Without always being consciously aware of it, we breathe 18 to 20 times per minute. But when each breath comes with a great amount of effort, when each breath comes with a feeling that it might be the last, our breathing becomes the only thing on our mind. To feel as if the lungs have been squeezed shut with no way for the air to enter inside, is exactly how an asthmatic would describe what they undergo every time they have an asthma attack. Yes, an asthmatic is acutely aware of every breath taken when suffering from an asthma attack.
Asthma is a chronic inflammatory disorder of the air passages of the lungs. Inflammation of the cells lining these airways causes the accumulation of water (oedema) leading to swelling. The swollen airway thus narrows the passage and prevents adequate entry of air into the lungs, producing a lack of oxygen to the lungs and the retention of the carbon dioxide that should be exhaled, resulting in breathlessness. The characteristic feature of asthma, which also separates it from other lung airway disorders, is that the narrowing of airways is reversible and temporary. After the inflammation subsides, the swelling and the narrowing of the airway goes away and the patient can breathe freely once more.1
Causes of Asthma
The exact cause of asthma is unknown but often the underlying cause of asthma is considered to be an exaggerated response to seemingly harmless stimuli from the environment. One of the most common environmental allergens resides right within the home, the dust mite (Dermatophagoides pternonyssinus). Over 7 species of the house dust mite have been identified as common allergens causing asthma.11 Anything that irritates the airways can essentially trigger an acute episode of asthma including cold air, strenuous physical exercise, strong emotions like anger and fear, and medications like beta-blockers or aspirin etc.2 Chemical irritants like tobacco smoke and chemical fumes in the workplace are also known triggers.2 Pollen and moulds are common environmental allergens causing allergic rhinitis, asthma and hay fever. Seasonal plants and weeds like the ragweed are known to cause waves of asthma in entire communities during peak season.1
Exposure to infections, commonly the respiratory syncytial virus, has been implicated with increased incidence of asthma. Inhalation of air pollutants like sulphur dioxide, nitrogenous fumes and ozone, have also shown to increase airway hypersensitivity. Research has shown maternal smoking to have increased the incidence of asthma in the child in later years.11
Sometimes the stimulus is within the body or there is no determinable stimulus at all which appears to trigger the reaction; in such cases it can be genetics to blame. Asthma is known to be prevalent in people with a strong family history of asthma. Studies comparing monozygotic twins and dizygotic twins have accounted that genetics caused almost 50% asthma cases over the last few decades. Genetic association studies have shown a direct relationship between Human Leucocyte Antigen (HLA) variants and asthma. High levels of Immunoglobulin E (IgE) and asthma have been associated directly in ample number of studies. Thus, quantification of IgE levels is done nowadays to confirm the diagnosis of asthma.11
An increasing amount of evidence is also pointing towards urbanization and material prosperity as a risk factor for asthma. Using school children, a study in Zimbabwe found asthma to be most common in the affluent city dwelling children, less common in the poor urban residents and uncommon in those residing in rural areas in Harare.7 Also, the prevalence was higher in school children residing in the city of Munich than in smaller towns like Halle and Leipzig in Germany,8 although these statistics may be down to the fact that there is increased awareness, better healthcare facilities and more physicians in cities than in rural areas.
Manifestations of Asthma
Most patients manifest breathlessness as chest tightness, difficulty in breathing, sudden gasping, loud wheezing and a facial expression as if they are suffocating.1 Breathlessness is often accompanied with dry or productive coughing. If the breathing difficulty continues for long, the patient’s lips might start to turn a dark shade of blue/purple. The patient starts looking pale or blanched and may even start sweating. Being a chronic disorder, there are episodes of exacerbation and remission. Most patients settle to a baseline with infrequent acute episodes occurring only at times of exposure to allergens like weeds/pollen or extreme exertions like playing a sport, jogging, dancing, having a fierce argument/fight, cleaning the house, etc. With passage of time, patients learn to read signs of their body and can predict an acute episode before it is about to come and take a break to rest.
Impact of Asthma
The significant impact of an growing community of asthmatics can be seen on the increasing healthcare expenditure, days missed at work or school, income lost due to absenteeism, income lost due to presenteeism (attending work whilst ill, fatigue at work), etc.3 Statistics show that in 2008, children of age group 5-17 years missed 10.5 million days of school due to at least one asthma attack in the preceding year. Adults faced similar problems with over 14.2 million days being missed at work by currently employed adults due an asthma attack in the past year.4 On an individual level, nearly 1 in 2 children miss a day of school and 1 in 3 adults miss a day at work due to asthma each year. In 2009 in the USA, an average $1,039 was spent on every child with asthma through the year. 5
Missed days at work cost the nation loss of productivity along with medical expenditure. In 2007 the US government bore $50.1 billion as medical expenditure, $3.8 billion as loss of productivity due to missed days at work or school and $2.1 billion due to premature deaths.4 Currently, about 15 million disability-adjusted life years (DALYs) are lost to asthma each year globally and this is competitive with the years lost to diabetes or schizophrenia or even liver cirrhosis!6
Not only does asthma add to yearly expenses but it limits ones physical activities as well. Roughly 3 out of every 5 people in the U.S. having asthma are forced to limit their regular physical activities due to the condition.5 Children have to limit the sports they participate in and adults have to cut down on their exercises like jogging, or outdoor activities like trekking, swimming, playing sports like volleyball, football etc due to the fear of a potential asthma attack being precipitated. The quality of life and happiness derived by such spontaneous activities takes a backseat. In a paper published by Erwin W. Gelfand, MD in 2008, he concluded that 31% of asthmatics felt their lifestyle to be limited due to asthma and a whopping 45% said they couldn’t do activities the way they preferred. Further, activity limitations affected 64% of asthmatic adults.12
Conventional Treatment of Asthma
Modern allopathic medicine aims to keep asthma under control with drugs, with the intention of giving maximum daytime and nocturnal relief, minimal acute episodes, reducing emergencies and reducing restriction of activity. Two main sets of drugs are available: bronchodilators that dilate the narrowed airways and give immediate relief in acute situations and controllers which keep the inflammation under control on a more long term basis.
Bronchodilators are of 3 types- Beta 2 adrenergic agonists, theophylline and its derivatives and anti-cholinergics.
The beta 2 agonists cause relaxation of the airway smooth muscles and give immediate relief in breathlessness, cough and increase mucus clearance. They are used maximally as acute medication in the form of inhalers. The most common side effects are muscle tremors, palpitations and rarely a fall in serum potassium levels. They are generally well tolerated and often combined with inhaled steroids for enhancing their effect.
Anti-cholinergics act by preventing constriction of airways and production of mucus in them. They are not as strong as other bronchodilators and only added when patients are not well-controlled on beta agonists. Side effects are rarely an issue due to minimal systemic absorption.
Theophylline and its derivatives were used widely earlier but have been predominantly replaced by beta agonists. They acted by molecular mechanisms that reduced the inflammation of the airways and thereby the swelling and narrowing. Side effects are plenty: nausea, headache, palpitations, cardiac arrhythmias, etc.
Occasionally, an asthma attack gets severe enough to land a patient in the ER despite usage of a rescue inhaler. Here oxygen, nebulised drugs and steroid injections might be given to bring the breathlessness under control.
Inhaled steroids are the strongest controllers and their use early on in asthma has changed patient’s lives. They reduce inflammation dramatically and are useful equally in both children and adults. They have minimal side effects such as oral candidiasis and hoarseness of voice and negligible systemic absorption. Oral steroids (systemic) are used sparingly due to their potential for side-effects in the long-term. They are used only when inhaled steroids and other drugs fail to control asthma. Also, their use is restricted to courses of 2-3 weeks.
Another class of drugs called leukotriene modifiers is used to control asthma on a long term basis. They inhibit inflammation albeit lesser than steroids. They are generally used as an add-on drug in under-controlled patients.
A fairly newer class of drugs called cromones are used as adjunctive therapy with steroids. They are extremely safe but have poor long term efficacy. They are more useful as specific controllers for exercise induced asthma and for allergy to chemical fumes.
Many other therapies that modify the level of immunity have been tried but the long term utility has not been proven. Methotrexate, azathioprine, cyclosporine, gold and intravenous immunoglobulins are some of them. Specific immune therapy by injecting pollen or dust mite extracts have been tried without any proven clinical efficacy or backing of trials and is not advised in any guideline. Therapies like acupuncture, chiropractic, meditation and yoga for example are often used by patients but lack clinical evidence and thus are not recommended by doctors. They might not have side-effects and may be tried along with conventional medications.13 It is certainly unlikely that they will do any harm.
Alternative Therapies for Asthma
A lot of people suffering from asthma become weary of the recurrent episodes and constant fear of breaking into an acute attack. They seek to get eliminate the need to carry an inhaler on them, or to become dependent on drugs for the rest of their lives. This is where complementary medicine becomes an inviting possibility. Patients tend to seek out alternative therapies like homoeopathy, herbal remedies, yoga & meditation, acupuncture, etc when conventional medicine is no longer helping a patient, or when a patient becomes disillusioned with the mainstream approach. Generally the approach with these therapies is to determine and eliminate the root cause of the condition, rather than simply treating the symptoms, as is the case with pharmaceuticals. Some patients seem to have benefitted from these therapies and swear by them, but sure shot clinical evidence is lacking for just about all of them. The reason for this is that invariably they are natural approaches, and as they cannot be patented and turned into billion-dollar revenue streams unlike drugs, it is often hard to get the funding needed for expensive clinical research. This is why many of these treatments rely on patient feedback and referral to ‘spread the word’.
There is the Buteyko Breathing Technique (BBT) which is a series of breathing techniques along with dietary changes and exercises. It claims to correct erroneous breathing techniques and reduce asthma symptoms. For lack of adequate clinical research it is recommended strictly as complementary to conventional medicines. Yoga has breathing techniques called pranayama which reduce stress and have been shown to partially relieve asthma in some people. Hypnosis and acupuncture have shown results in some patients although whether they can be safely recommended to everyone needs to be established by greater research. Similarly, salt mines and speleotherapy have shown some short term benefits in asthma but need more research before they can be recommended to the general population. Homoeopathy has given hope to many patients but for lack of large trials it is not recommended by any guidelines although a lot of people claim to have benefitted from it.
There is strict recommendation against the use of Royal jelly or propolis obtained from bees for treatment of asthma owing to the numerous severe attacks of asthma and urticaria induced by both products. It is likely that these reactions could be Herxheimer reactions, where the body is getting worse before it gets better, but for some asthmatics this can be an alarming response and often dangerous if not properly managed. Herbal remedies are plants or plant products that are to be consumed for treatment, and plants like ginkgo biloba, coleus forskholii, tylophora asthmatica etc. which are well known have offered positive results for many people who have used them, but research on their efficacy is also wanting, most likely for the same reason as highlighted above.14
Traditional Herbal African Medicine for Asthma
The African continent has had its own version of doctors or healers called Shamans for centuries. These shamans treated patients with medicinal plants available in the luscious forests present all over the land. One such village healer was Aku Asirifia who cured asthma, respiratory allergies and hay fever with her special powder. By rule, shamans never disclosed the source of their medicines in order to protect the forest from abuse. However, in the mid 1980s when word of hundreds of patients getting relieved of their chronic asthma troubles spread around the region, Akua’s fame spread wide. A Swiss doctor called Dr. Miser from a local missionary hospital in Ghana heard about her miraculous cures for asthma and approached her to share her secret and even though Akua refused, she gave him some medicine to treat and cure his own mild asthma. Dr. Miser was surprised with the results and requested her again to share the remedy, but to no avail.
However, when Akua’s grandson Jerry Yamoa migrated to the UK to make a living he saw the number of people who suffered from asthma and with a desire to help them approached his grandmother. With a tribal ceremony she finally passed on the secret to him before she passed away, and he carried along some powder to help his colleagues at the Nine Elms Post Office back in England. 90% sufferers got better and put to rest their inhalers and asthma medications forever.
Jerry Yamoa introduced his ‘Yamoa™ Powder’ to the UK in the mid 1990s and it has been used by many thousands of people who have heard of it through word of mouth and referral. The powder has been so heavily reviewed on the internet, that since it has been made available globally over the internet, it has sparked off interest in the research community, and scientists and researchers all over the globe have initiated and published their own laboratory experiments on the herb.
Science, not Snake Oil
Amongst others, a study published by Christian A. et al in Pharmaceutical Biology showed that both the leaf and bark of Funtumia elastica (Yamoa™ powder) had significant anti-inflammatory and anti-microbial properties. The study conducted in Ghana evaluated alcohol extracts from the leaves and stem bark of F. Elastica for action against common bacteria like E. Coli, Staph. Aureus as well as common fungal infectious agents like Candida albicans and Aspergillus niger. The team concluded that the ethnomedicinal use of the plant in treating whooping cough and asthma was probably owing to these anti-bacterial, anti-fungal and anti-inflammatory properties.16
Another study published in the Journal of Animal & Plant Sciences in 2009 studied the anti-malarial activities of extracts of F. Elastica on parasite called Plasmodium falciparum that is responsible for causing cerebral malaria. The research conducted by Zirihi GN showed that the bark had very strong activity against the malarial parasite and could potentially be used to produce medicines commercially in the future.17
A further paper published in Bioorganic & Medical Chemistry Letters by Guede NZ et al studied the anti-malarial activity of the alkaloids found in F. Elastica. The team used the bark extract of the plant in alcohol and found that the extracts were active against the parasites showing only weak cytotoxic activity.18 Other studies have shown that Yamoa™ powder contains flavonoids and tannins which are natural anti-histamines (anti-allergenic). They are helpful in treating both asthma and COPD.19,20,21
Along with the papers mentioned above, more than sufficient scientific evidence has been produced in the past decade regarding the healing properties of F. Elastica. On the other hand, so far, there is no evidence of it being harmful in any manner to human beings in clinical experience, scientific research or traditional knowledge. Scientists and research bodies from across the world have tested it independently as well as in collaborations and found corroborating data.
The growing body of positive data coupled with the need of alternative therapies to manage asthma on a daily basis makes Yamoa™ powder a worthy product for consideration if you or your loved ones suffer from the condition. The lack of adequate long-term control medication in conventional medical therapy, the potential danger caused by long term use of medications and inadequacy of knowledge regarding causations pushes all of us towards trying potentially useful products that are known to lack side-effects.
From my experience, I might add that herbal products like Yamoa™ powder, although seemingly innocuous, have the potential to produce brilliant results and give immense relief to patients whose lives are restricted and debilitated due to asthma. One can be truly mentally free and lead a fulfilling life only when the body supports the mind and both work together towards a joint common goal of happiness.
- David Warrell et al. Oxford Textbook of Medicine. Chapter-Asthma: genetic effects. 4th ed. March 2003. Oxford Press.
- Fauci, Braunwald et al. Harrison’s Principles of Internal Medicine. Chapter 248-Ashtma.17th ed. McGraw Hill.
- Pharmaceutical Biology, 2013; Early Online: 1–8c 2013 Informa Healthcare USA, Inc.ISSN 1388-0209 print/ISSN 1744-5116 online. DOI: 10.3109/13880209.2012.738330
- Guede NZ, et al. Isolation, characterization and antiplasmodial activity of steroidal alkaloids from Funtumia elastica (Preuss) Stapf. Bioorganic & Medicinal Chemistry Letters. Available at: www.sciencedirect.com
- Kawai M, Hirano T, Higa S, et al. Flavonoids and related compounds as anti-allergic substances. Allergol Int. 2007 Jun;56(2):113-23.
- Knekt P, Kumpulainen J, JŠrvinen R, et al. Flavonoid intake and risk of chronic diseases. Am J Clin Nutr. 2002 Sep;76(3):560-8.
- Romieu I, Trenga C. Diet and obstructive lung diseases. Epidemiol Rev. 2001;23(2):268-87.
An original work by
Dr. Rachita Narsaria M.D. (Hom.)