Be aware of unconventional, cultural therapies.

FORT LAUDERDALE, FLA. -- Ask patients in an open-minded way about their use of unconventional therapies related to asthma, allergies, and other pulmonary conditions.

"The take-home message is beware of being unaware,'" Dr. Cheryl Doyle said at a pediatric pulmonology meeting sponsored by the American College of Chest Physicians. Otherwise, drug or disease interactions, unnecessary testing or changes in therapy, and therapeutic failure can result.

Convey respect and tolerance toward unconventional therapies "with an open hand," incorporate questions about complementary or alternative medicine into history taking, and learn from your patients and other resources, said Dr. Doyle, a pediatric pulmonologist in private practice in Brooklyn, N.Y.

"It's a tremendous act of faith and [cooperation] to integrate complementary and conventional [therapies], when not contraindicated," Dr. Doyle said. She had no relevant financial disclosures.

The term "complementary medicine" has evolved into "integrative holistic medicine," because "complementary" assigns an adjunctive role to nonconventional medicine, Dr. Doyle said. "Healing addresses the body, mind, and spirit, and we as healers--not providers--are part of that system."

Integrative holistic medicine includes six systems: biomolecular therapies; botanical therapies; ethnic/cultural therapies; homeopathic remedies; manual therapies such as massage, yoga, and chiropractic treatment; and energy therapies such as reflexology, the laying-on of hands, and manipulation of people's auras.

The Chinese, Japanese, Hispanic, and African / Caribbean people have different nonconventional therapies. For example, asthma therapies in traditional Chinese medicine include ma huang, ginkgo biloba, ginseng, magnolia, Minor Blue Dragon, Scutellaria, cinnamon, and licorice. Ma huang, for example, is an acrid herb believed to open pores, facilitate lung energy, and control wheezing, Dr. Doyle said. "Why does it control wheezing? About 80%-90% is L-ephedrine, a [beta]-agonist that relaxes smooth muscle." The herb also contains D-pseudoephedrine, L-methylephedrine, L-norepinephrine, and D-N-methyl pseudoephedrine.

Albuterol, for instance, could attenuate the ma huang side effects, which include increased heart rate, increased blood pressure, palpitations, nervousness, headache, insomnia, and dizziness. "Wouldn't you want to know this as you write your prescription for albuterol?" Dr. Doyle asked.

Ginkgo biloba is commonly used in Europe for asthma, Dr. Doyle said. It is an expectorant and bronchodilator, and a treatment for coughing and wheezing when combined with Ephedra, apricot seed, and Morus alba root. The leaf extract contains ginkgetin, which inhibits histamine-induced bronchoconstriction. Panax ginseng, also known as Korean ginseng, is used to treat wheezing, shortness of breath, and dyspnea on exertion, Dr. Doyle said. The root is used for cough, and the leaves are used as emetics and expectorants. Animal studies show ginseng is an anti-inflammatory that decreases IgE serum levels.

Although Hispanic people come from diverse countries and backgrounds, they share some common medical beliefs. Religion, faith, and spiritual healing are an integral part of their health and well-being, for example, Dr. Doyle said. The opposing properties of illness and treatment are another common tenet. For example, a "cold" disease, such as asthma, is treated with "hot" remedies, Dr. Doyle said.

Unconventional Hispanic treatments are sometimes administered in combination as "zumas" or syrup mixtures. For example, the Siete Jarabes (Seven Syrups) contain honey syrup, sweet almond oil, castor oil, wild cherry, licorice, honey, and cocillana (a bark used for bronchitis). Because of the honey components, Dr. Doyle asked, "Wouldn't you want to know if a 3-year-old is getting sick on this?"

African/Caribbean therapies include the consumption of raw onion to treat asthma, chest colds, and persistent cough. Onion, or Allium cepa, contains quercetin, an anti-inflammatory used for allergic rhinitis, Dr. Doyle said. In addition, in Ghana, Jamaica, Colombia, and Venezuela, people sometimes treat asthma and cough with desmodium adscendens, the extract of a tropical plant.

The understanding and acceptance of nonconventional therapies can go a long way to help patients, Dr. Doyle said, quoting Dr. Harold S. Jenkins: "The truly competent physician is the one who sits down, senses the 'mystery' of another human being, and offers with an open hand the simple gifts of personal interest and understanding" (JAMA 2002;287:161-2).

BY DAMIAN McNAMARA

Miami Bureau