People who are having an asthma attack have real trouble taking a breath. Many people with stuffy noses from hay fever or colds say, "I can't breathe," but they retain the option of breathing through the mouth. Asthmatics, however, know what "I can't breathe" really means. Instead of their nasal passages, it is the bronchial tubes in their lungs that become swollen and clogged. Breathing can become frighteningly difficult.

Asthma involves two conditions: (1) contraction of the small muscles surrounding the bronchial tubes and (2) inflammation of the lining of those tubes. Traditionally, treatment primarily addressed the first aspect of asthma; in the past two decades, though, it has become clear that tissue swelling is the underlying cause.

The conventional treatment of asthma is highly effective for most people. Treatments include both short- and long-acting bronchodilators, which relax the bronchial muscles, and anti-inflammatory medication, which helps relieve the swelling of tissue. Bronchodilators alone may be sufficient treatment for mild asthma or asthma that occurs only with exercise. Anti-inflammatory steroids in the cortisone family taken by inhalation are the mainstay of treatment for moderate to severe asthma. Although these are much safer than oral steroids, they may still increase risk of osteoporosis and other problems when they are taken in high doses or for a long time. Other drugs used to reduce inflammation include montelukast (Singulair), nedocromil (Tilade) and cromolyn (Intal). (Interestingly, Intal is derived from a Mediterranean herb named khella.) The newest drug treatment for asthma, omalizumab (Xolair), appears to be very safe and effective, but it is currently extremely expensive and, for this reason, it is seldom used.

Warning: None of these treatments have been shown to be effective for severe asthma. Do not stop your standard asthma medication except on the advice of a physician.

The herb Tylophora indica (also called Tylophora asthmatica) appears to offer some promise as a treatment for asthma. It has a long history of use in the traditional Ayurvedic medicine of India. However, all of the studies on this herb were performed in India decades ago and fail to reach modern standards of design and reporting.

In a double-blind, placebo-controlledstudy of 195 individuals with asthma, the participants who were given 40 mg of a tylophora alcohol extract daily for 6 days showed significant improvement as compared to placebo.1Similar results were seen in two double-blind, placebo-controlled studies involving more than 200 individuals with asthma.2,3 However, the design of these studies was a bit convoluted, and various pieces of information are missing from the reports, causing some difficulty in evaluating the validity of these trials.

Another double-blind study that enrolled 135 individuals and followed a more straightforward design found no benefit from tylophora.4

The bottom line: Although tylophora is promising, larger and better studies are necessary to discover whether tylophora is truly effective.

For more information, including dosage and safety issues, see the full Tylophora article.

Boswellia: Possibly Helpful

The herb boswellia has shown promise as a treatment for rheumatoid arthritis. It is thought to work by inhibiting inflammation. Since asthma involves inflammation as well and can be treated by some of the same drugs that treat rheumatoid arthritis, boswellia has been tried for this purpose too.

One 6-week, double-blind, placebo-controlled study of 80 individuals with relatively mild asthma found that treatment with boswellia at a dose of 300 mg 3 times daily reduced the frequency of asthma attacks and improved objective measurements of breathing capacity.9 However, further research needs to be performed to follow up this pilot study before boswellia can be described as a proven treatment for asthma.

For more information, including dosage and safety issues, see the full Boswellia article.

Coleus forskohlii: May Be Effective, But More Like a Drug Than an Herb

Another herb sometimes recommended for asthma also comes from India, Coleus forskohlii. While there is some preliminary evidence that it might have value,10-12,66 this evidence is currently far too weak to be relied on. Furthermore, as presently sold, the herb is more like a drug than an herb. Natural Coleus forskohlii contains small amounts of a potent chemical called forskolin. Manufacturers deliberately modify the herb to dramatically increase its forskolin content; therefore, when using such products, one is essentially using an unlicensed drug. Forskolin appears to be safe, but more studies need to be undertaken before it can be recommended for self-treatment.

Ma Huang: Effective, But Not Safe

The Chinese herb ma huang, also called ephedra, is definitely effective for mild asthma since it contains the drug ephedrine. However, we cannot recommend using it because of safety concerns. This Chinese herb is a member of a primitive family of plants that look like thin, branching, connected straws. A related species, Ephedra nevadensis, grows wild in the American Southwest and is widely called Mormon tea. However, only the Asian species of ephedra contains the active compounds ephedrine and pseudoephedrine.

Ma huang was traditionally used by Chinese herbalists in the early stages of respiratory infections and for the short-term treatment of certain kinds of asthma, eczema, hay fever, narcolepsy, and edema. 

Japanese chemists isolated ephedrine from ma huang at the turn of the twentieth century, and it soon became a primary treatment for asthma in the United States and abroad. Ephedra's other major ingredient, pseudoephedrine, became the decongestant Sudafed.

Although ephedrine can still be found in a few over-the-counter asthma drugs, physicians seldom prescribe it today. The problem is that ephedrine mimics the effects of adrenaline and causes symptoms such as rapid heartbeat, high blood pressure, agitation, insomnia, nausea, and loss of appetite. The newer asthma drugs are much safer and easier to tolerate. This is a situation in which synthetic drugs are less dangerous than a natural one. We recommend against using ma huang for asthma.