Asthma

What is Asthma?

Asthma is a chronic inflammatory condition of the airways that causes intermittent airflow obstruction and an exaggerated airway response to triggers.^[1] It is one of the most common long-term diseases worldwide, and with good treatment most people can reach good control.^[2]

Common symptoms

The hallmark symptoms are coughing, wheezing and shortness of breath, and these often flare with triggers such as allergens or viral infections.^[1]

• Wheezing, a high-pitched whistle when breathing out
• Chest tightness
• Cough that is worse at night, early in the morning, with exercise or with a cold
• Shortness of breath during activity or at night

Severity ranges from occasional mild symptoms to life-threatening airway closure.^[1]

Causes and risk factors

Asthma arises from a mix of genetic and environmental factors, and it often begins in childhood alongside eczema and hay fever.^[1] Allergen exposure such as dust mites, animal dander and mold, smoking and obesity are linked with developing or worsening asthma.^{[3, 4]}

Common triggers include pollen, respiratory infections, cold air, exercise, strong odors and air pollution. Allergic, non-allergic, exercise-induced, occupational and cough-variant asthma are described as different types.^[1]

How it is diagnosed and treated conventionally

Diagnosis rests on your history, a physical examination and lung function testing. Spirometry before and after a bronchodilator is the main test.^[1]

Treatment is a cycle of assessing control and adjusting medicines. Most people use quick-acting bronchodilators for symptoms and controller medicines matched to severity, and biologic drugs are now available for severe asthma.^{[1, 2]} Undertreatment is still common, so reviewing your plan with your physician matters.^[2]

Why Asthma calls for a whole-person approach

Asthma is not only a lung problem. Allergy, infections, weight, stress and sleep can each affect how often symptoms flare and how well medicines work.^{[1, 4]}

Looking at these factors alongside your medical treatment is reasonable. It does not replace controller medicines or an asthma action plan.

Allergy and airway inflammation

Allergic sensitization is a major driver of asthma, with raised IgE antibodies to dust mites, animal allergens and mold increasing airway reactivity.^[3] Identifying your own triggers with your physician is a core part of care.

Excess weight

Obesity is a major risk factor for asthma and a disease modifier. People with asthma and obesity have more symptoms, more frequent and severe exacerbations and a reduced response to several asthma medicines.^[4]

Smoke and environmental exposures

Smoking is related to a higher risk of asthma.^[3] Smoke, strong fragrances and polluted air are common triggers, so reducing exposure supports medical treatment.^[1]

Stress and breathing patterns

Stress and anxiety can add to the experience of breathlessness. Small trials of meditation in people with asthma suggest it may improve quality of life and perceived stress, although the trials were few and of mixed quality.^[5] Breathing exercises are discussed under Ayurveda below.

Acupuncture for Asthma

What the research shows

Research on acupuncture for asthma is mixed. Several recent reviews report benefit, while older and stricter reviews found little, and many of the trials are small or poorly reported.

A 2023 meta-analysis of 16 sham- or placebo-controlled trials found acupuncture improved lung function (FEV1), quality of life and symptom scores compared with sham. Results varied widely between trials, and other lung function and medicine-use measures did not differ significantly.^[6] A 2024 meta-analysis of 21 trials with 2,510 people found that manual acupuncture added to conventional treatment gave better response rates and lung function than conventional treatment alone, and the authors called for higher-quality long-term trials.^[7]

An overview of 14 systematic reviews covering 167 studies found acupuncture-type therapies improved overall response rates. It rated the quality of evidence as low to moderate and noted that safety reporting was insufficient.^[8]

Earlier work was less encouraging. A Cochrane review of 11 trials with 324 participants found no significant or clinically relevant effect of acupuncture compared with sham and judged the trials too poor to draw conclusions.^[9] A small crossover trial of four sessions in 23 people with moderate persistent asthma found no change in lung function, airway reactivity or symptoms.^[10]

Moxibustion, a traditional warming technique, has also been studied. A review of 37 trials found that adding it to asthma drugs gave better response and lung function, but the evidence was moderate to very low quality.^[11]

How acupuncture may work

Researchers propose that acupuncture acts through the nervous system and on inflammatory and immune signaling, and reviews of asthma studies discuss such mechanisms.^[12] Some trials measured changes in immune markers such as T-lymphocyte levels.^[7] These explanations are proposed, not settled, and they do not show that acupuncture changes the course of asthma.

What treatment involves

Treatment uses fine, sterile, single-use needles placed at points on the chest, upper back, arms and legs, usually left in place for about 20 to 40 minutes. A course is typically several visits, and we reassess progress with you during it.

Serious problems are rare. In prospective studies, about 9 in 100 patients had a minor reaction such as brief bleeding, soreness or redness at a needle site, and serious events occurred in about 1 in 10,000 patients.^[13] Tell the practitioner first if you have a bleeding disorder, take blood thinners, are pregnant, or have a pacemaker (relevant to electroacupuncture). If you are having asthma symptoms on the day of a visit, use your rescue inhaler as your physician has directed and tell us.

Ayurvedic medicine for Asthma

The Ayurvedic view

In Ayurveda, asthma-like breathlessness is described as Tamaka Shvasa, a disorder traditionally linked to Kapha, the principle of heaviness and mucus, and to disturbed movement of Vata in the chest. These are traditional categories used to choose treatment, not biomedical diagnoses.

Therapies that may be used

Care is individualized and traditionally combines:

• Diet and daily routine that avoid cold, heavy and mucus-producing foods and keep regular sleep and meal times
• Breathing practices (pranayama) and gentle yoga, which are traditionally part of Ayurvedic care
• Herbs traditionally used for cough and breathlessness, such as vasaka (Adhatoda vasica), pippali, tulsi and licorice root, prescribed individually
• Warm oil massage of the chest and back, and steam inhalation

Panchakarma cleansing procedures are not appropriate during pregnancy, acute illness or frailty, or during an asthma flare. For a person with a chronic lung condition they should only be considered after discussion with the treating physician. Transdermal medication therapy, in which an herbal preparation is applied to the skin, may also be used; no study we found tests it in asthma.

What the research shows

There is no direct research on Ayurvedic treatment for asthma. Our PubMed searches found no systematic reviews or randomized trials of Ayurvedic treatment programs, Panchakarma or single Ayurvedic herbs such as Boswellia, curcumin or ashwagandha in people with asthma. Reviews of these herbs describe laboratory and general pharmacology findings, not asthma trials, so no benefit for asthma can be claimed.

Yoga and breathing exercises, which overlap with Ayurvedic practice, are better studied. A Cochrane review of 15 trials with 1,048 people, most done in India, found moderate-quality evidence that yoga probably leads to small improvements in quality of life and symptoms. Effects on lung function were not significant, and the data on side effects were limited.^[14] A Cochrane review of 22 trials of breathing exercises found they may improve quality of life, hyperventilation symptoms and some lung function measures, with evidence ranging from moderate to very low certainty.^[15]

Herbal medicine for Asthma

Herbs and formulas that have been studied

Chinese herbal formulas studied in asthma are usually mixtures. Trials have used ingredients such as licorice root, crow-dipper (Pinellia), astragalus and angelica.^[16] Herbal patches applied to acupuncture points, a traditional approach used in East Asia, have also been tested.^[17]

What the research shows

A review of 29 trials with 3,001 adults found that herbal medicines added to routine drug treatment improved lung function and asthma control scores and reduced rescue salbutamol use compared with drugs alone. The included studies were of low to moderate quality, most did not blind participants, and adverse events were rare.^[16]

A review of 16 trials of acupoint herbal patching found improved lung function and symptoms compared with placebo. The authors called the evidence encouraging but not conclusive because of heterogeneity and high risk of bias.^[17]

Overall, herbal medicine has some supportive trial evidence as an add-on, but it is limited by study quality. It has not been shown to replace asthma medicines.

Safety and herb-drug interactions

Herbs are active substances and can interact with medicines. Reviews describe bleeding when warfarin is combined with herbs including dang gui (Angelica sinensis), dan shen, ginger, ginseng and Boswellia.^[18] A broader review notes that St John's wort lowered blood levels of theophylline and that piperine from black and long pepper raised theophylline levels, which matters if you use this asthma medicine.^[19] Tell us about every medicine, including inhalers, oral steroids, theophylline and biologic injections.

In one study, about one fifth of Ayurvedic products bought online contained detectable lead, mercury or arsenic.^[20] Herbs should come from tested sources and be prescribed individually. Tell us if you are pregnant or breastfeeding, have liver or kidney disease, have high blood pressure or have surgery planned.

Translating traditional medicine into modern biological language

The links drawn here are interpretation, not equivalence. Chinese medicine often describes asthma as lung qi failing to descend, sometimes with phlegm or with weakness of the lung and kidney. Researchers studying such approaches measure things that loosely parallel this picture: airway inflammation, immune signaling, smooth muscle tone and the nervous system's control of breathing.^[12]

Ayurveda's Kapha and Vata in the chest describe mucus and disordered airflow. No study has shown that a dosha or a TCM pattern corresponds to a specific biological process in asthma.

How this care fits with your medical care

Integrative care for asthma is complementary. Keep your physician, and do not stop or change prescribed controller or rescue medicines without your prescriber. We do not diagnose asthma or manage your medicines, and new or worsening breathing symptoms should be medically evaluated.

For a condition like this, we ask that you are under a physician's care for it and that your treating team knows you are receiving complementary care. Please bring your diagnosis, spirometry results, your asthma action plan and a full list of medicines and supplements.

When to seek urgent medical care

Asthma attacks can become life-threatening, so know the warning signs and follow your written action plan.^[1]

• Severe shortness of breath, or being unable to speak a full sentence
• Blue or gray lips or face
• Little or no relief from your rescue inhaler
• Chest or neck muscles pulling in with each breath, or struggling to breathe
• Symptoms that are quickly getting worse, or a drop in peak flow your action plan marks as a danger zone
• Confusion, extreme drowsiness or fainting

Call 911 or go to the nearest emergency department for any of these.