Supported by multiple clinical trials and systematic reviews
Asthma
Asthma is a chronic inflammatory airway disease marked by variable respiratory symptoms (wheeze, cough, chest tightness, shortness of breath) and expiratory airflow limitation that fluctuates over time. In western medicine, diagnosis is confirmed by characteristic symptoms plus objective evidence of variable airflow obstruction, most commonly on spirometry with bronchodilator reversibility. Management follows a stepwise approach tailored to symptom control and risk of exacerbations, with inhaled corticosteroids (ICS) as the cornerstone. Modern guidelines (e.g., GINA 2024) discourage short-acting beta-agonist (SABA)-only treatment and emphasize as-needed low-dose ICS–formoterol or ICS taken whenever SABA is used, alongside daily controller therapy as needed. Add-ons include long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), and targeted biologics for severe Type 2 (T2) inflammation. Allergen immunotherapy can help in selected allergic phenotypes, and bronchial thermoplasty may be considered for highly selected refractory cases. Eastern and traditional systems conceptualize asthma differently. In Traditional Chinese Medicine (TCM), patterns such as Lung Qi deficiency, Kidney not grasping Qi, and Phlegm-Damp obstruction guide individualized herbal formulas and acupuncture. Historically, the TCM herb Ma Huang (Ephedra sinica) was a source of ephedrine—an early bronchodilator that bridged traditional practice and modern pharmacology; however, ephedra-containing supplements are now restricted in many countries due to cardiovascular risks. Acupuncture has mixed evidence, with Cochrane reviews finding insufficient or low-certainty evidence for clinically important lung function improvements, though some patients report symptom relief. Chinese herbal formulas have been studied in small trials with heterogeneous quality. Ayurveda frames asthma (Tamaka Shvasa) as an imbalance of doshas (often Vata-Kapha) and employs botanicals like Vasaka (Adhatoda/
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Clinical symptoms plus objective variability in airflow limitation: spirometry showing obstructive pattern with bronchodilator reversibility (increase in FEV1 ≥12% and ≥200 mL), or excessive PEF variability; bronchoprovocation if spirometry is normal; supportive markers include elevated FeNO and blood/sputum eosinophils in Type 2 asthma. Phenotyping (allergic, eosinophilic, non-T2) and assessment of triggers, comorbidities, and exacerbation risk inform therapy.
Treatments
- Education, inhaler technique training, adherence support, trigger and allergen avoidance, smoking cessation, vaccinations
- Stepwise pharmacotherapy per GINA 2024 (Track 1 preferred): as-needed low-dose ICS–formoterol for relief in all steps; daily ICS-containing controller therapy escalated from low-dose ICS to low/medium-dose ICS–LABA; high-dose ICS–LABA with add-ons for severe disease
- SMART/MART: Single Maintenance and Reliever Therapy using low-dose ICS–formoterol for both maintenance and relief (typically Steps 3–5)
- Alternative Track 2: SABA reliever taken with concomitant ICS when used; daily ICS or ICS–LABA maintenance
- Add-on LAMA (e.g., tiotropium) for persistent symptoms/exacerbations despite ICS–LABA
- Biologic therapy for severe asthma with T2 inflammation/endotypes: anti-IgE (omalizumab), anti–IL-5 (mepolizumab, reslizumab), anti–IL-5R (benralizumab), anti–IL-4Rα (dupilumab), anti-TSLP (tezepelumab)
- Allergen immunotherapy (SCIT/SLIT) for selected patients with allergic asthma sensitized to clinically relevant allergens
- Bronchial thermoplasty in carefully selected adults with severe refractory asthma under experienced centers
- Comorbidity management (allergic rhinitis, GERD, obesity, OSA, anxiety), structured physical activity, and breathing training as adjuncts
Medications
- Inhaled corticosteroids (beclomethasone, budesonide, fluticasone, mometasone, ciclesonide)
- LABA (formoterol, salmeterol); fixed-dose ICS–LABA combinations (e.g., budesonide–formoterol, fluticasone–salmeterol, fluticasone–vilanterol, mometasone–formoterol)
- Relievers: low-dose ICS–formoterol (preferred) or SABA (albuterol/salbutamol) with ICS when used; ipratropium in acute settings
- LAMA (tiotropium) add-on
- Leukotriene receptor antagonists (montelukast) as adjuncts/alternatives in selected patients
- Oral corticosteroids for severe exacerbations; minimize long-term use
- Biologics: omalizumab, mepolizumab, reslizumab, benralizumab, dupilumab, tezepelumab
Limitations
Real-world control is often limited by underuse of ICS, overreliance on SABA, poor inhaler technique, adherence challenges, and environmental triggers. Systemic and high-dose ICS can cause side effects (e.g., oral thrush, dysphonia; long-term systemic steroids carry significant risks). Biologics are costly, require phenotype/endotype matching, and may have access barriers. Bronchial thermoplasty benefits a subset and requires specialized expertise.
Sources
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention, 2024 Update.
- SYGMA 1 & SYGMA 2 trials: as-needed budesonide–formoterol in mild asthma (N Engl J Med, 2018).
- SMART/MART evidence summaries referenced in GINA 2024.
- Omalizumab: INNOVATE and related trials in severe allergic asthma.
- Mepolizumab: DREAM and MENSA trials (N Engl J Med, 2012; Lancet, 2014).
- Benralizumab: SIROCCO and CALIMA (Lancet, 2016).
- Dupilumab: QUEST and VENTURE (Lancet, 2018; N Engl J Med, 2018).
- Reslizumab: phase 3 trials in eosinophilic asthma (N Engl J Med, 2015).
- Tezepelumab: PATHWAY and NAVIGATOR (N Engl J Med, 2017; 2021).
- Allergen immunotherapy guidance: AAAAI/ACAAI practice parameters; GINA 2024.
- Bronchial thermoplasty: AIR2 trial and long-term safety registries.
Eastern & Traditional Medicine
Traditional Chinese Medicine (TCM)
Asthma is categorized under Xiao Chuan and treated based on pattern differentiation. Common patterns include Lung Qi deficiency (weak defensive Qi, dyspnea), Kidney not grasping Qi (worse on exertion/night), and Phlegm-Damp accumulation obstructing the Lung (cough, wheeze with sputum). Therapy aims to tonify Lung/Kidney, transform phlegm, and restore descending Lung Qi.
Techniques
- Individualized herbal formulas (e.g., modified Ding Chuan Tang for phlegm-heat; Sheng Mai San variants for Qi deficiency; note: Ma Huang/Ephedra historically used to disperse cold and relieve wheeze, now restricted)
- Dietary and lifestyle guidance per pattern
- Acupoints commonly selected: Dingchuan (EX-B1), LU1, LU5, LU7, BL13, BL23, ST40; moxibustion for deficiency patterns
Acupuncture (for asthma)
Used to modulate autonomic balance, reduce airway hyperresponsiveness, and relieve symptoms. Often adjunctive to conventional therapy.
Techniques
- Body acupuncture at respiratory-related points; adjunctive moxibustion; individualized protocols over several weeks
Chinese herbal medicine
Pattern-based formulas to relieve wheeze and resolve phlegm, or to tonify Lung/Kidney. Historically, Ephedra (Ma Huang) contained ephedrine, a sympathomimetic bronchodilator that informed modern beta-agonist development. Due to cardiovascular risks, ephedra-containing supplements are restricted/banned in many countries; safer alternatives are preferred.
Techniques
- Classical formulas (e.g., Ding Chuan Tang, Ma Xing Shi Gan Tang—modified to avoid contraindicated components)
- Granule or decoction preparations under professional supervision
Ayurveda (Tamaka Shvasa)
Viewed as Vata–Kapha imbalance with obstructed Prana Vayu. Therapy emphasizes Shamana (palliation) and Shodhana (cleansing) alongside diet and lifestyle. Herbs like Vasaka (Adhatoda/Justicia adhatoda) and Pippali (Piper longum) are traditionally used; modern formulations tailor combinations to prakriti and symptom profile.
Techniques
- Herbal preparations containing Vasaka (vasicine/vasicinone alkaloids), Pippali, Tulsi, and others
- Nasya and steam inhalation with appropriate oils in some protocols
- Dietary adjustments to reduce Kapha; gentle exercise
- Pranayama breathing techniques (e.g., Nadi Shodhana, Bhramari)
Sources
- TCM internal medicine texts (Xiao Chuan patterns) and contemporary TCM practice guidelines.
- Regulatory advisories on Ephedra/Ma Huang restrictions (e.g., U.S. FDA ban on ephedra alkaloids in dietary supplements, 2004).
- Cochrane Review: Acupuncture for chronic asthma—evidence insufficient or low certainty for clinically significant improvements in lung function; some trials suggest symptom/QoL benefits in subsets (earlier and updated reviews up to mid-2010s).
- GINA 2024 notes limited evidence for acupuncture as an adjunct.
- Systematic reviews of Chinese herbal formulas for asthma show heterogeneous, small RCTs with variable quality and inconsistent outcomes; safety depends on quality control and avoidance of ephedra-containing products.
- Historical pharmacology literature on ephedrine isolation from Ephedra sinica and subsequent bronchodilator development.
- Reviews of Ayurvedic management of Tamaka Shvasa describe traditional protocols; modern clinical evidence for specific herb combinations is limited and heterogeneous.
- Pharmacology reviews of Adhatoda vasica suggest bronchodilatory and anti-inflammatory properties; clinical trials remain small.
Integrative Perspective
Safety first: Alternative approaches must never replace rescue inhalers or prescribed controller medications in moderate-to-severe asthma or during exacerbations. Work with your clinician to confirm diagnosis, optimize inhaler technique, and implement guideline-based therapy. Integrative options can complement— not substitute—standard care: (1) Breathing training (Buteyko, yoga pranayama, or physiotherapist-led breathing exercises) may reduce symptoms and reliever use and improve quality of life; these should be taught by qualified instructors and practiced alongside ICS-containing therapy. (2) Yoga (postures plus mindful breathing) has moderate evidence for improved quality of life and symptoms; avoid poses that provoke bronchospasm. (3) Acupuncture and TCM/Ayurvedic herbal care may help some patients, but evidence is mixed and product quality varies; avoid ephedra-containing products due to cardiovascular risks and drug interactions. (4) Address comorbidities and triggers (allergic rhinitis, GERD, obesity, smoke, viral exposures); consider allergen immunotherapy for relevant sensitizations. (5) For severe asthma, phenotype-guided biologics have robust evidence; complementary practices can support stress reduction, sleep, and adherence, but should not delay escalation to biologics or specialist referral. The historical bridge from Ma Huang (Ephedra sinica) to ephedrine illustrates how traditional remedies informed modern bronchodilator pharmacology; however, today’s selective inhaled beta-agonists and ICS are vastly safer and more effective than crude ephedra preparations.
Sources
- Global Initiative for Asthma (GINA) 2024 Strategy Report.
- SYGMA 1 & 2 (as-needed ICS–formoterol in mild asthma).
- SMART/MART summaries in GINA 2024.
- Biologics trials: INNOVATE (omalizumab); DREAM/MENSA (mepolizumab); SIROCCO/CALIMA (benralizumab); reslizumab phase 3; QUEST/VENTURE (dupilumab); PATHWAY/NAVIGATOR (tezepelumab).
- Allergen immunotherapy guidelines (AAAAI/ACAAI) and GINA 2024.
- Bronchial thermoplasty: AIR2 and long-term follow-up.
- Cochrane Review: Breathing exercises for asthma (includes Buteyko and Papworth) – reduced symptoms/SABA use, limited effect on FEV1.
- Cochrane Review: Yoga for asthma (2016) – small-to-moderate improvements in quality of life/symptoms; limited lung function change.
- Cochrane and other systematic reviews on acupuncture for asthma – mixed/low-certainty evidence.
- Reviews of Chinese herbal medicine and Ayurveda for asthma – heterogeneous, small trials; safety/quality concerns, especially with ephedra/ma huang.
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.