Spring is a hard time for those who suffer from bronchial asthma, and in the world, according to various estimates, about 300 million. This figure doubles every 20 years.
Bronchial asthma is a chronic inflammatory disease of the respiratory tract, today, unfortunately, incurable. It manifests itself as bronchial obstruction, that is, the narrowing of the lumen of the bronchi, which leads to episodes of wheezing, shortness of breath, feelings of stuffiness in the chest and coughing. A severe asthmatic attack in the absence of medical intervention can lead to the death of the patient.
The most important component of the disease is immunological, since allergy leads to inflammation of the respiratory tract. That is why spring is a time of exacerbation for those who suffer from bronchial asthma, and in the world, according to various estimates, from 235 to 300 million.
The figure itself is large, but the most alarming fact is that the prevalence of asthma in the developed countries of the world has doubled every 20 years in the last 60-70 years. This means that there are some circumstances of a rapidly changing lifestyle that lead to an increase in morbidity, and studies that shed light on such factors are very important.
The search for asthma therapy does not lose its relevance, but the question of ways to prevent it is especially acute.
Where does the increase in morbidity come from?
The researchers have on this account a number of conjectures, supported by scientific evidence. About them, as well as some more new and interesting facts concerning asthma and its therapy, we will tell in this article.
We have already written, but it will not be superfluous to repeat: the scientists came to a consensus that to a large extent the increase in the incidence of asthma is explained by the widespread use of paracetamol as a priority antipyretic agent in children and pregnant women.
The popularity of paracetamol dates back to the 80s of the last century. Before that, the temperature was usually knocked down with aspirin, but 40 years ago, it stopped giving to children, fearing complications such as Ray’s syndrome and gastric bleeding.
Back in 1998, in a paper published in the Annals of Immunology (Allergy and Asthma), Dr. Arthur Warner, who taught immunology at the University of Wisconsin Medical School, first conjectured that switching to paracetamol could trigger a sharp rise in asthma.
Since then, more than 20 studies have been conducted, the results of which confirm it. Among them – a detailed analysis of data on more than 200,000 children, published in the journal Lancet. It indicates an increased risk of asthma in those who took paracetamol.
By the way, in children 6-7 years old, who received the drug in the last 12 months, the risk was not only of asthma, but also of rhinoconjunctivitis and eczema.
Dr. John T. McBride, pediatrician at the Children’s Hospital in Akron (Ohio, USA) argues that the link between paracetamol and asthma is justified enough to recommend that infants and children with asthma or at risk should avoid taking this medication .
His findings were published in November 2011 in the journal Pediatrics. They are confirmed by the results of a relatively recent large-scale study by Norwegian scientists who established that the intrauterine and early effects of paracetamol on children increase the risk of subsequent development of asthma.
“Hygienic hypothesis” and the best friend of man
If you read articles on medical topics, you probably already came across the term “hygienic hypothesis”. It was first used in 1989 by Professor David Strakan, an epidemiologist from St. George’s Hospital in London. He suggested that a high level of hygiene and reduced exposure to infections in early childhood leads to an increase in autoimmune chronic inflammatory diseases, especially allergies and asthma.
Since then, a huge amount of evidence has accumulated, suggesting that shifts in the microbioma (the gene composition of all microorganisms inhabiting the human body) are associated with an increase in the incidence of autoimmune diseases in general and asthma in particular.
How can the composition of microbes contribute to inflammation of the bronchi?
This question is partly answered by the study of American scientists, published in 2016.
The researchers studied the composition of the intestinal microflora of 130 one-month-old babies, and then examined their health at the age of two and four years. There was a clear connection between microorganisms in children and the subsequent risk of asthma. The highest risk was in children whose bowels lacked certain types of bacteria, in particular, Bifidobacterium, Akkermansia and Faecalibacterium, but in excess contained fungal, Candida and Rhodotorula.
Scientists are interested in the by-products of bacteria in the stools of healthy children. They found a number of fat molecules, feeding T-regulators, cells of the immune system, reducing inflammation. Children who are predisposed to allergies and asthma, these molecules were absent, but there was another type of fat molecule, which in earlier works, scientists found in adults with asthma.
But the most amazing discovery scientists made when they studied the socio-economic factors that affect the disease. It turned out that the risk of asthma in a child is reduced when there is … a dog in the house!
“The lifestyle has changed dramatically in the last few decades,” said Professor Susan Lynch, lead author of the study. “We have significantly reduced our exposure to environmental microbes. The presence of a dog can return the external environment to the house, and this is one way to expand the composition of microbes for a child at the beginning of his life. ”
Dr. Benjamin Marsland from the University of Lazagne (Switzerland) believes that it is best for a young child to live on a farm and drink raw milk, then there is no fear of asthma or allergies. But this is not suitable for everyone, so we have to look for more realistic ways to improve the microbiomas of adults and children, not only for the prevention, but also for the treatment of asthma.
Inulin and helminths
In March 2017, scientists from the University of Newcastle (Australia) at the annual meeting of the Thoracic Society of Australia and New Zealand reported on the results of their work.
Asthma sufferers daily received inulin, one of the types of fiber found in foods such as onions, garlic and banana. The human body does not digest inulin, but it does not prevent it from being the food of beneficial microorganisms of our intestines.
As a result of ingestion of inulin, the composition of the intestinal microflora changed in the participants of the study, and this reduced the inflammation of the bronchi and the manifestation of asthma symptoms. It is noteworthy that the best results were shown by those patients whose symptoms were worst affected by traditional medicines.
Another innovative method of treating asthma is helminthotherapy.
Details about different types of therapeutic helminths and how they affect the immune system, we wrote here in this article.
Despite extensive medical literature (a list of some sources is attached to this article) and a huge number of positive reviews of patients (for example, here), helminthotherapy is not yet officially approved as an asthma treatment method because of the lack of large-scale clinical trials. Everything depends on financing. Money is from large pharmaceutical companies, and they are not particularly interested in a product whose formula can not be patented, because in this case, the therapeutic agent is a living organism.
Many experts, in particular, William Parker, professor of Duke University (USA), believe that helminthotherapy is the future, and in a dozen years asthma and other autoimmune inflammations will be treated first of all by them.
Data on the benefits of vitamin D for respiratory diseases have been accumulating for a long time. A lot of research is devoted to its positive role in the treatment of asthma. And in the fall of 2016, a meta-analysis of these studies by the Cochrane Group of Experts was published.
Scientists selected seven most scientifically reliable scientific works, including a total of 435 children and two studies, including 658 adults. Participants in the studies differed ethnically, as they were conducted in Canada, India, Japan, Poland, the United Kingdom and the United States. Most of them suffered from symptoms of asthma of low and medium severity, a small part from severe illness. Most of the participants did not stop taking medications from asthma during the study.
The researchers found that oral vitamin D intake reduced the frequency of severe attacks in patients, and reduced the need for steroidal anti-inflammatory drugs.
These data are mainly derived from research on adults, so that the effectiveness of vitamin D in children requires additional research. It is also unclear whether the effectiveness of the vitamin in asthma depends on what is its original level in the patient’s body. It is possible that it is effective only for those who have a deficiency of D before the reception.
Another good news is that the studies clearly indicate the safety of taking vitamin D, so you can try now, but after consulting with your doctor.
“Let food be your medicine”
Already mentioned above, the Swiss doctor Benjamin Marsland, who recommends birth of a raw milk for the prevention of asthma in the family of farmers and all childhood, is fully aware of the low realism of his advice, and therefore seeks other ways to combat this disease.
Marsland experimented on the animal model and found that mice on a diet high in fiber had high levels of circulating in the body of short-chain fatty acids that protect against allergic inflammation of the respiratory tract. It is easy to guess that a diet with a low fiber content, on the contrary, worsened the course of the disease.
Dr. Marsland believes that the same pattern, with a high degree of probability, works for people.
Saturating the diet with fruits and vegetables – in any case, the correct tactics of a healthy lifestyle.
But a relatively recent study of Danish scientists. They studied the effect of a diet high in protein and low in carbohydrates (which is usually recommended for diabetics) and physical education for asthma in patients who are not obese. (With asthma in obese patients, these interventions have proved themselves positively in earlier studies).
Significant improvements were demonstrated by a group of participants in the study, who at the same time adhered to the diet and exercised (high intensity, but short in time). Those who did either one or the other, did not feel significant improvements.
As a rule, people with asthma are afraid of heavy physical exertion, as they can provoke an attack, but with gradual involvement and proper selection of exercises, physical education can be an important therapeutic factor for such patients in combination with proper nutrition.
And what about tablets?
Of course, everyone wants an effective drug: accepted – and there was relief. With asthma this is not always possible, but scientists are working on this problem.
In February this year, an American-Chinese group of scientists published the results of joint scientific work. The researchers tested more than 6000 compounds and found that one of them, TSG12, relaxes muscles and opens bronchial lumens in patients with asthma.
TSG12 is a derivative of the MT-2 protein that relaxes the smooth muscle of the airways. Scientists have found that in asthmatics, the content of this protein in the lung tissue is more than two times lower than normal, and experimental mice without MT-2 were twice as prone to asthma.
The TSG12 drug showed higher efficacy in the relief of asthma symptoms than those currently used.
In addition, the big problem with asthma medicines is that they have very unpleasant side effects, and the TSG12 has shown a good safety profile.
Ahead – clinical trials of the drug.