1) Factors which predispose a person to asthma.

Several factors are responsible in increasing a person’s chances of developing asthma.
–Heredity— Having a parent or blood relative with asthma increases the chances by 50%. If both parents are allergic then chances of the child becoming asthmatic are 70%.
–Atopic individuals with allergic conditions like eczema or hay fever/ allergic rhinitis. Atopic individuals are more sensitive to common triggers in food and air.
–Being overweight is also linked to asthma.
–Males–The lung size in males is smaller than females during childhood which increases the chances of wheezing during chest infections or colds.
–Over exposure to second hand smoke.
–Lowered levels of vitamin D in the body causes increase in allergy, rhinitis and asthma episodes.
–Poor posture

2) What happens in asthma attacks?

When an asthmatic comes in contact with an allergen then that person’s system overreacts and releases histamine which causes inflammation, constriction and mucus secretion from the airways causing the symptoms of –breathing difficulty, wheezing, breathlessness, tightness of chest and coughing.

Inflammation of the airways or the mucus membranes lining the airways causes thickening and narrowing of the airway tract.

Due to the inflammation more mucus is produced in the airway which further reduces easy flow of air. The increased mucus flow and inflammation cause tingling and coughing.

• • Constriction or narrowing of the airways is caused by contraction of the muscles lining the airways leading to tight feeling in chest and throat.

factors which aggravate symptoms in a person predisposed to asthma.

3) Common asthma triggers may be found indoors as well as outdoors:

Indoor triggers—

• Pollens, household pets, molds, dust mites, cockroaches and other pests.
• Others suffering from upper respiratory tract infections capable of transmitting infections.
• Environmental tobacco smoke or secondhand smoke,
• Cold dry air.
• Perfumes, mosquito repellants, paints, solvents, hair sprays, pesticides.
• Sudden change of temperature
• Emotional stress.

Outdoor triggers—

• Pollen grains from plants.
• Industrial and vehicle pollution—The main air pollution triggers are minute particles that come from smoke, road dust and emissions from factories, cars and power plants.
• Ozone–It is irritating to the lungs and airways, it makes deep breathing difficult. It is high in cities which have more cars and also in summers.
• Occupational exposure to chemicals and fumes.
• E.I.A—Exercise induced asthma.
• Sudden changes in temperature or exposure to extreme cold.

4) Some common respiratory conditions in children which mimic asthma.

Just having symptoms of asthma like—wheezing, coughing or difficult breathing does not mean that a child has asthma. Other similar health conditions can mimic asthma.

–Sinusitis—Almost more than 30% of the asthma patients have sinusitis and almost 50% of sinusitis patients have asthma. It is an inflammation of the sinuses.
–G.E.R.D (Gastro-esophageal reflux disease)–In this disorder the stomach contents flow back into the oesophagus and cause symptoms of heartburn and asthma.
–RSV (Respiratory syncytial virus)-Infection with this virus can cause symptoms of pneumonia and wheezing in children similar to asthma.
–Adenoids or enlarged tonsils- These can cause wheezing and night cough similar to asthma.
–VCD (Vocal cord dysfunction)-This also causes symptoms similar to asthma like hoarseness, wheezing, shortness of breath and tightness in chest and throat. VCD is suspected when the child fails to respond to common asthma medicines.
–Upper airflow obstruction- In this condition the airway is blocked by pressure from a tumor or enlarged thyroid giving rise to breathing difficulty.

5) How to avoid asthma attacks by identifying common triggers:

As of now there is no cure for asthma. A step-by-step action plan can help your child reduce flare-ups in day to day life. Fully understanding the conditions in which asthma aggravates and avoiding them is important for the child. ‘Prevention is better than cure’ applies to steps that are important in keeping triggers away.
Taking the right kind of diet can help the allergic child ward off attacks and fight infections. A detailed explanation of the steps that should be taken to prevent asthma attacks is given below:
Identify asthma triggers and try to keep your child away from them.

INDOOR TRIGGERS:
–Dust mites are microscopic spiders found in carpets, pillows, bed linens and in household dust. They grow well in humid conditions and can trigger rhinitis, itching and asthma symptoms. Try to dehumidify your house and keep your house well ventilated to reduce their growth. Wash your bed sheet and pillow covers weekly. Vacuum clean your curtains weekly to check dust mites. Put pillows in mite-allergen impermeable covers. Take care not to do dusting of bed sheets and curtains in presence of your allergic child.
–Cockroaches and insects-Droppings from insects and their dead bodies become airborne and can cause allergies in children. Pest control your house regularly and keep cleaning places and corners to avoid exposure of your child to these unwanted triggers.
–Pets- Animal dander, urine and saliva from dogs, cats, birds, cows and rodents can become airborne and cause allergic symptoms in your child. Try to keep your child away from them.
–Molds- Humid and damp conditions in the house can promote growth of fungus(molds). They reproduce by making and releasing spores which become airborne when touched. These spores trigger allergic reactions. It is advisable to keep proper ventilation, dehumidifiers and air conditioners to keep them in check. Keep humidity levels below 50%. Clean your bathroom with anti-mold agents like vinegar or chlorine-bleach solution and use exhaust fans in bathrooms.
–Viral infections- Keep your child away from persons who have viral infection at home or in the neighborhood. Viruses can cause asthma episodes and also aggravate existing asthma symptoms by making the child more sensitive to other triggers.
–Tobacco smoke and asthma- Secondhand smoke is a mixture of the mainstream smoke exhaled by a smoker and side stream smoke coming from a lighted cigarette. Over 4000 chemicals can be found in tobacco smoke.
— Children who breathe secondhand smoke are liable to have more frequent and severe asthma attacks.
—More importantly secondhand smoke may cause children to develop asthma.
—Secondhand smoke can make children more prone to catching pneumonia, acute bronchitis and dyspnoea.
Try to keep your child away from cigarette smoke, avoid smoking in front of your child and keep proper ventilation to remove secondhand smoke from your house by exhaust fan.
Indoor plants: Trees like palm(male), chamomile, sunflowers, daisies etc are allergic plants which pollinate and cause allergies when kept in the house or garden.
OUTDOOR TRIGGERS:
–Air pollution- Air pollutants affect children more than adults because they have smaller and narrower airways than adults. Secondly children tend to breathe mostly by mouth when they play or exercise and thus the air that enters the lungs is less filtered and this exposes them to more pollutants and triggers.
A study conducted by central pollution control board (CPCB) has found that almost every third child in Delhi had reduced lung function due to air pollution.
The major pollutants are—ozone(o3), sulphur dioxide(so2), nitrogen dioxide(no2) and particulate matter(pm).
—Ozone (o3)—‘Good ozone’ is found in the earth’s stratosphere which is the upper layer of ozone above the troposphere (the first layer of atmosphere just above the earth). The ‘good ozone’ protects us from the harmful rays (ultraviolet rays) of the sun. In industrialized cities with high motor traffic the volatile organic chemicals(voc’s) from the industrial and vehicle fumes reacts with nitrogen oxides(nox’s) in presence of sunlight and forms “ground-level” or bad ozone. This forms ‘smog’ in the troposphere of earth and ozone is a major component of smog.
Ozone causes decrease in lung function, chest pain and aggravation of asthma symptoms. The level of smog is higher in summers during evenings.
Avoid the exposure of your child to smog on days its levels are high.
—Sulphur di-oxide (Sio2)—It is an industrial gas that comes mostly from power plants which use coal as agents to produce electricity. This causes decrease in lung function and asthma episodes in children.
—Nitrogen di-oxide (No2)—It comes mainly from combustion of fuels-coal, oils and gas. The main source is motor vehicle exhaust and manufacturing industries. It forms smog. High levels of nitrogen dioxide in air can cause inflammation of mucus membranes of lungs and it also reduces the ability of a child to fight infections. This results in frequent cold and cough episodes with wheezing and severe attacks of asthma.
—Particulate matter (pm)—These include particles of different sizes depending on their source. Larger particles come from natural sources like soil and organic matter. Smaller particles come from combustion of fuels—motor vehicles and power plants. These particles may be of different sizes ranging from pm10 (particles of 10 microns size), pm2.5 (particles of 2.5microns size) to ultrafine particles. Particles that are smaller than 2.5 micrometers in diameter(more than 100 times thinner than human hair) are called pm2.5. Pm2.5 carries toxic chemicals and heavy metals. The smaller the particle size the greater is the risk of penetration of the pollutant deeper into the respiratory system and cause greater damage in the long term. These particles are linked to allergic attacks, breathlessness attacks and cause poor lung development in children.
—If you are living in an industrialized town with heavy motor traffic then make your child wear an anti-pollution mask when the child goes out or on days the air pollution seems high.
—Avoid travel during peak traffic hours and if you do then keep the window glasses closed and switch on the a/c.
—Cold air-Cold air is a problem for many reasons.
–Asthmatics have sensitive airways. Cold air is dry, so breathing in cold air takes away the moisture present on the mucus membranes lining the airways faster than it can be replaced by the body. Cold air causes the airways to produce histamine which in turn triggers an allergy attack. This causes wheezing and other asthma symptoms.
Children play outside and while playing they tend to breathe through the mouth. The nose is designed to warm the inhaled air and also filter it before it enters the lungs but breathing through mouth does not filter or warm the air. Thus the cold and unfiltered air sends more allergens and triggers an allergic reaction.
Children should be covered properly during winters and also should be educated to breathe mostly by nose. They should be kept more indoors when outside temperature is very cold.

6) how to treat asthma naturally at home?

—Vitamin D-

Vitamin D deficiency is now an epidemic issue. In today’s modern life people tend to spend more time indoors either at work or home. This causes low levels of vitamin D as it is a hormone that the body produces when the skin is exposed to solar UV-B in sunlight. Researchers believe that there is a link between vitamin D deficiency and asthma. Asthma, Atopy and Eczema have been linked to low vitamin D levels in children and adults. Vitamin D supplements significantly reduce the episodes of asthma and allergic diseases in children.
Upto 80% of childhood asthma episodes are triggered after a ‘cold’ or viral upper respiratory tract infection. A study showed that daily supplementation of vitamin D with a dose of 400-500 IU/day in children showed marked decrease in asthma attacks triggered by viral infections. These children also showed greater resistance to infections of the upper respiratory tract and reduced inflammatory responses. Children with lower vitamin D levels showed higher airway sensitivity, high eosinophil counts and also raised IgE levels.
The daily requirement of vitamin D is 400-800 IU/day. We also found in our clinical study that children when supplemented with a daily dose of vitamin D along with regular medication showed reduction in the frequency of cold and asthma attacks.
Foods rich in vitamin D are eggs, cheese, beef liver, fish and foods fortified with vitamin D like dairy products, orange juice, soy milk, cereals etc.

–Honey-

Honey has been proven to reduce night cough in children with asthma. Care should be taken not to give honey to children below 2 years of age.
Honey has anti-bacterial, anti-fungal, anti-inflammatory and anti-allergic properties. It strengthens the immune system and helps to protect against infections, cold and flu and thereby reduces frequency of asthma flare-ups. It contains alcohol and ethereal oil which break up mucus in throat and promote expectoration of cough. It contains traces of iron, phosphorus, calcium, copper, magnesium, gold, etc which strengthen the immune system and helps fight against infections. The darker varieties have more anti-oxidant properties.
Honey can be used with a variety of other natural products like-lemon, milk, turmeric, ginger, cloves, gooseberries, basil leaves, onion juice or cinnamon for benefit in asthmatics. All these boost the immune system and offer health benefit in asthma.
For one kilogram of honey the honey bee has to collect nectar from thousands of flowers and when a person takes that honey he/she gets exposed to those many varieties of pollen grains which in turn trigger anti-body formation and natural immune boosting in the system of that individual. We recommend honey mixed with other immune boosting herbs to our patients for natural immune boosting.

–Foods that help fight Asthma:

Foods don’t cure asthma but certainly avoiding dietary triggers and taking the right kind of diet helps in keeping asthma attacks at bay. A healthy diet can provide the asthmatic with antioxidants, anti-inflammatory and anti-allergic nutrients. The immune system has to be supported, protected and boosted with the right kind of foods.
Asthma symptoms are related to foods that cause:
–Allergies-in food and drinks,
–Inflammation of mucus membranes of airways,
— Increased mucus secretion in airways and lungs,
— Constriction of the airways with breathing difficulty,
–Coughing,
–Irritation of throat.
So the food that an asthmatic eats should have properties or ingredients which can reduce inflammation, decrease mucus secretion, reverse constriction of the airways and also minimize irritation of throat and coughing.
The diet should be rich in omega-3-fatty acids, magnesium, selenium, potassium, beta-carotene, vitamin b6, b12, C and E and flavonoids.

Omega-3-fatty acid

–Omega-3-fatty acids (epa- and dha) naturally reduce the production of inflammatory compounds like prostaglandins and leukotrienes. Leukotrienes are released by the body’s immune system after it comes in contact with an allergen. This in turn causes constriction of airways and production of excess mucus leading to wheezing, tightness of chest, breathlessness and coughing.
Majority of the children eat foods rich in omega-6-fatty acids present in processed foods and margarines which promotes inflammation. Omega-3 rich foods reduce inflammation and therefore help in asthma. A healthy diet should have omega-6 to omega-3 ratio of 3:1.
Omega-3 fatty rich foods include fish oils, soya beans(roasted), spinach, walnuts(fresh extracted), canola oil, chia seeds, flaxseeds, olive oil, garlic etc.
It has been observed in our clinical study that children who ate fish (fresh water fishes like –rohu and katla–Indian name) experienced asthma attacks after they ate fish but not after taking cod liver oil capsules.

Magnesium and potassium

–Magnesium helps in asthma by relaxing constriction of airways and reducing inflammation of mucus membranes.
In studies done with oral magnesium supplementation it was found that:
–It decreased skin and airway reactivity to allergens,
–Asthma attacks became less frequent,
–Improved pulmonary function tests,
–Reduced wheezing of lungs.
Asthma is an inflammatory condition and magnesium is the basic anti-inflammatory.
The magnesium rich foods are avocado, dark leafy vegetables, lentils, nuts, whole grains, yogurt, fish, banana, dried fruits and dark chocolate. Here individual reaction to foods may vary as many of our patients reported aggravation of cough and asthma symptoms from eating banana, fish and dried fruits.
Adequate potassium levels are also associated with improved lung function and reduced frequency of asthma attacks. Potassium is mostly found in root vegetables, beans, papaya, kiwi, orange, mango, banana. But, many parents have reported increase in cough and worsening of asthma symptoms after eating banana and orange.

Selenium

Selenium has anti-oxidant and anti-inflammatory properties which makes it useful in asthma management. Studies have shown that it does not improve lung functions but it can improve the quality of life of asthmatics. Selenium rich foods are brazil nuts, oysters, tuna, whole wheat bread, sunflower seeds, chicken, mushrooms, whole grains like brown rice and oatmeal.

Carotenoids– Beta-carotene and Lycopene.

Almost 90% of asthmatics and 10% of non-asthmatics suffer from exercise induced asthma (EIA). Taking beta-carotene rich foods reduces EIA. It is a fat soluble anti-oxidant that fights free radicals which cause constriction of the airways and hence prevents inflammation. Beta-carotene rich foods include spinach, carrots, mango, apricots, sweet potato, apples.
LYCOPENE has high anti-oxidative activity. Studies have shown reduction in severity of asthma attacks after taking lycopene supplementation in food. It is a deep yellow pigment found in fruits and vegetables like tomato, watermelon.

Vitamin C

Vitamin C is a water soluble potent antioxidant that boosts the immune system. It is one of the most useful antidotes to food allergies. We have also noted that patients who took adequate vitamin C supplementation showed marked decrease in allergies. Usually doctors prescribe antihistamines to tackle allergy. When a person comes in contact with an allergen (from air or food) the immune system releases histamine from mast cells (immune cells). The histamine attaches to receptors in blood vessels causing redness, inflammation and itching. Antihistamines work by blocking histamine and preventing it from attaching to receptors in blood and thereby preventing inflammation, redness or itching. Vitamin C is a natural antihistamine which works by destroying histamine in blood. Therefore in allergic persons a high level of vitamin C is needed to achieve this effect either by food or supplementation.
Studies have suggested that taking high doses of vitamin C helps in exercise induced asthma and in asthma attacks following viral colds. Dietary intake and supplements with low doses are not sufficient.
Some studies also suggest positive effects of vitamin C in E.I.A and pulmonary functions.
The body does not make vitamin C on its own and does not store it either therefore foods rich in vitamin C should be taken fresh as they lose their strength after being exposed to air. The foods rich in vitamin C are-guava, kiwi, orange, strawberries, papaya, broccoli, dark green vegetables, pineapple, grapefruit, mango, peppers, tomatoes, peas.

Deficiency of vitamin C is mainly due to lack of daily dose needed for the body. Different doctors have different opinions but those who take plenty of fresh fruits (citrus included) and vegetables, they do not need any supplements of vitamin C. For those whose diet lacks vitamin C, 50 to 300 mg once or twice may be sufficient.

Flavonoids:

–Flavonoids are polyphenolic plant secondary metabolites found in vegetables, fruits and beverages. They have powerful antioxidant, anti-inflammatory, anti-allergic and immune modulating properties. They include quercitin (from apple and onion), catechins( tea), curcuminoids (turmeric), zingiberols(ginger). All these have surprising effectivity in reducing the severity of asthma attacks. Flavonoids also inhibit histamine release.
Flavonoid rich foods are-red peppers, strawberries, citrus fruits, broccoli, brussels sprouts, mango, papaya, garlic, spinach, green teas.

–Foods that aggravate asthma.

There are different opinions about what foods to give and what to avoid in asthma but our opinion is based on our clinical experience on reports of asthma patients from the last 30 years.
The most common foods that may be associated with allergic symptoms are as follows:
–eggs
–fish
–tree nuts
–peanuts
–soy
–wheat
–cow’s milk and curd
–shellfish and seafood
–dry fruits
–pickles
–fresh fruits-except apples, pomegranate, papaya.
–Chinese foods
–tamarind
–Vegetables-ladyfinger(bhindi), jackfruit(Kathal), ivy gourd(kundru), brinjal.
Reaction to food is totally individual and depends on idiosyncrasies of different people but only a broad overview has been given above based feedback from patients

Outdoor triggers:
–Air Pollution- air pollutants efect children more than adults because they have smaller and narrower airways than adults. Secondly children tend to breathe mostly by mouth when they play or exercise and thus the air that enters the lungs is less filtered and this exposes them to more pollutants and triggers.
A study conducted by central pollution control board (cpcb) has found that almost every third child in delhi had reduced lung function due to air pollution.
The major pollutants are—ozone(o3), sulphur dioxide(so2), nitrogen dioxide(no2) and particulate matter(pm).
—Ozone (o3)—‘good ozone’ is found in the earth’s stratosphere which is the upper layer of ozone above the troposphere (the first layer of atmosphere just above the earth). The ‘good ozone’ protects us from the harmful rays (ultraviolet rays) of the sun. In industrialised cities with high motor traffic the volatile organic chemicals(voc’s) from the industrial and vehicle fumes reacts with nitrogen oxides(nox’s) in presence of sunlight and forms “ground-level” or bad ozone. This forms ‘smog’ in the troposphere of earth and ozone is a major component of smog.
Ozone causes decrease in lung function, chest pain and aggravation of asthma symptoms. The level of smog is higher in summers during evenings.
Avoid the exposure of your child to smog on days its levels are high.
—Sulphur Di-oxide (sio2)—it is an industrial gas that comes mostly from power plants which use coal as agents to produce electricity. This causes decrease in lung function and asthma episodes in children.
—Nitrogen Di-oxide (no2)—it comes mainly from combustion of fuels-coal, oils and gas. The main source is motor vehicle exhaust and manufacturing industries. It forms smog. High levels of nitrogen dioxide in air can cause inflammation of mucus membranes of lungs and also reduces the ability of a child to fight infections. This results in frequent cold and cough episodes with wheezing and severe attacks of asthma.
—Particulate Matter (pm)—these include particles of different sizes depending on their source. Larger particles come from natural souces like soil and organic matter. Smaller particles come from combustion of fuels—motor vehicles and power plants. These particles may be of different sizes ranging from pm10-particles (10 microns), pm2.5 – particles (2.5microns) to ultrafine particles. The smaller the particle size the greater is the risk of penetration of the pollutant deeper into the respiratory system. These particles are linked to allergic attacks, breathlessness attacks and cause poor lung development in children.
—if you are living in an industrialized town with heavy motor traffic then make your child wear an anti-pollution mask when the child goes out or on days the air pollution seems high.
—avoid travel during peak traffic hours and if you do then keep the window glasses closed and switch on the a/c.
—Cold Air is a problem for many reasons.
–asthmatics have sensitive airways. Cold air is dry, so breathing in cold air takes away the moisture present on the mucus membranes lining the airways faster than it can be replaced by the body. Cold air causes the airways to produce histamine which in turn triggers an allergy attack. This causes wheezing and other asthma symptoms.
Children play outside and while playing they tend to breath through the mouth. The nose is designed to warm the inhaled air and also filter it before it enters the lungs but breathing through mouth does not filter or warm the air. Thus the cold and unfiltered air sends more allergens and triggers an allergic reaction.
Children should be covered properly during winters and also should be educated to breath mostly by nose. They should be kept more indoors when outside temperature is very cold.