Childhood Asthma
Guest Blog by Sara Castoldi MSc (Hons) Ost
Childhood asthma is one of the most common respiratory disorders worldwide with increased prevalence in Western societies. According to World Health Organization (WHO, 2011) it is the most common chronic disease among children and in early childhood males are more susceptible to asthma than females (Tantisira et al, 2008). In particular, male preterm infants have higher rates of asthma incidence and chronic lung diseases (Drevenstedt et al, 2008). A number of factors have been implicated in the cause of childhood asthma. These include genetic predisposition, environmental stimuli during prenatal and early childhood that include allergens, maternal infection and smoking during pregnancy, tobacco smoke, mode of birth delivery, viral respiratory illness, obesity, diet, hygiene and toxic exposures.
Nutrition
Breastfeeding is strongly associated with reduction of respiratory illness in later childhood and adolescence. Maternal milk apart from its nutritional components has been shown to have a protective role in the newborn infant and also play an important role in the early acquired immune programming (Hanson et al, 1990). Furthermore, chronic respiratory complaints, such as rhinitis and asthma, may be attributed to food allergy (James, 2003).
Lifestyle
In the last decade there has been a dramatic increase in the incidence of childhood asthma. The modern industrialised lifestyle appears to be a significant contributor to asthma exacerbation rather than the genetic factors. In modern societies improved hygiene in combination with vaccination and early use of antibiotics (Murk et al, 2011), result in a reduced incidence of infection that would normally stimulate the infant’s immune system (McRae and Wong, 2002).
Psychosocial factors
It is also important to consider the role of psychosocial factors such as emotional stress of both mother and infant, maternal anxiety or depression and ineffective maternal responsive caregiving in early infancy are strongly associated with childhood asthma and allergies (Dieter, 2011).
A difficult diagnosis
To date, evidence suggests that early intervention is important (NHLBI, 2007). However, diagnosing pre-school children is difficult and often results in undertreatment of asthmatics and overtreatment of transient wheezes (Brand et al, 2008). The diagnosis is a clinical one and, consequently, it is largely based on reported symptoms. However, many symptoms that support an asthma diagnosis in young children are not necessarily “asthma specific” (Cave and Atkinson, 2014). For example, cough and wheezing may be seen in healthy children or are characteristic of other paediatric diseases (Bush, 2007).
Osteopathic Treatment
Osteopathic treatment can be used in treating patients with childhood asthma as it is a safe and non-invasive means of enhancing treatment. An osteopath aims to affect therapeutic responses via three distinct physiologic mechanisms, which are part of three main osteopathic models.
Structural Model
Firstly, the evaluation and treatment of the musculoskeletal system and a recognition of its role in patients’ well-being are essential. Although pharmacologic agents have been proven effective improving asthma symptoms, the structural component of respiration is clearly not addressed by pharmacologic therapy. Because it is an integral component of the respiratory mechanism, it follows that maximization of its efficiency allows for improved respiratory function (Guiney et al, 2005).
In patients with asthma, techniques that focus on the thoracic structures can be employed to maximize the effectiveness of the respiratory cycle. A fully effective respiratory cycle can be achieved by increasing the mobility of the thoracic cage and the thoracic spine to allow for full excursion of the ventilatory mechanism (Guiney et al, 2005). Patients with asthma who have suffered exacerbations that result in overuse injuries to the respiratory muscles and joints will benefit from releasing those strains.
Neurological Model
The second physiologic mechanism intended to affect therapeutic response in the patient is the normalization of autonomic nervous system function. Branches of the nervus vagus provide parasympathetic innervation to pulmonary structures and the respiratory diaphragm. The sympathetic supply originates in the first four or five thoracic spinal cord segments and the synapse to the costovertebral junctions in the upper thorax. Therefore, treatments that restore motion to the occipitoatloid and upper thoracic regions will improve responsiveness to adrenergic stimuli (Szentivaneji and Goldman, 1997).
In addition, asthma itself produces a self-sustaining cycle of viscerosomatic and somatovisceral reflexes long recognized in the osteopathic medical literature (Beal and Morlock, 1984). As a result of this conventional approach to treating asthma, breathing efficacy is not maximized and destructive somatovisceral pathways are allowed to continue their negative facilitative influence on the chronic cycle of recurrent asthma.
Circulatory model
Finally, osteopathic treatment can facilitate lymphatic flow to and from the bronchial tree. Tissues become oedematous and metabolic waste products accumulate when lymphatic flow is impeded, adversely affecting cellular function and contributing to disease. Treatment to release strains in the myofascia, the support structure of lymphatic vessels, reduces congestion in the airways of patients with asthma (Degenhardt and Kuchera, 1996).
Based on these mechanisms, osteopathic manipulative techniques have been shown to increase vital capacity and rib cage mobility, improve diaphragmatic function, enhance the clearing of airway secretions and possibly enhance autoimmune function (Rowane, 1999).
Suggested protocols
Notable improvements in patients’ peak expiratory flow rates have been reported following the use of osteopathy (Paul e Buser, 1996). This positive effect has been attributed to several factors, including a decrease in patients’ levels of anxiety, autonomic nervous system changes that relax the airways and smooth muscle tone and, importantly, a mechanically improved chest wall motion.
Bockenhauer et al (2002) found that thoracic cage excursion with forced respiration increased significantly after a single brief intervention using osteopathic techniques.
Guiney et al (2005) conducted a randomized controlled trial attempting to demonstrate the therapeutic relevance of osteopathic treatment in the paediatric asthma population. Results for experimental group showed a statistically significant improvement for peak expiratory flow rates.
References
Beal MC, Morlock JW (1984). Somatic dysfunction associated with pulmonary disease. The journal of the American Osteopathic Association. 84: 179-183.
Bockenhauer SE, Julliard KN, Lo KS, Huang E., Sheth A.M. (2002). Quantifiable effects of osteopathic manipulative techniques on patients with chronic asthma. The journal of the American Osteopathic Association. 102(7): 371-375.
Brand PLP, Baraldi E, Bisgaard H, et al. (2008). Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. The European
Respiratory Journal. 32: 1096-1110.
Bush A. (2007). Diagnosis of asthma in children under five. Primary Care Respiratory Journal. 16: 7-15.
Cave AJ, Atkinson LL (2014). Asthma in preschool children: a review of the diagnostic challenges. Journal of Applied Biomaterials and Functional Materials. 27(4): 538-548.
Degenhardt BF, Kuchera ML (1996). Update on osteopathic medical concepts and the lymphatic system. The journal of the American Osteopathic Association. 96: 97-100.
Dietert RR (2011). Maternal and childhood asthma: risk factors, interactions, and ramifications. Reproductive Toxicology. 32(2): 198-204.
Drevenstedt GL, Crimmins EM, Vasunilashorn S, Finch CE (2008). The rise and fall of excess male infant mortality. Proceding of the National Academy of Sciences.
Guiney PA, Chour R, Vianna A, Lovenheim J (2005). Effects of osteopathic manipulative treatment on pediatric patients with asthma: a randomized controlled trial. The journal of the American Osteopathic Association. 105 (1): 7-12.
Hanson LA, Adlerberth I, Carlsson B., Zaman S., Hahn-Zoric M., Jalil F., (1990). Antibody-mediated immunity in the neonate. Pediatrie Und Padologie. 25(5): 371-376.
James JM (2003). Respiratory manifestations of food allergy. Pediatrics. 111(6): 1625-1630. 105(13): 5016-5021.
McRae WM, Wong CS. (2002). Asthma, allergy and the hygiene hypothesis. Continuing Medical Education. 29: 31-37.
Murk W, Risnes KR, Bracken MB (2011). Prenatal or early-life exposure to antibiotics and risk of childhood asthma: a systematic review. Pediatrics. 127(6): 1125-1138.
National Heart, Lung, and Blood Institute (2007). Expert Panel Report 3 (EPR3): guidelines for the diagnosis and management of asthma. Full report. https://www.nhlbi.nih.gov/health-pro/guidelines/current/asthma-guidelines/full-report.
Noutsios GT, Floros J (2014). Childhood asthma: causes, risk, and protective factors; a role of innate immunity. Swiss Medical Weekly. 144: 14036.
Paul FA, Buser BR (1996). Osteopathic manipulative treatment applications for the emergency department patient. The journal of the American Osteopathic Association. 96: 403-409.
Rowane W, Rowane MP (1999). An osteopathic approach to asthma. The journal of the American Osteopathic Association. 99: 259-264.
Szentivaneji A, Goldman AL (1997). Vagotonia and bronchial ashtma. Chest. 111: 8-11.
Tantisira KG, Colvin R, Tonascia J, Strunk RC, Weiss ST, Fuhlbrigge AL, Group CAMPR (2008). Airway responsiveness in mild to moderate childhood asthma: sex influences on the natural history. American Journal of Respiratory and Critical Care Medicine. 178(4):325-331.