There are 5.2 million people in the UK currently receiving treatment for asthma - which makes for a lot of inhalers lurking in bathroom cabinets. Inhalers, the most common treatment for asthma, come in two types: preventers, which are taken daily to control inflammation in the airways long-term and usually contain low-dose steroids; and reliever inhalers, which instantly relax the muscles if something triggers symptoms. Most asthmatics agree it's no big deal having to take them. And yes, it's great that they work.
But as with anyone with a long-term reliance on drugs, many asthmatics would like to reduce their reliance on inhalers without increasing the likelihood of a potentially dangerous attack. "Lots of people are very keen to know what they can do about their asthma other than take drugs to control it," says Dr Mike Thomas, a GP and senior research fellow for the charity Asthma UK.
There's a large amount of information out there about "natural" treatments, from avoiding cow's milk to eating more shiitake mushrooms. But as Thomas warns: "There's a fairly low amount of evidence for many of these things because lots of the research is based on drug treatments. It's basically much harder to fund non-drug research - but that has been increasing in the last 10 years, so the evidence is growing."
So what are the alternatives, and how effective are they?
Breathing exercises
Buteyko is the best known of these - and proponents claim it can be beneficial to asthmatics (and those with emphysema or bronchitis). You normally attend a workshop, maybe over a couple of days, but it isn't available on the NHS. So is it worth it? "Quite a lot of people do breathe abnormally," says Thomas. "We think breathing is instinctive, but it's very complex and needs coordination of many muscle groups."
Quiet breathing - ie, when you are at rest - should come from the diaphragm, with little movement of the chest. But some people will breathe largely from their chests. "If people can be encouraged to use quiet natural diaphragmatic breathing, this may lead to improvements in their asthma control," says Thomas. "There are some extravagant claims made about Buteyko, but good-quality studies do show that it can help people, and mean they are less reliant on their reliever - although there's no evidence that it can cure asthma. Breathing normally is probably why it works." But Buteyko isn't the only breathing exercise regime that might help. "It could be the same with yoga - and there are some people who say that singing is very helpful," says Thomas.
A recent study published in the journal Thorax also showed success in controlling asthma with the Papworth technique - a series of breathing and relaxation exercises which may reduce symptoms by as much as a third. The technique encourages breathing from the abdomen, using the diaphragm, rather than taking rapid, shallow breaths.
And if singing, bending or breathing methods don't appeal? Try asking your GP for a referral to an NHS physiotherapist. Some are trained to work with people with respiratory conditions.
Allergies
Not all asthma is allergy-driven, but many asthmatics have allergic triggers that set off an attack. Top of the list comes pets - but if it means kicking out the cat for good, many asthmatics choose to live with the inconvenience. Dust mites are another common problem, but getting rid of them can be problematic.
"No matter how clean your house is, you can't completely get rid of dust mites," says Thomas. "There are ways to reduce levels ... but they can be rather extreme - like removing all carpets, having special covers on the bed, and putting all your kids' toys into the freezer. House-dust-mite studies have shown that you can reduce the levels, but it's much harder to reduce them enough to make a difference to asthma, particularly over a long period of time."
As for food allergies - many people (not just asthmatics) think they have them, but actually don't. If you're concerned, get a test (although you might not be offered it on the NHS). "A good thing about allergy tests is that it stops you doing things that aren't helping," says Thomas. "Food allergies can drive asthma, but by and large they are not a common trigger."
Diet
There is evidence to suggest that asthmatics may benefit from antioxidants such as vitamins E and C, as well as the mineral selenium, which can be found in foods such as brazil nuts, cereals, dairy products, fish and meat. Antioxidants help combat free radicals, which are thought to damage the airways.
But Dr Seif Shaheen, a senior lecturer in epidemiology at Imperial College and senior research fellow for Asthma UK who works in the area of asthma and diet, says: "In our selenium trial, a lot of the asthma sufferers had quite good selenium levels - so extra selenium wouldn't be expected to have any benefit, but it still might have an impact for people with really low selenium. However, the test relied on people taking supplements rather than changing their diets, which might also have an effect on the results. To derive maximum benefit from antioxidants, they may need to be consumed in food rather than as pills, although trying to change people's diets is notoriously difficult."
Dr Shaheen is investigating whether diet early in life, including nutrition when a mother is pregnant, might influence whether children develop asthma and whether beneficial effects of antioxidants might depend on a person's genetic make-up.
In the meantime, it might be worth eating more apples, which are a rich source of antioxidants. Research by Dr Shaheen suggests that adults who eat two or more apples a week are almost a third less likely to have asthma than those who eat them less than once a month.
Herbal
"There is a reasonable amount of evidence that some herbal remedies can help some people," says Thomas. Daniela Turley, a medical herbalist, recommends choosing a practitioner carefully. "You need to be treated by someone who knows what they're doing. Ask if they've dealt with asthmatics before."
The combination of herbs used will vary with the individual, but expect to be given anti-inflammatories (such as ginkgo) - to reduce inflammation in the airways - and sometimes antihistamines. "We can also give bronchial relaxers," says Turley. "They act as a relaxant on muscles around the airways, stopping them tightening." A good herbalist will not ask you to stop taking your steroids, but will work with you so that at some point, and after discussion with your doctor, you can think about reducing the level.
So there are ways of reducing your reliance on drugs, while still controlling symptoms. Just don't chuck your inhaler away. Instead, if something seems to help, talk to your GP about reducing your dosage.
