A Functional Medicine Asthma Protocol: Testing, Nutritional Considerations, and Supplements

Nearly 26 million Americans have asthma. In 2020, over 40% of affected children and adults experienced at least one asthma attack. Asthma accounts for almost five million doctor visits, not including emergency department visits, and $50 billion in medical costs annually. On average, ten people die from asthma daily in the United States; nearly all these deaths are avoidable with the right treatment. This article will discuss the importance of an integrative treatment plan, including the conventional and complementary treatment options that should be considered in properly treating and managing patients with asthma. (13)  

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What Is Asthma?

Asthma is a chronic respiratory condition characterized by chronic inflammation and hyperreactivity of the airways. Asthma attacks result from exposure to a trigger, which causes smooth muscle constriction, a proinflammatory immune response, and mucus production in the airways that obstructs airflow and makes breathing difficult. 

If asthma is severe or poorly controlled, irreversible changes, called airway remodeling, can occur over time. These changes involve structural modifications, such as thickening of the airway walls, enlargement of smooth muscle cells, and an excess accumulation of mucus, that contribute to persistent airway obstruction and reduced lung function. (15) 

Asthma Signs & Symptoms

The main symptoms of asthma include recurrent episodes of wheezing, shortness of breath, chest pain and tightness, and coughing that vary in frequency and intensity.

During an acute exacerbation, depending on the severity of the attack, patients may show signs of respiratory distress, which include sitting forward to help open the airways, cyanosis of the lips and nails, and confusion. A physical exam will reveal a bilateral expiratory wheeze on auscultation of the lungs, mild tachycardia (a common side effect of bronchodilating medications), and reduced oxygen saturation and peak expiratory flow. (15)  

What Causes Asthma?

Asthma is considered a complex disease involving a combination of genetic and environmental factors. 

Allergic, or extrinsic, asthma is triggered by exposure to specific allergens that the immune system recognizes as harmful. These allergens include pollen, dust mites, pet dander, mold spores, and certain foods. When individuals with allergic asthma come into contact with these allergens, their immune system overreacts, leading to airway inflammation, constriction, and the typical asthma symptoms. Allergic asthma often coexists with other allergic conditions like allergic rhinitis (hay fever) and atopic dermatitis (eczema) - collectively called the allergic triad. (10) 

Nonallergic, or intrinsic, asthma is triggered by factors other than allergens. These triggers include respiratory infections, exercise, cold air, irritants (such as smoke, strong odors, or chemicals), stress, and hormonal changes. Nonallergic asthma involves airway inflammation and constriction due to mechanisms other than an allergic immune response. (17) 

Functional Medicine Labs to Test for Root Cause of Asthma

Patients with suspected asthma should be referred to a pulmonologist for lung function testing. Spirometry is the primary diagnostic method of choice for asthma; it measures the amount of air the patient can exhale forcefully and how quickly they can do it. 

Peak flow monitoring is another test the patient can easily perform in the primary care setting and at home. It involves using a peak flow meter to measure how well the patient can forcefully exhale air. Regular peak flow monitoring can help track changes in lung function, identify asthma triggers or worsening symptoms, and guide treatment decisions.

Functional medicine labs play a vital role in comprehensively understanding the underlying factors contributing to asthma. Discussed below are common labs that functional and integrative doctors will order for their patients with asthma. 

Comprehensive Stool Test

Emerging research highlights the strong link between gut health and asthma, with the gut microbiome playing a crucial role in asthma development and progression. Alterations in gut bacteria composition and diversity, known as dysbiosis, increase the risk of asthma, while beneficial bacteria like Bifidobacterium and Lactobacillus species protect against asthma. The gut-lung axis connects gut health and asthma through immune response modulation, influencing allergic reactions and airway inflammation. Additionally, the gut microbiome's production of anti-inflammatory substances like short-chain fatty acids (SCFAs) contributes to immune system balance and may affect asthma outcomes. (7, 19)

Understanding this, a comprehensive stool test helps identify inflammation, SCFA deficiencies, and dysbiotic patterns within the gastrointestinal tract that can contribute to immune hyperreactivity and asthma severity. 

Allergy Testing

Since allergen exposure plays a significant role in triggering asthma attacks, identifying and eliminating allergens is critical to a successful asthma treatment plan. A comprehensive allergy test measures IgE reactions to common environmental and food antigens.

Comprehensive Nutritional Assessment

A comprehensive nutritional assessment screens for imbalances in essential nutrients that can contribute to immune dysregulation and inflammation. Additionally, these panels often include oxidative stress markers, representing how effectively the body's antioxidant systems can remove reactive oxygen species and repair the resulting damage. This test helps personalize dietary and supplement recommendations to the patient's cellular needs.

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Conventional Treatment for Asthma

The conventional stepwise treatment approach for asthma involves a systematic progression of medications and treatment strategies based on the severity and control of asthma symptoms. This approach is outlined in guidelines provided by organizations such as the Global Initiative for Asthma (GINA) and the National Asthma Education and Prevention Program (NAEPP). Short-acting bronchodilators (SABA), inhaled corticosteroids (ICS), and long-acting bronchodilators (LABA) are the predominant classes of medications prescribed for managing asthma. Depending on individual circumstances, oral corticosteroids, leukotriene receptor antagonists (LTRA), and biologics may be considered as other add-on medications.

Functional Medicine Treatment Protocol for Asthma

It is important to note that a functional medicine approach to treatment should not undermine the importance of pharmaceutical intervention. Uncontrolled asthma can lead to irreversible airway pathology and severe, life-threatening attacks. However, using complementary modalities, including evidence-based nutrition and supplements, to address the underlying factors of the disease can improve treatment outcomes and disease severity, resulting in decreased reliance on prescription medications.

Therapeutic Diet and Nutrition Considerations for Asthma

According to a 2018 study that examined the association between diet and asthma symptoms, an anti-inflammatory diet characterized by nutrient-dense whole foods and low in processed foods was best for overall asthma control. 

Anti-inflammatory diets aim to promote overall health and reduce systemic inflammation by emphasizing foods with anti-inflammatory properties and avoiding those known to promote inflammation and immune reactivity. Perhaps the most well-known and studied anti-inflammatory diet is the Mediterranean diet. Rich in antioxidants and healthy fats, studies consistently demonstrate this diet's protective effects for asthma by controlling respiratory symptoms.

Supplements Protocol for Asthma

The following supplements have been proven helpful in managing asthma.

Magnesium

Magnesium has many beneficial effects on the body that make it helpful in preventing and treating asthma. Magnesium promotes bronchial smooth muscle relaxation, is anti-inflammatory, and supports histamine metabolism. Low magnesium status has been associated with more severe asthma presentations. Intravenous and inhaled preparations of magnesium are administered in emergency settings for acute exacerbations of asthma, and long-term oral administration has been shown to reduce bronchial hyperreactivity and improve peak flow measurements and patient quality of life. (28) 

Dose: 300-500 mg daily

Duration: 6 months

Vitamin C

As an antioxidant, vitamin C helps protect against oxidative stress and reduces inflammation, key factors in asthma pathogenesis. It may also improve lung function by having a direct bronchodilator effect on the tracheal smooth muscle. Furthermore, vitamin C enhances the function of the immune system and strengthens respiratory defenses, potentially reducing the frequency and severity of respiratory infections that can trigger asthma exacerbations. 

Dose: 500-2,000 mg daily

Duration: at least two weeks

Fish Oil

Fish oil is concentrated in anti-inflammatory omega-3 fatty acids. Omega-3 supplementation reduces the production of chemical mediators involved in allergic inflammation by altering the ratio of omega-6 to omega-3 fatty acids in cell membranes. Research also demonstrates that fish oil supplementation reduces the risk of pediatric asthma. (28) 

Dose: 2,000-5,000 mg combined EPA + DHA daily

Duration: at least 6-8 weeks

Boswellia 

The boswellic acids concentrated in Boswellia possess potent anti-inflammatory properties by inhibiting pro-inflammatory enzymes and the production of inflammation cytokines. Supplementing with Boswellia extract has been shown to reduce asthmatic symptoms, frequency of attacks, and inhaler use, in addition to improving lung function scores (11, 14).

Dose: 500-900 mg daily, in split doses

Duration: 4-6 weeks

When to Retest Labs

With satisfactory medication administration technique and treatment adherence, patients should observe improvements in the frequency of symptoms, the extent of symptom interference with daily activities, and reliance on quick-relief medications within 4-6 weeks. If a clear benefit is not observed within this timeframe, consider stepping up in the pharmaceutical intervention and adjusting complementary therapies. Alternatively, if a patient's symptoms are well-controlled and stable for at least three months, it is reasonable to explore stepping down medications and supplements.

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Summary

Asthma is a chronic respiratory condition characterized by airway inflammation and hyperreactivity. Uncontrolled asthma can cause permanent changes to the airways, resulting in reduced lung function, and can be life-threatening. While a conventional pharmaceutical approach to treatment is essential in safely managing asthma, integrative medicine provides complementary treatment options that reduce inflammation, modulate the immune system, and optimize lung function.