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Spring 2008 Respiratory Therapist in Alabama Asthma Clinic Helps Serve Unmet Needs of His Community Food Triggers for Asthma and Allergies Debunking Cultural Myths on the Management of Asthma
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 Debunking Cultural Myths on the Management of Asthma I recently googled the term “asthma cures” on my computer and found that there are more than 2 million web sites that offer information on asthma remedies. The cures available from the World Wide Web range from solid evidence-based guidelines to the absurd. Did you know that in India every spring hundreds of thousands of asthma sufferers congregate in the Indian city of Hyderabad and wait in line for hours to be fed live fish, usually a sardine or murrel, along with a yellowish paste of which its contents are not revealed? This is followed by a 45-day diet of different foods. The ultimate result is supposed to be a cure for asthma. It is not. Native Americans, primarily the Winnebago and Dakota tribes, have used skunk cabbage to stimulate the removal of phlegm in managing asthma. I have taken care of patients in the inner-city who have claimed other cultural or family cures that they claim have worked. One family in particular told me that they treated their child’s asthma by putting tree bark under the child’s pillowcase. The child then slept at night breathing the vapors from the bark. This was particularly concerning because it was likely that there was a host of allergens and molds in that bark that were bound to provoke an asthma attack, not prevent it.
Complementary medicine It is estimated that about 40% of American adults use complementary medicine.1 In the inner city the most common form of complementary medicine includes prayers (53%), rubs (53%), and massage therapy (45%). Interestingly, 59% of those who follow this management plan feel that it is just as effective as pharmacotherapy.2 African-American asthma sufferers are more likely to rely on prayer, and Hispanic families are more likely to rely on herbal and massage therapies.3 Of particular concern is that some of the herbal remedies used in the Mazur study included lobelia, tea tree oil, and pennyroyal mint — all of which are potentially toxic. A recent study at Johns Hopkins found that most African-American families trusted their prescription asthma medicine along with at least one form of complementary medicine.4 Their concluding recommendation was that the clinician must be aware of the use of complementary medicine and discuss it with patients during clinical visits. Cultural and ethnic beliefs certainly play a huge role in whether patients adhere to an asthma action plan. It is essential that your health care provider discuss complimentary medicine with you, especially when harmful remedies are being used. During the same conversation it is important that this clinician propose other non-culturally adverse approaches to care. All of this must be noted in the asthma action plan for future reference.
Evidence-based perspective Beyond cultural beliefs there are other complementary and alternative medicines that are commonly used. The Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma does weigh in on this with an evidence-based perspective in the publication released in August of 2007.5 Acupuncture is not recommended as a treatment, according to the Expert Panel, due to the fact that there is an insufficient number of studies published on this method. Chiropractic therapy also was found to have insufficient evidence; and those studies that did show positive results were mixed at best, with some benefit in symptoms and quality-of-life measurements but with no definitive improvement on other objective measures of asthma outcomes. The lack of recommendations also holds true for breathing exercises, relaxation techniques, yoga, and herbal remedies for managing asthma. None of these complementary therapies are recommended for the management of asthma, at least according to the Expert Panel Report 3.
Respiratory therapists can help We live in a world where information is no farther away than the tips of our fingers. Unfortunately not all of it is vetted, much less safe. Your respiratory therapist knows how to treat and educate you about asthma, which includes asking questions about your asthma care and any complementary strategies that you are following.
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