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{{Asthma}} | {{Asthma}} | ||
{{CMG}}; [[Philip Marcus, M.D., M.P.H.]] [mailto:pmarcus192@aol.com]; {{AE}} | |||
==Overview== | |||
Asthmatic treatment therapies include both conventional pharmacological therapies and alternative, complementary medicinal therapies. Approximately 50% of asthma patients use some form of alternative, non-traditional therapies. There is little evidence to support these effectiveness of these therapies. | |||
==Alternative and | ==Alternative and Complementary Medicine== | ||
Many asthmatics, like those who suffer from | Many asthmatics, like those who suffer from accompanying chronic disorders, use [[Alternative medicine|alternative treatments]]. Surveys show that roughly 50% of asthma patients use some form of "unconventional" or alternative therapy.<ref name="blanc">Blanc PD, Trupin L, Earnest G, ''et al.'' Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. ''Chest''. 2001;120(5):1461–7. PMID 11713120</ref><ref name="shenfield">Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. ''J Paediatr Child Health''. 2002;38(3):252-7. PMID 12047692</ref> | ||
* There are little data to support the effectiveness of most of these therapies. A [[Cochrane Collaboration|Cochrane]] [[Evidence-based medicine|systematic review]] of acupuncture for asthma found no evidence of efficacy.<ref name=mccartney>McCarney RW, Brinkhaus B, Lasserson TJ, ''et al.'' Acupuncture for chronic asthma. ''Cochrane Database Syst Rev''. 2004;(1):CD000008. PMID 14973944</ref> | |||
* A similar review of [[air ioniser|air ionizer]] therapies found no evidence of improved asthma symptoms or bettered lung function. The findings in this analysis applied equally to positive and negative ion generators.<ref name=blackhall>Blackhall K, Appleton S, Cates CJ. Ionisers for chronic asthma. ''Cochrane Database Syst Rev.'' 2003;(3):CD002986 PMID 12917939</ref> | |||
* There are little data to support the effectiveness of most of these therapies. A [[Cochrane Collaboration|Cochrane]] [[Evidence-based medicine|systematic review]] of acupuncture for asthma found no evidence of efficacy. | *A study of "manual therapies" for asthma, defined as including osteopathic, [[chiropractic]], physio-therapeutic and [[respiratory therapy|respiratory therapeutic]] maneuvers, demonstrated insufficient evidence to support or refute their use in treating asthma.<ref name=hondras>Hondras MA, Linde K, Jones AP. Manual therapy for asthma. ''Cochrane Database Syst Rev''. 2005;(2):CD001002. PMID 15846609</ref> Specific manual therapy maneuvers included various osteopathic and chiropractic techniques to "increase movement in the rib cage and the spine to try and improve the working of the lungs and circulation"; chest tapping, shaking, vibration, and the use of "postures to help shift and cough up phlegm." | ||
* Conversely, another [[meta-analysis]] found that homeopathy has a potentially mild benefit in reducing symptom intensity.<ref name=reilly>Reilly D, Taylor MA, Beattie NG, ''et al.'' Is evidence for homoeopathy reproducible? ''Lancet.'' 1994;344(8937):1601–6. PMID 7983994</ref> However, the number of patients involved in the analysis was small, making it difficult to generalize the data. Subsequent studies have not supported this finding.<ref name=white>White A, Slade P, Hunt C, ''et al.'' Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. ''Thorax.'' 2003;58(4):317-21. PMID 12668794</ref> | |||
* A similar review of [[air ioniser|air | * Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programs<ref name=nagendra>Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. ''J Asthma.'' 1986;23(3):123-37. PMID 3745111</ref> —"yogasanas, Pranayama, meditation, and kriyas"— to ''sahaja'' yoga,<ref name=manocha>Manocha R, Marks GB, Kenchington P, ''et al.'' Sahaja yoga in the management of moderate to severe asthma: a randomized controlled trial. ''Thorax.'' 2002;57(2):110-5. PMID 11828038</ref> a form of meditation. | ||
* The [[Buteyko method]], a Russian therapy that utilizes breathing exercises, was also been studied for asthmatic treatment efficacy. A randomized, controlled trial of just 39 patients in 1998 showed a substantial reduction in the need for beta- agonists and a 50% reduction in the need for inhaled steroids. Quality of life scores improved significantly as people were less psychologically limited by their condition and more confident of the future. Lung function remained the same despite the decrease in medication.<ref name=bowler>Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. ''Med J Aust''. 1998;169(11-12):575-8. PMID 9887897. [http://www.mja.com.au/public/issues/xmas98/bowler/bowler.html Free full text]</ref> | |||
*A study of "manual therapies" for asthma, including osteopathic, [[chiropractic]], | * Another trial in New Zealand in 2000 investigating breathing technique interventions demonstrated an 85% reduction in the use of beta-agonist medication and a 50% reduction in inhaled steroid use after six months.<ref name=mchugh>McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko Breathing Technique for asthma: an effective intervention. ''NZ Med J. '' 2003;116:1187 PMID 14752538. [http://www.nzma.org.nz/journal/116-1187/710/ Free full text]</ref> | ||
* There are some bodies of [[Hookworm#Hookworm in therapy|research]] that have identified a negative association between helminth infection ([[hookworm]]) and asthma and hay fever<ref name="pmid12100049">{{cite journal |author=Huang SL, Tsai PF, Yeh YF |title=Negative association of Enterobius infestation with asthma and rhinitis in primary school children in Taipei |journal=Clin. Exp. Allergy |volume=32 |issue=7 |pages=1029-32 |year=2002 |pmid=12100049 |doi=}}</ref>. These researchers have suggested that hookworm infestation, although not medically sanctioned, would cure asthma. There is both anecdotal evidence and peer-reviewed research to support this viewpoint. <ref name="Jo Leonardi-Bee, David Pritchard, John Britton">{{cite journal |author=Leonardi-Bee J, Pritchard D, Britton J |title=Asthma and current intestinal parasite infection: systematic review and meta-analysis |journal=Am. J. Respir. Crit. Care Med. |volume=174 |issue=5 |pages=514-23 |year=2006 |pmid=16778161 |doi=10.1164/rccm.200603-331OC}}</ref> | |||
* | |||
Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programs | |||
—"yogasanas, Pranayama, meditation, and kriyas" | |||
* The [[Buteyko method]], a Russian therapy | |||
* | |||
* | |||
* [[Guaifenesin]], an expectorant available over the counter, may have a small effect in managing thickened bronchial mucus. | * [[Guaifenesin]], an expectorant available over the counter, may have a small effect in managing thickened bronchial mucus. | ||
==References== | ==References== | ||
{{reflist|2}} | {{reflist|2}} | ||
{{WH}} | |||
{{WS}} | |||
[[Category:Pulmonology]] | [[Category:Pulmonology]] | ||
[[Category:Immunology]] | |||
[[Category:Emergency medicine]] | [[Category:Emergency medicine]] | ||
[[Category: | [[Category:Mature chapter]] | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Philip Marcus, M.D., M.P.H. [2]; Associate Editor(s)-in-Chief:
Overview
Asthmatic treatment therapies include both conventional pharmacological therapies and alternative, complementary medicinal therapies. Approximately 50% of asthma patients use some form of alternative, non-traditional therapies. There is little evidence to support these effectiveness of these therapies.
Alternative and Complementary Medicine
Many asthmatics, like those who suffer from accompanying chronic disorders, use alternative treatments. Surveys show that roughly 50% of asthma patients use some form of "unconventional" or alternative therapy.[1][2]
- There are little data to support the effectiveness of most of these therapies. A Cochrane systematic review of acupuncture for asthma found no evidence of efficacy.[3]
- A similar review of air ionizer therapies found no evidence of improved asthma symptoms or bettered lung function. The findings in this analysis applied equally to positive and negative ion generators.[4]
- A study of "manual therapies" for asthma, defined as including osteopathic, chiropractic, physio-therapeutic and respiratory therapeutic maneuvers, demonstrated insufficient evidence to support or refute their use in treating asthma.[5] Specific manual therapy maneuvers included various osteopathic and chiropractic techniques to "increase movement in the rib cage and the spine to try and improve the working of the lungs and circulation"; chest tapping, shaking, vibration, and the use of "postures to help shift and cough up phlegm."
- Conversely, another meta-analysis found that homeopathy has a potentially mild benefit in reducing symptom intensity.[6] However, the number of patients involved in the analysis was small, making it difficult to generalize the data. Subsequent studies have not supported this finding.[7]
- Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programs[8] —"yogasanas, Pranayama, meditation, and kriyas"— to sahaja yoga,[9] a form of meditation.
- The Buteyko method, a Russian therapy that utilizes breathing exercises, was also been studied for asthmatic treatment efficacy. A randomized, controlled trial of just 39 patients in 1998 showed a substantial reduction in the need for beta- agonists and a 50% reduction in the need for inhaled steroids. Quality of life scores improved significantly as people were less psychologically limited by their condition and more confident of the future. Lung function remained the same despite the decrease in medication.[10]
- Another trial in New Zealand in 2000 investigating breathing technique interventions demonstrated an 85% reduction in the use of beta-agonist medication and a 50% reduction in inhaled steroid use after six months.[11]
- There are some bodies of research that have identified a negative association between helminth infection (hookworm) and asthma and hay fever[12]. These researchers have suggested that hookworm infestation, although not medically sanctioned, would cure asthma. There is both anecdotal evidence and peer-reviewed research to support this viewpoint. [13]
- Guaifenesin, an expectorant available over the counter, may have a small effect in managing thickened bronchial mucus.
References
- ↑ Blanc PD, Trupin L, Earnest G, et al. Alternative therapies among adults with a reported diagnosis of asthma or rhinosinusitis: data from a population-based survey. Chest. 2001;120(5):1461–7. PMID 11713120
- ↑ Shenfield G, Lim E, Allen H. Survey of the use of complementary medicines and therapies in children with asthma. J Paediatr Child Health. 2002;38(3):252-7. PMID 12047692
- ↑ McCarney RW, Brinkhaus B, Lasserson TJ, et al. Acupuncture for chronic asthma. Cochrane Database Syst Rev. 2004;(1):CD000008. PMID 14973944
- ↑ Blackhall K, Appleton S, Cates CJ. Ionisers for chronic asthma. Cochrane Database Syst Rev. 2003;(3):CD002986 PMID 12917939
- ↑ Hondras MA, Linde K, Jones AP. Manual therapy for asthma. Cochrane Database Syst Rev. 2005;(2):CD001002. PMID 15846609
- ↑ Reilly D, Taylor MA, Beattie NG, et al. Is evidence for homoeopathy reproducible? Lancet. 1994;344(8937):1601–6. PMID 7983994
- ↑ White A, Slade P, Hunt C, et al. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax. 2003;58(4):317-21. PMID 12668794
- ↑ Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. J Asthma. 1986;23(3):123-37. PMID 3745111
- ↑ Manocha R, Marks GB, Kenchington P, et al. Sahaja yoga in the management of moderate to severe asthma: a randomized controlled trial. Thorax. 2002;57(2):110-5. PMID 11828038
- ↑ Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J Aust. 1998;169(11-12):575-8. PMID 9887897. Free full text
- ↑ McHugh P, Aitcheson F, Duncan B, Houghton F. Buteyko Breathing Technique for asthma: an effective intervention. NZ Med J. 2003;116:1187 PMID 14752538. Free full text
- ↑ Huang SL, Tsai PF, Yeh YF (2002). "Negative association of Enterobius infestation with asthma and rhinitis in primary school children in Taipei". Clin. Exp. Allergy. 32 (7): 1029–32. PMID 12100049.
- ↑ Leonardi-Bee J, Pritchard D, Britton J (2006). "Asthma and current intestinal parasite infection: systematic review and meta-analysis". Am. J. Respir. Crit. Care Med. 174 (5): 514–23. doi:10.1164/rccm.200603-331OC. PMID 16778161.