Skin and Respiratory Flashcards
What is asthma? Describe the pathophysiology?
A chronic respiratory disorder characterised by variable airway obstruction and hyper-responsiveness to stimuli.
Airways narrow due to:
– Bronchial smooth muscle spasm.
– Swelling of bronchial mucosa.
– Excess viscous mucus secretion
1) Mediated by immunoglobulin E (IgE), triggered by allergic response to an allergen (e.g., pollen, animal dander).
2) This leads to the release of inflammatory mediators such as histamine leukotrienes, and prostaglandins, causing
bronchospasm, triggering an attack.
3) Mucus production by goblet cells plugs the airway and, together with increased airway tone and hyper-responsiveness, causes the airway to narrow,
4) Airway remodelling — chronic inflammation causes bronchial smooth muscle hypertrophy, resulting in
persistent airflow obstruction, similar to COPD.
Discuss the main causes and risk factors in asthma?
1) Th1 / Th2 balance imbalance: excessive Th2 response encourages IgE release, ↑ inflammatory mediators.
(Heightened Th2 immune response during pregnancy predisposes infant to allergic disease)
2) inadequate antigen exposure: causes abnormal responses to innocuous stimuli- exposure supports neonatal exposure by increasing Th1 ‘hygiene hypothesis’
3) Antibiotics: Pre- or post-natal exposure
— gut dysbiosis linked to early disruption of the immune system - first year of life critical.
- Compromised gut microbiome leads to antigen stimulation of antibody pathway causing heightened Th2 response with abnormal responses.
4) 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.
5) Not breastfeeding: protective via several
mechanisms including immune development and gut microbiome.Longer breastfeeding shown to result in ↓ risk of wheeze and to have a protective effect until school age.
* Ideally, exclusively breastfeed for 6–9 months
6) Early weaning (< 6 months): ↑ risk of food allergy, including asthma.
7) Obesity:
* Lung function: Changes in mechanical properties of lungs and chest wall significantly ↓ ERV and FRC.
* Diets that promote obesity: (↑ saturated fat and sugar,
↑ omega 6:3, low fibre and antioxidants) increase asthma risk.
* Microbiome changes: Obesity is linked with low Bacteroidetes bacteria (major producer of SCFAs)- alterations increase allergic airway disease.
* Systemic inflammation: ↑ cytokines released from adipose tissue contribute to airway hyper-responsiveness and remodelling.
8) Preservatives — benzoates, sulphur dioxide, sulphites
in food / drink may aggravate asthma in children.* Food colourings — azo dyes (esp. tartrazine) may trigger attack.
9) Molybdenum deficiency — as its needed to convert sulphite to sulphate to enable safe excretion, therefore can contribute to sulphite sensitivity
10) Female sex hormone fluctuations:
* Raised oestrogen favours TH2 (HRT increases risk in studies)
* Perimenstrual asthma — a cyclical worsening of asthma during the luteal phase and / or first few days of menstruation, relates to fluctuation in oestrogen
What are the two classifications of asthma?
- Extrinsic (allergic / atopic) asthma (60–90% of cases):
– Involves an IgE mediated response.
– Common triggers include pollen, mould, dust mites, pet dander. - Intrinsic (non-allergic) asthma (10–40% of cases):
– More common in females, typically develops later in life.
– Bronchial reaction, IgE can sometimes be involved.
– Possible triggers cold temperatures, humidity, stress, exercise, pollution, irritants in air such as smoke, and respiratory infections.
Which naturopathic investigations might be appropriate for asthma?
- Dietary / lifestyle evaluation: Diet diary, thorough case history, elimination diet, identification of triggers.
1) IgG / IgE food profile: e.g., York Test IgG foods and IgE foods test. to assess potential food allergy or intolerances.
2) IgG / IgE inhalant allergy profile: e.g., Genova’s inhalants / IgE moulds test. to Assess for chemical or environmental irritants.
3) Food / chemical intolerance test: e.g., Genova’s toxic element clearance profile, elemental analysis.
Assess specific food additives, colourings, pharmaco-active agents, environmental chemicals
4) GI profile or digestive analysis: e.g., Genova’s NutrEval.
To ensure optimal digestion, microflora colonisation and immune health.
Dietary approach to asthma?
1) Allergies and sensitivities: Reduce pre-disposition in child; consider nutritional status of parents and pre-conception toxin exposure.
2) Follow CNM Naturopathic Diet, Eat only fresh, natural, unprocessed organic food pre-conception / pregnancy.
Reduce intake of sugar, dairy, processed foods,
wheat, additives, preservatives, colourings.
3) Eliminate / reduce common allergenic foods: most common foods associated with asthma
are cows’ milk, eggs, chocolate, rice, soy, corn, citrus fruit, apple.
4) Assess salicylate sensitivity — may cause delayed intolerance reaction. Assess client tolerance.
5) Avoid dietary sulphites — alcohol, dried fruits, bagged / prepared salads.
* Avoid nitrates: Cured meat ↑ symptoms.
6)Reduce red meat — arachidonic acid link to ↑ series 2 prostaglandins and leukotrienes (transient airway hyper-responsiveness).
7) Dehydration — may exacerbate exercise-induced asthma.
8) Excess salt — potentially increases bronchial reactivity.
9) Include Antioxidants: Include vitamins A, C, E, carotenes, co-factors — zinc, selenium, copper, and flavonoids (particularly quercetin). These:
– Inhibit leukotriene formation and histamine release.
– Increase epithelial lining integrity.
– Protect lung against free radicals and oxidising agents that may stimulate bronchial constriction
* Increase selenium (a co-factor of GPO) — often low in asthmatics.
* vitamin E — potent antioxidant, improves lung
function, optimises Th1 and suppresses Th2, ↓ IgE and atopy.
10) include Flavonoids — such as quercetin inhibit histamine
release from mast cells and basophils when
stimulated by antigens, decreases
airway inflammation and hyper-responsiveness.
11) Optimise omega-6:3 ratio — an inflammatory
omega 6:3 profile causes ↑ prostaglandin E2
(PGE2)IgE = atopy and inflammation.
12) increase Dietary fibre- anti-oxidant and anti-inflammatory effects (25 g / d women; 35 g / d man).
* 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.
Specific nutrients for asthma?
1) Vitamin B complex 50–150 mg / day
* B3 decreases histamine release — calms the allergic response.
* B5 beneficial for those with allergies and asthma.
Reduces secretion of cortisol in times of stress.
* B6 reduces frequency and severity of asthma
(25–30 mg / day).
* B12 helps in the oxidation and metabolism of sulphites
and may help reduce inflammatory reactions.
2) Vitamin C: 2–3 g / day in divided doses
* 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).
3) Vitamin D:Optimise levels
* Modulates genes for asthma / allergy. Maternal levels linked to allergy — higher levels protective against asthmatic wheezing in young children.
* Inhibits eosinophils (involved in pathogenesis of asthma).
4) Magnesium: 200‒400 mg / day
* Improves lung function, reduces bronchial reactivity.
* Antagonises movement of calcium across membranes, ↓ calcium uptake in bronchial smooth muscles
leads to relaxation / dilation bronchial airways.
5) Zinc: 15‒30 mg / day
* 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.
6) Probiotics: L. rhamnosus GG and GR-1 Dosage as per label
* 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 lymphocytes infiltration to the respiratory tract, ↓ IgE, IgG1, IgG2a production.
* ↑ butyrate / IgA production, alleviate symptoms, ↑ quality life.
7) Fish oils:1 g of actual EPA or higher as required.
* Improves respiratory health, reduces inflammatory markers
* Needed for production of anti-inflammatory prostaglandins.
8) Coenzyme Q10: 150 mg / day
* Antioxidant — ↓ oxidative stress and asthma symptoms.
* May ↓ long-term side-effects of glucocorticoid medications.
9) Ginger 400–500 mg with Turmeric 500–2000 mg
(or curcumin)
* Gingerols (ginger) and curcumin (turmeric) are dual inhibitors of arachidonic acid metabolism (↓ leukotrienes).
What are the most common chemical mediators in asthma and why ?
- Because Asthmatics have an imbalance in arachidonic acid metabolism, this leads to increases in lipoxygenase products, Leukotrienes are 1000 times more potent stimulators of bronchial constriction than histamine.
- COX is downregulated in favour of LOX leading to ↑ leukotrienes.
Lifestyle factors for ashtma
1) Stress and anxiety contribute to asthma exacerbations.
Occurs through various mechanisms e.g., oxidative stress pathways, glucocorticoid resistance, nerve-mast cell interaction.
2) Avoid potential triggers: Environmental pollutants
(incl. tobacco smoke), household chemicals (e.g., cleaning products, paint), moulds, pollens, dust mites etc.
3) Buteyko breathing exercises — uses shallow breathing through the nose to correct the breathing pattern.
4) Posture — compression of the lungs exacerbating symptoms. Smartphones ― development of forward head posture.
5) Essential oils — adding a few drops of lavender oil to a diffuser or
humidifier may reduce airway inflammation and help alleviate stress.
What is bronchitis with hallmark symptoms?
Acute or chronic inflammation of the bronchi:
* Associated with:
– 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.
Hallmark symptoms:
* Hacking unproductive cough, becoming productive within days (thick, yellowy mucus).
* Fever, sore throat, shortness of breath,
headache, runny or blocked nose, muscle pain.
Natural approach to bronchitis?
1) Reduce bronchial irritants:
* Stop smoking, avoid dust / smoky atmospheres, avoid environmental irritants.
2) Reduce intake of sugar, salt, saturated fats, cows’ dairy, wheat, processed foods, additives, preservatives, colourings, , Follow the principles of the CNM Naturopathic Diet
3) 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.
4) Ensure adequate fluid intake; water, herbal teas, juices, broths.
5) Increase intake of mucolytic foods e.g., garlic, onions; decrease catarrh; horseradish (not for dry cough); ginger reduces inflammation, has antiseptic properties; cinnamon — a warming expectorant.
6) Bromelain, a proteolytic enzyme from pineapple decreases airway inflammation, is mucolytic and has potential as an anti-viral agent.
7) Onion Thyme Manuka Honey Combo:
Onions — contain phytonutrients and vitamin C that support immunity; the sulphur compounds are mucolytic. Thyme — antimicrobial, expectorant.
Manuka honey — antibacterial, anti-inflammatory, soothing.
Nutrients for bronchitis
1) Vitamin A 5000 iu daily
* Maintains mucous membrane integrity and promotes mucin secretion, contributing to mucociliary defence.
* Enhances T-cell proliferation and interleukin-2 secretion; reduces lung inflammation.
2) Vitamin C 3–10 g / day in small frequent doses.
* Increases T-cells, interferons and natural killer cells.
* Reduces oxidative stress and inflammation of airways.
3) Vitamin D Optimise levels
* Deficiency is associated with increased risk of respiratory infection.
* Moderates pulmonary inflammatory responses.
* Enhances innate immune responses to pathogens.
4) Zinc 15–30 mg / day
* Modulates antiviral and antibacterial immunity and regulates the inflammatory response.
* Helps maintain mucous membrane integrity.
* Maintains phagocytic and NK cell function.
What is COPD with main causes and risk factors?
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.
Combination of two main pathologies:
* Emphysema: Dilation of alveolar sacs by destruction of alveolar wall, leading to collapse of alveoli during expiration = breathlessness.
- Chronic bronchitis: Inflammation and thickening of bronchial lining with mucus hyper-secretion = cough and wheezing.
Causes and risk factors:
* Smoking: Predominant cause (approx. 90%).
* Exposure to lung irritants: Air pollution, industrial
chemicals, dusts, etc., genetic susceptibility.
What lifestyle interventions may help COPD?
1) Smoking cessation is essential!
* Cigarette toxins initiate inflammatory effects
by activating the NFκB pathway leading to an inflammatory cascade in the airway epithelial
cells and recruitment of macrophages and neutrophils.
2) Healthy weight management:
* Overweight puts greater pressure on the heart and lungs.
* Underweight impedes ability to maintain normal body function. COPD is associated with weight loss and ↑ risk of sarcopenia and pulmonary cachexia (↓ physical activity, metabolic changes).
4) A combination of eucalyptus and peppermint essential oils inhaled, can loosen mucus and dilate the airways.
5) Exercise improves bodyweight, muscle strength and quality of life.
6) Manual therapy (e.g., osteopathy, physio) and
breathing exercises support breathing mechanics.
What dietary support may help with COPD?
1) Avoid refined grains and sugar, fast foods, processed foods, saturated fats, take-aways, soft drinks, alcohol.
2) Avoid mucus-producing foods: Known intolerances, cows’ dairy.
3) Include nutrient-rich, easily digested foods e.g., fresh juices, broths to improve anorexia ( increased work of breathing can impact this)
4) include Fruits / vegetables ― ↑ antioxidant and anti-inflammatory nutrients. Have vegetables lightly cooked rather than raw.
5) Include antioxidant, anti-inflammatory and warming herbs such as turmeric, ginger and garlic.
6) Ensure good intake of beneficial fats omega-3 fatty acids (↑ energy, anti-inflammatory).
7) Good intake of quality protein is essential (sarcopenia risk) with specific focus on leucine,
8) Consider all nutrients outlined for bronchitis noting that:
* Vitamin D deficiency in COPD is associated with ↑ risk of exacerbations
9) Combining bioflavonoids with vitamin C enhances utilisation and free radical scavenging capacity, positively associated with forced expiratory volume (FEV)
* Increased oxidative stress during disease exacerbation is linked to lowered serum levels of vitamin A and E.
What specific nutrients may help with COPD?
1) N-acetyl cysteine 400–1200 mg / day
* Mucolytic (breaks disulphide bonds in mucoproteins) enabling expulsion of mucus.
* Increases glutathione and decreases the oxidative damage associated with inflammation
* Increases mean forced expiratory flow.
2) Fish oils EPA 800– 1000 mg DHA: 300 mg
* associated with reduced COPD morbidity (↓ exacerbation risk, fewer respiratory symptoms and ↑ quality of life).
* Reduces inflammation, improves body composition and enhances exercise performance.
3) Shiitake 1.5–10 g / day- powder or include in the diet
* Heightens immune vigilance against potential pathogens: ↑ phagocytes, T- and B-lymphocytes and NK cells.
* Enhances interferon synthesis (anti-viral proteins).
* Increases SIgA.
4) Cordyceps 2–5 g / day
* Improves FEV1% and FEV1 / FVC ratio
* Improves exercise tolerance (antioxidant and anti- fatigue mechanisms e.g., ↓ lactate accumulation).
* Strengthens the immune system.
5) Thyme - expectorant with mucolytic and antibacterial activities. Has antioxidant properties, downregulates activated NF-kB in COPD.
