Jaber Raja
Division of Wellness and Chronic Illness, Department of Family Medicine, University Hospital and Medical Center, Health Sciences Center, State University of New York at Stony Brook, Stony Brook, NY 11794-8461, USA.
Prim Care. 2002 Jun;29(2):231-61. doi: 10.1016/s0095-4543(01)00008-2.
Patients with asthma and allergic rhinitis may benefit from hydration and a diet low in sodium, omega-6 fatty acids, and transfatty acids, but high in omega-3 fatty acids (i.e., fish, almonds, walnuts, pumpkin, and flax seeds), onions, and fruits and vegetables (at least five servings a day). Physicians may need to be more cautious when prescribing antibiotics to children in their first year of life when they are born to families with a history of atopy. More research is needed to establish whether supplementation with probiotics (lactobacillus and bifidobacterium) during the first year of life or after antibiotic use decreases the risk of developing asthma and allergic rhinitis. Despite a theoretic basis for the use of vitamin C supplements in asthmatic patients, the evidence is still equivocal, and long-term studies are needed. The evidence is stronger for exercise-induced asthma, in which the use of vitamin C supplementation at a dosage of 1 to 2 g per day may be helpful. It is also possible that fish oil supplements, administered in a dosage of 1 to 1.2 g of EPA and DHA per day, also may be helpful to some patients with asthma. Long-term studies of fish oil and vitamin C are needed for more definite answers. For the patient interested in incorporating nutritional approaches, vitamin C and fish oils have a safe profile. However, aspirin-sensitive individuals should avoid fish oils, and red blood cell magnesium levels may help in making the decision whether to use additional magnesium supplements. Combination herbal formulas should be used in the treatment of asthma with medical supervision and in collaboration with an experienced herbalist or practitioner of TCM. Safe herbs, such as Boswellia and gingko, may be used singly as adjuncts to a comprehensive plan of care if the patient and practitioner have an interest in trying them while staying alert for drug-herb interactions. No data on the long-term use of these single herbs in asthma exist. For the motivated patient, mind-body interventions such as yoga, hypnosis, and biofeedback-assisted relaxation and breathing exercises are beneficial for stress reduction in general and may be helpful in further controlling asthma. Encouraging parents to learn how to massage their asthmatic children may appeal to some parents and provide benefits for parents and children alike. Acupuncture and chiropractic treatment cannot be recommended at this time, although some patients may derive benefit because of the placebo effect. For patients with allergic rhinitis, there are no good clinical research data on the use of quercetin and vitamin C. Similarly, freeze-dried stinging nettle leaves may be tried, but the applicable research evidence also is poor. Further studies are needed to assess the efficacy of these supplements and herbs. Homeopathic remedies based on extreme dilutions of the allergen may be beneficial in allergic rhinitis but require collaboration with an experienced homeopath. There are no research data on constitutional homeopathic approaches to asthma and allergic rhinitis. Patients with COPD are helped by exercise, pulmonary rehabilitation, and increased caloric protein and fat intake. Vitamin C and n-3 supplements are safe and reasonable; however, studies are needed to establish their efficacy in COPD. On the other hand, there are convincing data in favor of N-acetyl-cysteine supplementation for the patient with COPD at doses ranging between 400 and 1200 mg daily. Red blood cell magnesium levels may guide the use of magnesium replacement. The use of L-carnitine and coenzyme Q10 in patients with COPD needs further study. The addition of essential oils to the dietary regimen of patients with chronic bronchitis is worth exploring. Patients with upper respiratory tract infections can expect a shorter duration of symptoms by taking high doses of vitamin C (2 g) with zinc supplements, preferably the nasal zinc gel, at the onset of their symptoms. Adding an herb such as echinacea or Andrographis shortens the duration of the common cold. The one study on Elderberry's use for the flu was encouraging, and the data on the homeopathic remedy Oscillococcinum interesting, but more studies should be performed. Saline washes may be helpful to patients with allergic rhinitis and chronic sinusitis. Patients also may try the German combination (available in the United States) of elderberry, vervain, gentian, primrose, and sorrel that has been tested in randomized clinical trials. Bromelain is safe to try; the trials of bromelain supplementation were promising but were never repeated. The preceding suggestions need to be grounded in a program based on optimal medical management. Patients need to be well educated in the proper medical management of their disease and skilled at monitoring disease stability and progress. Asthmatic patients need to monitor their bronchodilator usage and peak flow meter measurements to step up their medical treatment in a timely manner, if needed. Patients welcome physician guidance when exploring the breadth of treatments available today. A true patient-physician partnership is always empowering to patients who are serious about regaining their function and health.
哮喘和过敏性鼻炎患者可能会从补充水分以及低钠、低ω-6脂肪酸和反式脂肪酸、高ω-3脂肪酸(如鱼类、杏仁、核桃、南瓜和亚麻籽)、洋葱、水果和蔬菜(每天至少五份)的饮食中受益。对于有特应性疾病家族史的家庭所生的一岁以内儿童,医生在开具抗生素时可能需要更加谨慎。需要更多研究来确定在生命的第一年或使用抗生素后补充益生菌(乳酸杆菌和双歧杆菌)是否能降低患哮喘和过敏性鼻炎的风险。尽管有理论依据支持哮喘患者使用维生素C补充剂,但证据仍不明确,需要进行长期研究。对于运动诱发性哮喘,证据更强,每天服用1至2克维生素C补充剂可能会有帮助。每天服用1至1.2克二十碳五烯酸(EPA)和二十二碳六烯酸(DHA)的鱼油补充剂对一些哮喘患者也可能有帮助。需要对鱼油和维生素C进行长期研究以获得更明确的答案。对于有兴趣采用营养方法的患者,维生素C和鱼油安全性良好。然而,对阿司匹林敏感的个体应避免使用鱼油,红细胞镁水平可能有助于决定是否使用额外的镁补充剂。联合草药配方应在医学监督下并与经验丰富的草药师或中医从业者合作用于哮喘治疗。如果患者和从业者有兴趣尝试安全的草药(如乳香和银杏),可单独用作综合护理计划的辅助手段,但要警惕药物与草药的相互作用。目前尚无关于这些单一草药长期用于哮喘治疗的数据。对于积极主动的患者,瑜伽、催眠以及生物反馈辅助的放松和呼吸练习等身心干预措施总体上有助于减轻压力,可能有助于进一步控制哮喘。鼓励父母学习如何为患有哮喘的孩子按摩,这可能会吸引一些父母,并对父母和孩子都有益处。目前不推荐针灸和脊椎按摩治疗,尽管有些患者可能因安慰剂效应而受益。对于过敏性鼻炎患者,关于使用槲皮素和维生素C尚无良好的临床研究数据。同样,可以尝试冻干的荨麻叶,但相关研究证据也不足。需要进一步研究评估这些补充剂和草药的疗效。基于过敏原极度稀释的顺势疗法药物可能对过敏性鼻炎有益,但需要与经验丰富的顺势疗法医生合作。目前尚无关于针对哮喘和过敏性鼻炎的体质顺势疗法方法的研究数据。慢性阻塞性肺疾病(COPD)患者通过运动、肺康复以及增加热量、蛋白质和脂肪摄入而受益。维生素C和n-3补充剂安全且合理;然而,需要进行研究以确定它们在COPD中的疗效。另一方面,有令人信服的数据支持COPD患者每天服用400至1200毫克的N-乙酰半胱氨酸补充剂。红细胞镁水平可指导镁补充剂的使用。COPD患者使用左旋肉碱和辅酶Q10需要进一步研究。在慢性支气管炎患者的饮食中添加精油值得探索。上呼吸道感染患者在症状出现时服用高剂量维生素C(2克)并补充锌,最好是鼻用锌凝胶,可缩短症状持续时间。添加紫锥菊或穿心莲等草药可缩短普通感冒的病程。一项关于接骨木用于流感的研究令人鼓舞,关于顺势疗法药物奥司他韦的数据也很有趣,但需要进行更多研究。盐水冲洗可能对过敏性鼻炎和慢性鼻窦炎患者有帮助。患者也可以尝试在美国有售的接骨木、马鞭草、龙胆、报春花和酸模的德国组合,该组合已在随机临床试验中进行了测试。菠萝蛋白酶尝试使用是安全的;补充菠萝蛋白酶的试验前景良好,但从未重复进行。上述建议需要以基于最佳医疗管理的方案为基础。患者需要在疾病的正确医疗管理方面接受良好教育,并熟练掌握监测疾病稳定性和进展的方法。哮喘患者需要监测支气管扩张剂的使用情况和峰值流量计测量结果,以便在需要时及时加强医疗治疗。当患者探索当今可用的广泛治疗方法时,他们欢迎医生的指导。真正的医患合作关系对于认真想要恢复功能和健康的患者总是具有 empowering 作用。 (最后一个单词“empowering”在原文语境下可能是想说“有帮助的、赋予力量的”等意思,但原词有误,推测原文可能是“empowering”,这里按推测翻译,供你参考。)