Big Apple Parent: December 1999 For kids with asthma - two new, natural approaches By Grace Yen and Donna LeSchander OMT Dec. 99: Asthma is a huge problem in kids, and it's getting worse. It's the number one chronic condition causing absence from school, accounting for 10.1 million school days missed annually, according to the American Lung Association. It is also established that five million children under 18 years of age have asthma, and that asthma is the highest ranked cause of pediatric hospitalization in the U.S. The disease's statistics also result in a huge amount of medication being prescribed for kids, leading some parents to explore alternative health options for their children. "I was willing to try anything when we almost lost him," says Yvette Nievez of her 17-year-old son, Nefthalie, who has had asthma since the age of six. In 1997, when Nefthalie almost died of respiratory arrest, Nievez decided to try Osteopathic Manipulation Technique (OMT) for her son at the Pediatric Asthma OMT Clinic in Far Rockaway. "He was taking six different medications at one time," says Nievez, "and I was worried about the side effects of so many drugs. And he was only getting worse." Through simple manipulation and exercise, OMT is believed to help relieve spasms and help the child breather easier. "OMT works by increasing the motion of the chest walls, and we've found it to be extremely effective," says osteopath Dr. Peter Guiney. An associate director of family practice at Peninsula Hospital Center, Dr. Guiney specializes in OMT for treatment of children with asthma, and established the weekly clinic where children are treated and their parents can learn OMT exercise and breathing techniques. "We check the patient's ability to breathe and we watch his ribs and do a structural examination," he explains. "If one set of ribs isn't moving all the way up when he takes a deep breath, we try to help those ribs move a little bit." Developed in 1874 by physician Andrew Taylor Still, the theory behind OMT medicine is that the body makes its own remedies when it is in a normal position. OMT physicians believe that the coughing, wheezing and constricted breathing associated with asthma may cause misalignment. Unlike chiropractic manipulation that focuses on the spine and the nervous system, OMT traces psychological disturbances in the body to abnormalities in the musculoskeletal system. The physician then tries to correct the structural abnormalities with hands-on therapy, performing stretching exercises and applying pressure on affected areas in order to correct motion deficits or asymmetry. While an October 1998 study in the New England Journal of Medicine found that chiropractic manipulation has no impact on pediatric asthma, there are now more than 40,000 osteopathic physicians in the U.S. The practice of OMT, however, remains alternative medicine and is still being held to scientific scrutiny. According to pediatrician Dr. Carolyn Rosen of Bellevue Hospital, asthma remains a chronic disease of the passageways that carry air into the lungs. Dr. Rosen notes asthma is a chemical reaction within the body, and that external manipulation of the body has not been proven to combat the underlying causes of asthma. In asthma patients, airways become narrow and the linings become swollen, irritated and inflamed as a reaction to certain triggering stimuli, like dust. The narrowing and inflammation of the airways cause labored breathing, coughing, feelings of chest tightness, and shortness of breath. "The inflammation also causes mucus to be secreted into the airways and therefore makes the space for air smaller," adds Dr. Rosen. Asthma medications therefore aim to help reduce underlying inflammation in the airways and relieve or prevent airway narrowing. Dr. Rosen recommends observing the environment around the child and advises that prevention be part of treatment by controlling the presence of triggering stimuli, removing carpets and pets, and washing sheets to eliminate dust mites. However, Dr. Guiney believes OMT goes one step further than traditional medicine in battling the disease. While asthma is a chronic illness, traditional medicine does not address the structural deviation of the body that results from the disease, he contends. "When a person has emphysema, for example, he winds up after many years with a big barrel chest," Dr. Guiney points out. A similar change, he continues, occurs in asthma patients. By correcting the structural deviations caused by asthma, the body can better heal itself. Patients can continue standard medical treatment, says Dr. Guiney, because there is no conflict in terms of treatment. While a patient takes steroids to combat the asthmatic inflammatory process, OMT addresses the motion of the ribs and structure of the chest, areas on which medicines have little effect. Dr. Guiney hopes that a study at the clinic will prove the benefits of OMT. "In 1995, we saw 18 people for the entire year. Now we are seeing over 150 people for the last two years. We've come a long way in terms of people's responses. People are pretty good judges of whether they're benefiting from treatment. They usually don't come back if they are not feeling better." For Yvette Nievez, OMT has helped her son manage asthma. "Since beginning OMT, Nefthalie feels better," she says, "and he's only taking one type of medication regularly. As a mom, anything that helps my child to live with asthma and not die from an attack is positive in every way." YOGA Stress can also be a contributing factor in an asthma attack, and with that in mind Park Ridge Family Health Center in Brooklyn is pioneering a new program which incorporates yoga and breathing techniques along with comprehensive medical management to help alleviate asthma symptoms. Dr. Seema Khaneja is heading up this innovative program, which started this past spring with a small group of asthmatic children. Dr. Khaneja explains that "initially a comprehensive medical and home environmental evaluation is done for each child, and parents receive teaching in asthma triggers, symptoms, and management. Then, over six to eight weeks, a yoga instructor teaches the children 'belly' breathing and general relaxation exercises, as well as posture techniques which promote opening of the lung airways." Dr. Khaneja also uses relaxation techniques and imagery exercises with the children - "Children are usually good at this," she says. Although there have been studies reporting the results of yoga and relaxation and breathing techniques on adults and young adults, there has never been a substantive study of their effects on children. "We figured it would probably benefit children as well," Dr. Khaneja says. "Our instructor, Marzia Monroe, is trained in yoga, and also is accustomed to working with children." The studies done on older people have shown that yoga-based exercises, along with good medical management, decrease asthma symptoms, inhaler use, and wheezing frequency. The children in this program, ranging from 7 to 15 years old, felt that their symptoms decreased after their involvement in the program. "The kids said that they left feeling more relaxed," Dr. Khaneja reports, and adds that their parents noticed improvement as well and asked that the program be continued.