Dr. Kerri Dow, Naturopathic Doctor RESPIRATORY AILMENTS IN CHILDREN & YOUTH: NATUROPATHIC INTERVENTIONS.

Dr. Kerri Dow, Naturopathic Doctor

RESPIRATORY AILMENTS IN

CHILDREN & YOUTH: NATUROPATHIC

INTERVENTIONS

• Intro to Naturopathic Medicine

• 4 common Respiratory Ailments in Children & Youth:•Asthma•Colds & Flu•Bronchitis•Pneumonia

• Naturopathic Treatment

• Botanicals/Herbs

AGENDA

• A primary healthcare system that uses natural therapies to support and stimulate the body’s ability to heal

• Big focus on prevention through lifestyle and nutritional counselling

• Goal of the naturopathic perspective: address the cause of illness

WHAT IS NATUROPATHIC MEDICINE?

• Licensed naturopathic doctors have the following training:

• Undergraduate degree with premedical prerequisites• 4 years study at an accredited naturopathic college•Min 1500 hours supervised clinical experience• 2 sets of licensing board exams (NPLEX)• Ongoing continuing education courses

EDUCATION

•Clinical Nutrition•Botanical/Herbal Medicine•Homeopathy•Physical Medicine•Traditional Chinese Medicine (TCM)•Lifestyle Counseling

NATUROPATHIC MODALITIES

• Naturopathic Medicine is guided by six founding principles:

•First do no harm•The healing power of nature• Identify and treat the cause•Treat the whole person•Doctor as teacher•Emphasize prevention

TENETS OF NATUROPATHIC MEDICINE

• Proper breathing is the simplest and most powerful technique for improving health.

• Regulates the heart, circulation, nervous system, digestion and other vital functions.

• Breathing is the bridge between the body, mind and consciousness.

BREATHING

•Asthma•Colds & Flu•Bronchitis•Pneumonia

COMMON RESPIRATORY AILMENTS IN CHILDREN & YOUTH

• Pathophysiology involves 3 inter-related components:• 1) airway inflammation• 2) intermittent airflow obstruction• 3) hyper-responsiveness of the bronchi

• Treatment should involves a systematic process to:• Address the reason for excessive inflammation• Modulate the inflammatory process• Avoid triggering allergens• Treat for bronchoconstriction

ASTHMA

• NATUROPATHIC APPROACH involves some or all of the following:

1) Environment2) Diet 3) Clinical Nutrition 4) Herbs

NATUROPATHIC APPROACH

• Minimize exposure to air-borne allergens

• Avoid cats, dogs, upholstery

• Install air-purification filters to central heating or AC systems

ASTHMA AND ENVIRONMENT

•The elimination of food triggers (via a food challenge test) can be very beneficial in the management of asthma.

•Study: Significant improvements in symptoms and lung function in asthmatic children (3-14 years of age) when they followed an egg & milk-free diet for 8 weeks.

•The most common allergens:• Dairy**•Wheat• Corn• Eggs

ASTHMA AND DIET

• Asthma is quite receptive to nutritional treatments. Patients can reduce their use of bronchodilators and experience a decrease in the severity of their symptoms

• Possible Interventions:•Magnesium • Vitamin B12• Vitamin B6• Omega 3 fatty acids

ASTHMA AND CLINICAL NUTRITION

• Low dietary intakes of magnesium have been associated with increased bronchial reactivity.

• Several studies show that intravenous (IV) magnesium and magnesium inhaled through a nebulizer can help treat acute attacks of asthma in children 6 - 18 years of age.

• Oral Magnesium supplementation has been shown to:• reduce bronchoconstriction • increase the force of respiratory muscles• reduce bronchodilator use• general improvement in symptoms

• *Study

ASTHMA AND MAGNESIUM

• More effective than drugs in blocking reactions due to sulphites

• Often the case with pediatric asthma

• Vitamin B12 is able to block the sulphite-induced bronchospasm associated with chronic allergy related asthma.

• IM injections produce better results than oral administration

ASTHMA AND B-12

• Theophylline (dimethylxanthine) treatment: decreases vitamin B6 levels

• Theophylline-induce seizures may be to low GABA in the brain (secondary to low vitamin B-6 status)**

• B6 is required for metabolism of:

•Fatty acids, Serotonin, Tryptophan, GABA

• and > 50 enzymatic reactions

• Shown to reduce exacerbations & wheezing episodes

ASTHMA AND B-6

• Teenaged female with severe asthma.

• Had visited ER frequently due to severe attacks.

• Required 2 different inhalers several times per day.

• Visit to ND clinic seeking relief from symptoms

• Prescription:

• Oral magnesium and B-6. IM B-12 injection in clinic.

• Next day: phone call from mother; patient could breathe deeply for 1st time in months.

• 4 week follow-up: only had to use inhaler twice. Controlled well for months.

CASE STUDY

•Omega 3’s have been shown to:

•Decrease inflammation

•Decrease eosinophils (therefore histamine)

•Decrease airway hyper-responsiveness

•Decrease exercise-induced airway bronchoconstriction (Vitamin C also)

ASTHMA AND OMEGA 3

• Viral: therefore antibiotics are of no use

• Strengthening the immune system is the #1 form of prevention and cure

• 9 days versus 3 weeks

• HAND WASHING!!

COLD & FLU

• Excess consumption: dairy, refined grains, & SUGAR*

•If you are coming down with something: avoid sugar!

• Inadequate sleep

• Stress

• Vitamin D deficiency

• Lack of exercise (crucial for resistance to illness)

• Food sensitivities and altered gut function

CAUSES OF IMPAIRED IMMUNITY

• PROBIOTICS reduce the incidence of:• Fever by 72%

•Coughing by 62%

•Runny nose by 59%

• Vitamin D: higher levels • fewer respiratory tract infections

• Elderberry (Sambucol): Great for kids. Great for nasal congestion and prevention throughout the winter.

TREATMENT & PREVENTION

• Omega 3 fats

• Fruits and vegetables

• Garlic

• Spices such as: Turmeric, Cloves, Oregano,

Cinnamon

• Lots of water!!

• Chicken noodle soup (thins the mucous)

FOODS FOR TREATMENT & PREVENTION

•Wonderful for chronic and acute sinusitis and lung infections.

• Boil water and poor into large stainless steel or glass bowl. Add 3-5 drops of Eucalyptus Oil to the boiled water. Breathe in the steam with towel over your head and the bowl. Be careful not to burn yourself.

• Not recommended for small children.

STEAM INHALATION

• For that feeling of heaviness and congestion at the onset of a cold!

• Dip a pair of cotton socks in cold water, wring them out & put them on your feet. Yes, it will feel uncomfortable! Place a pair of wool socks over the cotton socks and go to sleep. When you wake up in the morning your feet will be toasty! For best results: repeat for 3 nights in a row.

• The treatment helps to reflexively increase circulation and relieve congestion in the upper respiratory passages, head, and throat. Also very sedating!

WARMING SOCKS!!

• Children over 2: nasal spray vaccines (weakened viruses) better at preventing flu (82%) than injected vaccines (59%).

• Neither type good at preventing 'flu-like illness' caused by other types of viruses (33% and 36% respectively).

• In children under 2: efficacy of vaccine similar to placebo.

• It was not possible to analyse the safety of vaccines from the studies due to the lack of standardisation in the information given but very little information was found on the safety of inactivated vaccines, the most commonly used vaccine, in young children.

FLU VACCINE IN CHILDREN: COCHRANE REVIEW

• Inflammation of trachea and large bronchi

• Etiology:

•Bacterial, viral, or allergic (most often viral)**

•MC in winter after a URTI

•Air pollution

•Cold climate

•Malnutrition

BRONCHITIS

• Diet & Lifestyle measures:

•Determine individual food allergens and avoid them

• Increase fluid consumption (chicken soup, tea with honey and lemon)

•Hot showers and baths if tolerated (to soothe the bronchi)

BRONCHITIS

• Clinical Nutrition:

•Vitamin C: enhances immunity; anti-viral; improves tissue elasticity

•Zinc Picolinate: enhances immunity; anti-viral•Zinc deficiency favors TH2 immune response which

favors pulmonary inflammation and mucous hyper secretion

•NAC (n-acetyl cysteine): mucolytic & anti-oxidant

BRONCHITIS

• Infection and subsequent swelling of the lung

• Etiology:•Bacterial, viral, fungal•MC in winter after influenza•Smoking•Hospitalization•Malnutrition

• Children < 1 year: Respiratory syncytial virus (RSV)• Children > 1 year: Parainfluenza virus (Croup)

PNEUMONIA

• Naturopathic approach is recommended as an adjunctive treatment to conventional medications.

• Diet & Lifestyle:

•Main concern is adequate caloric and protein intake therefore protein or meal replacement shakes are required

• Increase fluid consumption

•Hot showers and baths

PNEUMONIA

•Zinc picolinate (20-30 mg qd)• decreases cytokines involved in inflammation

• Decreases incidence by over 40%

•Vitamin A: —children with RSV have low serum vitamin A levels. **Measles pneumonia.

Vitamin C: may be more relevant in deficient populations

Herbs

PNEUMONIA

Marrubium vulgare

Lobelia inflata

Grindelia robusta

Glycyrrhiza glabra

Inula helenium

RESPIRATORY HERBS

• Indications:• Pulmonary disease with copious phlegm but cough is non-

productive• Asthma with difficult expectoration• Chronic bronchitis• Pneumonia

• Actions:• Expectorant• Purgative & diuretic at high doses*

• Dosage: 1-10 drops TID for a 50 lb. child

MARRUBIUM VULGARE

• Indications:• Asthma• Croup•Whooping cough• Pneumonia

• Actions:• Reduces spasmodic cough• Relaxes respiratory muscles• Helps expel mucous; relieves congestion

• Dosage: 3 drops TID-QID for 50 lb. child

LOBELIA INFLATA

• Indications:• Harsh, dry cough• Cough with cyanosis or arrhythmia• Asthma**•Walking pneumonia

• Actions:• Expectorant• Respiratory stimulant• Anti-spasmodic

• Dosage: 3-10 drops TID for a 50 lb. child

GRINDELIA ROBUSTA

• Indications:•viral URI•Asthma•Bronchitis

•Actions:•anti-inflammatory•Expectorant; ease mucus removal•Demulcent; soothes irritated mucus membranes

• Dosage: approx 10 drops TID for 50 lb. child

GLYCYRRHIZA GLABRA

INULA HELENIUM

• Barak V, Halperin T, Kalickman I. The effect of sambucol, a black elderberry-based, natural product, on the production of human cytokines: I. inflammatory cytokines. Eur cytokine Netw. 200; 12 (2) 290-6.

• Bhutta ZA, Black RE, et al. Prevention of diarrhea and pneumonia by zinc supplementation in developing countries: pooled analysis of randomized controlled trials. J Pediatr. 1999, 135 (6): 689-97.

• El-Hashemy S, Naturopathic standards of primary care. CCNM Press, 2007.

• Gontijo-Amaral C, Ribeiro MA, Gontijo LS, et al. Oral magnesium supplementation in asthmatic children; a double blind randomized placebo-controlled trial. Eur J Clin Nutr 2007; 61: 54-60

• Leyer GJ, Li S, Mubasher ME, et al. Probiotic effects on cold and influenza-like symptoms incidence and duration in children. Pediatrics 2009; 124 (2): 172-9.

• Prousky, J. Principles and practices of naturopathic clinical nutrition. CCNM Press, 2008.

• Tanaka I, Hiraga Y, Inaba J, et al. [Serum pyridoxal concentration in children during theopylline therapy for bronchial asthma], 1994; 43: 1172-78.

• Yussof NA, Hampton SM, Dickerson JW, Morgan JB. The effects of exclusion of dietary egg and milk in the management of asthma in children: a pilot study. J R Soc Health 2004; 124: 74-80

REFERENCES

www.doctordow.ca

www.pilatesbygarda.ca

www.nband.ca

www.cand.ca

www.oand.ca

www.ccnm.edu

RESOURCES

THANK YOU!

Dr. Kerri Dow, Naturopathic Doctor

494 Queen Street, Suite 400Fredericton, NB

454-8381

EMAIL: [email protected]

www.doctordow.ca