmental chemicals - in addition to inherited allergic conditions. Approaches to treating allergies are numerous, embracing all the major complementary therapies. The above research studies illustrate the magnitude of effort being devoted to treating such chronic and distressing conditions which afflict so many people’s lives.

Issue 24

KHANAM and colleagues, Department of Physiology, All India Institute of Medical Science, New Delhi India write that the concept that yoga may be helpful in the treatment of bronchial asthma has stimulated a great deal of interest within medical research fields. The authors conducted a study to determine whether autonomic and pulmonary functions are improved following short term yoga training. METHODS: 9 patients diagnosed with bronchial asthma participated in a 7-day yoga training camp. Autonomic function tests – Deep Breathing, Valsalva Manoeuvre, Hand Grip, Cold Pressure tests – and pulmonary functions tests – FVC, FEV1, PEFR, PIF, BHT and CE – were recorded prior to and following yoga training. RESULTS: Resting heart rate was significantly decreased following yoga training, as was sympathetic reactivity. There was no change in parasympathetic reactivity. FVC, FEV1, PEFR did not change significantly, but PIF, BHT and CE improved significantly. CONCLUSIONS: These results demonstrated reduction in sympathetic reactivity and improvement in pulmonary ventilation by relaxation of voluntary inspiratory and expiratory muscles. The short term yoga training for patients with bronchial asthma has resulted in significant benefit even within only 7 days.
Khanam AA et al. Study of pulmonary and autonomic functions of asthma patients after yoga training. Indian J Physiol Pharmacol 40(4): 318-24. Oct 1996.

DAI and colleagues, Department of Pharmacology of Chinese Materia Medica, China Pharmaceutical University, Nanjing, People’s Republic of China write that Wu-Hu-Tang (WHT) is a Chinese formulation consisting of 7 crude drugs which has been used for the treatment of asthma for hundreds of years. METHODS: The authors studied the anti-allergic activity of an aqueous extract of WHT to discover the pharmacological basis for the ethnomedical use of the formulation. RESULTS: The use of WHT resulted in a significant inhibition on the homologous passive cutaneous anaphylaxis (PCA) in rats and heterologous PCA in mice, a decrease in the degranulation of mast cells of calvarial periosteum in rats, an inhibition of the release of anaphylactic mediators from sensitised lung tissues of guinea pigs and the contraction of isolated guinea pig ileum induced by histamine. CONCLUSIONS: These data indicate that the therapeutic activity of WHT in the treatment of asthma may be associated with its inhibitory effects upon immediate hypersensitivity.
Dai Y et al. Anti-allergic effect of an aqueous extract of wu-hu-tang. J Ethnopharmacol 55(2): 127-32. Jan 1997.

COMMENTS: Despite the multitude of research papers published which demonstrate the therapeutic benefits for asthma sufferers of yoga, relaxation, autogenic training, synchronised breathing and supplementation with antioxidant vitamins, the medical establishment appears to have fallen in love with diagnosing the majority of us as having asthma, and then equipping us with inhalers and steroids for the duration of our lives. This, despite the serious medical side effects and risks carried by the current orthodox asthma treatment. This comment is made at the risk of belabouring my disgust at the medical profession’s persistent inability to read the research literature and act upon its content. Or is it that breathing, relaxing and stretching don’t have fancy price tags?

PETERS-FUTRE, Division of Physical Education, University of the Witwatersrand, Johannesburg, South Africa writes that moderate submaximal exercise results in neutrophilia, enhanced phagocytic and oxidative capacity of neutrophils. However, it has been hypothesised that this pro-oxidative effect becomes suppressive during intensive exercise and periods of intensive training. Vitamin C is widely recognised for its antioxidant property in extracellular fluid and has been documented to neutralise various oxygen free radicals and to attenuate the suppression of phagocyte function. However, the clinical demonstration of reduced neutrophil function following the participation in marathon races has not been observed. Although neutrophils comprise 50-60% of leukocytes and although they are the first line of defense against bacterial infection, post-marathon race episodes of upper respiratory tract infection (URTI) are not associated with a decline in the function of this immune function parameter. The therapeutic efficacy of vitamin C supplements to reduce incidence of postrace URTI symptoms cannot therefore be fully explained at the present.
Peters-Futre EM. Vitamin C, neutrophil function, and upper respiratory tract infection risk in distance runners: the missing link. Exerc Immunol Rev 3: 32-52. 1997.

Issue 23

BLACK and SHARPE, Dept of Medicine, University of Auckland, Auckland Hospital, New Zealand review (72 references) the possible connection between the fall in the consumption of saturated fat, the increased consumption of polyunsaturated fat in the diet and the increased prevalence of asthma, eczema and allergic rhinitis in developed countries. RESULTS: The changes in the types of fats consumed in the diet is largely due to a reduction in the consumption of animal fat and the increased use of margarine and vegetable oils containing omega-6 polyunsaturated fatty acids (PUFAs) including linoleic acid. There has also been a reduced consumption of oily fish containing omega-3 PUFAs including eicosapentaenoic acid (EPA). In some countries, there are social class and regional differences between the prevalence of allergic disease which are associated with differences in the consumption of PUFAs. Linoleic acid is a precursor to arachidonic acid, which can be converted to prostaglandin E2 (PGE2), whereas EPA inhibits PGE2 formation. PGE2 acts upon T-lymphocytes, reducing the formation of interferon-gamma (IFN-gamma) but not affecting the formation of interleukin-4 (IL-4). This may lead to allergic sensitisation, as IL-4 promotes immunoglobulin E (IgE) synthesis, whereas IFN-gamma has the opposite effect. CONCLUSIONS: Changes in diet may explain the increased prevalence of asthma, eczema and allergic rhinitis. The effects of diet may be mediated through an increased synthesis of prostaglandin E2, which in turn may promote the formation of immunoglobulin E.
Black PN and Sharpe S. Dietary fat and asthma: is there a connection? Eur Respir J 10(1): 6-12. Jan 1997.

COMMENTS: For perhaps a partial answer to this question, please read the next research update, where researchers have determined the presence of allergenic proteins in commercially available butter and margarine.

YOKOTA and colleagues, Department of Pediatrics, Yokahama City University, Japan determined the allergenic proteins in commercially available butter and margarine, extracted the protein fractions and analysed them immunologically against milk, hen egg and soybean antigens. RESULTS: Butter and 10 kinds of margarine were demonstrated to contain these allergenic proteins using ELISA and immunoblotting techniques. However, hypoallergenic margarine was found to contain no such proteins whatsoever. Using sera obtained from atopic dermatitis patients, which previously detected high levels of IgE antibodies to milk, hen egg or soybeans, the extracted protein fraction from butter and margarine was analysed to see whether these proteins reacted with IgG antibodies in the patients’ sera. The sera with high levels of specific IgE reacted with protein antigens in these extracts, except from those from hypoallergenic margarine, suggesting that proteins in butter and margarine may become allergenic for the patients sensitive to the allergenic proteins and that hypoallergenic margarine may be a reasonable alternative for the allergic patients to milk, hen egg or soybeans.
Yokota S et al. Immunologic analysis of milk, hen egg and soybean proteins in butter and margarine and clinical assessment for availability of hypoallergenic margarine (HAM). Arerugi 45(12): 1237-43. Dec 1996.

COMMENTS: This work may be incredibly valuable for the countless millions of infants, children and adults with allergies to commonly consumed everyday foods such as milk, eggs and soybean. If the allergens can be replaced with a hypoallergenic margarine for a temporary period to enable immune recovery, this may prevent the development or progression of full-blown serious allergic reactions. I would like to know what the composition of this hypoallergenic margarine was.

CAMBACH and colleagues, Dept of Physiotherapy, VU Hospital, Amsterdam, The Netherlands conducted a multicentre randomised controlled study to compare the differences in efficacy between a 3-month rehabilitation programme including drug treatment and a 3-month control period of drug treatment only, for patients with asthma and chronic obstructive pulmonary disease (COPD). METHODS: The programme, conducted by physiotherapists in 8 local practices, included exercise training, patient education, breathing retraining, mucus evacuation, relaxation techniques and recreational activities. The randomised controlled trial had a cross-over design. The effects of rehabilitation were evaluated 3 and 6 months following baseline measurements regarding exercise tolerance and quality of life (QOL). Exercise tolerance was assessed using submaximal cycle ergometer tests and a 6 minute walking test. QOL was evaluated using the Chronic Respiratory Disease Questionnaire (CRDQ). RESULTS: After 3 months, compared to the control group, patients in the rehabilitation programme showed significant improvements in endurance time (421 s) and cardiac frequency (6 beats/min) during cycling, walking distance (39m), and total CRDQ score (17 points). These improvements were still significant after 6 months. The patients with asthma and COPD responded to rehabilitation in a similar way, except that there was a greater improvement in walking distance for patients with asthma. Exercise tolerance improvements were not significantly correlated with QOL improvements. CONCLUSIONS: In patients with asthma or chronic obstructive pulmonary disease, rehabilitation in local physiotherapy practices improves exercise tolerance and quality of life.
Cambach W et al. The effects of a community-based pulmonary rehabilitation programme on exercise tolerance and quality of life: a randomized controlled trial. Eur Respir J 10(1): 104-13. Jan 1997.

ESTEVE and colleagues, Unite IRM, Centre Hospitalier Universitaire de Grenoble, France studied the effects of a particular breathing pattern training (BPT) upon forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) in patients with chronic obstructive pulmonary disease (COPD). METHODS: Patients adjusted each breath to a target breath, chosen in an individual sample recorded at rest, displayed on a video screen using visual feedback. In a randomised controlled study, 20 patients with stable COPD, FEV1 less than 1.5 litres undergoing a traditional rehabilitation programme were randomly assigned either to the BPT or the control group. The BPT people underwent 30-35 training sessions over 4 weeks, in addition to the traditional programme. FEV1 and FVC were measured prior to and following this programme. RESULTS: In BPT patients, FEV1 and FVC improved significantly, with a mean percent increase of 22% and 19% respectively. Changes in the controls were not significant. CONCLUSIONS: These results showed short-term increases in FEV1 and FVC in COPD patients practising BPT in addition to respiratory rehabilitation. Further research is required to clarify the mechanisms and duration of this effect.
Esteve F et al. The effects of breathing pattern training on ventilatory function in patients with COPD. Biofeedback Self Regul 21(4): 311-21. Dec 1996.

BLANC-GRAS and colleagues, Laboratoire de Physiologie, Faculte de Medecine de Grenoble, Paris, France trained 15 asthmatic and 15 healthy children to adjust their breathing pattern to a target pattern displayed on a video screen using visual feedback. RESULTS: The error scores between the two groups were not significantly different. This data does not support the hypothesis that voluntary control of respiratory muscles is impaired in asthmatics.
Blanc-Gras N ete al. Voluntary control of breathing pattern in asthmatic children. Percept Mot Skills 83(3 Pt 2): 1384-6. Dec 1996.

COHEN and colleagues, Pediatric Ambulatory Clinic, Rabin Medical Center, Petach Tiqva, Israel sought to discover whether vitamin C has a protective effect upon the hyperreactive airways of people with exercise-induced asthma (EIA). METHODS: 20 asthma patients ( 13 males; 7 females) aged 7-28 years participated in the study. All patients underwent pulmonary function tests at rest, prior to and 1 hour following 2 g oral vitamin C. They were then randomly assigned, double-blind, to receive 2 g vitamin C or a placebo 1 hour prior to a 7-minute exercise session on a treadmill. Pulmonary functions tests were conducted following an 8-minute rest. This sequence was repeated 1 week later, with each patient receiving the other treatment (vitamin C or placebo). Patients were advised to stop using their regular asthma medication or bronchodilatory 12 hours prior to the test. RESULTS: All 20 patients were diagnosed with EIA, which is defined as a decline of at least 15% in their forced expiratory volume in 1 second following a standard exercise test on a motorised treadmill. Vitamin C did not affect the pulmonary function test results at rest after 1 hour. However, in 9 patients, a protective effect upon exercise-induced hyperreactive airways was documented with vitamin C. 4 out of 5 patients receiving vitamin C and who documented a protective effect upon EIA were given 0.5 g/day vitamin C for 2 additional weeks, with the same protective effect. CONCLUSIONS: Although vitamin C may not be able to prevent EIA, vitamin C may have a protective effect upon airway hyperreactivity in certain patients with EIA.
Cohen HA et al. Blocking effect of vitamin C in exercise-induced asthma. Arch Pediatr Adolesc Med 151(4): 367-70. Apr 1997.

COMMENTS: It is interesting yet self-evident that the two most prevalently researched options in the treatment of asthma are: 1) nutritional, with supplementation with vitamins, minerals and essential fatty acids\; and 2) changes in breathing pattern, the latter either through relaxation, hypnosis, yoga, autogenic or biofeedback. The above research updates illustrate both these approaches. Cohen et al, by working with exercise-induced asthma, combines indirectly the nutritional approach with the effects of exercise and therefore the breath. Asthma is such a huge problem, affecting such a significant minority of all children in the developed world, that all avenues of exploration need to be pursued.

Issue 21

FEDOSEEV and colleagues, Eastern Europe researched the treatment of bronchial asthma with dietary therapy. METHODS: 10 bronchial asthmatic (BA) patients were assigned to the control group, who were treated with conventional medicine, 10 BA patients were assigned to absolute diet therapy (group 1) and 10 BA patients were treated with absolute diet therapy combined with wheat herb juice (group 2). The patients from all three groups were assessed for their tolerance to 12 antibiotics of different classes and a number of immunity factors using diagnostic methods which included a case history, humoral and cellular immunity defense system tests, chemical erythrogram, and leukocyte migration inhibition tests. RESULTS: Compared with the control group, Groups 1 and 2 showed increased tolerance of antibiotics, as well as changes in humoral defense, particularly in immunoglobulin E. CONCLUSIONS: Drug tolerance may be a therapeutic criterion of absolute diet therapy in bronchial asthma patients.
Fedoseev GB et al. Absolute diet therapy and antibiotic tolerance in bronchial asthma patients. Ter Arkh 68(80): 28-31. 1996.

COMMENTS: I find this research abstract somewhat imponderable. Unfortunately, many foreign language publications come only with an English language abstract, and in this instance there is no institutional affiliation. Perhaps readers other than myself will understand what absolute diet therapy means and can enlighten the rest of us?

SCHERRER-CROSBIE and colleagues, Departement de Medecine Nucleaire, Institut National de la Sante et de la Recherche Medicale Unite 296, Creteil, France write that cigarette smoking increases the permeability of alveolar epithelium to small solutes. The authors tested in the involvement of lipid peroxidation in this increased clearance. METHODS: 8 asymptomatic young smokers were supplemented with oral vitamin E (1,000 IU/day) for 3 weeks, in a single-blind crossover study. Actue tobacco intoxication and lung function parameters were measured. RESULTS: Pulmonary clearance was abnormally increased and correlated strongly with expired CO, HbCO, urinary cotinine and Krogh factor (KCO). Supplementation with vitamin E neither decreased pulmonary clearance nor changed the above correlations. However, the strong correlations between pulmonary clearance and indices of acute tobacco intoxication, reflecting the amount of inhaled smoke and resultant oxidant stress, do not rule out the involvement of lipid peroxidation in the pulmonary clearance increase seen in smokers.
Scherrer-Crosbie M et al. Pulmonary clearance and lung function: influence of acute tobacco intoxication and of vitamin E. J Appl Physiol 81(3): 1071-7. Sep 1996.

LEWITH and WATKINS, University of Southampton UK write that acupuncture, homoeopathy, mind-body therapies and nutritional, herbal and environmental medicine have all been applied in the treatment of patients with asthma. This paper reviews (105 references) the evidence for the use of these unconventional or complementary therapies. Although there may be a shortage of large randomised controlled trials in this field, there is sufficient clinical evidence to suggest that many of these therapies may produce objective and subjective benefit in selected groups of patients. In light of the increasing popularity of complementary medicine among patients and general practitioners, there is an urgent need for high-quality research to determine how these therapies may be combined with the more orthodox treatments currently available.
Lewith GT and Watkins AD. Unconventional therapies in asthma: an overview. Allergy 51(11): 761-9. Nov 1996.

COMMENTS: Absolutely!

Issue 20

MONTELEONE and SHERMAN, Department of Medicine, University of Medicine and Dentistry of New Jersey Robert Wood Johnson Medical School, New Brunswick USA write that the search for the causes of asthma has led to the investigation of genetic, atopic, viral and nutrition factors. The authors state that over the last two decades, several studies have linked particular nutrients to asthma, studying both the suboptimal status of particular nutrients as causes of asthma and the supplementation of specific nutrients as therapy for asthma. The authors review (61 references) and analyse the research data from these studies to determine the role of nutritional therapy in the management of asthma. RESULTS and CONCLUSIONS: Studies regarding food allergies demonstrate that IgE-mediated reactions to food are a minor cause of respiratory symptoms, affecting more children than adults. They conclude that there are no available data to support the use of nutritional supplements in the treatment of chronic asthma.
Monteleone CA and Sherman AR. Nutrition and asthma. Arch Intern Med 157(1): 23—34. Jan 13 1997.

COMMENTS: There is a body of research evidence demonstrating that vitamins A and E and fish oils are effective in the treatment of asthma. For a summary of the role of nutritional supplements in the treatment of a variety of illnesses, please see Chapter 11 – Nutrition: Pivotal in prevention and treatment of disease and promotion of health by Sandra Goodman, Ph.D. In: Mind-Body Medicine (A Watkins, Editor), Churchill Livingstone. In Press.

NESS and colleagues, Institute of Public Health, University Forvie Site, Robinson Way, Cambridge UK studied the relationship between respiratory function and vitamin C levels in blood plasma. METHODS: 835 men and 1025 women aged 45—75 registered with GP practices in Norfolk completed a health and lifestyle questionnaire and attended a health check. The outcome measures were: forced expiratory volume in one second (FEV1); forced vital capacity (FVC); and non-fasting plasma vitamin C. RESULTS: Plasma vitamin C was positively correlated with both FEV1 and FVC in men, following adjustment for age and height; the association in women was weaker and not statistically significant. In men, differences in FEV1 and FVC for a 50micromol/l difference in vitamin C were 0.22 litres and 0.23 litres respectively. 12.1% of men with vitamin C levels less than or equal to 30 micromol/L had an FEV1 of less than 2 litres, whereas only 4.6% of men with vitamin C levels greater than or equal to 60 micromol/L had an FEV1 less than 2 litres. CONCLUSIONS: These results are consistent with data from other studies of vitamin C and respiratory function and suggest that vitamin C is protective for lung function through the whole normal range of dietary intake and lung function.
Ness AR et al. Vitamin C status and respiratory function. Eur J Clin Nutr 50(9): 573—9. Sep 1996.

HEMILA, Department of Public Health, University of Helsinki, Finland writes that various studies have shown an increased risk of respiratory infections in people performing heavy physical exercise. Since vitamin C has been shown to affect some components of the immune system, it may have effects upon the increased incidence of respiratory infections caused by heavy physical stress. METHODS: Results were analysed from 3 placebo-controlled studies examining the effect of vitamin C supplementation on the incidence of common cold in people under acute physical stress. In one study, the participants were school children at skiing camp in the Swiss Alps; in the second they were military troops training in Northern Canada; in the third they were participants in a 90 km race. RESULTS: A considerable reduction in common cold incidence in the vitamin C supplemented (0.6—1.0 g/day) group was found in all 3 studies. The pooled rate ratio (RR) of common cold infections was 0.5 for the vitamin C groups. CONCLUSIONS: The results suggest that vitamin C supplementation is beneficial for individuals performing heavy exercise and who suffer with frequent upper respiratory infections.
Hemila H. Vitamin C and common cold incidence: a review of studies with subjects under heavy physical stress. Int J Sports Med. 17(5): 379—83. Jul 1996.

COMMENTS: I recall reading recently an article in the popular press where the author stated that there was absolutely no evidence for vitamin C having any effect on colds. Touché!

Issue 19

ADRABOVA and colleagues, Institute of Preventive and Clinical Medicine, Bratislava, Slovak Republic write that lowered selenium (Se) status has been observed in asthma patients. Increased production of reactive oxygen species (ROS), due to inflammatory conditions has also been found in these people, implying the importance of antioxidant properties of Se via the activity of glutathione peroxidase (GPx). METHODS: Plasma and red blood cell Se and red blood cell GPx concentrations were compared in 22 patients with intrinsic asthma with 33 control subjects. RESULTS: Compared with controls, Se concentration in plasma and red blood cells and GPx activity were decreased in the intrinsic asthma patients. There was a significantly high positive correlation between Se plasma and red blood cell concentrations. CONCLUSIONS: Se supplementation may be beneficial to patients with intrincis asthma, who may be at risk of Se deficiency.
Kadrabova J et al. Selenium status is decreased in patients with intrinsic asthma. Biol Trace Elem Res 52(3): 241-8. Jun 1996.

PEAT, Dept of Medicine, University of Sydney, NSW, Australia writes in this review (185 references) that environmental factors which have changed within the past decade appear to be largely responsible for the increased prevalence of asthma in affluent countries, and that it ought to be possible to design interventions to reverse these trends and reduce asthma incidence. Primary preventive strategies could potentially reduce the acquisition of sensitisation to common allergens and thereby the risk of developing symptoms and also reduce the morbidity in people who already are asthmatic. He cites accumulating epidemiological evidence that dietary excesses of sodium and omega-6 fatty acids, dietary deficiency of antioxidants and omega-3 fatty acids, reduced breastfeeding rates, exposure to allergens and environmental tobacco smoke, are all associated factors in asthma's aetiology. Reduction of the incidence and thereby the prevalence of asthma could potentially be accomplished by modifying these factors, particularly environmental intervention which could be effective for children who have inherited or are at high risk of developing asthma. CONCLUSIONS: Reviewing the available evidence, it appears reasonable to assume that applying interventions based upon our current knowledge of risk factors could reduce by 50% the prevalence of asthma in the next generation of children.
Peat JK. Prevention of asthma. Eur Respir J. 9(7): 1545-55. Jul 1996.

COMMENTS: Recently published findings suggest that in addition to environmental factors, the "normal" development of immunity in children by challenge with common childhood diseases and microorganisms, may be hindered by increased reliance upon immunisation and a more sanitised lifestyle. Our diminished ability to cope with external allergens may also be key components in the dramatic rise of asthma in developed nations.