Whatever your thoughts on global warming, one disturbing fact recently surfaced: Carbon Dioxide (CO2) emissions in the atmosphere have reached a peak level not seen for over 3 million years.CO2 monitoring stations high on the Mauna Loa volcano (Hawaii), run by the National Oceanic and Atmospheric Administration (NOAA), announced the record measurement in early May. The daily average has passed 400 ppm for the first time since readings began in 1958 and is predicted to rise to 720 ppm by 2075. This is the culmination of a steady rise from 280 ppm at the beginning of the age of industrialization.

CO2 Emissions in the Industrial Age

How do we know what the air was like millions of years ago? Incredibly, we can actually evaluate the air from millions of years ago by analyzing air trapped in ancient glacial or permafrost ice. You have to go back 3-5 million years to find these levels in “fossil” air. During that era, the temperature was several degrees higher than today, even higher in the polar regions. This caused forests to grow all the way to the Northern edge of the Arctic Ocean (treeless tundra today).

Why does all this matter to me as a physician, and as someone interested in the issue of survival in times of trouble? Because higher CO2 levels have an impact on your health in ways you may not realize. Due to higher pollen counts and longer pollen seasons, especially in the Northern latitudes, more and more people are testing positive for allergies. In many parts of the U.S., 20% of the population is allergic to, for example, ragweed.
Studies show that the more CO2 in the air, the more plants grow. This may allow us to grow more food, perhaps, but it also means that there’s a lot more pollen. It also means more hay fever and asthmatic reactions. Allergists all over the country are noticing that their patients are requiring stronger and stronger therapy to treat their condition. Let’s discuss asthmatic reactions and what you can do about them.

What is Asthma?

Asthma is a chronic condition that affects your ability to breathe. It affects the airways, which are the tubes that transport air to your lungs. When people with asthma are exposed to a substance that they are allergic to (an “allergen”), these airways become inflamed. As the airways become swollen, the diameter of the airway decreases and less air gets to the lungs. As such, you will develop shortness of breath, tightness in your chest, and start to wheeze and cough. This is referred to as an “asthma attack”.

In rare situations, the airways can become so constricted that a person could suffocate from lack of oxygen. This extreme condition is sometimes referred to as “Status Asthmaticus”. Here are common allergens that trigger an asthmatic attack:

• Pollen
• Pet or wild animal dander
• Dust or the excrement of dust mites
• Mold and mildew
• Smoke
• Severe stress
• Pollutants in the air
• Some medicines
• Exercise

There are many myths associated with asthma; the below are just some:

• Asthma is contagious. (False)
• You will grow out of it. (False-it might become dormant for a time but you are always at risk for it returning)
• It’s all in your mind. (False)
• If you move to a new area, your asthma will go away. (False – it may go away for a while, but eventually you will become sensitized to something else and it will likely return)

Here’s a “true” myth: Asthma is, indeed, hereditary. If both parents have asthma, you have a 70% chance of developing it compared to only 6% if neither parent has it.

Asthmatic symptoms may be different from attack to attack and from individual to individual. Some of the symptoms are also seen in heart conditions and other respiratory illnesses, so it’s important to make the right diagnosis. Symptoms may include:
-Cough
-Shortness of Breath
-Wheezing (usually sudden)
-Chest tightness (sometimes confused with coronary artery spasms/heart attack)
-Rapid pulse rate and respiration rate
-Anxiety
Besides these main symptoms, there are others that are signals of a life-threatening episode. If you notice that your patient has become “cyanotic”, they are in bad shape. Someone with cyanosis will have blue/gray color to their lips, fingertips, and face.

You might also notice that it takes longer for them to exhale than to inhale. Their wheezing may take on a higher pitch. Once the patient has spent enough time without adequate oxygen, they will become confused, then drowsy, and then possibly lose consciousness.

To make the diagnosis, medic, use your stethoscope to listen to the lungs on both sides. Make sure that you listen closely to each lung from top to bottom in the areas shown in the above image. In a mild asthmatic attack, you will hear relatively loud, musical noises (wheezes) when the patient breathes for you. As the asthma worsens, less air is passing through the airways and the pitch of the wheezes will be higher and perhaps not as loud. If no air is passing through, you will hear nothing, not even when you ask the patient to inhale forcibly. This person is in trouble.

You can measure how open your airways are with a simple diagnostic instrument known as a peak flow meter. It can help you identify if a patient’s cough is part of an asthma attack or not, or whether they are having a panic attack instead. It also identifies the severity of respiratory compromise.

This is what you do: Take your patient’s peak flow meter instrument and then (forcefully) exhale into it. This will give you a baseline reading of their normal baseline air flow. Then, when they’re having an attack, have them blow into it again.

In moderate asthma, peak flow will be reduced 20-40%. Greater than 50% is a sign of a severe episode. In a non-asthma related cough or upper respiratory infection, your peak flow will be close to normal. The same goes for a panic attack; even though you may feel short of breath, your peak flow is still about normal.

The cornerstones of asthma treatment are the avoidance of “trigger” allergens and the maintenance of open airways. Medications come in one of two forms: drugs that give quick relief from an attack and drugs that control the frequency of asthmatic episodes.

Quick relief drugs include inhalers that open airways (known as bronchodilators), such as Albuterol (Ventolin, Proventil), among others. These drugs should open airways in a very short period of time and give significant relief. These drugs are sometimes useful for people going into a situation where they are exposed to a known “trigger”, such as before strenuous exercise. Don’t be surprised if you notice a rapid heart rate on these medications; it’s a common side effect.

If you find yourself using quick-relief asthmatic medications more than twice a week, you are a candidate for daily control therapy. These drugs work (when taken daily) to decrease the number of episodes and are usually some form of inhaled steroid. There are long-acting bronchodilators as well, such as ipratropium bromide (Atrovent). Another family of drugs known as Leukotriene Modifiers prevents airway swelling before an asthma attack even begins. These are usually in pill form and may make sense for storage purposes. The most popular is Montelukast (Singulair).

Often, medications will be used in combination, and you might find multiple medications in the same inhaler. U.S. commercial product Advair, for example, contains both a steroid and an airway dilator. Remember that inhalers lose potency over time. An expired inhaler, unlike many pills or tablets, will lose potency relatively quickly.

It’s important to figure out what allergens trigger your asthma attacks and work out a plan to avoid them as much as possible. Furthermore, make sure to stockpile as much of your asthma medication as possible in case of emergency. Physicians are usually sympathetic to requests for extra prescriptions from their asthmatic patients.

In mild to moderate cases, you might consider the use of natural remedies. There are actually quite a few substances that have been reported to be helpful:

Ginger and Garlic Tea: Put four minced garlic cloves in some ginger tea while it’s hot. Cool it down and drink twice a day. Some have reported a beneficial effect with just the garlic.

Other herbal teas: Ephedra, Coltsfoot, Codonopsis, Butterbur, Nettle, Chamomile, and Rosemary all have the potential to improve an asthmatic attack.
Coffee: Black unsweetened coffee is a stimulant that might make your lung function better when you are having an attack. Don’t drink more than 12 ounces at a time, as coffee can dehydrate you. Interestingly, coffee is somewhat similar in chemical structure to the asthma drug Theopylline.

Eucalyptus: Essential oil of eucalyptus, used in a steam or direct inhalation, is well-known to open airways. Rub a few drops of oil between your hands and breathe in deeply. Alternatively, a few drops in some steaming water will be good respiratory therapy.
Honey: Honey was used in the 19th century to treat asthmatic attacks. Breathe deeply from a jar of honey and you should see improvement in a few minutes. To decrease the frequency of attacks, stir one teaspoon of honey in a twelve ounce glass of water and drink it three times daily.
Turmeric: Take one teaspoon of turmeric powder in 6-8 ounces of warm water three times a day.

Licorice and Ginger: Mix licorice and ginger (1/2 teaspoon of each) in a cup of water. Warning: Licorice can raise your blood pressure.

Black Pepper, Onion, and Honey: Drink ¼ cup of onion juice with a tablespoon of honey, after adding 1/8 tablespoon of black pepper.

Mustard Oil Rub: Mix mustard oil with camphor and rub it on your chest and back. There are claims that it gives instant relief in some cases.

Gingko Biloba leaf extract: Thought to decrease hypersensitivity in the lungs; not for people who are taking aspirin or ibuprofen daily, or anticoagulants like Coumadin.

Vitamin D: Some asthmatics have been diagnosed with Vitamin D deficiency.

Lobelia: Native Americans actually smoked this herb as a treatment for asthma. Instead of smoking, try mixing tincture of lobelia with tincture of cayenne in a 3:1 ratio. Put 1 milliliter (about 20 drops) of this mixture in water at the start of an attack and repeat every thirty minutes or so.

With a number of these substances, further research is necessary to corroborate the amount of effect that they have on severe asthma, so take standard medications if your peak flow reading is 60% or less than normal.

Don’t underestimate the effect of your diet on your condition. Asthmatics should:

• Replace animal proteins with plant proteins.
• Increase intake of Omega-3 fatty acids.
• Eliminate milk and other dairy products.
• Eat organically whenever possible.
• Eliminate trans-fats; use extra-virgin olive oil as your main cooking oil.
• Always stay well-hydrated; more fluids will make your lung secretions less viscous.

Finally, various breathing methods, such as taught in Yoga classes, are thought to help promote well-being and control the panic response seen in asthmatic attacks.

Dr. Bones