Botanicals
Use of botanicals is one of the oldest and most widely applied therapeutic approach in all of asthma care worldwide. Historical documents beginning several thousand years ago from many world healing traditions document dozens of herbs used in the treatment of breathing disorders.
Although there is a large amount of knowledge and information regarding herbal or botanical treatment of asthma, a significant part of it is not based on any well-designed or well-performed clinical studies. Nonetheless, many of the botanicals used are similar to pharmaceuticals in their chemical properties.
Common herbs for asthma are:
Tylophora Indica
ASHMI (Ganoderma lucidum, Sophora flavascens, Glycyrrhiza uralensis)
Boswellia Serrata
Coleus forskohlii
Glycyrrhiza glabra
Ma Huang
Ginkgo biloba
Tylophora Indica
Tylophora indica is a common plant that grows in the forests and sandy areas of India. The plant parts used for treatment of asthma include the leaves and roots.
Five high-quality randomized trials have shown that treated subjects improve on both subjective and objective measures. Unfortunately, this herb also has a high side effect profile – nausea, vomiting, sore mouth and abdominal pain. Additionally, the herb is difficult to find in the U.S.
AHSMI Trial
The Anti-Asthma Herbal Intervention (AHSMI) trial studied a standard combination of three traditional Chinese herbs:
Ganoderma lucidum (Reishi - Ling-Zhi)
Sophora flavascens (Shrubby sophora - Ku-shen)
Glycyrrhiza uralensis (Chinese licorice - Gan-Cao)
In mice models, these herbs have been shown to almost eliminate airway hyperactivity, reduce the total number of cells and percentage of eosinophils in bronchoalveolar lavage fluid, and inhibit mucus production in the lungs. Importantly, their action differs from corticosteroids, which suppress both TH1 and TH2 response, by only suppressing TH2. This preferential action avoids adrenal and immune suppression common to steroids.
In 2005 Wen published a four-week RCT comparing the ASHMI herbs to prednisone 20 mg daily in inpatients with moderate-severe persistent asthma. There was a significant reduction in subjective and objective measures in both groups, but the ASHMI group also showed no adrenal suppression, confirming the mouse studies.
These herbs can be found in a standardized extract with dosing of one capsule twice per day.
Boswellia Serrata
Boswellia serrata is a gum resin known in Ayurvedic medicine (Traditional Indian Medicine) as Salai guggal. This extract contains boswellic acids, which have been shown to inhibit leukotriene biosynthesis. Boswellia has a potent anti-inflammatory effect and is traditionally used in asthma, collagenous colitis, dermatitis, and Crohn's Disease.
In 1998 Gupta published an RCT forty patients, 23 males and 17 females. A standard dose of 300 mg po 3 times daily for a period of 6 weeks was used in patients with moderate asthma. 70% of patients showed improvement of disease with reduction in:
Dyspnea and rhonchi
Number of asthma attacks
Increase in FEV1, FVC and PEFR
Decrease in eosinophilic count and ESR
Only 27% of patients in the control group showed improvement. Boswellia, like the ASHMI herbs, are readily available in the U.S.
Typically, recommended dosing is 300-400 mg po TID for prophylaxis of asthma symptoms. Few side effects have been noted with either herbs.