If ever a disease were misunderstood by modern medicine, it is asthma. Although doctors finally have begun to accept that asthma may be caused by an allergy, they assume that a disease involving the lungs must be caused - or at least aggravated - by inhaled pollutants. In fact, many studies demonstrate that food allergies can be just as likely triggers. It's also the case that allergies may have nothing to do with asthma. Some research into alternative treatments for asthma show that it may have an emotional cause, or even be an accident of modern medicine. Preliminary evidence suggests that asthma can be brought on by either vaccination or suppressive drugs used for other diseases, such as eczema (see box, p 4).

Because of this complicated aetiology, alternative medicine, with its emphasis on individualised treatment, is particularly well suited to treating asthma. Many therapies have impressive scientific records of curing or significantly alleviating asthmatic symptoms as well as those of its frequent companion, eczema.

Homoeopathy
Homoeopathy has the most scientific proof of all the alternative practices which successfully treat asthma. The most impressive clinical trials on alternative treatments for asthma are those conducted by Dr David Reilly of the Glasgow Homeopathic Hospital in Scotland. In his final study, of 28 patients with allergic asthma, mostly from housedust mites, those given homoeopathic immunotherapy for their chief allergy showed improvements in respiratory function and bronchial reactivity tests for up to eight weeks after treatment. The fact that Dr Reilly has carried out three nearly identical trials and produced positive results in all three lends further weight to his findings, and strengthens the evidence that homoeopathy works (Lancet, 1994; 344: 1601-6).

In a French study of 182 children aged between 2 and 8, the homoeopathic remedy Poumon histamine 5CH produced a striking decrease in the number of severe asthmatic attacks. In the study, which monitored the children for three months before giving them the remedy for three months, found that severe attacks were reduced by four and a half times, while those given a placebo hardly reduced at all (Homeop Fr, 1990; 78: 35-9).

Although other studies are less well designed (at least according to the methods imposed by orthodox science), they demonstrate the effectiveness of individualised remedies for treating and even curing asthma. (They also provide a blueprint for how holistic disciplines like homoeopathy can be scientifically tested.) In one study of 26 patients followed for up to 11 years and given individualised remedies, 57 per cent were cured (that is, had at least one year free of any asthmatic symptom). In all, 22 homoeopathic medicines were used, most frequently Sulphur, Calcarea carbonica, Lycopodium and Pulsatilla (Br Homeop J, 1992; 81: 168-72).

Another trial carried out with the support of the Medical Institute for Homoeopathic Research and Application involved 45 asthmatics between 6 and 75, treated with individualised remedies over 12 months. After the first month, the frequency of cough and inability to breathe decreased by 90 per cent, and 17 patients had totally recovered during the first four months. Although a number of patients developed aggravation of their symptoms, or had old problems (such as eczema) reappear, this is a positive sign in homoeopathic treatment, signifying that the natural law of treatment (which follows an inner-outer direction) is being followed. This means that in the process of an illness being cured, symptoms will move from an inner part of the body (the lungs, say) to a more outward part (the skin). In total, 38 patients experienced a 90 per cent improvement, and only three had less than a 40 per cent improvement (paper presented in the Proceedings of the 43rd LMHI Congress, Athens, 1988).

Acupuncture
Besides diet, acupuncture is probably the most studied alternative treatment for asthma, although the results are confusing. Many of the studies that have been carried out suggest that acupuncture won't work in controlling asthma in the long-term, even if it offers temporary improvement (Med Klin, 1975; 70: 1827-30; Prog Respir Res, 1980; 14: 271-5). Patients oftentimes reported that they felt better, but no improvement showed up in airways function, as measured scientifically (J R Soc Med, 1982; 75: 245-8).

In other studies, acupuncture doesn't work as well as drugs in alleviating symptoms. One comparison of real acupuncture against a sham needling treatment and the drug isoproterenol showed that real acupuncture worked better than the sham treatment, but not as well as the drug (Ann Allergy, 1977; 39: 379-87). Both auricular (ear) and laser acupuncture haven't worked in scientific trials (Lung, 1983; 161: 321-6; Atemwegs Lungenkr, 1994; 20: 701-5; Ann Allergy, 1993; 70: 295-8).

Other, small studies show improvements in lung function over time with fewer drugs needed (Allergy, 1984; 39: 379-85); in breathlessness and six-minute walking distance in chronic obstructive pulmonary disease (Lancet, 1986; ii: 1416-8); and in reducing bronchospasm and hyperinflation (Ann Allergy, 1977; 39; 379-87).

The Chinese journals, as always, provide the most optimistic view (but remember, the Research Council for Complementary Medicine has cautioned us to accept such studies with care, since virtually every Chinese study offers a positive result). One study of 102 cases of allergic rhinitis caused by allergens treated by acupuncture claimed nearly a 75 per cent cure rate after two years (Chin J Modern Dev Trad Med, 1991; 11: 721-3).

Overviews of trials on acupuncture for asthma are disappointing. Two reviews of the controlled trials to date showed that of 13 trials, eight were positive in showing the effectiveness of acupuncture and five negative; nevertheless, the overview rated the quality of the better studies as decidedly mediocre and the results, at best, highly contradictory (Thorax 1991; 46: 799-802). And even this result itself was contradicted by a German overview in a complementary medicine journal (Forsch Komplementarmed, 1996; 3: 148-55).

A careful analysis of a major study in the prestigious journal Chest (1989; 96: 102-5) may explain the poor results. In this study, 16 patients suffering from asthma were subjected to histamine-containing inhalations. The effect of this on their lung function tests were assessed first with no intervening treatment and then after either real or sham acupuncture. The results showed no significant physical improvement after either form of acupuncture.

G. Ruth Lever of Complementary Medical Research, who reviewed the study, argues that the architects of this study, as well as a number of others, don't understand the individual nature of holistic treatment, or that Chinese medicine recognises a number of types of asthma, rather than just one. 'For example, a young patient with asthma might cough up frothy white sputum and have a slow pulse and a sticky white coating on his tongue,' she writes.

'In such a case, the asthma would be said to be due to invasion by cold and 'phlegm', causing stagnation of Qi (or Ch'i, the energy or vital force of the body), and treatment would be quite different from that of an older patient whose sputum tended to be yellow, whose tongue was red and who had a fast pulse. The latter patient would be diagnosed as suffering from stagnation of Qi resulting from an invasion by heat and phlegm. Different again is the child who has recurrent attacks of asthma and who is underweight with a yellowish complexion, a pale tongue and a forceless pulse. Here the diagnosis would be a deficiency of Qi and an invasion by cold and damp. 'To treat all three patients in the same way would be as effective as treating three different bacterial infections with a narrow-spectrum antibiotic.

'In the paper under review, the 'real' acupuncture points used were Ren 17, Lung 6 and Lung 7 which, the authors claim, are 'used for protection against acute asthma as recommended by the theory of traditional Chinese medicine'. To back this up, they refer to Essentials of Chinese Acupuncture by the Academy of Traditional Chinese Medicine. However, in my copy of this book, differentiation is made between the treatment of the various types of asthma, and five different prescriptions are given in which Ren 17 appears once, Lung 7 once and Lung 6 not at all ... one would not tend to use Lung 6 and Lung 7 together since they would be indicated for different types of asthma and, used together, might even cancel each other out.

Meanwhile, the points used for 'placebo' acupuncture in this study cannot categorically be said, as the authors claim, to have no effect on the treatment of asthma. Triple Heater 5 disperses heat, Gallbladder 34 eliminates damp and heat, and Stomach 25 stimulates stagnant Qi. To add to this confusion, the 16 patients differed widely, their ages ranging from 11 to 60, and the age of onset of asthma from birth to 55. It seems most unlikely, therefore, even from this small amount of information, that the treatment appropriate to one would also have suited all the others.'

In the end, the success of acupuncture appears to depend on a correct and individualised diagnosis. In all patients in one study, symptoms of bronchoconstriction improved if the right point was stimulated and, in five patients, wheezing was abolished altogether. When the correct point was stimulated, there was a significant increase in air volume and flow rates. Acupuncture also provided a significant fall in carbon dioxide (see box above), and made drugs like isoprenaline more effective (Clip Sci Molec Med, 1976; 51: 503-9).

Body-mind therapies
The best studied of the mind-over-matter disciplines is hypnosis, which has been investigated by orthodox groups like the British Tuberculosis Association. In its trial, a group given hypnosis monthly and using self-hypnosis daily for a year were compared with a control group given a specially devised set of breathing relaxation exercises. The results were independently assessed by physicians in nine centres. Of the 176 patients who completed the programme, both groups appeared to have improved. However, those in the hypnosis groups showed better improvement in terms of volume and overall capacity than controls (BMJ, 1968; 4: 71-6).

Smaller studies show even better results. In another randomised, blinded, controlled trial, 12 patients rated highly susceptible to hypnotherapy showed a dramatic improvement in symptoms, use of bronchodilators and response to methacholine (a challenge which usually worsens symptoms) (BMJ (Clip Res), 1986; 293: 1129-32). Another study of 62 patients found that hypnosis could help reduce their wheezing and reliance on drugs (BMJ, 1962; 2: 371-6).

Besides hypnosis, autogenic training (AT), a systematic relaxation technique, has also been proved effective. One study showed that AT achieved a greater than 15 per cent improvement in respiratory function (J Psychosom Res, 1993; 37: 265-70). Transcendental Meditation is another relaxation-centering technique demonstrated to improve symptoms (Respiration, 1975; 32: 74-80). Even self-hypnosis in children has resulted in fewer emergency room visits and less school missed (Hypnos, 1995; 22: 132-44).

Biofeedback for inducing facial relaxation can also help, but as an adjunct to other treatment. In one study, children using biofeedback had better scores in lung function and more positive attitudes toward their condition. They also had less chronic anxiety than a control group, although the procedure didn't lessen the severity of the disease, medication usage or frequency of attacks. General relaxation exercises have produced improvement in breathing flow rates (J Behav Med, 1994; 17: 1-12), although not enough to be considered significant. A combination of biofeedback and relaxation therapy was shown to help decrease emotional triggers (J Psychosom Res, 1986; 30: 13-25).

Yoga can also be used to improve lung function. In one controlled study, 53 asthmatics given two-week training in yogic exercises, including breathing, physical postures, breath slowing and medication, demonstrated far more improvement in weekly number of asthmatic attacks, drug usage and peak flow rate than those in the study who were simply taking drugs (BMJ (Clin Res), 1985; 291: 1077-9).

Reflexology
Reflexology has had a mixed result with asthma. One Russian trial demonstrated that the discipline worked with 130 patients using acupuncture points which had been identified as most suitable (Nevropatol Psikhiatr Imeni S - S. Korsakova, 1986; 86: 1790-4); while a small Danish trial of patients taking inhaled steroids found no difference between those given reflexology and those acting as controls, as both groups improved similarly (Ugeskr For Laege, 1992; 154: 2065-8).

Chiropractic
Some scientific evidence suggests that manipulative therapies can be helpful as an adjunctive treatment in easing the tight chest muscles that accompany this disease. The most important study was conducted at a university hospital in Denmark. Chiropractic spinal manipulative therapy and a sham manual treatment were compared in 31 patients aged between 18 and 44. All the patients in the study suffered from bronchial obstruction requiring six or more puffs a day of beta-2-agonists or inhaled steroids. The study observed lung capacity, use of medication, the patient's own rating of asthma severity and lung symptoms. Although the results showed no change in lung function, the study members' own rating of their disease severity and measurements of bronchial hyperresponsiveness decreased significantly in both groups during the study. Nevertheless, this was a crossover study (the treated group switched with the controls and the trial was then repeated), and the washout time was only a week, so that both groups were, in effect, treated (J Manip Physiol Ther, 1991; 14: 338; Clin Exp Allergy, 1995; 25: 80-8).

Herbs
A number of herbs have a good track record for alleviating the symptoms of asthma, although in many cases, the herbs treat only the symptoms and not the cause, necessitating that they be taken for long stretches of time. For deeper and longer-lasting treatment, some traditional Chinese herbal medicines have shown success, particularly in those patients diagnosed as 'cold and mixed'.

In one Russian study, 42 patients with bronchial asthma underwent combined treatment of traditional Chinese medicine. Of the patients with asthma diagnosed by Chinese criteria as cold and mixed, 81 per cent achieved a partial or complete response. 'Hot' asthma cases only achieved a satisfactory response in 19 per cent of cases (Terapevticheskii Arkhiv, 1996; 68: 52-5). Saiboku-to, a Chinese herbal medicine composed of 10 different herbal extracts, has helped a minority of patients with severe asthma who were dependent on steroids (J Pharm Phramacol, 1993; 45: 844-6). Other studies show that Saiboku-to and other 'Kanapo medicines' (Syouseiryu-to and Sairei-to) exert weak immunosuppressive effects (Jpn J Allergol, 1996; 45: 494-502).

Tylophora indica (also known as Tylophora asthmatica) has had some positive results in the treatment of asthma, reportedly due to its antihistamine and antispasmotic actions ( J Allergy, 1969; 43: 145-50; J Assoc Phys India, 1968; 16: 9-15). In one study of 135 patients, those given 200 mg of Tylophora leaves twice a day for six days had improved respiratory function for up to two weeks after treatment, although nearly 10 per cent suffered from nausea and vomiting, and other side-effects (Ind J Med Res, 1979; 69: 981-9).

Mullein leaf has long been used in India and by American Indians to treat all sorts of respiratory problems because of its soothing, antibiotic and anti-inflammatory properties (Lloydia, 39 (92-3): 160-71; Ind J Exp Biol, 1969; 7: 250).

Nutritional expert Dr Melvyn Werbach has found evidence of a number of effective herbs for asthma (Werbach M, Murray M, Botanical Influences on Illness, Third Line Press, 1994). Coleus forskohlii, an Ayurvedic herb, has been shown to dilate the bronchi almost as powerfully as the beta-2-agonist fenoterol, at least initially, although the drug has stronger action over time (Clip Pharmacol Ther,1993; 53: 76-83).

Besides its well recognised use for memory and arteries, Ginkgo biloba can help ease bronchoconstriction (Br J Clin Pharmacol, 1990; 29: 85-91; Prostaglandins, 1987; 34: 723-31). Aloe vera has worked well for those who aren't dependent upon steroids (Planta Med, 1985; 51: 273-5). Other herbs which have been tested include ammi visnaga (khella) (Thorax, 1952; 7: 43-65) (although be sure to use khella extract with a 12 per cent khellin content to avoid toxicity).

Ironically, smoked marijuana also has been shown to immediately abort exercise-induced asthma and hyperinflation of the lungs (Am Rev Respir Dis, 1975; 112: 377-86).

Breathing exercises themselves can improve lung function. In one study comparing yoga and breathing exercises, the exercises produced significant improvements in respiratory volume, even more than the beta-2-agonist albuterol (Pneumologie, 1994; 48: 484-90). In another good, randomised, double-blind, placebo-controlled crossover trial, patients using two pranayama yoga breathing exercises required a significant increase in the dose of histamine to provoke an asthmatic reaction (Lancet, 1990; 335: 1381-3). Yoga breathing and posture also produces better results than physiotherapy breathing exercises (Thorax, 1978; 33: 514-7).

The Butekyo breathing method also has a few encouraging studies. Russian Konstantin Butekyo believed that asthma develops because patients are hyperventilating, which starves tissues of oxygen and floods them with carbon dioxide. He developed a method to recondition patients to breathe by a series of exercises which alternate shallow breathing with holding the breath. One study backed up his theory, demonstrating that asthma was often caused by hyperventilation, brought on by the patient's fear of another attack (Br J Psychiatry, 1988; 253: 687-8). In one Australian workshop of 35 patients, 27 claimed to have improvement in symptoms and nearly half were able to reduce bronchodilators or steroids. Two-thirds felt the treatment was superior to the conventional treatment (Med J Aust, 1995; 162: 53). A study of acupuncture showed that improvement followed a significant fall in carbon dioxide (Clip Sci Molec Med, 1976; 51: 503-9).

Although asthma is commonly viewed as a allergic response to airborne substances, increasing evidence shows that, in a number of cases, the disease has emotional or iatrogenic (doctor-induced) causes.

One probable trigger is vaccination. During a study of long-term breastfeeding, Dr Michel Odent and his London-based Primal Health Research Centre discovered, in a surprise finding, that children immunised against whooping cough were six times more likely to have asthma than those who hadn't been given the jab (JAMA, 1994; 272: 592-3). In a homoeopathic study (Br Homeop J, 1992; 81: 168-72), the Spanish doctor who carried out the study detected a relationship between bronchial asthma and vaccination, and suppressive treatment of eczema with steroids. Of 26 patients (14 of them children), asthmatic attacks began after immunisation in three cases, four patients developed asthma after having their tonsils or adenoids removed and five were using steroid creams to suppress eczema eruptions. In the author's view, it appeared that 58 per cent of patients' asthma was probably doctor-induced.

Besides these iatrogenic causes, there is some evidence that emotional triggers play a role in asthma, particularly large airway (but not small airway) obstruction (J Psychosom Res, 1986; 30: 13-25). In the Spanish study noted above, two cases developed after a traumatic emotional situation.

Perhaps the most telling evidence of the emotional cause of asthma is the number of trials which show that both treated and control groups get better, suggesting that mind-body treatments may be among the most effective.

If you are asthmatic, the best prospect is to follow the diet and supplement programme recommended below, and then to pursue one or more of alternative remedies.

Diet
* Follow a low-allergy wholefood diet, avoiding the most common food allergens (wheat, milk, corn, soy, egg and orange). Cow's milk, in particular, is a common trigger allergen seen by our panellists (Eur J Pediatr, 1979; 132: 1). Follow a low-tryptophan diet, which can trigger symptoms. Asthma can often be aggravated by sulphite, a food preservative. If you are pregnant, avoiding or rotating these allergens can help to prevent the development of allergies in your child (J Allerg Clin Immunol, 1989; 84: 72-89).

* If you have a baby, breastfeed for as long as possible, and avoid bottlefeeding or introducing cow's milk and the other major allergens too soon into your child's diet.

* Reduce salt, which tends to make asthmatics more reactive to histamine (Thorax, 1989; 44: 36-41).

* Avoid alcohol, which also can constrict the bronchi (Immunol Allergy Pract, 1988; 10: 423-34).

* Have your stomach acid checked out. American nutritional pioneer Dr Jonathan Wright finds that most children with asthma have poor stomach acid, often due to consumption of cow's milk. This can be tested by radiotelemetry, using a Heidelberg capsule containing a tiny radiotransmitter, which is swallowed by the patient, then tracked by a computer. (Tests are available through Biolab in London: 020 7636 5959.) If stomach acid is low, you can regulate it by taking betaine hydrochloride tablets with pepsin. Work with an experienced practitioner.
Low stomach acid due to cow's milk may also cause low production of pepsin and intrinsic factor, which helps to digest B12. Low levels of B12 are known to cause wheezing.

Supplements
The following supplements may prove helpful in reducing symptoms of asthma:

* Selenium. Scientific evidence suggests that asthma is linked with reduced circulatory levels of the antioxidant mineral selenium. In one double-blind study, patients given selenium supplements showed a significant clinical improvement (Allergy, 1993; 48: 30-6).

* Vitamin B6. Pyridoxine (B6) reportedly can largely correct an abnormality of tryptophan metabolism in patients with asthma and reduce symptoms over the long term.

* Vitamin B12. Supplementing with B12 (particularly through intramuscular shots) markedly reduces asthma symptoms. In one study of 85 patients, all benefitted from 1000 mcg of B12 at weekly (and then less frequent) intervals, and the younger the patient, the better the response; among children under 10, 83 per cent showed a moderate-to-marked improvement (Acta Allergol, 1957; XI: 261-8). Dr Wright has patients self-administer daily shots in the following doses over 10 days: 1000 mcg for 2-3 year olds; 2000 mcg for 3-12 year olds; and 3000 mcg for teens and above.

* Magnesium. Several studies have shown that improvement in wheezing is related to blood magnesium levels. Like B6, this has marked success when delivered by injection (J Asthma, 1985; 22: 3-11).

* Vitamin C. In one study of children, those receiving 1000 mg of vitamin C daily for two weeks had less than a quarter as many asthmatic attacks as those given a placebo (Trop Geograph Med, 1980; 32: 132-7). For adults, Dr Melvyn Werbach recommends 2 grams of C a day, with 4-7 grams during reactions.

* Essential fatty acids. Omega-3 essential fatty acids have helped asthma (J Clin Allergy, 1988; 81: 183).

* Other important nutrients include niacin, calcium, vitamin D, molybdenum and zinc.

* Check that your copper levels aren't too high, as is often the case for those on the Pill.