Title: Asthma, nutrition and treatment

Key words: Useful references, chemicals, children, immune system, oxidative stress, antioxidants, fresh fruit, fish, cystic fibrosis, COPD, dietary modification, PUFA, cytokines, membrane phospholipids, dietary linoleic acid, alternative therapies, EPA arachidonic acid, fish oils, conventional drugs

Date: May 2001

Category: Specific conditions

Type: Article

Author: Various


Title: Chemical children

Author: Mansfield P

Address: Templegarth Trust, Grimoldby, Lincolnshire, England.

Source: Nutr Health, 1988, 6:1, 63-6


Following the Industrial Revolution technology has led to the identification and employment of a vast variety of chemicals. This has affected both agriculture and nutrition. The body's capacity to cope with chemicals is limited. Many, obviously, are toxic. What is safe is what is serviceable. Children, long before immune defences have been properly organised, are particularly vulnerable. Body changes are apt to result--food intolerance and asthma are becoming increasingly common and behaviour has been shown to be affected. Means of dealing with the results are discussed.



Title: Asthma, oxidant stress, and diet.

Author: Greene LS

Source: Nutrition, 1999 Nov, 15:11-12, 899-907


It has been suggested that the increased prevalence of atopy and asthma observed in many developed countries over the past 30 years is in part the result of a decrease in the incidence and severity of early childhood infections. The immunologic consequence of this phenomenon has been the expansion of T-lymphocyte populations away from the T-helper 1 (Th1) subset and in the direction of the Th2 subset. This leads to the creation of a cytokine-mediated propensity for the development of an intense inflammatory response in the airways, resulting in oxidative stress, airway tissue injury, and the development of atopy and asthmatic symptomatology. Over this same period, there has been a decreased intake of dietary substances that contribute to antioxidant defense, and this appears to have contributed to the rise of atopy and asthma. Studies evaluating the efficacy of these antioxidant substances in the prevention of asthma and as adjuvants in the treatment of asthma are reviewed, and suggestions are made for the direction of future studies.

Title:Nutrition and lung health.

Author: Sridhar MK

Source: Proc Nutr Soc, 1999 May, 58:2, 303-8


There is an increasing interest in the relationship between nutrition and lung health. Epidemiological studies suggest that dietary habits may have an influence on lung function and the tendency to common lung diseases such as asthma, chronic obstructive pulmonary disease (COPD) and lung cancer. In particular, a diet rich in fresh fruit and fish has been associated with a salutary effect on lung health. End-stage COPD is associated with a state of nutritional depletion which is refractory to conventional nutritional supplementation. In contrast, malnutrition associated with cystic fibrosis is amenable to nutritional therapy, which has been shown to improve prognosis in this disease.

Title: Reduced asthma symptoms with n-3 fatty acid ingestion are related to 5-series leukotriene production.

Author: Broughton KS; Johnson CS; Pace BK; Liebman M; Kleppinger KM

Source: Am J Clin Nutr, 1997 Apr, 65:4, 1011-7


Asthma may respond to dietary modification, thereby reducing the need for pharmacologic agents. This study determined the effectiveness of n-3 polyunsaturated fatty acid (PUFA) ingestion in ameliorating methacholine-induced respiratory distress in an asthmatic population. The ability of urinary leukotriene excretion to predict efficacy of n-3 PUFA ingestion was assessed. After n-3 PUFAs in ratios to n-6 PUFAs of 0.1:1 and 0.5:1 were ingested sequentially for 1 mo each; patient respiratory indexes were assessed after each treatment.

Forced vital capacity (FVC), forced expiratory volume for 1 s (FEV1), peak expiratory flow (PEF), and forced expiratory flow 25-75% (FEF 25-75) were measured along with weekly 24-h urinary leukotriene concentrations.

With low n-3 PUFA ingestion, methacholine-induced respiratory distress increased. With high n-3 PUFA ingestion, alterations in urinary 5-series leukotriene excretion predicted treatment efficacy.

Elevated n-3 PUFA ingestion resulted in a positive methacholine bronchoprovocation dose change in > 40% of the test subjects (responders). The provocative dose to cause a 20% reduction (PD20) in FEV1, FVC, PEF, and FEF25-75 values could not be calculated because of a lack of significant respiratory reduction. Conversely, elevated n-3 PUFA ingestion caused some of the patients (nonresponders) to further lose respiratory capacity. Five-series leukotriene excretion with high n-3 PUFA ingestion was significantly greater for responders than for nonresponders. A urinary ratio of 4-series to 5-series leukotrienes < 1, induced by n-3 PUFA ingestion, may predict respiratory benefit.


The changes of lymphocyte membrane receptors in bronchial asthma and atopic dermatitis in pediatric patients receiving treatment with polyenic fatty acids.

Author: Gorelova JYu; Semikina EM

Source: Z Ernahrungswiss, 1998, 37 Suppl 1:, 142-3


The influence of a diet supplemented with n-3 PUFA on the immune status of children with atopic dermatitis and asthma was investigated. The results of the investigation have shown the improvement of cell immunity along with a decrease in the clinical manifestation of the disease. n-3 PUFA could be used as immunocorrectors in combination with pathogenic treatment of children with allergic diseases.

Title: Modulation of pro-inflammatory cytokine biology by unsaturated fatty acids.

Author: Grimble RF; Tappia PS


Source: Z Ernahrungswiss, 1998, 37 Suppl 1:, 57-65


The production of pro-inflammatory cytokines, such as interleukins 1 and 6 and tumour necrosis factors, occurs rapidly following trauma or invasion of the body by pathogenic organisms. The cytokines mediate the wide range of symptoms associated with trauma and infection, such as fever, anorexia, tissue wasting, acute phase protein production and immunomodulation. In part, the symptoms result from a co-ordinated response, in which the immune system is activated and nutrients released, from endogenous sources, to provide substrate for the immune system. Although the cytokine mediated response is an essential part of the response to trauma and infection, excessive production of pro-inflammatory cytokines, or production of cytokines in the wrong biological context, are associated with mortality and pathology in a wide range of diseases, such as malaria, sepsis, rheumatoid arthritis, inflammatory bowel disease, cancer and AIDS. Cytokine biology can be modulated by antiinflammatory drugs, recombinant cytokine receptor antagonists and nutrients.

Among the nutrients, fats have a large potential for modulating cytokine biology. A number of trials have demonstrated the anti-inflammatory effects of fish oils, which are rich in n-3 polyunsaturated fatty acids, in rheumatoid arthritis, inflammatory bowel disease, psoriasis and asthma. Animal studies, conducted by ourselves and others, indicate that a range of fats can modulate pro-inflammatory cytokine production and actions. In summary fats rich in n-6 polyunsaturated fatty acids enhance IL1 production and tissue responsiveness to cytokines, fats rich in n-3 polyunsaturated fatty acids have the opposite effect, monounsaturated fatty acids decrease tissue responsiveness to cytokines and IL6 production is enhanced by total unsaturated fatty acid intake.

There are a large number of potential cellular mechanisms which may mediate the effects observed. The majority relate to the ability of fats to alter the composition of membrane phospholipids. As a consequence of alterations in phospholipid composition, membrane fluidity may change, altering binding of cytokines to receptors and G protein activity. The nature of substrate for various signalling pathways associated with cytokine production and actions may also be changed. Consequently, alterations in eicosanoid production and activation of protein kinase C may occur.

We have examined a number of these potential mechanisms in peritoneal macrophages of rats fed fats with a wide range of fatty acid composition. We have found that the total C18:2 and 20:4 diacyl species of phosphatidyl-ethanolamine in peritoneal macrophages relates in a positive curvilinear fashion with dietary linoleic acid intake; that TNF induced IL1 and IL6 production relate in a positive curvilinear fashion to linoleic acid intake; that leukotriene B4 production relates positively with dietary linoleic acid intake over a range of moderate intakes and is suppressed at high intakes, while PGE2 production is enhanced. There was no clear relationship between linoleic acid intake and membrane fluidity, however fluidity was influenced in a complex manner by the type of fat in the diet, the period over which the fat was fed and the presence of absence of TNF stimulation. None of the proposed mechanisms, acting alone, can explain the positive effect of dietary linoleic acid intake on pro-inflammatory cytokine production. However each may be involved, in part, in the modulatory effects observed.

Title: The use of complementary/alternative medicine for the treatment of asthma in the United States.

Author: Davis PA; Gold EB; Hackman RM; Stern JS; Gershwin ME

Source: J Investig Allergol Clin Immunol, 1998 Mar, 8:2, 73-7


Despite our advances in the diagnosis and treatment of asthma, the incidence of mortality is increasing in developed countries. As patients and health care providers seek new options for the treatment and prevention of asthma, various complementary and alternative medical therapies are being used.

With funding from the Office of Alternative Medicine, National Institutes of Health, our goal was to identify the type and prevalence of complementary and alternative treatments for asthma in use in the United States in order to establish a research agenda for the study of the most promising therapies. A survey was developed by an expert panel. After undergoing a preliminary round of testing and improvement, the survey was then sent along with a postage-paid return envelope as inserts in the May 1996 issue of Alternative Therapies in Health and Medicine, a peer-reviewed periodical of complementary and alternative medical research and scholarly activity; 10,000 surveys were distributed. We asked that only those who treated asthma respond.

The surveys were designed to identify characteristics of the respondent, their particular practice type, use of complementary and alternative medicine, or conventional medicine in general, patient characteristics and numbers, and their use of 20 specific potential therapies to treat asthma. A total of 564 surveys were returned. The 5.64% response rate was low but was reflective of the demographics of the readership of this journal of complementary and alternative medicine. The survey population was 46% male and 43% female; 11% did not specify gender. They ranged in age from under 31 years old to over 70. The largest group (37%) of respondents held degrees as medical doctors, 27% held doctorates in complementary and alternative medicine related disciplines, 11% had registered nursing degrees, 4% were acupuncturists and 18% did not specify their training. Practice characteristics between MD and non-MD asthma care providers did not differ. The majority had general practices (75%) seeing all ages of patients. MDs were less likely to employ complementary and alternative medicine techniques for asthma compared to non-MDs.

Both groups identified dietary and nutritional approaches as their most prevalent and useful asthma treatment option. Use of botanicals, meditation and homeopathy were frequently cited; statistically significant differences appeared in the rankings of treatment usefulness and prevalence between MD and non-MDs. Non-MD asthma care providers were more likely to ask patients about their use of complementary and alternative treatments for asthma than MDs (92% vs. 70%), while both groups showed statistically significant increases in their levels of patient inquiries compared to 2 years previously (up 9% and 8% for MDs and non-MDs respectively).

The predominance of diet and nutrition supplementation used by MDs and non-MDs suggests that further attention and research efforts should be directed toward this area of complementary and alternative practice. Other complementary and alternative medicine practices such as botanicals, meditation and homeopathy appear to warrant research efforts. Differences between MDs and non-MDs in their use of such therapies may reflect different philosophies as well as training.

Title: Atopy in childhood and diet in infancy. A nine-year follow-up study. I. Clinical manifestations.

Author: Pöysä L; Korppi M; Remes K; Juntunen Backman K

Source: Allergy Proc, 1991 Mar, 12:2, 107-11


A national program for the prevention of atopy in children has been in progress in Finland since 1979. Its aim is to prevent or at least to reduce atopic symptoms in childhood. Since the start of the program we have followed a group of 119 children with and without a family history of atopy. Half the atopy-prone children kept to the diet intended to prevent atopy, i.e., breast-feeding prolonged up to age 3 months and introduction of solid food and formulae based on cow's milk after age 3 months. All children were examined at ages 5 and 10 years. In addition to clinical examination and interview, skin-prick tests using eight common inhalant allergens were performed. At age 9 to 10 years, 38 of the 119 children (32%) exhibited at least one atopic illness (bronchial asthma, allergic rhinitis, allergic conjunctivitis, atopic eczema or food allergy). Forty percent of children with family histories of atopy had atopic illness, independent of diet in infancy. The occurrence of atopic manifestations in the children of nonatopic families was 21%. Only half the children who had atopic symptoms at age 12 months had symptoms 9 years later. Asthma, allergic rhinitis, and positive skin-prick test results at age 5 years, however, correlated well with the subsequent occurrence of respiratory allergy. Our observations indicate that the preventive measures in early infancy intended to reduce the risk of atopy had no influence on atopic manifestations 9 years later.


Title: The relationship of dietary fish intake to level of pulmonary function in the first National Health and Nutrition Survey (NHANES I)

Author: Schwartz J; Weiss ST

Source: Eur Respir J, 1994 Oct, 7:10, 1821-4


Eicosapentaenoic acid (EPA), which predominates in marine fish, tends to counteract and inhibit the uptake and incorporation of arachidonic acid and membrane phospholipids and dilute arachidonic acid as a potential substrate for oxidation. Thus, fish intake may be protective for the occurrence of asthma and other pulmonary diseases. We wanted to examine the relationship between the effect of chronic dietary intake to fish and its relationship to level of pulmonary function. We performed this analysis using data from the First National Health and Nutritional Examination Survey (NHANES I). A detailed subsample of 2,526 adults had a medical history questionnaire, that included a 24-hour dietary recall, and performed spirometric examination. Log of forced expiratory volume in one second (FEV1) served as a dependent variable in regression analysis which included an adjustment for height, age, cigarette smoking and gender. When added to the regression model including the above variables dietary fish intake showed a protective association with FEV1 (beta = 0.008 +/- 0.004, p = 0.028). When smokers were excluded from the analysis, the effect of fish intake on pulmonary function appeared to increase slightly (beta = 0.0108 +/- 0.006, p = 0.61). These data suggest that chronic dietary intake of fish is associated with higher levels of pulmonary function and is consistent with the hypothesis of an effect of fish oil on arachidonic acid metabolism.


Title: Maintenance therapy for obstructive lung disease. How to achieve the best response with the fewest agents.

Author: Jacobs M

Source: Postgrad Med, 1994 Jun, 95:8, 87-90, 93-6, 99


Asthma is now thought to be primarily an inflammatory condition with secondary bronchospasm; hence, the mainstay of maintenance therapy is an inhaled anti-inflammatory drug, either a corticosteroid (especially in adults) or a mast-cell stabilizer (especially in children). Inhaled beta agonists are reserved for acute exacerbations and systemic corticosteroids for severe refractory disease. Oral theophylline is sometimes helpful, especially for nocturnal exacerbations. Chronic bronchitis and emphysema almost always stem from cigarette smoking. Bronchospasm is the predominant cause of symptoms, and maintenance therapy with an inhaled anticholinergic (eg, ipratropium bromide [Atrovent]) is the best approach. If symptoms are not controlled, an inhaled bronchodilator should be added. An oral or inhaled corticosteroid benefits a minority of patients. Theophylline is especially helpful for chronic bronchitis and nocturnal exacerbations.