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Küçük E, Tozcu D, Topaktaş B, Coşkun G. Immediate effects of manual therapy on respiratory functions in healthy young individuals: a randomized controlled trial. Sci Rep 2024; 14:17419. [PMID: 39075156 PMCID: PMC11286797 DOI: 10.1038/s41598-024-68654-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Accepted: 07/26/2024] [Indexed: 07/31/2024] Open
Abstract
This study aimed to investigate the immediate effects of manual therapy (MT) on the respiratory functions of healthy young individuals. The study included 104 participants, consisting of university students (87 females, 17 males, mean age 20.1 ± 2.2). Participants were randomly assigned to the MT (experimental; n = 52) and sham-MT (control; n = 52) groups. The experimental group underwent thoracic manipulations and mobilizations along with diaphragm mobilization. In the control group, the hands were placed on the same regions, but no specific intervention was applied. All participants underwent respiratory function testing before and after the intervention using a portable spirometer (PEF- Peak expiratory flow; FEV 1- Forced expiratory volume in 1 s; FVC- Forced vital capacity and FEV1/FVC- Tiffeneau index). In the experimental group, there was a significant increase in the mean PEF value following MT application from 296.3 ± 110.8 to 316.1 ± 119.1 (p = 0.018). Conversely, the mean PEF value in the control group showed a slight decrease from 337.1 ± 93.3 to 324.5 ± 89.2 (p = 0.002). No significant changes were observed in FVC, FEV1, or FEV1/FVC values pre- and post-intervention in either groups. A single MT session led to a significant improvement in PEF in healthy young individuals. Further research is needed to explore the long-term effects of MT on respiratory functions and its potential implications in clinical practice.Trial registration ClinicalTrials.gov: NCT05934240 (06/07/2023).
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Affiliation(s)
- Eylem Küçük
- Sabuncuoglu Serefeddin Health Services Vocational School, Programme of Physiotherapy, Amasya University, Ipekköy Campus, Tavşanli Street Amasya Erzurum Road No:1 PC: 05100 Center, Helvaci District, Amasya, Turkey.
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey.
| | - Duygu Tozcu
- Department of Physiology, School of Medicine, Amasya University, Amasya, Turkey
| | - Berkhan Topaktaş
- Department of Public Health, School of Medicine, Amasya University, Amasya, Turkey
| | - Gürsoy Coşkun
- Faculty of Physiotherapy and Rehabilitation, Hacettepe University, Ankara, Turkey
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Khalaf ZM, Margulies P, Moussa MK, Bohu Y, Lefevre N, Hardy A. Valid and Invalid Indications for Osteopathic Interventions: A Systematic Review of Evidence-Based Practices and French Healthcare Society Recommendations. Cureus 2023; 15:e49674. [PMID: 38161897 PMCID: PMC10756711 DOI: 10.7759/cureus.49674] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2023] [Indexed: 01/03/2024] Open
Abstract
The main aim of this study was to determine the level of evidence in the literature for the main indications of osteopathy as recommended by the French osteopathy societies. This systematic review followed the 2020 Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and evaluated articles published between January 2012 and January 2022 with one modification: when level one evidence studies were available, level two to five studies were excluded. Sources included PubMed, the Cochrane library, the French National Health Authority (HAS) and its affiliates. Inclusion criteria were level one published studies on the indications for osteopathic treatment in French and English, and level two to three studies when no level one studies were available. The level of evidence assessment was based on the Oxford Centre for Evidence-Based Medicine (OCEBM) Levels of Evidence classification. The primary outcome was the level of evidence in the literature supporting osteopathic practices. The secondary outcome was to assess French professional osteopathy recommendations and French HAS guidelines in relation to the scientific literature. A total of 51 articles and nine recommendations from the HAS and its affiliates met the inclusion criteria for the systematic review. Analysis of the studies revealed 41 osteopathic indications from French osteopathy societies for musculoskeletal, neurosensory, psychological, pediatric, gynecological, digestive, and pulmonary disorders. High-level scientific evidence supported the use of osteopathy for low back pain, sciatica, cervical radiculopathy, and ankle sprain. There was moderate evidence for tension headache, temporomandibular joint disorder, endometriosis, and low back and pelvic pain in pregnant women. HAS recommended five indications, while nine indications were supported in the scientific literature. Osteopathy has been shown to have evidence-based benefits for a range of conditions, in particular for musculoskeletal and neurosensory disorders.
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Affiliation(s)
- Zeinab M Khalaf
- Endocrinology, Diabetes, and Metabolism, clinique du Sport, Paris, FRA
| | | | | | - Yoann Bohu
- Orthopedic Surgery, Clinique du Sport, Paris, FRA
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Clemente-Suárez VJ, Mielgo-Ayuso J, Ramos-Campo DJ, Beltran-Velasco AI, Martínez-Guardado I, Navarro Jimenez E, Redondo-Flórez L, Yáñez-Sepúlveda R, Tornero-Aguilera JF. Basis of preventive and non-pharmacological interventions in asthma. Front Public Health 2023; 11:1172391. [PMID: 37920579 PMCID: PMC10619920 DOI: 10.3389/fpubh.2023.1172391] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 09/18/2023] [Indexed: 11/04/2023] Open
Abstract
Asthma is one of the most common atopic disorders in all stages of life. Its etiology is likely due to a complex interaction between genetic, environmental, and lifestyle factors. Due to this, different non-pharmacological interventions can be implemented to reduce or alleviate the symptoms caused by this disease. Thus, the present narrative review aimed to analyze the preventive and non-pharmacological interventions such as physical exercise, physiotherapy, nutritional, ergonutritional, and psychological strategies in asthma treatment. To reach these aims, an extensive narrative review was conducted. The databases used were MedLine (PubMed), Cochrane (Wiley), Embase, PsychINFO, and CinAhl. Asthma is an immune-mediated inflammatory condition characterized by increased responsiveness to bronchoconstrictor stimuli. Different factors have been shown to play an important role in the pathogenesis of asthma, however, the treatments used to reduce its incidence are more controversial. Physical activity is focused on the benefits that aerobic training can provide, while physiotherapy interventions recommend breathing exercises to improve the quality of life of patients. Nutritional interventions are targeted on implement diets that prioritize the consumption of fruits and vegetables and supplementation with antioxidants. Psychological interventions have been proposed as an essential non-pharmacological tool to reduce the emotional problems associated with asthma.
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Affiliation(s)
- Vicente Javier Clemente-Suárez
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
| | - Juan Mielgo-Ayuso
- Department of Health Sciences, Faculty of Health Sciences, University of Burgos, Burgos, Spain
| | - Domingo Jesús Ramos-Campo
- LFE Research Group, Department of Health and Human Performance, Faculty of Physical Activity and Sport Science-INEF, Universidad Politécnica de Madrid, Madrid, Spain
| | | | - Ismael Martínez-Guardado
- BRABE Group, Department of Psychology, Faculty of Life and Natural Sciences, Universidad Camilo José Cela, Madrid, Spain
| | | | - Laura Redondo-Flórez
- Department of Health Sciences, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain
| | | | - Jose Francisco Tornero-Aguilera
- Faculty of Sports Sciences, Universidad Europea de Madrid, Madrid, Spain
- Studies Centre in Applied Combat (CESCA), Toledo, Spain
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4
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Busse JW, Pallapothu S, Vinh B, Lee V, Abril L, Canga A, Riva JJ, Viggiani D, Dilauro M, Harvey MP, Pagé I, Bhela AK, Sandhu S, Makanjuola O, Hassan MT, Moore A, Gauthier CA, Price DJ. Attitudes towards chiropractic: a repeated cross-sectional survey of Canadian family physicians. BMC FAMILY PRACTICE 2021; 22:188. [PMID: 34525953 PMCID: PMC8442384 DOI: 10.1186/s12875-021-01535-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Accepted: 09/01/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Many primary care patients receive both medical and chiropractic care; however, interprofessional relations between physicians and chiropractors are often suboptimal which may adversely affect care of shared patients. We surveyed Canadian family physicians in 2010 to explore their attitudes towards chiropractic and re-administered the same survey a decade later to explore for changes in attitudes. METHODS A 50-item survey administered to a random sample of Canadian family physicians in 2010, and again in 2019, that inquired about demographic variables, knowledge and use of chiropractic. Imbedded in our survey was a 20-item chiropractic attitude questionnaire (CAQ); scores could range from 0 to 80 with higher scores indicating more positive attitudes toward chiropractic. We constructed a multivariable regression model to explore factors associated with CAQ scores. RESULTS Among eligible physicians, 251 of 685 in 2010 (37% response rate) and 162 of 2429 in 2019 (7% response rate) provided a completed survey. Approximately half of respondents (48%) endorsed a positive impression of chiropractic, 27% were uncertain, and 25% held negative views. Most respondents (72%) referred at least some patients for chiropractic care, mainly due to patient request or lack of response to medical care. Most physicians believed that chiropractors provide effective therapy for some musculoskeletal complaints (84%) and disagreed that chiropractic care was beneficial for non-musculoskeletal conditions (77%). The majority agreed that chiropractic care was a useful supplement to conventional care (65%) but most respondents (59%) also indicated that practice diversity among chiropractors presented a barrier to interprofessional collaboration. In our adjusted regression model, attitudes towards chiropractic showed trivial improvement from 2010 to 2019 (0.31 points on the 80-point CAQ; 95%CI 0.001 to 0.62). More negative attitudes were associated with older age (- 1.55 points for each 10-year increment from age 28; 95%CI - 2.67 to - 0.44), belief that adverse events are common with chiropractic care (- 1.41 points; 95% CI - 2.59 to - 0.23) and reported use of the research literature (- 6.04 points; 95% CI - 8.47 to - 3.61) or medical school (- 5.03 points; 95% CI - 7.89 to - 2.18) as sources of knowledge on chiropractic. More positive attitudes were associated with endorsing a relationship with a specific chiropractor (5.24 points; 95% CI 2.85 to 7.64), family and friends (4.06 points; 95% CI 1.53 to 6.60), or personal treatment experience (4.63 points; 95% CI 2.14 to 7.11) as sources of information regarding chiropractic. CONCLUSIONS Although generally positive, Canadian family physicians' attitudes towards chiropractic are diverse, and most physicians felt that practice diversity among chiropractors was a barrier to interprofessional collaboration.
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Affiliation(s)
- Jason W Busse
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada. .,Department of Anesthesia, Michael G. DeGroote School of Medicine, McMaster University, HSC-2V9, 1280 Main St. West, Hamilton, ON, L8S 4K1, Canada.
| | | | - Brian Vinh
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Vivienne Lee
- The School of Interdisciplinary Science, McMaster University, Hamilton, ON, Canada
| | - Lina Abril
- Department of Health Sciences, McMaster University, Hamilton, ON, Canada
| | - Albana Canga
- Institute for Work & Health, Toronto, ON, Canada
| | - John J Riva
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Daniel Viggiani
- Department of Kinesiology, University of Waterloo, Waterloo, ON, Canada
| | - Marc Dilauro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Marie-Pierre Harvey
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada
| | - Isabelle Pagé
- Département de chiropratique, Université du Québec à Trois-Rivières, QC, Trois-Rivières, Canada.,Center for Interdisciplinary Research in Rehabilitation and Social Integration (Cirris), Quebec City, QC, Canada
| | - Avneet K Bhela
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | - Serena Sandhu
- Department of Biology, McMaster University, Hamilton, ON, Canada
| | | | | | - Ainsley Moore
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | | | - David J Price
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
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Pokladnikova J, Park AL, Draessler J, Lukacisinova A, Krcmova I. The use of complementary and alternative medicine by adults with allergies: a Czech national representative survey. BMC Complement Med Ther 2021; 21:171. [PMID: 34126974 PMCID: PMC8204506 DOI: 10.1186/s12906-021-03316-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Accepted: 05/06/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prevalence rates of the use of Complementary and Alternative Medicine (CAM) in allergy patients range from 42% in the United States up to 50% in Europe. In the Czech Republic, no such data exists. Our aim was to examine patterns in CAM use in populations with self-reported allergies in the Czech Republic. METHODS A cross-sectional survey was conducted. A sample of citizens aged 15 years and older, sex, age, and region-stratified, was randomly selected from the 2014 voter registration lists (n = 8,395,132). Respondents with self-reported allergies were further analyzed. RESULTS Overall, 93% of the respondents with self-reported allergies reported the use of 1 or more CAM modalities during the past 30 days. Herbal teas, relaxation techniques, a detoxifying diet, dietary supplements (excluding vitamins and minerals), and reflexology were used in respondents with allergies. Females, under age 30, with higher education, higher income, and self-reported poor health, were significantly associated with the use of CAM among respondents with allergies. CONCLUSIONS The prevalence of CAM use among people with self-reported allergies in the Czech Republic is higher compared to other countries, with determinants of CAM varying across specific CAM categories. More attention to existing use is needed to promote the healthy adoption of CAM by raising awareness of its safe and effective use, both for CAM users as well as for health care providers.
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Affiliation(s)
- Jitka Pokladnikova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic.
| | - A-La Park
- Department of Health Policy, Personal Social Services Research Unit, The London School of Economics and Political Science, London, UK
| | - Jan Draessler
- Department of Informatics and Quantitative Methods, Faculty of Informatics and Management, University of Hradec Kralove, Hradec Králové, Czech Republic
| | - Anna Lukacisinova
- Department of Social and Clinical Pharmacy, Faculty of Pharmacy, Charles University, Hradec Králové, Czech Republic
| | - Irena Krcmova
- Department of Clinical Immunology and Allergy, Charles University, University Hospital Hradec Kralove, Hradec Králové, Czech Republic
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Jones LM, Regan C, Wolf K, Bryant J, Rakowsky A, Pe M, Snyder DA. Effect of osteopathic manipulative treatment on pulmonary function testing in children with asthma. J Osteopath Med 2021; 121:589-596. [PMID: 33962511 DOI: 10.1515/jom-2020-0040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 03/09/2021] [Indexed: 11/15/2022]
Abstract
CONTEXT Asthma is a leading cause of pediatric chronic illness, and poor disease control can lead to decreased quality of life and impaired academic performance. Although osteopathic manipulative treatment (OMT) has been shown to have positive effects on pulmonary function in adult patient populations, less is known about its impact in children. OBJECTIVES To evaluate changes in pulmonary function testing (PFT) in pediatric patients on the same day they received OMT compared with PFT in those who received usual care. METHODS We recruited patients between the ages of 7-18 years with a diagnosis of asthma who were receiving routine care at a primary care asthma clinic and had undergone baseline spirometry. Patients were excluded if they met any of the following criteria: clinical indication for pre- and postbronchodilator spirometry on the day of their visit, albuterol use in the last 8 hours, oral steroid use in the previous 2 weeks, or diagnosis of asthma exacerbation in the previous 4 weeks. Eligible patients were then randomized to either an OMT or a control group. Patients in the OMT group were treated with rib raising and suboccipital release in addition to standard asthma care, while control group patients received standard care only. A second PFT was performed for patients in both groups at the end of the visit. OMT was performed by multiple osteopathic pediatric residents specifically trained for this study. Change in spirometry results (forced vital capacity [FVC], forced expiration volume in 1 second [FEV1], FVC/FEV1, and forced expiratory flow 25-75%) were then compared. RESULTS The study population included 58 patients: 31 (53.4%) were assigned to the OMT group and 27 (46.6%) were assigned to the standard of care group. Patients who received OMT had greater improvement in all spirometry values compared to the usual group; however, these changes were not statistically significant. CONCLUSIONS The benefits of OMT on short term spirometry results in pediatric asthma patients remain unclear.
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Affiliation(s)
| | - Christopher Regan
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Kimberly Wolf
- Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
| | | | - Alexander Rakowsky
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Melissa Pe
- Christiana Care Pediatric Associates, Newark, DE, USA
| | - Dane A Snyder
- Department of Pediatrics, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
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Morrow BM. Airway clearance therapy in acute paediatric respiratory illness: A state-of-the-art review. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2019; 75:1295. [PMID: 31309166 PMCID: PMC6620562 DOI: 10.4102/sajp.v75i1.1295] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 02/19/2019] [Indexed: 11/01/2022] Open
Abstract
Background Despite unclear evidence of effectiveness or safety, airway clearance therapy (ACT) is frequently performed in infants and children with acute pulmonary disease. Objectives The aim of this review was to critically synthesise published evidence, expert opinion and pathophysiological principles to describe the indications, effects, precautions and application of commonly used ACT modalities for managing infants and children with acute pulmonary disease. Method A comprehensive narrative review of published literature was conducted. Articles describing paediatric populations were prioritised, but adult and animal studies were also considered where appropriate. Results There is a dearth of high-level evidence supporting the use of ACT in acutely ill infants and children. Conversely, studies have highlighted the lack of effect of different modalities for a variety of conditions, and in some cases serious associated complications have been reported.Airway clearance therapy may be considered when there is retention of pulmonary secretions, and the consequential airway obstruction impacts either acutely on respiratory mechanics and gaseous exchange and/or has the potential for long-term adverse sequelae [a condition that is the consequence of a previous disease or injury]. However, it should not be considered a routine intervention. Conclusion Airway clearance therapy should not be performed routinely in children admitted to hospital with acute respiratory conditions. Patients should be clinically assessed and treatment planned according to individual presentation, in those with signs and symptoms that are potentially amenable to ACT. Clinical implications This review can serve as a guide for physiotherapists in the respiratory management of children with acute respiratory illness, as well as identifying areas for clinical research.
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Affiliation(s)
- Brenda M Morrow
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
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Schuers M, Chapron A, Guihard H, Bouchez T, Darmon D. Impact of non-drug therapies on asthma control: A systematic review of the literature. Eur J Gen Pract 2019; 25:65-76. [PMID: 30849253 PMCID: PMC6493294 DOI: 10.1080/13814788.2019.1574742] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 11/29/2018] [Accepted: 01/21/2019] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Despite growing access to effective therapies, asthma control still needs improvement. Many non-drug factors, such as allergens, air pollutants and stress also affect asthma control and patient quality of life, but an overview of the effectiveness of non-drug interventions on asthma control was lacking. OBJECTIVES To identify non-drug interventions likely to improve asthma control. METHODS A systematic review of the available literature in Medline and the Cochrane Library was conducted in March 2017, without any time limit. Initial searching identified 884 potentially relevant clinical trial reports, literature reviews and meta-analyses, which were screened for inclusion using criteria of quality, relevance, and reporting outcomes based on asthma control. RESULTS Eighty-two publications met the inclusion criteria. In general, the quality of the studies was low. Patient education programmes (22 studies) significantly improved asthma control. Multifaceted interventions (10 studies), which combined patient education programmes with decreasing exposure to indoor allergens and pollutants, significantly improved asthma control based on clinically relevant outcomes. Renovating homes to reduce exposure to allergens and indoor pollutants improved control (two studies). Air filtration systems (five studies) were effective, especially in children exposed to second-hand smoke. Most measures attempting to reduce exposure to dust mites were ineffective (five studies). Dietary interventions (eight studies) were ineffective. Promoting physical activity (five studies) tended to yield positive results, but the results did not attain significance. CONCLUSION Twenty-six interventions were effective in asthma control. Simultaneously combining several action plans, each focusing on different aspects of asthma management, seems most likely to be effective.
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Affiliation(s)
| | - Anthony Chapron
- Department of General Medicine, Rennes University, Rennes, France
| | - Hugo Guihard
- Department of General Medicine, Rouen University, Rouen, France
| | | | - David Darmon
- Department of General Medicine, Nice University, Nice, France
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9
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Massage Therapy in Children with Asthma: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2017; 2017:5620568. [PMID: 28607574 PMCID: PMC5457772 DOI: 10.1155/2017/5620568] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Accepted: 04/12/2017] [Indexed: 11/25/2022]
Abstract
Objective To systematically evaluate the efficacy of massage, a traditional treatment method of traditional Chinese medicine on children with asthma. Methods Literatures from 5 databases using the date ranging from 1 January, 1990, to 13 December, 2016, were reviewed, which were all randomized controlled trials evaluating the efficacy on children with asthma and effect on lung function mainly by massage therapy. Results 14 researches with 1299 patients were included in the meta-analysis. Compared with control group, a better efficacy was found in treatment group, which focused on massage therapy. Compared with control group, there was remarkable increase on FEV1 as well as PEF in treatment group. Conclusion All studies have shown that massage therapy has a significantly positive effect on children with asthma, improves the pulmonary function parameters of large airway, reduces the plasma concentrations of PAF and prostaglandin, and increases the levels of PAF-AH and DP1; therefore, it greatly improves pulmonary function. However, the limited research designs of included studies lead to high risk of bias. More randomized controlled trials with better methodological quality are needed to further confirm the effectiveness of massage.
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Nielsen SM, Tarp S, Christensen R, Bliddal H, Klokker L, Henriksen M. The risk associated with spinal manipulation: an overview of reviews. Syst Rev 2017; 6:64. [PMID: 28340595 PMCID: PMC5366149 DOI: 10.1186/s13643-017-0458-y] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 03/15/2017] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Spinal manipulative therapy (SMT) is a widely used manual treatment, but many reviews exist with conflicting conclusions about the safety of SMT. We performed an overview of reviews to elucidate and quantify the risk of serious adverse events (SAEs) associated with SMT. METHODS We searched five electronic databases from inception to December 8, 2015. We included reviews on any type of studies, patients, and SMT technique. Our primary outcome was SAEs. Quality of the included reviews was assessed using a measurement tool to assess systematic reviews (AMSTAR). Since there were insufficient data for calculating incidence rates of SAEs, we used an alternative approach; the conclusions regarding safety of SMT were extracted for each review, and the communicated opinion were judged by two reviewers independently as safe, harmful, or neutral/unclear. Risk ratios (RRs) of a review communicating that SMT is safe and meeting the requirements for each AMSTAR item, were calculated. RESULTS We identified 283 eligible reviews, but only 118 provided data for synthesis. The most frequently described adverse events (AEs) were stroke, headache, and vertebral artery dissection. Fifty-four reviews (46%) expressed that SMT is safe, 15 (13%) expressed that SMT is harmful, and 49 reviews (42%) were neutral or unclear. Thirteen reviews reported incidence estimates for SAEs, roughly ranging from 1 in 20,000 to 1 in 250,000,000 manipulations. Low methodological quality was present, with a median of 4 of 11 AMSTAR items met (interquartile range, 3 to 6). Reviews meeting the requirements for each of the AMSTAR items (i.e. good internal validity) had a higher chance of expressing that SMT is safe. CONCLUSIONS It is currently not possible to provide an overall conclusion about the safety of SMT; however, the types of SAEs reported can indeed be significant, sustaining that some risk is present. High quality research and consistent reporting of AEs and SAEs are needed. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015030068 .
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Affiliation(s)
- Sabrina Mai Nielsen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Simon Tarp
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Robin Christensen
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Henning Bliddal
- Clinical Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Louise Klokker
- The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark
| | - Marius Henriksen
- Physiotherapy and Biomechanics Research Unit, The Parker Institute, Copenhagen University Hospital, Frederiksberg & Bispebjerg, Frederiksberg, 2000, Denmark.
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Abstract
Asthma is a common long-term condition that remains poorly controlled in many people despite the availability of pharmacological interventions, evidence-based treatment guidelines and care pathways.(1) There is considerable public interest in the use of non-pharmacological approaches for the treatment of asthma.(2) A survey of people with asthma reported that many have used complementary and alternative medicine, often without the knowledge of their clinical team.(3) Such interventions include breathing techniques, herbal products, homeopathy and acupuncture. The role of breathing exercises within the management of asthma has been controversial, partly because early claims of effectiveness were exaggerated.(4) UK national guidance and international guidelines on the management of asthma have included the option of breathing exercise programmes as an adjuvant to pharmacological treatment.(5,6) Here we discuss the types of breathing exercises used and review the evidence for their effectiveness.
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Morrow BM. Chest Physiotherapy in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2015; 4:174-181. [PMID: 31110870 DOI: 10.1055/s-0035-1563385] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 10/31/2014] [Indexed: 10/23/2022] Open
Abstract
Despite widespread practice, there is very little, high-level evidence supporting the indications for and effectiveness of cardiopulmonary/chest physiotherapy (CPT) in critically ill infants and children. Conversely, most studies highlight the detrimental effects or lack of effect of different manual modalities. Conventional CPT should not be a routine intervention in the pediatric intensive care unit, but can be considered when obstructive secretions are present which impact on lung mechanics and/or gaseous exchange and/or where there is the potential for long-term complications. Techniques such as positioning, early mobilization, and rehabilitation have been shown to be beneficial in adult intensive care patients; however, little attention has been paid to this important area of practice in pediatric intensive care units. This article presents a narrative review of chest physiotherapy in pediatric critical illness, including effects, indications, precautions, and specific treatment modalities and techniques.
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Affiliation(s)
- Brenda M Morrow
- Department of Pediatrics and Child Health, University of Cape Town, Rondebosch, Cape Town, South Africa
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13
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Croft AM, Bager P, Garg SK, Manning P. Helminths for asthma. Hippokratia 2015. [DOI: 10.1002/14651858.cd009564.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Ashley M Croft
- Ministry of Defence; Surgeon General's Department; London UK SW1A 2HA
| | - Peter Bager
- Statens Serum Institut; Department of Epidemiology Research; Ørestads Boulevard 5 Copenhagen Denmark DK-2300
| | - Sushil K Garg
- University of Minnesota; Department of Medicine; Minneapolis MN USA
| | - Pat Manning
- Bon Secours Hospital; Consultants Clinic; Glasnevin Dublin Ireland 9
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Bain E, Pierides KL, Clifton VL, Hodyl NA, Stark MJ, Crowther CA, Middleton P. Interventions for managing asthma in pregnancy. Cochrane Database Syst Rev 2014; 2014:CD010660. [PMID: 25331331 PMCID: PMC6599853 DOI: 10.1002/14651858.cd010660.pub2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND Asthma is the most common respiratory disorder complicating pregnancy, and is associated with a range of adverse maternal and perinatal outcomes. There is strong evidence however, that the adequate control of asthma can improve health outcomes for mothers and their babies. Despite known risks of poorly controlled asthma during pregnancy, a large proportion of women have sub-optimal asthma control, due to concerns surrounding risks of pharmacological agents, and uncertainties regarding the effectiveness and safety of different management strategies. OBJECTIVES To assess the effects of interventions (pharmacologic and non-pharmacologic) for managing women's asthma in pregnancy on maternal and fetal/infant outcomes. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (2 June 2014) and the Cochrane Airways Group's Trials Register (4 June 2014). SELECTION CRITERIA Randomised and quasi-randomised controlled trials comparing any intervention used to manage asthma in pregnancy, with placebo, no intervention, or an alternative intervention. We included pharmacological and non-pharmacological interventions (including combined interventions). Cluster-randomised trials were eligible for inclusion (but none were identified). Cross-over trials were not eligible for inclusion.We included multi-armed trials along with two-armed trials. We also included studies published as abstracts only. DATA COLLECTION AND ANALYSIS At least two review authors independently assessed trial eligibility and quality and extracted data. Data were checked for accuracy. MAIN RESULTS We included eight trials in this review, involving 1181 women and their babies. Overall we judged two trials to be at low risk of bias, two to be of unclear risk of bias, and four to be at moderate risk of bias.Five trials assessed pharmacological agents, including inhaled corticosteroids (beclomethasone or budesonide), inhaled magnesium sulphate, intravenous theophylline, and inhaled beclomethasone verus oral theophylline. Three trials assessed non-pharmacological interventions, including a fractional exhaled nitric oxide (FENO)-based algorithm versus a clinical guideline-based algorithm to adjust inhaled corticosteroid therapy, a pharmacist-led multi-disciplinary approach to management versus standard care, and progressive muscle relaxation (PMR) versus sham training.The eight included trials were assessed under seven separate comparisons. Pharmacological interventionsPrimary outcomes: one trial suggested that inhaled magnesium sulphate in addition to usual treatment could reduce exacerbation frequency in acute asthma (mean difference (MD) -2.80; 95% confidence interval (CI) -3.21 to -2.39; 60 women). One trial assessing the addition of intravenous theophylline to standard care in acute asthma did not report on exacerbations (65 women). No clear difference was shown in the risk of exacerbations with the use of inhaled beclomethasone in addition to usual treatment for maintenance therapy in one trial (risk ratio (RR) 0.36; 95% CI 0.13 to 1.05; 60 women); a second trial also showed no difference, however data were not clearly reported to allow inclusion in a meta-analysis. No difference was shown when inhaled beclomethasone was compared with oral theophylline for maintenance therapy (RR 0.88; 95% CI 0.59 to 1.33; one trial, 385 women). None of these trials reported on neonatal intensive care admissions. SECONDARY OUTCOMES inhaled magnesium sulphate in acute asthma was shown to improve lung function measures (one trial, 60 women); intravenous theophylline in acute asthma was not associated with benefits (one trial, 65 women). No clear differences were seen with the addition of inhaled corticosteroids to routine treatment in three trials (374 women). While inhaled beclomethasone, compared with oral theophylline, significantly reduced treatment discontinuation due to adverse effects in one trial (384 women), no other differences were observed, except for higher treatment adherence with theophylline. Four of the five trials did not report on adverse effects. Non-pharmacological interventionsPrimary outcomes: in one trial, the use of a FENO-based algorithm was shown to significantly reduce asthma exacerbations (RR 0.61; 95% CI 0.41 to 0.90; 220 women); and a trend towards fewer neonatal hospitalisations was observed (RR 0.46; 95% CI 0.21 to 1.02; 214 infants). No exacerbations occurred in one trial assessing pharmacist-led management; this approach did not reduce neonatal intensive care admissions (RR 1.50; 95% CI 0.27 to 8.32; 58 infants). One trial (64 women) assessing PMR did not report on exacerbations or neonatal intensive care admissions. SECONDARY OUTCOMES the use of a FENO-based algorithm to adjust therapy led to some improvements in quality of life scores, as well as more frequent use of inhaled corticosteroids and long-acting β-agonists, and less frequent use of short-acting β-agonists (one trial, 220 women). The FENO-based algorithm was associated with fewer infants with recurrent episodes of bronchiolitis in their first year of life, and a trend towards fewer episodes of croup for infants. Pharmacist-led management improved asthma control scores at six months (one trial, 60 women); PMR improved lung function and quality of life measures (one trial, 64 women). No other differences between comparisons were observed. AUTHORS' CONCLUSIONS Based on eight included trials, of moderate quality overall, no firm conclusions about optimal interventions for managing asthma in pregnancy can be made. Five trials assessing pharmacological interventions did not provide clear evidence of benefits or harms to support or refute current practice. While inhaled magnesium sulphate for acute asthma was shown to reduce exacerbations, this was in one small trial of unclear quality, and thus this finding should be interpreted with caution. Three trials assessing non-pharmacological interventions provided some support for the use of such strategies, however were not powered to detect differences in important maternal and infant outcomes. While a FENO-based algorithm reduced exacerbations, the effects on perinatal outcomes were less certain, and thus widespread implementation is not yet appropriate. Similarly, though positive effects on asthma control were shown with PMR and pharmacist-led management, the evidence to date is insufficient to draw definitive conclusions.In view of the limited evidence base, further randomised trials are required to determine the most effective and safe interventions for asthma in pregnancy. Future trials must be sufficiently powered, and well-designed, to allow differences in important outcomes for mothers and babies to be detected. The impact on health services requires evaluation. Any further trials assessing pharmacological interventions should assess novel agents or those used in current practice. Encouragingly, at least five trials have been identified as planned or underway.
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Affiliation(s)
- Emily Bain
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Kristen L Pierides
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
| | - Vicki L Clifton
- Lyell McEwin HospitalClinical Research DevelopmentHaydown RoadAdelaideAustralia5112
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
| | - Nicolette A Hodyl
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
| | - Michael J Stark
- The University of AdelaideRobinson Research InstituteAdelaideAustralia
- Women's and Children's HospitalDepartment of Neonatal Medicine72 King William RoadAdelaideAustralia5005
| | - Caroline A Crowther
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
- The University of AucklandLiggins InstitutePrivate Bag 9201985 Park RoadAucklandNew Zealand
| | - Philippa Middleton
- The University of AdelaideARCH: Australian Research Centre for Health of Women and Babies, Robinson Research Institute, Discipline of Obstetrics and GynaecologyAdelaideSouth AustraliaAustralia5006
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Hung YC, Hung IL, Sun MF, Muo CH, Wu BY, Tseng YJ, Hu WL. Integrated traditional Chinese medicine for childhood asthma in Taiwan: a Nationwide cohort study. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2014; 14:389. [PMID: 25304233 PMCID: PMC4198671 DOI: 10.1186/1472-6882-14-389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/28/2014] [Accepted: 10/06/2014] [Indexed: 11/23/2022]
Abstract
Background Traditional Chinese medicine (TCM) is the most commonly used alternative therapy in children with asthma, especially in the Chinese community. This study aimed to investigate the effects of the government-sponsored Outpatient’s Healthcare Quality Improvement (OHQI) project with integrated TCM treatment on childhood asthma. Methods This study used the Longitudinal Health Insurance Database 2000, which is a part of the Taiwan National Health Insurance Research Database (NHIRD). Children with diagnosed asthma and aged under 15 years from 2006–2010 were enrolled. They were collated into 3 groups: (1) subjects treated with non-TCM; (2) subjects treated with single TCM; and (3) subjects treated with integrative OHQI TCM. The medical visits and the cost of treatment paid by the Bureau of National Health Insurance (BNHI) to the outpatient, emergency room, and inpatient departments were evaluated for the study subjects within 1 year of the first asthma diagnosis during the study period. Results Fifteen multi-hospitals, including 7 medical centers, and 35 TCM physicians participated in OHQI during the study period. A total of 12850 children from the NHIRD database were enrolled in this study, and divided as follows: 12435 children in non-TCM group, 406 children in single TCM group, and 9 children in integrative OHQI TCM group. Although the total medical cost paid by the BNHI per patient in the integrative OHQI TCM group was greater than that in the non-OHQI groups, the patients in the integrative OHQI TCM group exhibited greater therapeutic effects, and did not require ER visits or hospitalization. In addition, ER visits and hospitalization among patients who received a combination of conventional therapy with integrated TCM were lower than those among patients who underwent conventional therapy alone or single TCM treatment. Conclusions Asthmatic children at partly controlled level under conventional therapy may benefit from adjuvant treatment with integrated TCM.
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Silvers WS, Bailey HK. Integrative approach to allergy and asthma using complementary and alternative medicine. Ann Allergy Asthma Immunol 2014; 112:280-5. [PMID: 24679731 DOI: 10.1016/j.anai.2014.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Revised: 01/23/2014] [Accepted: 01/25/2014] [Indexed: 01/26/2023]
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Abstract
Integrative medicine is a relatively new discipline which attempts to combine allopathic medicine with alternative or complementary medicine, to reap the benefits of both forms of medicine in optimizing the care of patients. Integrative medicine concentrates on treating the patient as a whole, both in body and mind. While the scientific method and "evidence-based" clinical research drives the management and treatment of diseases in conventional Western medicine, alternative or complementary medicine is based on unproven yet potentially beneficial techniques that have been developed throughout history, dating back to the ancient cultures in the Middle East, Africa, and China. In spite of the lack of evidence of most alternative medicine techniques, these methodologies have been practiced for centuries with great acceptance in many countries. It is in the Western world, where "modern" medicine is dictated by the scientific method, that the most controversy in the use of these alternative modes of therapy exists. Since the science behind alternative medicine is incomplete or non-existent, it is difficult for those trained in Western medicine to accept or adopt this approach. But perhaps it is the failure of Western medicine to adequately guarantee our well being and good health that have led to the ongoing debate between the medical profession and the general public as to the benefits of these alternative treatments. In one sense, integrative medicine may be a futile attempt to coin a new term in the hope of legitimizing alternative medicine. On the other hand, there is a wealth of historical experience in the use of the techniques. Studies to evaluate the scientific basis behind ancient medical techniques are ongoing, and it is to be expected that the results will neither be uniformly positive nor negative. Of particular interest is the effect of traditional medicine, herbal formulations, and manipulative techniques on the immune system, and its application in the treatment of autoimmune and allergic diseases. Studies are being designed or conducted to investigate immune effects of herbal formulations or their components. Herbal plants or medicines may lead to skewing of the Th1/Th2 balance in either direction, thus may offer potential application in the treatment of allergic or autoimmune diseases.
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18
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Scholten-Peeters GGM, Thoomes E, Konings S, Beijer M, Verkerk K, Koes BW, Verhagen AP. Is manipulative therapy more effective than sham manipulation in adults : a systematic review and meta-analysis. Chiropr Man Therap 2013; 21:34. [PMID: 24274314 PMCID: PMC3850908 DOI: 10.1186/2045-709x-21-34] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 09/28/2013] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Manipulative therapy is widely used in the treatment of spinal disorders. Manipulative techniques are under debate because of the possibility of adverse events. To date, the efficacy of manipulations compared to sham manipulations is unclear. The purpose of the study is: to assess the efficacy of manipulative therapy compared to sham in adults with a variety of complaints. STUDY DESIGN Systematic review and meta-analysis. METHODS Bibliographic databases (PubMed, EMBASE, CINAHL, PEDro, Central) along with a hand search of selected bibliographies were searched from inception up to April 2012. RESULTS In total 965 references were screened for eligibility and 19 RCTs (n = 1080) met the selection criteria. Eight studies were considered of low risk of bias. There is moderate level of evidence that manipulative therapy has a significant effect in adults on pain relief immediately after treatment (standardized mean difference [SMD] - 0.68, 95% confidence interval (-1.06 to -0.31). There is low level of evidence that manipulative therapy has a significant effect in adults on pain relief (SMD - 0.37, -0.69 to -0.04) at short- term follow-up. In patients with musculoskeletal disorders, we found moderate level of evidence for pain relief (SMD - 0.73, -1.21 to -0.25) immediate after treatment and low level of evidence for pain relief (SMD - 0.52, -0.87 to -0.17) at short term-follow-up. We found very low level of evidence that manipulative therapy has no statistically significant effect on disability and perceived (asthma) recovery. Sensitivity analyses did not change the main findings. No serious adverse events were reported in the manipulative therapy or sham group. CONCLUSIONS Manipulative therapy has a clinical relevant effect on pain, but not on disability or perceived (asthma) recovery. Clinicians can refer patients for manipulative therapy to reduce pain.
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Affiliation(s)
- Gwendolijne GM Scholten-Peeters
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Erik Thoomes
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Sophie Konings
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Michelle Beijer
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Karin Verkerk
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
- Rotterdam University of Applied Sciences, Rotterdam, Department physical therapy, Museumpark 40, Rotterdam, CX 3015, The Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
| | - Arianne P Verhagen
- University of Applied Sciences AVANS, Research Group Diagnostics, PO Box 90116, Breda, RA 4800, The Netherlands
- Department of General Practice, Erasmus Medical Centre, University Medical Center, PO Box 2040, Rotterdam, CA 3000, The Netherlands
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Bose S, Jun J, Diette GB. High-frequency chest wall oscillation successful in controlling refractory asthma. J Asthma 2013; 50:219-21. [PMID: 23394251 DOI: 10.3109/02770903.2012.757773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION High-frequency chest wall oscillation (HFCWO) has been traditionally implemented for airway secretion clearance in conditions such as cystic fibrosis (CF) and bronchiectasis. There have been few reports of its use in refractory asthma. CASE REPORT A 36-year-old, non-smoker male presented with a lifelong history of poorly controlled asthma. Despite multiple controller medications, he reported daily chest congestion, copious phlegm, and frequent exacerbations. Imaging, blood work, and bronchoscopy ruled out atypical infections, immunodeficiency, CF, and other chronic conditions. Pulmonary function tests supported a diagnosis of asthma. RESULTS We initiated HFCWO therapy twice daily in addition to standard inhaled pharmacological therapy. After 2 months, the patient noted resolution of respiratory symptoms as well as improvement in lung function. He remained symptom-free at his 2-year follow-up. CONCLUSION High-frequency chest oscillation may be useful in phenotypes of asthma characterized by prominent mucus hypersecretion.
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Affiliation(s)
- Sonali Bose
- Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD 21205, USA.
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Cukic V, Lovre V, Dragisic D, Ustamujic A. Asthma and Chronic Obstructive Pulmonary Disease (COPD) - Differences and Similarities. Mater Sociomed 2013; 24:100-5. [PMID: 23678316 PMCID: PMC3633485 DOI: 10.5455/msm.2012.24.100-105] [Citation(s) in RCA: 105] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Accepted: 03/15/2012] [Indexed: 12/26/2022] Open
Abstract
Bronchial asthma and COPD (chronic obstructive pulmonary disease) are obstructive pulmonary diseases that affected millions of people all over the world. Asthma is a serious global health problem with an estimated 300 million affected individuals. COPD is one of the major causes of chronic morbidity and mortality and one of the major public health problems worldwide. COPD is the fourth leading cause of death in the world and further increases in its prevalence and mortality can be predicted. Although asthma and COPD have many similarities, they also have many differences. They are two different diseases with differences in etiology, symptoms, type of airway inflammation, inflammatory cells, mediators, consequences of inflammation, response to therapy, course. Some similarities in airway inflammation in severe asthma and COPD and good response to combined therapy in both of these diseases suggest that they have some similar patophysiologic characteristics. The aim of this article is to show similarities and differences between these two diseases. Today asthma and COPD are not fully curable, not identified enough and not treated enough and the therapy is still developing. But in future better understanding of pathology, adequate identifying and treatment, may be and new drugs, will provide a much better quality of life, reduced morbidity and mortality of these patients.
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Affiliation(s)
- Vesna Cukic
- Clinic for Pulmonary Diseases and TB "Podhrastovi", Clinical center of Sarajevo University, Bosnia and Herzegovina
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Bruurs MLJ, van der Giessen LJ, Moed H. The effectiveness of physiotherapy in patients with asthma: a systematic review of the literature. Respir Med 2013; 107:483-94. [PMID: 23333065 DOI: 10.1016/j.rmed.2012.12.017] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2012] [Revised: 12/19/2012] [Accepted: 12/21/2012] [Indexed: 11/25/2022]
Abstract
Since the introduction of medical therapy for asthma the interest in non-medical treatments deteriorated. Physiotherapy could have beneficial effects in asthmatics. This review investigates the effectiveness of physiotherapy in the treatment of patients with asthma. A review was performed on the terms breathing exercises (BE), inspiratory muscle training (IMT), physical training (PhT) and airway clearance (AC) in patients with asthma. The search resulted in 237 potentially relevant articles, after exclusion 23 articles remained. BE (n = 9) may improve disease specific quality of life (QoL), reduce symptoms, hyperventilation, anxiety and depression, lower respiratory rate and medication use. IMT (n = 3) can improve inspiratory pressure and may reduce medication use and symptoms. PhT (n = 12) can reduce symptoms, improve QoL and improve cardiopulmonary endurance and fitness. In conclusion, physiotherapy may improve QoL, cardiopulmonary fitness and inspiratory pressure and reduce symptoms and medication use. Further studies, investigating combinations of techniques, are needed to confirm these findings.
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Affiliation(s)
- Marjolein L J Bruurs
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Affiliation(s)
- Edzard Ernst
- Peninsula Medical School; University of Exeter; Veysey Building, Salmon Pool Lane; Exeter; EX2 4SG; UK
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Alcantara J, Alcantara JD, Alcantara J. The chiropractic care of patients with asthma: a systematic review of the literature to inform clinical practice. ACTA ACUST UNITED AC 2012. [DOI: 10.1016/j.clch.2012.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Use of complementary and alternative medicine in children with asthma. Can Respir J 2011; 17:183-7. [PMID: 20808977 DOI: 10.1155/2010/682142] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children. OBJECTIVE To ascertain the prevalence and type of CAMs, and to identify factors associated with their use. METHODS A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children's Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition. RESULTS The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31). CONCLUSION The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.
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Busse JW, Jim J, Jacobs C, Ngo T, Rodine R, Torrance D, Kulkarni AV, Petrisor B, Drew B, Bhandari M. Attitudes towards chiropractic: an analysis of written comments from a survey of north american orthopaedic surgeons. Chiropr Man Therap 2011; 19:25. [PMID: 21970333 PMCID: PMC3212887 DOI: 10.1186/2045-709x-19-25] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2011] [Accepted: 10/04/2011] [Indexed: 11/10/2022] Open
Abstract
Background There is increasing interest by chiropractors in North America regarding integration into mainstream healthcare; however, there is limited information about attitudes towards the profession among conventional healthcare providers, including orthopaedic surgeons. Methods We administered a 43-item cross-sectional survey to 1000 Canadian and American orthopaedic surgeons that inquired about demographic variables and their attitudes towards chiropractic. Our survey included an option for respondants to include written comments, and our present analysis is restricted to these comments. Two reviewers, independantly and in duplicate, coded all written comments using thematic analysis. Results 487 surgeons completed the survey (response rate 49%), and 174 provided written comments. Our analysis revealed 8 themes and 24 sub-themes represented in surgeons' comments. Reported themes were: variability amongst chiropractors (n = 55); concerns with chiropractic treatment (n = 54); areas where chiropractic is perceived as effective (n = 43); unethical behavior (n = 43); patient interaction (n = 36); the scientific basis of chiropractic (n = 26); personal experiences with chiropractic (n = 21); and chiropractic training (n = 18). Common sub-themes endorsed by surgeon's were diversity within the chiropractic profession as a barrier to increased interprofessional collaboration, endorsement for chiropractic treatment of musculoskeletal complaints, criticism for treatment of non-musculoskeletal complaints, and concern over whether chiropractic care was evidence-based. Conclusions Our analysis identified a number of issues that will have to be considered by the chiropractic profession as part of its efforts to further integrate chiropractic into mainstream healthcare.
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Affiliation(s)
- Jason W Busse
- The Institute for Work & Health, 481 University Avenue, Suite 800, Toronto, Ontario M5G 2E9, Canada.
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Bailey CD, Wagland R, Dabbour R, Caress A, Smith J, Molassiotis A. An integrative review of systematic reviews related to the management of breathlessness in respiratory illnesses. BMC Pulm Med 2010; 10:63. [PMID: 21143887 PMCID: PMC3016307 DOI: 10.1186/1471-2466-10-63] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Accepted: 12/09/2010] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Breathlessness is a debilitating and distressing symptom in a wide variety of diseases and still a difficult symptom to manage. An integrative review of systematic reviews of non-pharmacological and pharmacological interventions for breathlessness in non-malignant disease was undertaken to identify the current state of clinical understanding of the management of breathlessness and highlight promising interventions that merit further investigation. METHODS Systematic reviews were identified via electronic databases between July 2007 and September 2009. Reviews were included within the study if they reported research on adult participants using either a measure of breathlessness or some other measure of respiratory symptoms. RESULTS In total 219 systematic reviews were identified and 153 included within the final review, of these 59 addressed non-pharmacological interventions and 94 addressed pharmacological interventions. The reviews covered in excess of 2000 trials. The majority of systematic reviews were conducted on interventions for asthma and COPD, and mainly focussed upon a small number of pharmacological interventions such as corticosteroids and bronchodilators, including beta-agonists. In contrast, other conditions involving breathlessness have received little or no attention and studies continue to focus upon pharmacological approaches. Moreover, although there are a number of non-pharmacological studies that have shown some promise, particularly for COPD, their conclusions are limited by a lack of good quality evidence from RCTs, small sample sizes and limited replication. CONCLUSIONS More research should focus in the future on the management of breathlessness in respiratory diseases other than asthma and COPD. In addition, pharmacological treatments do not completely manage breathlessness and have an added burden of side effects. It is therefore important to focus more research on promising non-pharmacological interventions.
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Affiliation(s)
- Chris D Bailey
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Highfield, Southampton, SO17 1BJ, UK
| | - Rasha Dabbour
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester M13 9PL, UK
| | - Ann Caress
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester M13 9PL, UK
| | - Jaclyn Smith
- Department of Translational Medicine, University of Manchester, Manchester, UK & Johns Hopkins Asthma and Allergy Center, Boston, USA
| | - Alex Molassiotis
- School of Nursing, Midwifery & Social Work, University of Manchester, Manchester M13 9PL, UK
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Abstract
The self-medication phenomenon in upper respiratory tract infections, rhinosinusitis, asthma, and chronic obstructive pulmonary disease are significant and will continue to increase. Current level of evidence is poor because of the small number of good quality studies, small sample size, short duration, and variation in the composition of the herbal interventions or therapies. The current review points to several potential therapies that could be effective either alone, or as adjuncts to conventional therapies.
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Affiliation(s)
| | - Wadie Najm
- Department of Family Medicine, Irvine School of Medicine, University of California, 101 The City Drive South, Building 200, Suite 512, Irvine, Orange, CA 92868, USA
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Abstract
Osteopathic medicine is a profession that has existed for more than 130 years. However, the profession is poorly understood by many health care professionals. This article introduces osteopathic medicine, including similarities and differences between osteopathic physicians (DOs) and allopathic physicians (MDs). It describes osteopathic manipulative treatment (OMT), including the risks and many of the challenges faced while doing clinical research on OMT. Finally, the article reviews the research that has evaluated the effect of OMT on various medical conditions, including musculoskeletal, neurologic, respiratory, obstetric, gynecologic, and pediatric conditions.
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Affiliation(s)
- Brian E Earley
- Department of Family Medicine, University of Wisconsin School of Medicine and Public Health, 1100 Dela Plaine Court, Madison, WI 53715, USA.
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Rauch A, Kirchberger I, Stucki G, Cieza A. Validation of the Comprehensive ICF Core Set for obstructive pulmonary diseases from the perspective of physiotherapists. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2009; 14:242-59. [DOI: 10.1002/pri.448] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Affiliation(s)
- Kenneth R Chapman
- Asthma and Airway Centre, University Health Network, Toronto Western Hospital and University of Toronto, Toronto, Ont
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Abstract
Management decisions for pediatric asthma (in patients younger than 12 years of age) based on extrapolation from available evidence in adolescents and adults (age 12 years and older) is common but rarely appropriate. This article addresses the disparity in response between the two age groups, presents the available pediatric evidence, and highlights the important areas in which further research is required. Evidence-based recommendations for acute and interval management of pediatric asthma are provided.
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Affiliation(s)
- Paul D Robinson
- Department of Respiratory Medicine, The Children's Hospital at Westmead, Westmead, Sydney, Australia.
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De Boeck K, Vermeulen F, Vreys M, Moens M, Proesmans M. Airway clearance techniques to treat acute respiratory disorders in previously healthy children: where is the evidence? Eur J Pediatr 2008; 167:607-12. [PMID: 18322699 DOI: 10.1007/s00431-008-0689-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2008] [Accepted: 02/06/2008] [Indexed: 11/26/2022]
Abstract
Airway clearance techniques are an important part of the respiratory management in children with cystic fibrosis, bronchiectasis and neuromuscular disease. They are also, however, frequently prescribed in previously healthy children with an acute respiratory problem with the aim to speed up recovery. The current review explores the evidence behind this use of airway clearance techniques in children without underlying disease. Few studies have been performed; many different techniques are available and the therapies used are often poorly specified. It is necessary to name the specific airway clearance technique used in treatment rather than to just state "chest physiotherapy," a term that is often confused with chest clapping or vibration plus postural drainage. There is little evidence that airway clearance techniques play a role in the management of children with an acute respiratory problem. Physicians routinely prescribing airway clearance techniques in previously healthy children should question their practice.
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Affiliation(s)
- Kris De Boeck
- Department of Paediatrics, University Hospital of Leuven, Herestraat 49, 3000 Leuven, Belgium.
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Shaw A, Noble A, Salisbury C, Sharp D, Thompson E, Peters TJ. Predictors of complementary therapy use among asthma patients: results of a primary care survey. HEALTH & SOCIAL CARE IN THE COMMUNITY 2008; 16:155-164. [PMID: 18290981 DOI: 10.1111/j.1365-2524.2007.00738.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Patients with chronic conditions are increasingly using complementary therapies. Asthma is the most common chronic disease in the UK. Qualitative research has suggested reasons why asthma patients use complementary therapies. However, there is little reliable quantitative evidence regarding the prevalence of complementary therapy use among asthma patients and predictors of use. A postal survey of complementary therapy use among asthma patients was therefore conducted via 27 general practices across seven Primary Care Trusts within the South West Strategic Health Authority (England), during August 2005 to May 2006. A total of 14,833 asthma patients were identified. A 1-in-4 random sample generated 3693 potential respondents, of whom 1320 (36%) returned questionnaires. Taking full account of the survey design, 14.5% (190/1308; 95% confidence interval 12.5% to 16.6%) had used complementary therapies for asthma; 54% of these patients had not disclosed their complementary therapy use to a health professional. The three therapies most commonly used were homeopathy, herbal medicine and relaxation. Just over half of those using complementary therapies for asthma reported that they usually or always helped; the most common reported benefits were symptom reduction, calming breathing and reducing panic. Multivariable analyses indicated an inverted U-shaped relationship between complementary therapy use for asthma and age, and increased likelihood of use among women, those with educational qualifications, those not usually helped by asthma medication, and those who have difficulty sleeping because of asthma symptoms. Dissatisfaction with conventional care was not associated with complementary therapy use for asthma. Asthma patients may use complementary therapies with or without the knowledge of their healthcare providers. Open communication between professionals and patients about complementary therapies may be valuable to give patients enhanced opportunities to discuss the impact of asthma on their quality of life and the effectiveness of their conventional treatment.
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Affiliation(s)
- Alison Shaw
- Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, and Bristol Homeopathic Hospital, United Bristol Healthcare Trust, UK.
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Cowie RL, Conley DP, Underwood MF, Reader PG. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respir Med 2008; 102:726-32. [PMID: 18249107 DOI: 10.1016/j.rmed.2007.12.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2007] [Revised: 11/21/2007] [Accepted: 12/09/2007] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess the effectiveness of a non-pharmacological intervention in patients with asthma on conventional therapy including inhaled corticosteroid. DESIGN A randomised controlled trial of the Buteyko technique in a group of adults with asthma. The control group was trained by a physiotherapist in breathing and relaxation techniques. SETTING A single centre associated with a University-based asthma programme. MAIN OUTCOME MEASURE Asthma control, defined by a composite score based on the Canadian asthma consensus report 6 months after completion of the intervention. RESULTS Both groups showed substantial and similar improvement and a high proportion with asthma control 6 months after completion of the intervention. In the Buteyko group the proportion with asthma control increased from 40% to 79% and in the control group from 44% to 72%. In addition the Buteyko group had significantly reduced their inhaled corticosteroid therapy compared with the control group (p=0.02). None of the other differences between the groups at 6 months were significant. CONCLUSIONS Six months after completion of the interventions, a large majority of subjects in each group displayed control of their asthma with the additional benefit of reduction in inhaled corticosteroid use in the Buteyko group. The Buteyko technique, an established and widely recognised intervention, or an intensive programme delivered by a chest physiotherapist appear to provide additional benefit for adult patients with asthma who are being treated with inhaled corticosteroid.
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Affiliation(s)
- Robert L Cowie
- Calgary COPD and Asthma Program, University of Calgary, 3330 Hospital Drive NW, Calgary, Alberta, Canada T2N 4N1.
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Abstract
Childhood asthma is a spectrum of symptoms and clinical presentations. The treatment begins with developing goals of therapy for a child by the health care provider, the family, and the child as a team. The primary objective is to reduce symptoms and exacerbations using therapies that include conventional medications, environmental controls, and lifestyle modification while reducing the potential for adverse effects of medications and the disease. Complementary and alternative medicine (CAM) may play a role in meeting these objectives, and through the integration of conventional and CAM therapies, an integrative medicine approach may facilitate reaching these objectives in a more effective manner.
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Pollentier A, Langworthy JM. The scope of chiropractic practice: A survey of chiropractors in the UK. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.clch.2007.02.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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von Steinaecker K, Welke J, Bühring M, Stange R. [Pilot study of breathing therapy in groups for patients with bronchial asthma]. Complement Med Res 2007; 14:86-91. [PMID: 17464159 DOI: 10.1159/000100378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND The present study examines the efficacy of breathing and body therapy (according to the organization of breathing therapists, BVA) on bronchial asthma. This psychophysical therapy procedure has never before been studied for its efficacy on asthma, much in contrast to breathing exercises, which have been extensively examined. PATIENTS AND METHODS This uncontrolled observational study is of preliminary character. It examines the influence of psychophysical breathing and body exercises practiced in short-term intervention groups on quality of life (SF-36) as well as subjective discomfort (discomfort diary) in patients with bronchial asthma. As there are no prior studies on the breathing and body therapy (BVA) method, it was hypothesized, based on experience, that it would improve ventilation, lower anxiety, and perhaps even allow for a reduction of medication. RESULTS An anti-obstructive effect could not be addressed here, as the study only included patients who were free of clinically relevant obstructions through conventional treatment. However, a tendency for an anxiety-relieving effect could be observed in the SF-36. Subjective reports of respiratory discomfort, obtained through assessment of the patients' diaries, did not show any tendencies or even significant changes over the course of the therapy. CONCLUSION The suggested anxiety-relieving effect of breathing therapy should be examined in future studies with more patients and stricter inclusion criteria.
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Mark JD. Asthma. Integr Med (Encinitas) 2007. [DOI: 10.1016/b978-1-4160-2954-0.50036-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Shaw A, Thompson EA, Sharp D. Complementary therapy use by patients and parents of children with asthma and the implications for NHS care: a qualitative study. BMC Health Serv Res 2006; 6:76. [PMID: 16776833 PMCID: PMC1538997 DOI: 10.1186/1472-6963-6-76] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2006] [Accepted: 06/15/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients are increasingly using complementary therapies, often for chronic conditions. Asthma is the most common chronic condition in the UK. Previous research indicates that some asthma patients experience gaps in their NHS care. However, little attention has been given to how and why patients and parents of children with asthma use complementary therapies and the implications for NHS care. METHODS Qualitative study, comprising 50 semi-structured interviews with a purposeful sample of 22 adults and 28 children with asthma (plus a parent), recruited from a range of NHS and non-NHS settings in Bristol, England. Data analysis was thematic, drawing on the principles of constant comparison. RESULTS A range of complementary therapies were being used for asthma, most commonly Buteyko breathing and homeopathy. Most use took place outside of the NHS, comprising either self-treatment or consultation with private complementary therapists. Complementary therapies were usually used alongside not instead of conventional asthma treatment. A spectrum of complementary therapy users emerged, including "committed", "pragmatic" and "last resort" users. Motivating factors for complementary therapy use included concerns about conventional NHS care ("push factors") and attractive aspects of complementary therapies ("pull factors"). While participants were often uncertain whether therapies had directly helped their asthma, breathing techniques such as the Buteyko Method were most notably reported to enhance symptom control and enable reduction in medication. Across the range of therapies, the process of seeking and using complementary therapies seemed to help patients in two broad ways: it empowered them to take greater personal control over their condition rather than feel dependant on medication, and enabled exploration of a broader range of possible causes of their asthma than commonly discussed within NHS settings. CONCLUSION Complementary therapy use reflects patients' and parents' underlying desire for greater self-care and need of opportunities to address some of their concerns regarding NHS asthma care. Self-management of chronic conditions is increasingly promoted within the NHS but with little attention to complementary therapy use as one strategy being used by patients and parents. With their desire for self-help, complementary therapy users are in many ways adopting the healthcare personas that current policies aim to encourage.
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Affiliation(s)
- Alison Shaw
- Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol, England, UK
| | - Elizabeth A Thompson
- Bristol Homeopathic Hospital, United Bristol Healthcare Trust, Cotham Hill, Bristol, England, UK
| | - Debbie Sharp
- Academic Unit of Primary Health Care, Department of Community Based Medicine, University of Bristol, Cotham House, Cotham Hill, Bristol, England, UK
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Passalacqua G, Bousquet PJ, Carlsen KH, Kemp J, Lockey RF, Niggemann B, Pawankar R, Price D, Bousquet J. ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol 2006; 117:1054-62. [PMID: 16675332 DOI: 10.1016/j.jaci.2005.12.1308] [Citation(s) in RCA: 118] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2005] [Revised: 12/12/2005] [Accepted: 12/12/2005] [Indexed: 12/26/2022]
Abstract
Complementary-alternative medicines are extensively used in the treatment of allergic rhinitis and asthma, but evidence-based recommendations are lacking. To provide evidence-based recommendations, the literature was searched by using MedLine and the Cochrane Library to March 2005 (Key words: Asthma [OR] Rhinitis, [AND] Complementary [OR] Alternative Medicine, [OR] Herbal, [OR] Acupuncture, [OR] Homeopathy, [OR] Alternative Treatment). Randomized trials, preferably double-blind and published in English, were selected. The articles were evaluated by a panel of experts. Quality of reporting was assessed by using the scale validated by Jadad. The methodology of clinical trials with complementary-alternative medicine was frequently inadequate. Meta-analyses provided no clear evidence for the efficacy of acupuncture in rhinitis and asthma. Some positive results were described with homeopathy in good-quality trials in rhinitis, but a number of negative studies were also found. Therefore it is not possible to provide evidence-based recommendations for homeopathy in the treatment of allergic rhinitis, and further trials are needed. A limited number of studies of herbal remedies showed some efficacy in rhinitis and asthma, but the studies were too few to make recommendations. There are also unresolved safety concerns. Therapeutic efficacy of complementary-alternative treatments for rhinitis and asthma is not supported by currently available evidence.
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