Many asthma sufferers self-treat with herbs
Some may help; more studies, regulations needed
Some patients with asthma are quite literally returning to the roots of modern medicine to find old ways of treating disease.
A recent review study of herbs popularly used in seven cultures to treat asthma or alleviate its symptoms presents some thought-provoking conclusions: Some herbal remedies can be very effective, and patients with asthma can find relief often without side effects commonly associated with current therapies.
Health care professionals should not discount the effectiveness of herbal remedies, says Leonard Bielory, MD, director of the asthma and allergy research center at the University of Medicine and Dentistry of New Jersey in Newark and lead author of the study published in the Journal of Asthma earlier this year.
Bielory sifted through hundreds of papers on the use of herbs to treat asthma, throwing out the testimonials and looking for "hard scientific evidence" among the remaining studies that employed a wide range of methods.
Scientific evidence is often hard to find, says Irwin Ziment, MD, professor of medicine at UCLA School of Medicine and chief of medicine at Olive View-UCLA Medical Center at Sylmar, CA. "There are so few double-blind control studies on this subject because they’re hard to do. They’re expensive, and they’re not patentable," he says. "It’s not surprising when companies can make a great deal of money selling herbs as dietary supplements without having to prove their claims."
Bielory is cautious about his findings, but says, "There are definitely some herbal-based compounds that have very interesting abilities. There are some great potential agents. I would definitely like to see more research."
Some of his findings include:
• A number of studies support the use of herbal medicines in asthma and allergy.
• The results show positive effects of some herbs on bronchodilation, pulmonary function, antagonism of asthma mediators such as histamine and platelet activating factor, corticosteroid levels, and clearance of mucus.
• Use of herbal medicine has increased in recent years.
• Some herbs provided relief equal to allopathic medicines used, without many of the side effects of current therapies.
"Through the history of medicine, drugs have been developed from traditional medicine," Bielory wrote in the journal article. "By continuing to investigate how some of these herbal interventions work, we may be able to find additional effective medicines to treat asthma and allergies."
He says ma huang, also known as ephedra sinica, an herb commonly used in Chinese medicine, is the herbal remedy that stands out among all others because numerous studies show its active ingredients, ephedrine and several of its derivatives, are effective against mild bronchospasms. They stimulate the sympathetic and central nervous systems and act as an anti-tussive.
"There are quite a few studies that show it is effective," says Bielory.
However, Ziment cautions clinicians, "If I had a patient taking ma huang, I would tell him to stop because of the danger of overstimulating the sympathetic nervous system." (Reports have shown high doses of the product can cause cardiac rhythm disorders and a rise in blood pressure. Some doctors have advised patients to stop taking ma huang until it is regulated as a pharmaceutical and not as an herb.)
Ephedra is the basis of some of the most effective medications used in the treatment of asthma today, he says. "From Sudafed to Albuterol, these drugs were developed from ephedra," he says.
He notes several other folk remedies form the basis for today’s asthma medications. Atrovent is an example. The effective bronchodilator is developed from ingredients derived from atropine. But atropine originated from a smoked mixture of compounds widely used in India. And cromolyn, a folk plant remedy from Egypt, led to the development of Intal, used to treat bronchospasm.
Bielory found several other popular remedies he thinks warrant further investigation — and several others he thinks have little scientific validation. For example, with the popular gingko biloba: "There are about 10 animal studies that show gingko has a positive effect in relieving bronchospasm," says Bielory. "It definitely needs further analysis."
Studies have shown that even the lowly onion (allium cepa) has a mild bronchodilator effect. "There are real data for that," Bielory says.
However, the jury is still out on skullcap (scutellaria lateriflora) and licorice (glycyrrhiza glabra), he says.
On the other hand, there are some herbs for which there is little or no validated use against asthma, Bielory says. Among them are ginseng (panax ginseng) and cinnamon.
While the actions of some herbs are real, he says, there is undoubtedly a placebo effect at work in some cases. "Do not discount the placebo effect even if you think herbs don’t do anything," he warns health care professionals. "Recent research shows the placebo effect can help people improve by 20% to 30%."
Ziment says the real question in his mind is why are so many asthma sufferers seeking therapies outside the realm of allopathic medicine?
One reason, he theorizes, is that patients are losing their confidence in doctors and in the medical system. "There’s a strong belief in alternative approaches," Ziment says. "We may need to alter the way we are approaching our patients."
Many health care professionals look down their noses at patients who use herbs or other alternative therapies, he says. "The worst thing to do is to make the patient feel stupid," Ziment says. "When you do that, the patient won’t tell you about it and you’re losing something."
"It’s not alternative medicine anymore," he says, "but integrative medicine. We bring together the best of each in a great combination."
Just a few years ago, patients had "100% trust in their doctors," Ziment says. "Now it’s more like 95% or even less. That other 5%, they’re getting from TV, magazines, their hairdresser."
Bielory says lower back pain is the primary health problem for which Americans seek alternative therapies, but the No. 2 reason is to relieve symptoms of allergies and asthma.
"It’s because people like to be in control of their lives," he says. "The patient who wants a magic pill to cure him won’t do well. But patients looking for alternative therapies are involved in their health; they are active. They’re the good ones to work with."
Bielory adds that successful disease management includes getting the patient involved in controlling the disease. If patients want to be involved, that aids success.
[Leonard Bielory can be reached at (973) 972-2762 and Irwin Ziment at (818) 364-1555.]
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