It’s the Water, Not the Caffeine, That Helps With Asthma

By Dr. Paul Ehrlich
Those who read the New York Times religiously, and I admit to being fairly orthodox on this point myself, will have noticed an item in “The Claim” column in Tuesday’s science section about caffeine providing possible short-term relief in an asthma attack. “The suspicion stems in part from its chemical structure, which resembles that of theophylline, a common asthma medication that relaxes the airway muscles and relieves wheezing, shortness of breath and other respiratory problems. Indeed, when caffeine is ingested and broken down by the liver, one byproduct is small amounts of theophylline.” It cites a study showing small improvement lasting for some hours.

This was one of those subjects that provided fodder for coffee break conversation back when I was doing my fellowship in allergy years ago, along with other chemicals found in other foods. All I can say is, don’t leave your albuterol at home and rush down to Starbucks.

However, it does raise another point. Namely, that an asthma attack often involves lung congestion because mucus is stuck in the lungs; what we called the “mucocillary escalator” has shut down, leaving nasty allergens in the lungs to do their work. (Anyone who has ever been stuck on a subway platform at rush hour or in the basement floor of a department store when the escalator shuts down can imagine what problems this can cause.) What it needs is water to loosen up. In our book we tell the story of a boy who was an emergency room regular whose mother called me on a Saturday to ask if they should go again.

“I told her, ‘Get a 2-liter bottle of juice or soda, and make him drink it overnight, and call me in the morning.’ Sure enough, he was fine the next day. Good hydration is necessary to keep that mucus in a liquid state so the escalator can do its work.”

If this mother bought Coca-Cola, fair enough—the caffeine may have helped. But I suggested soda or juice because I thought that the kid would drink it readily at intervals over the hours to come. It was the liquid that made the difference. Proper hydration is a modern fetish. It doesn’t have to be bottled water—New York City tap water is still wonderful—but other non-alcoholic drinks are fine.

If your child is asthmatic, make sure she drinks liquid at regular intervals. Keep that mucocillary escalator moving.