The effects of coffee on asthma
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I rarely ever drank coffee until I was 40. Then, for some inexplicable reason, I became a coffee fiend, drinking 6-7 cups of coffee every day. Then I quit cold turkey. As I sit here today, sipping on a hot tea, I wonder: what effect, if any, does coffee have on asthma?

As a kid I learned that coffee was once used as an asthma remedy.
Sometimes, in desperation (and when my parents weren’t looking) I’d pour some coffee grounds in a cup of cold water and slam it down. It never worked to end my asthma attacks. That’s not to say that it wouldn’t work for other asthmatics, as my asthma was diagnosed as severe.

The bronchodilation effects of coffee

In 2010, I started writing about asthma’s history. This was when I was introduced to Dr. Henry Hyde Salter. He was the doctor of Teddy Roosevelt during the 1870’s when the former President was a child asthmatic. He (Dr. Salter, that is) wrote a book called, “On Asthma.” It was the most well respected book on asthma during the second half of the 19th century. So, whatever Dr. Salter believed about asthma became the gold standard.

He had many theories about asthma, the most famous of which was that asthma was a nervous disorder. He also believed that asthma was brought on by sleep. He had already heard about coffee as an asthma remedy from his many asthma patients. He speculated that it worked for asthma because of its stimulant effect. He wrote:

“For, what are the physiological effects of coffee? They consist in the production of a state of mental activity and vivacity, of acuteness of perception and energy of volition, well known to those who have experienced it, and to a certain extent very pleasurable, and which is the very reverse of that abeyance of will and perception which, in drowsiness or sleep, so favors the development of asthma.” 1

Dr. Salter further explained that coffee, as a remedy for asthma, should be served hot, black, and not too strong.

About a hundred sixty years after Dr. Salter’s book was published, a review of studies was performed to see if coffee had any true impact on lung function and asthma. The authors wrote:
“Caffeine is found in coffee, tea, cola drinks and cocoa. Caffeine is a drug that is very similar to theophylline. Theophylline is a bronchodilator drug that is taken to open up the airways in the lungs and therefore relieve the symptoms of asthma, such as wheezing, coughing and breathlessness. Scientists are interested in finding out whether caffeine has the same effect on the lungs as theophylline.”2
And they concluded:
“This review found that even small amounts of caffeine can improve lung function for up to four hours.” 2

Caffeine is a methylxanthine. It falls into the same family of medicine as theophylline, a strong bronchodilator that was a top-line asthma remedy during the 1970’s through the 1990’s. I was chronically dependent on theophylline from the mid 1970’s until 2007.

But the bronchodilation effect of caffeine is mild

Modern evidence suggests that caffeine, when it is metabolized (broken down) by the liver, forms low doses of theophylline. This might help explain the benefits of caffeine for asthma. 3-5

As a side note here, caffeine is also metabolized into theobromine, a component of cocoa and chocolate. It’s also a member of the methylxanthine family. This would explain why chocolate tends to make people happy. It has been shown to be an equal bronchodilator to caffeine, although not quite as strong as theophylline. Theobromine has actually been shown to be a good cough suppressant too. I will expound further on this in my next post. 6

One study showed that 5 mg/kg of caffeine reached a peak bronchodilator effect in 2 hours and lasted for six hours. This means that a 200 pound man (90 kg) like myself would require (If I do my math right, that’s 90×5) 450 mg of caffeine. 7

To put this into perspective, two tablespoons of Folgers ground coffee contains 60-80 mg of coffee. This makes two 8 ounce cups of coffee. 8

So, we would have to consume 5-8 cups of coffee at breakfast time to achieve the desired bronchodilator effect for the first six hours of your day. Then around 2 or 3 p.m. we’d have to drink up again.

Of course, you would also have to deal with the side effects of coffee, which include trouble sleeping, nervousness, upset stomach, anxiety, headache, etc. It is also known to relax the esophageal sphincter, which can cause gastrointestinal reflux (GERD), which can cause heartburn and asthma.

As a twist here, it was due to these side effects that my doctor and I decided to wean me off of theophylline in 2007. It was a very slow wean, as theophylline, like coffee, is highly addicting. I did not realize it at the time, but only after I was weaned off theophylline did I start drinking coffee. I was aware that caffeine and theophylline were sisters, but I was unaware that caffeine was metabolized into theophylline.

So, while I thought I had been weaned off theophylline, I was, in effect, consuming a small dose every day in my coffee. So, as I was consuming between 600-800 mg of coffee every day, I was pretty much having to deal with the same side effects I was dealing with when on theophylline.

This was effectively why I decided to quit drinking coffee.

Yes, with all due respect, I still get a small dose of caffeine by drinking tea. It just brings so much joy to the morning as I do my writings that I can’t seem to completely cut myself off. Of course, I can’t help thinking it might have something to do with the fact I’ve been consuming methylxanthines since I was six or seven.

Caffeine is not considered a top-line treatment for asthma. In fact, I have no memory of it ever being brought up seriously in any discussion between my physicians and either my parents or myself. I do not ever remember my mom giving me a cup of coffee during asthma attacks.

However, in the days before rescue inhalers, it probably would have been a viable option. For those with very mild asthma, or for the many people who can’t gain access for whatever reason to the many wonderful asthma medicines now available, perhaps coffee would prove useful. But it will never be a top-line asthma treatment, not like theophylline once was, anyway.

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