13. SKIN & RESPIRATORY HEALTH - Lou Flashcards
This module covers: • Asthma. • Bronchitis. • Chronic obstructive pulmonary disease. • Integumentary system. • Acne vulgaris. • Rosacea. • Atopic dermatitis. • Psoriasis.
What is asthma?
A chronic respiratory disorder characterised by variable airway obstruction and hyper-responsiveness to stimuli.
What could cause airway narrowing in asthma?
- Bronchial smooth muscle spasm.
- Swelling of bronchial mucosa.
- Excess viscous mucus secretion.
What are the hallmark symptoms of asthma?
Wheeze, intermittent shortness of breath, chest tightness and dry cough.
List three signs / symptoms of asthma
- Initially shortness of breath, coughing or chest tightness
- Itching of chest or neck (especially in children)
- Expiratory wheeze
- Dry cough at night or while exercising
- Anxiety and sweating
By which of the following glycoproteins is asthma usually mediated?
* IgM
* IgG
* IgA
* IgE
* IgD
IgE
List three examples of inflammatory mediators which can cause bronchospasm, triggering an asthma attack?
- histamine
- leukotrienes
- prostaglandins
Following inflammatory mediators, what can cause further airway narrowing in asthma?
If inflammation is not adressed, eosinophils, T-helper cells and mast cells migrate into the airways.
Mucus production by goblet cells is increased, plugging the airway and
along with increased airway tone and hyper-responsiveness, causes the airway to narrow, further exacerbating symptoms.
What is ‘Airway remodelling’?
Bronchial smooth muscle hypertrophy, formation of new vessels and interstitial collagen deposition due to chronic inflammation. This results in persistent airflow obstruction, similar to COPD.
What is the relevance of arachidonic acid metabolism in asthmatics?
Asthmatics have an imbalance in arachidonic acid metabolism, leading to relative increases in lipoxygenase products.
What are lipoxygenase products?
They are the most potent chemical mediators in asthma. Leukotrienes are 1000 times more potent stimulators of bronchial constriction than histamine.
COX is downregulated in favour of LOX leading to ↑ leukotrienes.
Why is disrupted Th1 / Th2 balance a risk factor for asthma?
Immune tolerance (Th1 / Th2 balance) is important as excessive Th2 response encourages IgE release, increasing inflammatory mediators.
What is the ‘Hygiene Hypothesis’?
Pathogen exposure is needed for the neonatal immune system to develop.
When inadequate, it is associated with increased atopic diseases and autoimmunity.
Neonates are born with a TH2 immune bias, and exposure to pathogens increases TH1, achieving immune learning and balance, in parallel with acquisition of gut microflora. Lack of exposure is linked to increased atopic allergy.
Outline how pre- or post-natal exposure to antibiotics can be linked to asthma?
It can ↑ the risk and severity of asthma in children:
- First year of life is critical in gut microbiome development — gut dysbiosis is linked to early disruption of the immune system and the development of chronic atopic and inflammatory diseases.
- Compromised gut microbiome leads to antigen stimulation of antibody pathway causing heightened Th2 response with increased antigen sensitivity and abnormal responses.
- The presence of pathogenic bacteria and fungi (e.g., Candida albicans) in the gut and lungs of infants and children has been linked with development of allergic sensitisation and asthma.
What advice can be given to pregnant women and new mothers to reduce the risk of atopic conditions?
- Natural birth: Appropriate microbial innoculation of the neonatal microbiome reduces the chance of dysbiosis and immune imbalance.
- ** Breastfeeding:** is protective via several mechanisms including immune development and gut microbiome.
-
Weaning: Longer breastfeeding ( > 6 months) is shown to result in ↓ risk of wheeze and to have a protective effect until school age.
Ideally, exclusively breastfeed for 6–9 months. Early weaning and feeding infant formula, ↑ risk of food allergy, including asthma.
List three factors implicated in obese asthma
- Lung function: Changes in mechanical properties of lungs and chest wall significantly ↓ ERV and FRC.
- Diets that promote obesity: (↑ sat. fat & sugar, ↑ omega 6:3, low fibre & antioxidants) increase asthma risk.
- Microbiome changes: Obesity is linked with low Bacteroidetes bacteria (major producer of SCFAs). Alterations in circulating SCFAs increase allergic airway disease.
-
Systemic inflammation:
↑ cytokines released from adipose tissue contribute to airway hyper-responsiveness and remodelling.
ERV = expiratory reserve volume
FRC = functional residual capacity
Which components in highly processed foods could aggravate or trigger asthma?
- Preservatives — benzoates, sulphur dioxide, sulphites.
- Food colourings — azo dyes, especially tartrazine (E102).
A deficiency in which essential trace mineral could contribute to asthma occurence?
Molybdenum deficiency
can contribute to sulphite sensitivity as it is a co-factor for sulphite oxidase (oxidises sulphite to sulphate, enabling safe urinary excretion).
or sulfites as they are known in most other countries
Why could female sex hormone fluctuations cause asthma?
Female sex hormone fluctuations can affect asthma:
* Raised oestrogen: Oestrogen favours Th2.
* HRT: linked with ↑ risk of severe exacerbations in asthmatic women. Greater risk with previous rather than current use.
* Perimenstrual asthma: a cyclical worsening of asthma during the luteal phase and / or first few days of menstruation.
* Hormone fluctuations: particularly the impact of oestrogen changes at ovulation and prior to menstruation.
What is the gold standard test for diagnosing asthma?
There is no gold standard test.
Medical history, physical examination, lung function tests (spirometry / peak expiratory flow) is taken.
Which percentage of asthma cases can be classified as extrinsic? What does this classification mean?
60–90% of cases
Extrinsic (allergic / atopic) asthma:
- Involves an IgE mediated response.
- Common triggers include pollen, mould, dust mites, pet dander.
What is intrinsic asthma?
Intrinsic (non-allergic) asthma (10–40% of cases):
- More common in females, typically develops later in life.
- Bronchial reaction, IgE sometimes involved.
- Possible triggers: cold temperatures, humidity, stress, exercise, pollution, irritants in air such as smoke, and respiratory infections.
How could dietary / lifestyle evaluation be applied to establish a possible asthma diagnosis?
- Diet diary
- thorough case history
- elimination diet
- identification of triggers.
Which functional tests would you consider for a client with suspected asthma?
-
IgG / IgE food profile: e.g., York Test IgG foods and IgE foods test.
Assess potential food allergy or intolerances. -
IgG / IgE inhalant allergy profile: e.g., Genova’s inhalants / IgE moulds test.
Assess for chemical or environmental irritants. -
Food / chemical intolerance test: e.g., Genova’s toxic element clearance profile, elemental analysis.
Assess specific food additives, colourings, pharmaco-active agents, environmental chemicals -
GI profile or digestive analysis: e.g., Genova’s NutrEval.
To ensure optimal digestion, microflora colonisation and immune health.
Suggest five dietary exclusions that might be recommended in the treatment protocol of an asthmatic client.
- Remove allergens and foods triggering sensitivities: most common foods associated with asthma are cows’ milk, eggs, chocolate, rice, soy, corn, citrus fruit, apple. Consider an elimination diet or Cyrex array 10 to identify trigger foods.
- Reduce red meat intake: arachidonic acid link to ↑ series 2 prostaglandins and leukotrienes, causing transient airway hyper-responsiveness.
- Avoid dietary sulphites: alcohol, dried fruits, bagged / prepared salads.
- Avoid nitrates: Cured meat ↑ symptoms.
- MSG and its derivatives can trigger symptoms.
- Reduce excess salt: potentially increases bronchial reactivity.
- Avoid very cold drinks: can trigger bronchial spasm.
What pre-conception advice can be given to reduce the risk of asthma in the child?
- Allergies and sensitivities: Reduce pre-disposition in child; consider nutritional status of parents and pre-conception toxin exposure.
- Follow CNM Naturopathic Diet: Eat only fresh, natural, unprocessed organic food pre-conception / pregnancy. Eliminate / reduce common allergenic foods. Eat fish / purified fish oil supplement (during pregnancy / lactation).
- Breastfeeding: reduces incidence and severity of asthma.
- 1st year of child’s life critical: minimise chemical exposure as immature liver is unable to detoxify many compounds.
- Ensure good sleep
- Minimise stress
Recommend five dietary inclusions to reduce oxidative stress and address asthma.
- Antioxidants: Include vitamins A, C, E, carotenes, co-factors — zinc, selenium, copper, and flavonoids (particularly quercetin).
- Increase selenium: A co-factor of GPO which is often low in asthmatics.
- Increase vitamin E: A potent antioxidant, improves lung function, optimises Th1 & suppresses Th2, ↓ IgE and atopy.
-
Flavonoids: Such as quercetin inhibit histamine release from mast cells and basophils when stimulated by antigens. Quercetin decreases
airway inflammation and hyper-responsiveness. Increase in diet and/or supplement up to 3 g / day (adult dose) before meals. - Support SIgA levels: Probiotics incl. S. boulardii, zinc, A, D, colostrum for immune tolerance and reduced food reactions.
- Optimise omega-6:3 ratio: An inflammatory omega 6:3 profile causes ↑ prostaglandin E2 (PGE2)➔IgE = atopy and inflammation.
Why is ensuring optimal digestive function key in addressing asthma, especially in children?
Make one dietary recommendation to this effect.
Low HCl and protein maldigestion is linked to asthma in children.
Increase dietary fibre
- Associated with improvements in lung function — anti-oxidant and anti-inflammatory effects (25g / d women; 35g / d men).
- Studies show an inverse association between fibre intake and pro-inflammatory interleukin-6 (IL-6),
tumour necrosis factor-α receptor-2, and C-reactive protein.
- Fibre is metabolised by gut bacteria into SCFAs which positively influence immune and metabolic responses.
Give three lifestyle recommendations to support the asthmatic client
- Avoid potential triggers: Environmental pollutants (incl. tobacco smoke), household chemicals (e.g., cleaning products, paint), moulds, pollens, dust mites etc.
- Buteyko breathing: Exercises using shallow breathing through the nose to correct the breathing pattern.
-
Stress reduction: Stress and anxiety contribute to asthma exacerbations.
Occurs through various mechanisms e.g., oxidative stress pathways, glucocorticoid resistance, nerve-mast cell interaction. - Address posture: compression of lungs exacerbates symptoms. Smartphones ― development of forward head posture.
Which supplemental nutrients could be considered to enhance immune tolerance and address asthma?
- Vit C
- Vit D
- Magnesium
- Zinc
- Probiotics
- Fish oil
- CoQ10
- Boswellia
List two spices that an asthmatic client can include in their daily diet to inhibit arachidonic acid metabolism?
Ginger and turmeric
Include in meals, add to fresh vegetable juices, freshly grate and infuse in boiling water or take powdered as a supplement.
Which herb can be recommended for asthma. Include rationale and dosage.
Boswellia
Inhibits leukotriene production. Shown to improve shortness of breath, number of attacks, respiratory capacity and indicators of inflammation in asthmatics.
200 mg–500 mg / day
Outline the rationale and dosage for Vitamin C supplementation in asthma
- Vit C is an antioxidant, anti-histamine, stimulates neutrophils, increases lymphocyte and interferon production.
- ↓ release of arachidonic acid which impedes prostaglandin E2 (PGE2) synthesis = ↓ inflammation and bronchoconstriction.
- ↓ bronchial spasm (1 g daily), prevents exercise-induced asthma (500 mg).
- 2–3 g / day in divided doses
Why is it important to optimise Vitamin D levels in the client with asthma?
- Vitamin D modulates genes for asthma / allergy. Maternal levels linked to allergy — higher levels protective against asthmatic wheezing in young children.
- It inhibits eosinophils (involved in pathogenesis of asthma).
Outline the rationale and dosage for supplementating the following minerals in asthma:
1. Magnesium
2. Zinc
-
Magnesium
* Improves lung function, reduces bronchial reactivity.
* Antagonises movement of calcium across membranes: ↓ calcium uptake in bronchial smooth muscles = relaxation / dilation of bronchial airways.
* Used as bronchodilator in acute asthma attacks. Linked with↓ bronchial reactivity.
200‒400 mg / day -
Zinc
* Improves cell-mediated immunity: increases production of T-lymphocytes, regulates function of white blood cells.
* Deficiency may shift Th1 / Th2 response, favouring Th2 response characteristic of asthma.
15‒30 mg / day
How is probiotic supplementation helpful for supporting immune tolerance to improve asthma symptoms?
Which two specific strands have been found especially beneficial?
- Probiotics can balance Th1 / Th2 immunity — ↑Th1 cytokines profile (IL-12, IFN-γ, and TGF-β), ↓Th2 cytokine profile (IL-4, IL-5, IL-10, and IL-13).
- ↓ eosinophil and lymphocyte infiltration to the respiratory tract, ↓ IgE, IgG1, IgG2a production.
- ↑ butyrate / IgA production alleviate symptoms, ↑ quality life.
- L. rhamnosus GG and GR-1
Outline the rationale and dosage for fish oil supplementation in asthma
- Fish oil reduces inflammatory markers, improving respiratory health and symptoms in children (in combination with vitamin C and zinc).
- Needed for production of anti-inflammatory prostaglandins.
- 1 g of actual EPA or higher as required.
Outline the rationale and dosage for CoQ10 supplementation in asthma
- Antioxidant: ↓ oxidative stress and asthma symptoms.
- May ↓ long-term side-effects of glucocorticoid medications.
- 150 mg / day
Which two tissue salts could be recommended for asthma?
Kali. mur. & Mag. phos.
2 pills x 2 daily.
Recommend one way in which to use essential oils to alleviate asthma symptoms.
Adding a few drops of lavender oil to a diffuser or
humidifier may reduce airway inflammation and help alleviate stress.
What is ‘bronchitis’?
Acute or chronic inflammation of the bronchi associated with environmental irritants, inducing:
- Mucosal oedema, infiltration with macrophages and neutrophils.
- Hypertrophy of bronchial glands.
- Hypertrophy / hyperplasia of bronchial smooth muscle.
- Irreversible scarring of the airway walls, reducing airflow.
What are the hallmark symptoms of bronchitis?
- Hacking unproductive cough, becoming productive within days (thick, yellowy mucus).
- Fever, sore throat, shortness of breath, headache, runny or blocked nose, muscle pain.
Which Dietary exclusions could be considered in adressing bronchitis?
- Reduce intake of sugar, salt, saturated fats, cows’ dairy, wheat, processed foods, additives, preservatives, colourings.
- Avoid mucus-forming foods: Known allergens / intolerances; histamine-rich foods e.g., processed meats, dried fruit cheese, fermented foods, smoked fish, alcohol, avocado, tomato, spinach, mushrooms.
What dietary inclusions can be recommended for the client with bronchitis?
- Follow the principles of the CNM Naturopathic Diet and include easy-to-digest foods e.g., soups.
- Ensure adequate fluid intake; water, herbal teas, juices, broths.
- Increase intake of mucolytic foods (changes the viscosity of mucus enabling easier expulsion) e.g., garlic, onions; decrease catarrh; horseradish (not for dry cough); ginger reduces inflammation, has antiseptic properties; cinnamon — a warming expectorant.
- Bromelain, a proteolytic enzyme from pineapple decreases airway inflammation, is mucolytic and has potential as an anti-viral agent.
What is a common aetiological factor in chronic bronchitis?
Acute bronchitis is most commonly associated with a weak terrain and subsequent infection. Support immunity to assist recovery.
Optimal levels of vitamin A function to maintain \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ integrity and promote \_\_\_\_\_\_\_\_ secretion, contributing to mucociliary defence.
It enhances \_\_\_\_\_\_\_ proliferation and interleukin-2 secretion reducing lung inflammation.
mucous membrane
mucin
T-cell
What dosage of vitamin A can be recommended in bronchitis?
5000 iu daily
Name the nutrient for bronchitis:
- Increases T-cells, interferons and natural killer cells.
- Reduces oxidative stress and inflammation of airways.
- High plasma concentrations are associated with reduced risk of acute and chronic respiratory illness and shorter duration of existing infection.
vitamin C
Name the vitamin for bronchitis:
- Deficiency is associated with increased risk of respiratory infection.
- Moderates pulmonary inflammatory responses.
- Enhances innate immune responses to pathogens.
Vitamin D
Outline the rationale for supplementation of 15-30mg zinc/day for bronchitis
- Zinc modulates antiviral and antibacterial immunity and regulates the inflammatory response.
- Helps maintain mucous membrane integrity.
- Maintains phagocytic and NK cell function.
- Supports aspects of cellular and humoral immunity
What is COPD?
COPD is a chronic inflammatory response of the lungs causing airflow limitation due to airway and functional lung tissue damage that is progressive and not fully reversible.
How does COPD differ from asthma?
Unlike asthma, the airflow obstruction in COPD is only partially (or not at all) reversible, and the disease process is progressive.
