Managing Childhood Asthma: Exploring The Role of Homeopathy

Abstract

Asthma is a chronic respiratory condition that affects millions of children worldwide. In India, where traditional medicine systems like homeopathy have a strong presence, it is essential to explore the role of homeopathy in managing childhood asthma. In childhood asthma, the lungs and airways become easily inflamed when exposed to certain triggers. Such triggers include inhaling pollen or catching a cold or other respiratory infection. This article provides an in-depth analysis of asthma in children, its epidemiology, causes, risk factors, symptoms, complications, and conventional management. It also delves into the potential of homeopathy as an alternative or complementary approach to treating asthma in Indian children.

Keywords: Asthma, children, homeopathy, respiratory condition, management.

Introduction: Asthma is a prevalent chronic respiratory condition characterized by airway inflammation and bronchoconstriction. It can affect individuals of all ages, but it is especially concerning when it occurs in children. Asthma is a chronic (long-term) lung disease. It affects the airways, the tubes that carry air in and out of the lungs. If suffering from asthma, the airways can become inflamed and narrowed. This can cause wheezing, coughing, and tightness in the chest. 

Like a pinched straw, this makes it hard for a child to breathe, which can cause wheezing, coughing and chest tightness. Certain triggers can set off or worsen these symptoms, causing an asthma attack. Attacks can come on fast or develop slowly, and they may be life-threatening.

Asthma can begin at any age, but it most often starts during childhood when a child’s immune system is still developing. Most children who get asthma have their first symptom by age 5. Some of these factors may be leading to more and more children developing asthma. These factors include:

• Exposure to more allergens such as dust, air pollution and secondhand smoke.
• Not enough exposure to childhood illnesses that build up their immune systems.
• Lower rates of breastfeeding (chestfeeding), which prevent babies from receiving important immune system substances.

Epidemiology

Asthma is a global health concern, with India being no exception. According to estimates, over 6% of the Indian population, including a significant number of children, suffer from asthma. The prevalence of asthma is influenced by various factors, including genetics, environmental triggers, and socio-economic conditions.

Between 1970 and 2000, the prevalence of asthma climbed rapidly in both industrialized and developing nations.

However, the incidence of chronic asthma that requires ongoing therapy is rising. According to hospital- based research conducted in Bengaluru, the prevalence of asthma climbed gradually from 9% in 1979 to 29.5% in 1999. It fell 3% in 2004 and then another 1% in 2009. But from 1999 to 2009, persistent asthma grew by 20–72% and persistent severe asthma by 4–11%.The following circumstances show an increased incidence of asthma:

Rapid urbanization is boosting semirural regions’ incidence of urban children. Children attending schools in busy places, especially those from lower socioeconomic backgrounds; Children living in single-room huts and dwellings with insufficient ventilation; Rapid urbanization increasing predominance in semirural regions compared to rural. Children living in homes where people smoke tobacco, cow dung cakes, agricultural waste, and firewood are used as cooking fuel; and during celebrations like Diwali and others (by 100%) owing to an increase in SO2. 

Children under the age of five make up 75% of the population; those over five make up 25%. Positive family history of asthma, either in parents, siblings, or grandparents. Male predominance—the male to female ratio is 2:1 due to the comparatively shorter airways with which they are born and inherited as an autosomal dominant feature.

Pathophysiology: 

Asthma, a prevalent chronic respiratory condition affecting individuals of all ages, warrants a deeper understanding of its pathophysiology, particularly in pediatric patients. The key pathophysiological mechanisms underlying asthma involve chronic airway inflammation, heightened airway reactivity or hyperresponsiveness, excessive bronchoconstriction, increased mucus production causing airway blockage, infiltration of eosinophils that release inflammatory mediators, and an immunoglobulin E (IgE) mediated response often associated with allergic asthma. Additionally, chronic inflammation and repeated asthma attacks can lead to structural changes in the airways, a process termed airway remodeling, which includes increased smooth muscle mass, airway wall thickening, and fibrosis. These complex mechanisms collectively contribute to the characteristic symptoms and exacerbations observed in children with asthma, emphasizing the need for tailored treatment strategies to manage both the immediate symptoms and the underlying inflammatory processes.

Causes: 

Asthma in children is a complex respiratory condition with multiple contributing factors. While the exact cause remains elusive, it is widely accepted that asthma arises from a combination of genetic predisposition and environmental influences. Here are some key causes and contributing factors:

• Genetic Factors: A family history of asthma or allergic conditions significantly increases a child’s risk of developing asthma. Specific genes associated with asthma susceptibility have been identified, emphasizing the hereditary component.
• Allergies: Allergic reactions to substances like pollen, dust mites, pet dander, mold spores, and certain foods can trigger asthma symptoms. Children with allergies are more prone to asthma, particularly if there’s a family history of both conditions.
• Respiratory Infections: Viral respiratory infections, such as the common cold and respiratory syncytial virus (RSV), can trigger asthma symptoms or exacerbate existing asthma in children. Early exposure to infections may also influence the development of asthma.
• Environmental Factors: Exposure to environmental pollutants like tobacco smoke, air pollution, and indoor irritants (e.g., strong odors, fumes, and allergens) can increase the risk of asthma in children. Maternal smoking during pregnancy and postnatal smoke exposure are particularly significant risk factors.
• Low Birth Weight and Prematurity: Children born prematurely or with low birth weight are at a higher risk of developing with asthma. Incomplete lung development in preterm infants may contribute to this increased risk.
• Obesity: Obesity is associated a higher likelihood of developing asthma in children. The exact mechanisms linking obesity and asthma are not fully understood but may involve inflammation and changes in lung function.
• Stress and Psychological Factors: Emotional stress and exposure to adverse childhood experiences may influence the development and severity of asthma in children, possibly through their impact on the immune system.
• Dietary Factors: Diet plays a role in asthma development, with some studies suggesting that a diet high in processed foods and low in fruits and vegetables may increase the risk. However, more research is needed in this area.

It’s important to note that asthma is a heterogeneous condition, and the causes and triggers can vary from one child to another. Additionally, the interplay of genetic susceptibility and environmental factors makes asthma a multifactorial disease. Understanding these causes helps in both preventing and managing asthma in children through targeted interventions and lifestyle modifications.

Risk Factors: 

Factors that might increase a child’s chance of developing asthma include:

• Exposure to tobacco smoke, including before birth.
• Previous allergic reactions, including skin reactions, food allergies or hay fever, also called allergic rhinitis.
• A family history of asthma or allergies.
• Living in an area with high pollution such as Delhi, Uttar Pradesh etc.
• Obesity.
• Respiratory conditions, such as a chronic runny or stuffy nose, inflamed sinuses, or pneumonia.
• Gastroesophageal reflux disease (GERD)
• Being male.
• Being Black or Puerto Rican.

Symptoms and Clinical Manifestations: 

All wheezing is not asthma, but the majority of people with asthma don’t wheeze. The following are some examples of prevalent clinical traits:

• 90% of the time, persistent cough is the primary presenting complaint in children. The cough tends to occur more at night or in the morning and is brought on by mental or physical stress (crying, laughing, or screaming).
• A major sign of lower airway blockage is recurrent wheezing. Many individuals confuse chest rumbling for wheezing. When the chest is palpated, wheezing is not felt.
• Retractions are a common feature of airway obstruction; depending on the severity of asthma, they may be present over the subcostal, intercostal, or suprasternal area, with flared nostrils. 
• Post-tussive vomiting (vomiting after a coughing fit) occurs in 5% of cases. 
• Abdominal pain is a rare complication from overusing the abdominal muscles during expiration. 
• Chest pain is also uncommon. 
• Other comorbid conditions include allergic rhinitis, sinusitis, eczema etc.

Complications 

Untreated childhood asthma can result in a number of consequences, including:

• Reduced Quality of Life: Coughing and wheezing are persistent symptoms that can affect a child’s everyday activities, sleep, and general well-being.
• Respiratory infections are common in children with asthma, who are especially prone to them. Respiratory infections can make asthma symptoms worse and put a child in the hospital.
• Reduced Lung Function: If asthma is not under control, chronic inflammation and airway remodeling can result in long-term lung damage and decreased lung function.
• Missed School Days: A child’s academic performance may suffer if they often skip school due to asthma episodes.
• Chronic illness can cause emotional stress and worry, which can have an adverse effect on a child’s mental health.
• Situations that Call for Emergency Medical Attention: Severe asthma episodes can be fatal if not treated quickly. 

To reduce these side effects and allow children with asthma to maintain healthy, active lives, proper asthma control and adherence to recommended therapies are crucial

Diagnosis 

Diagnosing asthma in children involves a comprehensive evaluation that takes into account medical history, clinical symptoms, physical examination, and various diagnostic tests. Here’s a breakdown of the key steps in diagnosing asthma in children:

1. Medical History: The child’s medical history is crucial in identifying potential risk factors and symptoms of asthma. Physicians will inquire about symptoms such as recurrent coughing, wheezing, shortness of breath, and chest tightness, especially at night or in response to specific triggers. Family history of asthma, allergies, or other respiratory conditions is assessed since genetics can play a significant role.
2. Physical Examination: A thorough physical examination helps the healthcare provider assess the child’s lung function and overall health. Physical signs such as wheezing, increased respiratory rate, nasal flaring, and chest retractions may be observed during the exam.
3. Pulmonary Function Tests: Spirometry is a key diagnostic test for asthma in children aged 5 and older. It measures lung function by assessing how much air a child can inhale and exhale and how quickly. Peak expiratory flow (PEF) measurements may be used in older children to monitor lung function over time.
4. Assessment of Symptom Patterns: Physicians evaluate the frequency, duration, and severity of symptoms. The presence of recurrent episodes of coughing, wheezing, or breathlessness, particularly at night or in response to specific triggers, is highly suggestive of asthma.
5. Allergy Testing: Allergy tests, such as skin prick tests or blood tests (specifically IgE levels), may be conducted to identify allergens that could trigger asthma symptoms.
6. Chest X-ray or Imaging: Chest X-rays or other imaging studies may be ordered to rule out other respiratory conditions or complications in cases with atypical symptoms.
7. Response to Bronchodilators: A positive response to bronchodilator medications (e.g., albuterol) during a breathing test may support an asthma diagnosis. Improved lung function following bronchodilator use suggests reversible airway obstruction, a hallmark of asthma.
8. Asthma Action Plans: Developing an asthma action plan in collaboration with the child’s healthcare provider helps monitor and manage symptoms effectively, especially in cases of confirmed asthma.
9. Monitoring and Follow-Up: Regular follow-up appointments are essential to track asthma control, adjust treatment plans, and ensure that the child’s symptoms are well-managed over time.

Asthma diagnosis in children is a multifaceted process that combines clinical evaluation, medical history, objective tests, and ongoing monitoring. Early and accurate diagnosis allows for timely intervention and management, leading to better control of asthma symptoms and improved quality of life for the child.

Management: Asthma management in children focuses on achieving symptom control, maintaining normal activities, and preventing exacerbations. This typically involves:

• Medications: Long-term control medications, like inhaled corticosteroids, reduce airway inflammation, while quick-relief medications provide rapid symptom relief during attacks.
• Short-acting beta agonists. These inhaled bronchodilator medicines can rapidly ease symptoms during an asthma attack. They include albuterol and levalbuterol (Xopenex HFA). These medicines act within minutes, and effects last several hours.
• Allergy shots, also called immunotherapy. Immunotherapy injections are generally given once a week for a few months, then once a month for a period of 3 to 5 years. Over time, they gradually reduce your child’s immune system reaction to specific allergens.
• Combination inhalers. These medicines contain an inhaled corticosteroid plus a long-acting beta agonist (LABA). They include fluticasone and salmeterol (Advair Diskus), budesonide and formoterol (Symbicort), fluticasone and vilanterol (Breo Ellipta), and mometasone and formoterol (Dulera).
• Asthma Action Plan: Developing a personalized asthma action plan with a healthcare provider helps parents and children recognize worsening symptoms and know when to adjust medications.
• Trigger Avoidance: Identifying and avoiding asthma triggers, such as allergens or irritants, is crucial.
• Regular Monitoring: Routine follow-up visits and lung function tests ensure asthma is well-managed and treatment adjustments are made as needed.
• Education: Educating both children and parents on asthma management is essential for effective long-term control.

Homeopathic Management: 

Homeopathy is an alternative medical system that has been practiced for over two centuries. It is based on the principle of “like cures like,” which means that a substance that can cause symptoms in a healthy person can be used in highly diluted form to treat similar symptoms in a person with an illness.

In homeopathic treatment for asthma, practitioners conduct a thorough assessment of the child’s symptoms, medical history, and overall health. They then select a homeopathic remedy that closely matches the child’s individualized symptoms and constitution.

Proponents of homeopathy argue that it offers a holistic approach to asthma treatment by addressing the underlying causes of symptoms, improving overall health, and reducing the frequency and severity of asthma attacks. They claim that homeopathic remedies are safe, non-toxic, and have no adverse side effects.

Homeopathic medicines for asthma in children help manage the tendency of chronic recurrence. These medicines also reduce the frequency and intensity of the asthma symptoms. Where required, homeopathy also focuses on addressing allergic tendencies (which are a cause of asthma) by moderating the immune system.
Made of natural substances, these medicines do not cause any side effects and can be treated n a safe, effective manner.
Homeopathic treatment for asthma can be used alongside conventional medicine in acute cases of asthma.
In case of an acute asthma attack, it is necessary to get conventional help, (like an inhaler in case of extreme shortness of breath). This provides immediate relief to the child and can be followed by a homeopathic medicine for shortness of breath.

1. Sambucus Nigra – Sambucus Nigra is one of the best homeopathic medicines for asthma in children. It is a natural homeopathic medicine prepared from a plant named Common Elder. The plant belongs to the family of Caprifoliaceae. Fresh leaves and flowers of this plant are used to prepare the medicine. Sambucus Nigra tends to bring remarkable recovery in cases of childhood asthma. Nightly suffocative attacks of asthma in children are the key indicators to use this medicine. The child suddenly gets up at night, feeling suffocated. Along with suffocation, the child is restless and cranky. A cough with excessive difficulty in breathing, the expulsion of a small amount of tough mucus, nasal obstruction are the typical symptoms.
2. Natrum Sulph – Natrum Sulph is an excellent homeopathic medicine used to treat asthma in children. It is a constitutional homeopathic medicine that is highly suitable for treating asthma in children. This medicine works towards eradicating the chronic tendency of asthma in children. A child needing Natrum Sulph has a cough, dyspnea, and rattling of mucus in the chest. An expulsion of green colored mucus may be noted. Asthma triggered by cold and exertion and asthma that worsens in damp weather are the symptoms indicative of using Natrum Sulph.
3. Arsenic Album – Arsenic Album is an important homeopathic medicine frequently used to treat asthma in children. Asthma with extreme difficulty in breathing is treated well with this medicine. The child cannot breathe comfortably due to constricted air passages. He/She puts great effort to breathe normally. Cough is attended with a difficult expulsion of mucus and wheezing in the chest. Homeopathic medicine Arsenic Album is mostly used to treat asthma that worsens upon going to bed, or during midnight.
4. Cina – Cina is a homeopathic medicine prepared from the plant Artemisia Maritime. It belongs to the family Compositae. Cina is a useful homeopathic medicine for cough variant asthma where violent dry cough is markedly present. Cough is intense and spasmodic and ends with vomiting. The cough appears in paroxysms (suddenly). After a cough, the child may moan and turn pale. Evening and night aggravation, a sensation of being suffocated, and irritability are well noted.
5. Cuprum Met – Cuprum Met is a useful homeopathic medicine for treating asthma with a spasmodic cough. Here child gets a strong, violent fit of cough that ends in vomiting. The child gets stiff feels suffocated, has difficulty in breathing with a cold face and blue lips. Drinking water can help relieve the cough. White mucus may be expelled, and difficulty in respiration along with whistling occurs. The cough tends to appear at night disturbing, disturbing the child’s sleep. A pressure or constricted sensation in the chest may appear. Asthmatic attack when walking quickly is also indicative to use homeopathic medicine Cuprum Met.
6.  Antimonium Tart – Antimonium Tart is a well-indicated homeopathic medicine for asthma accompanied with cough and rattling of mucus in the chest. The airways seem overloaded with mucus. The chest is intensely congested with great rattling of mucus. Cough is present all the time, without any expulsion of sputa. Shortness of breath and a sensation of suffocation may be present.
7.  Spongia Tosta – Spongia Tosta is an excellent homeopathic medicine for an asthmatic cough. The key feature to use Spongia Tosta is a dry cough, with wheezing in the chest. The cough is extremely dry, deep, and bark-like. It is present all day and night. Warm drinks may relieve the cough for a while. Along with this, suffocation and short, difficult respiration is present. 
8. Ipecac – Ipecac is a homeopathic medicine for the treatment of asthma. It is prepared from the root of the plant Ipecac. This plant belongs to the natural order Rubiaceae. It is indicated for an asthmatic cough with intense shortness of breath and constriction in the chest. Slight exercise tends to bring shortness of breath. The child has short, panting, heavy breathing with an exhausting cough. Phlegm rattling in the chest may be present. There is marked suffocation. Vomiting appears with coughing. The child’s face turns blue, and the child stiffens with a spasmodic cough. The child may feel better in the open air. 
9. Hepar Sulph – Hepar Sulph is a prominent homeopathic medicine for asthma that gets worse in the cold air. Following exposure to cold air, the child gets a cough along with difficulty in breathing and wheezing. The cough is loose with mucus in the chest. An expulsion of yellow colored phlegm may occur. The cough gets worse in the morning, and consuming cold drinks also makes the cough worse.

Conclusions: In conclusion, asthma in children is a common chronic respiratory disorder that, if not well controlled, can have a substantial influence on their quality of life. For symptom management and the avoidance of consequences, prompt diagnosis, thorough asthma action plans, and adherence to recommended medicines are essential. To reduce exacerbations, asthma therapy should take into account tailored treatment programs that include trigger avoidance techniques. For the purpose of tracking asthma control and making the required modifications, routine monitoring and follow-up with healthcare professionals are crucial. With the right treatment, children with asthma may live full, active lives that allow them to grow while successfully managing their illness. 

Homeopathic treatment focuses on the patient as a person. When on the base of simllimum a well selected medicine is administered to a sick person, there is gradual relief in symptoms and restoration of health. It represents the reaction of susceptible organism to the impression of the curative remedy. With homoeopathic treatment, the right medicine will manage the increased sensitivity to gluten protein to normal and regulation of diet along with homoeopathic treatment can intensify the management of asthma in children.

References:

• Colledge, Walker and Ralston, Davidson’s Principles & Practice of Medicine, 20th edition, Churchill Livingstone ELSEVIER, 2006, Page No. 894 
• Dennis L. Kasper; Harrison’s Principles of Internal medicine, 15th edition, McGraw Hill’s, 2001, Page no. 1673 to 1675 
•  Behrman and Kliegman, Nelson Textbook of Paediatrics, 17th edition, Philadelphia, Elsevier Health Science, Saunders, 2003, Page No. 1264 
•  Siddharth Shah, API Textbook of medicine, 6th Edition, Mumbai, Association of Physicians of India, 1999 
• Agarwal , Mukesh, Textbook of Paediatrics, 1st edition, Mumbai, Bhalani Publishers, 2009, Page No. 346 
•  Ghai, O.P., Ghai Essential Paediatrics, 6 th edition ( revised and enlarged), Delhi, CBS Publishers, 2006, Page No. 281 
•  Allen H.C. Allen’s Keynotes, Rearranged and Classified with leading remedies of the MateriaMedica& Bowel Nosodes, 9th edition : B. Jain Publisher Pvt. Ltd., New Delhi, Reprint edition 2004
• Global Initiative for Asthma. (2021). Global strategy for asthma management and prevention.
• Biju, N. (2013). Homeopathy for asthma: A review. Homeopathy: The Journal of the Faculty of Homeopathy, 102(1), 24-29.
• Asthma and Allergy Foundation of America. (2021). Childhood asthma.
• Ministry of Health and Family Welfare, Government of India. (2019). National health profile 2019.
• National Heart, Lung, and Blood Institute. (2007). Expert panel report 3: Guidelines for the diagnosis and management of asthma.
• Mathur, P. (2015). Management of pediatric asthma. Indian Journal of Pediatrics, 82(9), 817-823.
• Boericke, William. Pocket Manual of Homoeopathic  Materia Medica and Repertory comprising of the Characteristic and guiding symptoms of all Remedies (clinical and pathogenetic) including Indian Drugs. B. Jain Publishers Pvt. Ltd, New Delhi, 2007. 
•  Kent James Tyler. Lectures on Homoeopathic Philosophy. Memorial Edition Reprint. B. Jain Publishers Pvt. Ltd., New Delhi , 2004. 
•  Hahnemann Samuel. Organon of medicine, 6th edition, Translated by William Boericke. B. Jain Publishers Pvt. Ltd., New Delhi, Reprint Edition 2002. 
•  Sarkar. B. K. Hahnemann’s Organon of Medicine. Reprint Edition, Birla Publications Pvt. Ltd., Delhi, 2007- 2008. 
• Lilienthal Samuel, Homoeopathic Therapeutics, B. Jain Publishers (P) Ltd. New Delhi. 
•  Master Farokh 2006, clinical Organon of Medicine, B. Jain Publishers Pvt. Ltd., New Delhi.

Corresponding Author:- 

Dr. Pravleen Kaur; BHMS, PG Scholar, Deptt. of pediatrics; Sri Ganganagar Homeopathic College, Hospital and Research Institute, Sri Ganganagar (Raj.) 

Dr. Simran Khanna; BHMS, PG Scholar, Deptt. of organon of medicine; Sri Ganganagar Homeopathic College, Hospital and Research Institute, Sri Ganganagar (Raj.) 

Dr. Jaspinder Kaur; M.D. (Hom.), Ph. D (hom.) (Scholar), Asst.Professor, Dept. of materia medica, Sri Ganganagar Homeopathic College, Hospital and Research Institute, Sri Ganganagar (Raj.) 

Dr. Sunil Kumar; M.D. (Hom.), Professor and HOD, Dept. of organon of medicine, Sri Ganganagar Homeopathic College, Hospital and Research Institute, Sri Ganganagar (Raj.)