**Complementary Therapy with Traditional Chinese Medicine for Childhood Asthma**

Bei-Yu Wu, Chun-Ting Liu, Yu-Chiang Hung and Wen-Long Hu

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/62333

#### **Abstract**

Asthma is a heterogeneous disease that is typically characterized by chronic airway inflammation and obstruction of airflow; it frequently presents in early childhood and is the leading chronic disease in children in the western world. This review presents a brief description of the pathophysiology of asthma and summarizes re‐ cent research results on the mechanisms of action of anti-asthma Chinese herbal medicine commonly used in clinical practice. Other interventions of traditional Chi‐ nese medicine (TCM), such as acupuncture, tai chi, and meditation are also briefly discussed. We believe that this contribution is theoretically and practically relevant because the prevalence of asthma is increasing and, in addition to standard treat‐ ment, the use of complementary therapy is increasing and there is increasing scien‐ tific evidence demonstrating that TCM has potential for the treatment of childhood asthma.

**Keywords:** Childhood asthma, traditional Chinese medicine, Acupuncture, complemen‐ tary and alternative medicine

### **1. Introduction**

Asthma is a heterogeneous disease that is typically characterized by chronic airway inflam‐ mation and obstruction of airflow. Asthma is defined by a history of respiratory symptoms such as wheezing, shortness of breath, chest tightness, and cough [1]. Both these symptoms and airflow limitation characteristically vary over time as well as in intensity. These variations are often triggered by external factors, such as exercise, allergen or irritant exposure, change in the weather, or viral respiratory infections [2]. Symptoms and airway limitation may resolve with or without medication and may sometimes be absent for weeks or months at a time.

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Asthma, a life-long condition, frequently presents in early childhood and is the leading chronic disease in children in the Western world. Although the prevalence of childhood varies widely across the world as described in the Phase III ISAAC study [3], most studies have reported that this prevalence has increased in recent decades [4–6]. This increase has been associated with a rise in atopic sensitization and other allergic disorders, such as eczema and rhinitis [6]. Approximately 25.9 million Americans (including 7.1 million children) had asthma in 2011, which equates to a rate of 84.8 per 1,000 in the population. The highest prevalence rate was seen in those in the 5–17 years of age bracket (105.5 per 1,000). Overall, the rate in those under the age of 18 years (94.9 per 1,000) was significantly greater than that in those over 18 years (81.6 per 1,000). The current asthma prevalence rate for boys under 18 years (101.7 per 1,000) was 16% higher than the rate among similarly aged girls (87.8 per 1,000) [7]. In 2008, the condition accounted for an estimated 14.4 million lost school days in children and 14.2 million lost work days in adults. Asthma is thus a leading cause of activity limitation and amounts to \$56.0 billion in health care costs annually in the United States [7].

Approximately 80 percent of children with asthma develop symptoms before 5 years of age, but the disease is frequently misdiagnosed or not suspected, particularly in infants [8]. Coughing and wheezing are the most common symptoms of childhood asthma. Breathless‐ ness, chest tightness or pressure, and chest pain have also been reported [1, 2]. Descriptors may vary between cultures and by age; for example, children may be described as having heavy breathing [2]. Confirmation of the diagnosis of asthma in children requires a careful review of a child's current and past medical history, family history, as well as a physical examination.

Asthma is characterized by variable expiratory airflow limitation. Pulmonary function tests are sometimes needed to diagnose asthma and to rule out other possible causes of the symptoms. Spirometry is the most common pulmonary function test; it measures the flow and volume of air blown out after a child takes a very deep breath and then forcefully exhales. The important parameters derived from spirometry include forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), flow between 25% and 75% of the vital capacity (FEF 25– 75%), and peak expiratory flow rate (PEFR) [9]. The greater the variation in lung function, or the more times excess variation is seen in a patient with respiratory symptoms, the more likely the diagnosis is to be one of asthma. The FEV1/FVC ratio is normally >0.75–0.80 and usually exceeds 0.90 in children [10]. In asthma, at least once during diagnostic process, the FEV1 is low, confirming that the FEV1/FVC ratio is reduced. Generally, an increase in FEV1 of >12% of that predicted after inhalation of a rapid-acting bronchodilator and/or average daily diurnal peak expiratory flow (PEF) variability exceeding 13% indicates that a child has asthma [2]. In young children, in whom lung function testing is not feasible, including most preschool children, asthma is defined by the presence of variable respiratory symptoms.

Traditional Chinese medicine (TCM), particularly herbal medicine, has been used for the treatment of asthma for hundreds of years, as documented in the *Yellow Emperor's Inner Canon* (*Huangdi Neijing*) and the *Essential Prescriptions from the Golden Cabinet* (*Jin Gui Yao Lue*). In Taiwan, Chinese herbal medicine is commonly used as complementary and alternative therapy for the treatment of atopic diseases such as asthma, allergic rhinitis, and atopic dermatitis. The medicines used for the prevention and treatment of asthma have received much attention in recent years. The cellular and molecular details of the underlying mecha‐ nisms of action of Chinese herbal medicine efficacious for treating asthma are just beginning to be understood.

This chapter presents a brief description of the pathophysiology of asthma and summarizes recent research results on the mechanisms of action of anti-asthma Chinese herbal medicine commonly used in clinical practice. Other interventions of TCM, such as acupuncture, *tai chi*, and meditation, are also briefly discussed.
