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Part 2 of Top 10 Prescribed Medications: Albuterol (2)

CONDITIONS TREATED: ASTHMA, COPD, OTHER LUNG DISEASES


Albuterol as a metered dose inhaler (MDI) is the 2nd most prescribed medication in the United States. Albuterol is a short acting bronchodilator - it prevents and treats bronchospasm, or narrowing of the tubes that lead to the lungs. Albuterol may also be prescribed for treatment of bronchitis and other respiratory infections. Substances have been inhaled to treat asthma for 3,500 years. Albuterol was patented in 1972 and was a life-changing invention for asthmatics, now known as the "rescue inhaler". Every person living with asthma should be carrying a rescue inhaler at all times, they rescue people living with asthma from potentially life-threatening emergencies.


While asthma is not a modern disease, the number of people living with asthma is increasing, especially in America. There are hypothetical causes, including hygiene hypothesis, increasing environmental toxins, and antibiotic over-use, but no definitive answer. Asthma is a hypersensitivity reaction, or a reaction of the body to an antigen that's not harmful. In an asthma attack, the body responds quite drastically by closing the tubes for air to enter in order to protect it from further exposure to the antigen.

  • The Hygiene hypothesis states we have become more sensitive to antigens because the immune system is not adequately exposed to antigens in childhood. In other words, we have become too clean and children aren't exposed to enough antigens in childhood to de-sensitize their immune systems to otherwise innocuous substances.

  • The environmental exposure doctrine assumes more not-so-innocuous substances are in the environment, triggering asthma. Asthma attacks come with triggers - cold air, smoke, perfume, car exhaust, pollen, etc. If living with asthma, it's important to know triggers and avoid them as much as possible.

  • The over-use of antibiotics may be implicated because the body's microbiome plays a significant role in the development of the immune system, when antibiotics wipe out the microbiome, less foreign material is present to de-sensitize the immune system, causing a reaction when foreign materials enter the body.

FUNDAMENTALS OF HEALTH: Asthma


DIET

  • Obesity is a known risk factor for poor asthma outcomes. Weight loss is dependent on maintaining a consistent calorie deficit over time. See Part 1 of this series for more information about calorie deficits and sustainable weight loss.

  • Fruit and vegetable consumption is protective. The anti-oxidants in fruits and vegetables regulate the inflammatory response by neutralizing free radicals before they irritate the lungs. Choose a wide variety of fruits and vegetables in a variety of colors for a broad array of phytonutrients.

  • Include fermented foods in daily diet. Examples include yogurt, sauerkraut, kim chi, and some cheeses. Another important source of bacteria is the soil. Eat foods from your garden and wild foods - blackberries, huckleberries, edible greens - without washing. If you have a garden and don't use pesticides, another popular suggestion is 1 tsp of dirt in water daily. Don't drink the sediment, let it settle and the necessary components will disperse in the water that's consumed.

  • About 5-10% of asthmatics are sulfite sensitive. The most common high sulfite foods include prepared juices (non-frozen), dried fruits (there are exceptions), wine, and store-bought sauerkraut or other fermented vegetables (home fermentation is easy). There are tests available for diagnosing sulfite sensitivity, usually at an allergist's office. You can also do an elimination using a more extensive list of sulfite containing foods and meticulously reading food ingredient labels. Eliminate all high-moderate foods for 4 weeks and monitor asthma symptoms and need for rescue inhaler. Notice changes. If, after the 4 weeks are up, you would like to challenge sulfite foods, choose a very small amount of a moderate sulfite food, like a taste of wine vinegar instead of wine. Give yourself some time, several hours or so, before trying a higher sulfite food. If asthma symptoms worsen, then you're likely sulfite sensitive.

  • Allergy testing can be a valuable tool in determine environmental and dietary factors contributing to asthma, skin prick testing is the most accurate.

  • Milk is a traditional remedy for nourishing the lungs, but some people feel worse when drinking milk, possibly due to the acidity of milk causing increased production of mucous and cough. Citrus fruits, such as orange juice, may have the same effects.

  • Elimination diets can be helpful for determining how you feel eating certain foods.

  • Many people are allergic to grass, does it make sense that the seeds of grasses (grains) may also negatively affect asthma in these people? A trial off grains may be helpful.

  • The carnivore diet is an extreme diet of only animal products and salt, and some practitioners only eat ruminant animals (cow, lamb, deer, buffalo, elk, moose, goat). There are case studies reporting complete resolution of asthma within months of a carnivore diet. I only mention this diet because I've seen it miraculously work twice, for a period of time of up to 2 years without sign of deficiency. Electrolytes are important with this diet, as is coaching from an experienced provider. My nutrition education always praised plant based diets, so I remain skeptical of this way of eating. That being said, I know humans don't know that much about nutrition and evidence is variable. I rule nothing out, and if someone eats a carnivore diet and reports a higher quality of life doing so, I do not deny what they're doing is healthy. I do check their labs, though, and so far, so good. Learning to hunt your own meat makes this diet more affordable, healthier, and more climate friendly. Also, directly procuring one of the necessities of life, food, increases feelings of purpose, especially when fed to someone you love.

  • Mullein leaf is a known lung nourisher. Make an infusion (strong tea) using 1 oz dried herb with 1 quart of boiling water, steeped at room temperature for at least 4 hours (overnight), then strained through a fine mesh strainer. Drink iced or hot.

  • Dried Mullein probably needs to be bought online, I like Frontier Coop.

  • If you are adventurous, Mullein is a weed that grows wild and can be harvested mid-late summer, making herbal medicine affordable and helping develop a relationship with the plant. Plants are living beings and when we develop a relationship with them, they work better.

  • Here's a recipe for Mullein chai, a lung nourishing treat.

EXERCISE

Maintaining physical fitness is important for everyone, and can especially benefit people living with asthma. Exercise increases air capacity of the lungs and blood flow to the lungs. Increased blood flow to the lungs helps the blood pick up more oxygen from extra air, which increases oxygen delivery to the body's tissues.


Generally, those living with asthma can participate in any physical activity. Many Olympic and professional athletes are living with asthma. As always, start slowly and work up to increased frequency, duration and intensity. Recovery is important, as is using your Albuterol inhaler if needed.


STRESS MANAGEMENT

Stressful situations are a trigger for asthma attacks. Breathing practices not only help the body develop resilience against stressful situations, but they have also been shown to reduce the frequency of asthma attacks.


Diaphragmatic breathing, or belly breathing, allows a fuller exchange of oxygen and carbon dioxide during respiration. It improves all around function of the body, including that of the lungs. Diaphragmatic breathing makes full use of the dome like muscle, the diaphragm, to expand the lungs and move abdominal contents outward with the inhale. On the exhale, the diaphragm relaxes and moves back into the thoracic cavity, and the abdominal contents contract inward. This is why it's called belly breathing, the belly moves with the breath. The diaphragm is the major muscle of breathing, it's meant to be used!

  • Chest breathing is common in adult humans. The habit is developed through the stresses of life and, I suspect, the fear of a bulging belly. Diaphragmatic breathing as a habit takes practice, treat breathing exercises the same way you treat other exercises. Breathing exercises are biceps curls for the pulmonary system (and the nervous system). To build and maintain bicep muscles, they must be regularly worked over time. To change the way we breathe, we must practice breathing techniques more than a couple weeks.

  • To diaphragmatically breathe, place one hand on your chest and one hand on your belly. On the inhale, move only the hand on your belly. This is often easiest laying down on your back with knees bent, and can be a strangely challenging activity at first. Like everything in life, diaphragmatic breathing becomes easier with practice. The diaphragm is a muscle that will strengthen upon being used just like your gluts.

  • Next time you're around a baby, watch how he/she breathes. Babies belly breathe, it's how we are born. Chest breathing is an adaption.

  • Buteyko breathing is a well-known system of breathing with a good track record for relieving asthma symptoms early in an attack. For more information, here's a good You tube page to follow: Buteyko Clinic International. Buteyko breathing, which it can bring some out of an asthma attack, does not replace the need to carry your rescue inhaler.

SLEEP

Night time can be difficult for those living with asthma.

  • Increased hygiene practices in the bedroom may be indicated if symptoms worsen at night. Sometimes this is termed "hysterical hygiene" as it involves cleaning frequently - almost hysterically washing sheets and drapes, dusting, vacuuming, etc.

  • Other key improvements can be replacing carpets with non-allergenic flooring and a HEPA filter for the room.

  • Temperature should be tepid - not too hot and not too cold.

  • Lying on your back puts extra pressure on the lungs. It also allows mucous from the nose to drip into the throat, which can trigger a cough. Side sleeping is tolerated by most people, and can become the preferred position. Try different pillows to comfortably set yourself up for a night's rest. Pregnancy pillows are popular for this purpose.

  • When asthma symptoms arise at night, it's often a sign asthma is not adequately controlled and a visit with your provider is needed. Asthma symptoms may also worsen with acid reflux, sometimes silent. I will go over dietary habits for addressing acid reflux in my upcoming Omeprazole article.

  • See other Parts of this series for sleep tips and tricks.

FINAL COMMENT

If you smoke or vape, stopping will greatly improve your lung health. Quitting smoking is much easier said than done, but accomplishing hard things is very good for the human spirit. Support is available for help getting through those difficult nicotine fits. As my Dad always says, "it'll feel better when it quits hurting". When you are quitting, constantly remind yourself you will not always crave nicotine.









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