Asthma alternative and complementary medicine

Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [mailto:mgibson@perfuse.org] Phone:617-632-7753; Philip Marcus, M.D., M.P.H. [mailto:pmarcus192@aol.com]

Overview
Asthmatic treatment therapies include both conventional pharmacological therapies and alternative, complementary medicinal therapies. Approximatley 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.
 * 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.
 * 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.
 * A study of "manual therapies" for asthma, defined as including osteopathic, chiropractic, physiotherapeutic and respiratory therapeutic maneuvers, demonstrated insufficient evidence to support or refute their use in treating asthma. 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. 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.
 * Several small trials have suggested some benefit from various yoga practices, ranging from integrated yoga programs — "yogasanas, Pranayama, meditation, and kriyas"—to sahaja yoga, 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.
 * 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.
 * There are some bodies of research that have identified a negative association between helminth infection (hookworm) and asthma and hay fever . 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.
 * Guaifenesin, an expectorant available over the counter, may have a small effect in managing thickened bronchial mucus.