The use of alternative therapies by children with asthma: a brief report

Efficiency of physiotherapy with Caycedian Sophrology on children with asthma: A randomized controlled trial

BACKGROUND

Asthma is the most common chronic disease in pediatrics. Along with the usual drug therapy using corticosteroids and bronchodilators, some interest has been shown for adjuvant therapies, such as sophrology. However, the level of evidence for non-pharmaceutical therapies in asthma remains low, especially in children. This study aimed to assess whether in children with asthma, peak expiratory flow (PEF) improved more after a sophrology session alongside standard treatment than after standard treatment alone.

METHODS

We carried out a prospective randomized controlled clinical trial among 74 children aged 6-17 years old, hospitalized for an asthma attack. Group 1: conventional treatment (oxygen, corticosteroids, bronchodilators, physiotherapy) added to one session of sophrology. Group 2: conventional treatment alone. The primary outcome was the PEF variation between the initial and final evaluations (PEF₂ -PEF₁ ).

RESULTS

Demographic and clinical characteristics were similar in both groups at baseline. Measures before and after the sophrology session showed that the PEF increased by mean 30 L/min in the sophrology group versus 20 L/min in the control group (P = 0.02). Oxygen saturation increased by 1% versus 0% (P = 0.02) and the dyspnea score with visual analogue scale improved by two points point (P = 0.01). No differences were observed between the two groups in terms of duration of hospitalization, use and doses of conventional medical treatment (oxygen, corticosteroids, and bronchodilators), and quality of life scores.

CONCLUSIONS

Sophrology appears as a promising adjuvant therapy to current guideline-based treatment for asthma in children.

A Critical Review of the Sociology of Alternative Medicine: Research on Users, Practitioners and the Orthodoxy

The popularity of alternative therapies in the past two decades has been accompanied by a proliferation of sociological works investigating different aspects of this phenomenon.1,2 A major strand of the literature in ‘the sociology of alternative medicine’, which concerns three social actors: users of alternative therapies; practitioners of alternative therapies; and physicians (the orthodoxy). Research on users of alternative medicine has mainly investigated the causes of people’s use of these modalities and has focused on three questions: Why do people use alternative medicine? Why has alternative medicine become popular in recent times? and, What is the sequence of events that leads to alternative medicine use? Research on alternative practitioners has mainly investigated the issue of professionalization of these practitioners. Research on physicians has mainly investigated: physicians’ views on and professional relationships with alternative therapists; physicians’ views on the efficacy of alternative therapies; the orthodoxy’s views on the knowledge base of these therapeutic systems; and physicians who use alternative techniques. The article argues that a paucity of empirical research is a major weakness of the present state of the sociology of alternative medicine and thus several research possibilities are delineated. Its aim is to provide a critical review of the literature on each of the above topics and suggest future research possibilities.

Complementary and alternative medicine use among paediatric emergency department patients

AIM

To determine the period prevalence and nature of complementary and alternative medicine (CAM) use among paediatric emergency department (ED) patients and the perceptions of CAM among the CAM administrators.

METHODS

A survey was undertaken in four Victorian EDs (January to September 2013). A convenience sample of parents/carers accompanying paediatric patients completed a self-administered questionnaire. The main outcome measures were CAM use and perceptions of CAM.

RESULTS

The parents/carers of 883 patients participated. Three hundred eighty-eight (43.9%, 95% confidence interval (CI) 40.6-47.3) and 53 (6.0%, 95% CI 4.6-7.8) patients had taken a CAM within the previous 12 months and on the day of presentation, respectively. There were no gender differences between CAM users and non-users (P = 0.83). The use of CAM was significantly more common among older patients (P < 0.001), those with European ethnicity (P = 0.046) and among those with chronic disease (P < 0.01). Fish oil, garlic, chamomile and acidophilus were the most commonly used CAM. Only 4.4% of CAM use was reported to the ED doctor. There were reports of potentially dangerous CAM use (St John's wort, ginseng). Parents/carers who had administered CAM were more likely to report that CAMs are safe, drug free and could prevent illness (P < 0.01). In addition, a number of this group reported that CAMs are more effective than prescription medicines and safe when taken with prescription medicines.

CONCLUSION

CAM use is common among paediatric ED patients although rarely reported to the ED doctor. Parents/carers who administer CAM have differing perceptions of CAM safety from those who do not.

Investigation into the use of complementary and alternative medicine and affecting factors in Turkish asthmatic patients

AIMS

The purpose of this study was to examine the frequency of complementary and alternative medicine usage in asthmatic patients living in the west of Turkey, the most frequently used complementary and alternative medicine methods and socio-demographic factors affecting this and factors related to the disease.

BACKGROUND

While the rate of complementary and alternative medicine usage in asthmatic patients and the reasons for using it vary, practices specific to different countries and regions are of interest. Differing cultural and social factors even in geographically similar regions can affect the type of complementary and alternative medicine used.

METHODS

Two hundred asthmatic patients registered in the asthma outpatient clinic of a large hospital in Turkey and who had undergone pulmonary function tests within the previous six months were included in this study, which was planned according to a descriptive design. The patients filled out a questionnaire on their demographic characteristics and complementary and alternative medicine usage.

RESULTS

The proportion of patients who reported using one or more of the complementary and alternative medicine methods was 63·0%. Of these patients, 61·9% were using plants and herbal treatments, 53·2% were doing exercises and 36·5% said that they prayed. The objectives of their use of complementary and alternative medicine were to reduce asthma-related complaints (58%) and to feel better (37·8%). The proportion of people experiencing adverse effects was 3·3% (n = 4). Factors motivating asthmatic patients to use complementary and alternative medicine were the existence of comorbid diseases and a long period since diagnosis (p < 0·05). No statistically significant difference was found between the use of complementary and alternative medicine and the severity of the disease, pulmonary function test parameters, the number of asthma attacks or hospitalisations because of asthma within the last year (p > 0·05).

RELEVANCE TO CLINICAL PRACTICE

Understanding by nurses of the causes and patterns of the use of complementary and alternative medicine in asthmatic patients helps them in directing patient care and patient safety. Nurses should conduct comprehensive diagnostics in the light of complementary and alternative medicine use, and they should be aware of the potential risks.

Role of chiropractic and sacro-occipital technique in asthma treatment

Asthma is a multifactorial dysfunction of the respiratory system. Nutritional, environmental, genetic, and emotional factors all play animportant part in the etiology of this condition. One form of chiropractic, Sacro Occipital Technique (SOT), offers some conservative alternatives to the treatment of asthma. SOT expands the chiropractic armamentarium of techniques available, allowing methods putatively affecting the viscera, vertebra, post and preganglionic reflexes, as well as cranial and sacral influences on the primary respiratory mechanism. Though more research is needed to evaluate the efficacy of chiropractic care of asthma, the conservative nature of chiropractic care with its minimal side effects, warrants patient and a health practitioner's consideration prior to embarking on any course of treatment that might have serious side effects.

Complementary and alternative medicine behaviors and beliefs in urban adolescents with asthma

BACKGROUND/PURPOSE

Up to 80% of adolescents with asthma have used complementary and alternative medicine (CAM) for symptom management. However, little is known about patient characteristics associated with CAM factors other than use. Previous studies recommend provider-patient discussion of CAM use, although few adolescents with asthma disclose their CAM use to their providers. To inform clinical interactions, this study examined prevalence and predictors of CAM use, consideration of use, disclosure of use, and perceived efficacy of use, in urban adolescents with asthma.

METHODS

Adolescents with asthma (N = 151) recruited from a children's hospital completed questionnaires addressing demographic and clinical variables and 10 CAM modalities. Response frequencies to four questions assessing CAM use, consideration of use, disclosure, and perceived efficacy were calculated for each modality. Multivariable logistic regression analyses examined characteristics associated with responses to each question for the two most commonly used CAM modalities.

RESULTS

Participants' mean age was 15.8 (SD = 1.8), 60% were female and 85% were African-American. Seventy-one percent reported using CAM for symptom management in the past month. Relaxation (64%) and prayer (61%) were the most frequently reported modalities and were perceived to be the most efficacious. Adolescents most commonly reported considering using relaxation (85%) and prayer (80%) for future symptom management. Participants were most likely to disclose their use of yoga (59%) and diet (57%), and least likely to disclose prayer (33%) and guided imagery (36%) to providers. In multivariable analyses, older adolescents (OR = 1.27, p < .05) and African-Americans (OR = 2.76, p < .05) were more likely to use relaxation. Adolescents with more frequent asthma symptoms (OR = 0.98, p < .05) were more likely to use prayer. African-Americans were more likely to report using prayer (OR = 3.47, p < .05) and consider using prayer (OR = 7.98, p < .01) in the future for symptom management.

CONCLUSIONS

Many urban adolescents used and would consider using CAM, specifically relaxation and prayer, for asthma symptom management. African-Americans, older adolescents, and those with more frequent symptoms were more likely to use and/or consider using CAM. Providers caring for urban adolescents with asthma should discuss CAM with patients, particularly those identified as likely to use CAM. Future studies should examine relationships between CAM use and health outcomes.

Barriers to asthma management among urban families: caregiver and child perspectives

OBJECTIVE

Asthma is one of the most common chronic diseases of childhood. Those particularly affected are young, poor, African American children. Moreover, rates of emergency department visits, hospitalizations, and mortality are substantially higher for black children. Despite the ample published research on asthma prevalence and asthma management interventions, there is little research available on barriers to asthma care among urban, low-income families as perceived by children with asthma and their caregivers.

METHODS

This qualitative study analyzed data from five focus groups conducted with 28 participants in metropolitan Atlanta.

RESULTS

This study found caregiver and child health beliefs and perceptions concerning the use of daily controller medications to be a significant barrier to asthma care and proper self-management at home and at school. Barriers to environmental control consisted mostly of financial constraints, which made residential environmental remediation activities difficult to implement. Psychological distress was prevalent among both children and caregivers, which demonstrated the burden associated with managing a chronic illness.

CONCLUSION

Families in urban, low-income communities require asthma management interventions tailored to their specific characteristics, barriers, and challenges. Our findings can be used to inform and enhance asthma management interventions for urban families with children with asthma.

Use of complementary and alternative medicine by patients presenting to a Paediatric Emergency Department

Although the popularity of complementary and alternative medicine (CAM) has risen in the last decade, information about its use by paediatric patients presenting to an Emergency Department is still sparse. We report here the results of a cross-sectional survey of paediatric patients presenting to an urban, tertiary paediatric Emergency Department between October 2006 and March 2007. In total, 1143 questionnaires (68% of those distributed) were completed and available for analysis. Of these, 58% (n = 665) of all respondents admitted that their child had received some form of CAM therapy, while 25% (n = 291) admitted that their child was receiving CAM for the present illness. In 31% of the respondents (n = 354), CAM had been prescribed by a physician, while 50% (n = 575) used CAM as self-medication. Patients presented to the Emergency Department mostly because of an infection (42% of total; 29% of these used CAM) or a trauma (38% of total; 19% of these used CAM). Parents of CAM-users were significantly older, more often born in Switzerland and had significantly higher school education than those of the non-users. Nearly two-thirds of the administered CAM therapies were not prescribed by a physician, and 50% of the families using CAM did not discuss this with their general practitioner. Parental requirements implied that medical professionals on a paediatric Emergency Department should know the effects and side-effects of CAM therapies and even be able to recommend them. The study population, even trauma patients, frequently used CAM. The use of CAM is characterised by a high rate of self-medication and the exclusion of the physicians from the decision-making process. The parents of paediatric patients frequently demand that CAM be considered as a possible treatment option and wish to have an open discussion with the medical professionals on this topic.

A multicenter survey of childhood asthma in Turkey. II: Utilization of asthma drugs, control levels and their determinants

Many surveys worldwide have consistently demonstrated a low level of asthma control and under-utilization of preventive asthma drugs. However, these studies have been frequently criticized for using population-based samples, which include many patients with no or irregular follow-ups. Our aim, in this study, was to define the extent of asthma drug utilization, control levels, and their determinants among children with asthma attending to pediatric asthma centers in Turkey. Asthmatic children (age range: 6-18 yr) with at least 1-yr follow-up seen at 12 asthma outpatient clinics during a 1-month period with scheduled or unscheduled visits were included and were surveyed with a questionnaire-guided interview. Files from the previous year were evaluated retrospectively to document control levels and their determinants. From 618 children allocated, most were mild asthmatics (85.6%). Almost 30% and 15% of children reported current use of emergency service and hospitalization, respectively; and 51.4% and 53.1% of children with persistent and intermittent disease, respectively, were on daily preventive therapy, including inhaled corticosteroids. Disease severity [odds ratio: 12.6 (95% confidence intervals: 5.3-29.8)], hospitalization within the last year [3.4 (1.4-8.2)], no use of inhaled steroids [2.9 (1.1- 7.3)], and female gender [2.3 (1.1-5.4)] were major predictors of poor asthma control as defined by their physicians. In this national pediatric asthma study, we found a low level of disease control and discrepancies between preventive drug usage and disease severity, which shows that the expectations of guidelines have not been met even in facilitated centers, thus indicating the need to revise the severity-based approach of asthma guidelines. Efforts to implement the control-based approach of new guidelines (Global Initiative for Asthma 2006) would be worthwhile.

Unconventional therapy use among asthma patients in a tertiary care center in Riyadh, Saudi Arabia

OBJECTIVES

Unconventional therapy (UT) is a therapeutic practice of alternative and complementary medicine that is not currently considered an integral part of modern medical practice. The aim of this article is to investigate the experience of Saudi patients with UT modalities in the treatment of asthma.

MATERIALS AND METHODS

We carried out a cross-sectional study of asthma patients referred to King Abdulaziz Medical City, Riyadh, Saudi Arabia, during the year 2004. Information was collected using a pre-designed questionnaire administered through interviews.

RESULTS

Two hundred consecutive patients with a mean age of 52.3 years (+/-18.7) were included in this study. Sixty-nine (34.5%) of those patients used some form of UT in the previous year. There was a tendency to use UT among the older age group (P = 0.029) and among those with longer duration of disease (P = 0.009). However, there was no significant correlation observed between the use of UT and gender, FEV(1), or disease control. The most commonly used form of UT was recitation of Holy Quran (9%), honey (24.5%), herbs (23.5%), cautery (12%), and blackseed (10%). There was no significant correlation between disease control and the use of modalities.

CONCLUSION

Unconventional therapy is frequently practiced by asthma patients in Saudi Arabia, who commonly believe that UT will lead to improvement. The lack of evidence necessitates the fostering of a national project to address the practice of UT.

Integrative medicine and asthma

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.

Complementary medicine use in multi-ethnic paediatric outpatients

OBJECTIVE

To determine the prevalence and determinants of complementary medicine (CM) use in a multi-ethnic paediatric outpatient population.

METHODOLOGY

A parent-completed questionnaire survey of paediatric outpatients attending general and sub-specialist outpatient clinics at a North West London hospital during September to December 2005.

RESULTS

Parents' use of CM for their children in this multi-ethnic population was higher than expected at 37%. Use was correlated with parental CM use and education but independent of ethnic group. Parental CM use and child's health status were significant predictors of child CM use. The main reason for using CM was word of mouth (45%) and the main source of information was friends and family (51%). The most popular treatments used for children were homeopathy and herbal medicine (used by 30% and 28% of CM users, respectively). 88% of CM was bought over the counter and 53% of CM use was not reported to their doctor. Parents also used traditional complementary remedies for their children.

CONCLUSIONS

These results suggest that CM use in children is higher than previously estimated in the UK. This indicates the need for greater professional awareness of CM as part of clinical care. There is a need to acknowledge the beliefs that inform parents' decision-making process.

The characteristics of complementary and alternative medicine use by parents of asthmatic children in Southern Israel

AIM

The aim of this study was to estimate the rate and describe the characteristics of complementary and alternative medicine (CAM) use by children with asthma in a paediatric primary care clinic in southern Israel.

METHOD

A cross-sectional study including 252 asthmatic children aged 2-12-years was conducted. Socio-demographic data and asthma history were collected using a telephone questionnaire. Computerized medical records were used to complete the data.

RESULTS

Sixteen percent (95% CI 11.5-20.5) of the asthmatic children participating in this study used CAM; most popular were homeopathy (36.6%) and reflexology (14.6%). According to multivariate model, CAM use was more prevalent in families in which fathers had professional training (OR = 4.9, 95% CI 1.82-13.02, p = 0.002), mothers were employed (OR = 4.1, 95% CI 1.018-16.1, p = 0.047), and origin of maternal grandfathers was European (OR = 4.7, 95% CI 1.86-11.8, p = 0.001). Families who used CAM, also more frequently sought rabbinical advice (OR = 11.9, 95% CI 2.94-47.7, p = 0.001).

CONCLUSIONS

The prevalence of CAM use found in this study is lower than seen in other Western countries. The 'average family' using CAM to treat its asthmatic child includes an educated father, an employed mother and maternal grandfather from Europe, and would more often seek rabbi's advice.

Pediatricians' attitudes, experience and referral patterns regarding Complementary/Alternative Medicine: a national survey

BACKGROUND

To assess pediatricians' attitudes toward & practice of Complementary/Alternative Medicine (CAM) including their knowledge, experience, & referral patterns for CAM therapies.

METHODS

An anonymous, self-report, 27-item questionnaire was mailed nationally to fellows of the American Academy of Pediatrics in July 2004.648 of 3500 pediatricians' surveyed responded (18%).

RESULTS

The median age ranged from 46-59 yrs; 52% female, 81% Caucasian, 71% generalists, & 85% trained in the US. Over 96% of pediatricians' responding believed their patients were using CAM. Discussions of CAM use were initiated by the family (70%) & only 37% of pediatricians asked about CAM use as part of routine medical history. Majority (84%) said more CME courses should be offered on CAM and 71% said they would consider referring patients to CAM practitioners. Medical conditions referred for CAM included; chronic problems (headaches, pain management, asthma, backaches) (86%), diseases with no known cure (55.5%) or failure of conventional therapies (56%), behavioral problems (49%), & psychiatric disorders (47%). American born, US medical school graduates, general pediatricians, & pediatricians who ask/talk about CAM were most likely to believe their patients used CAM (P < 0.01).

CONCLUSION

Pediatricians' have a positive attitude towards CAM. Majority believe that their patients are using CAM, that asking about CAM should be part of routine medical history, would consider referring to a CAM practitioner and want more education on CAM.

Complementary and alternative therapies: survey of knowledge and attitudes of health professionals at a tertiary pediatric/women's care facility

Nurses, physicians, and allied health professionals at the IWK Health Centre, Halifax, NS, Canada, a tertiary care, regional center for a population of 2.5 million were surveyed. We examined personal attitudes and professional practice in addressing the use of complementary and alternative medicine (CAM) use by patients. We also examined the availability of CAM-related information to health professionals. The findings suggest that health professionals: (1) are supportive of the use of selected CAM therapies by patients; (2) have almost no personal experience of CAM; (3) have limited knowledge about CAM and acquire that information mainly from the Internet, friends or family rather than professional journals; (4) are uncomfortable discussing CAM with patients and; (5) rarely or never ask patients about CAM use. We have identified barriers for health professionals to effective communication about CAM use by their patients and families. Improved access to existing policies and scientific publications, and specific continuing professional development opportunities focused on speaking openly and non-judgmentally with patients are likely to enhance accurate guidance of patients in the highly prevalent use of CAM.

Use frequency of traditional Chinese medicine in Taiwan

Background

Use of Traditional Chinese medicine (TCM), an important category of complementary and alternative medicine (CAM), has increased substantially in Western countries during the past decade. Use of TCM is also widespread in the Chinese population. However, few informative data have been obtained to date by large-scale investigations of TCM use in the Chinese population. This study was aimed at elucidating the demographics and patterns of TCM use in Taiwan.

Methods

We employed the complete datasets of TCM outpatient reimbursement claims from 1996 to 2001, including the use of Chinese herbal remedies, acupuncture and traumatology manipulative therapy, to analyse use frequencies, the characteristics of TCM users, and the disease categories that were treated by TCM in Taiwan.

Results

At the end of 2001, 6,142,829 (28.4%) among the 21,653,555 valid beneficiaries of the National Health Insurance in Taiwan had used TCM during the year. However, 13,536,266 subjects (62.5%) had used TCM at least once during the whole 6-year period from 1996 to 2001, with a total of 156,224,266 visits (mean 11.5 visits per user). The mean number of TCM users per annum was 5,733,602, with a mean increment of 1,671,476 (29.2%) of new users yearly. Among TCM users, female was higher than male (female:male = 1.13:1), and the age distribution displayed a peak at around the 30s, followed by the 20s and 40s. Chinese herbal remedies (85.9%) were the most common TCM modality used by this population, followed by acupuncture (11.0%) and traumatology manipulative therapies (3.1%). Private TCM clinics provided most of the TCM care (82.6%), followed by private TCM hospitals (12.0%). The top ten major disease categories for TCM visits were diseases of the respiratory system, musculoskeletal system and connective tissue; symptoms, signs and ill-defined conditions; injury and poisoning; diseases of the digestive system, genitourinary system, skin and subcutaneous tissue, nervous system and sense organs, circulatory and endocrine system; nutritional and metabolic diseases; and immunological disorders.

Conclusion

TCM was popular among the Chinese population in Taiwan during the period studied. More than 60% of all subjects had used TCM during the 6-year interval. TCM was widely used by the Chinese population to treat problems and diseases of major human organ systems recognised by western medicine. This study provides information about the use frequencies of TCM and the disease categories treated by TCM, which should be useful for health policy makers and for those considering the integration of TCM and Western medicine.

The use of complementary/alternative therapies among children attending an urban pediatric emergency department

The incidence of and factors associated with complementary/alternative medicine use by pediatric patients was determined by face-to-face interviews with 602 parents/caregivers of children aged birth to 18 years who presented to an urban pediatric emergency department from February 2004 to September 2004. The overall use of complementary/alternative medicine among children was 15% and more common among children older than 5 years (21%). Families who used complementary/alternative medicine thought results were best when both complementary/alternative medicine and conventional medicine were integrated (P < .001). Most common types of complementary/alternative therapies used were folk remedies/home remedies (59%), herbs (41%), prayer healing (14%), and massage therapy (10%). Complementary/alternative medicine use was significant among the sample of children visiting an urban pediatric emergency department. Pediatricians should inquire about complementary/alternative use in the emergency department, particularly in children older than 5 years and those with parents/caretakers using complementary/alternative medicine themselves.

Complementary and alternative medicine use in asthma: who is using what?

Consumer interest in complementary and alternative medicine (CAM) has grown dramatically in Western countries in the past decade. However, very few patients volunteer information about CAM use unless directly questioned by their health-care practitioner. Therefore, by being informed about the prevalence and modality of CAM use for asthma, as well as characteristics of users, health-care practitioners may be better able to identify patients who use CAM. In turn, this may facilitate proactive discussion and optimization of the patient's overall asthma management. This review aims to summarize the current knowledge about use of CAM by people with asthma, and to assess the applicability of the available studies to the broader asthmatic population. Computerized literature searches were conducted on Medline, Embase, Cochrane and Allied and Complementary Medicine (AMED) databases from their inception to 13 April 2005. Search terms included: complementary medicine/therapies, alternative medicine/therapies and asthma. The bibliographies of accessible articles were searched for further papers. Seventeen studies have examined the use of CAM by people with asthma. The reported level of use for adults ranged from 4% to 79%, and for children from 33% to 89%. Among the most commonly used CAMs were: breathing techniques, herbal products, homeopathy and acupuncture. There is no strong evidence for effectiveness for any of these modalities. There is little consistency among available prevalence studies making conclusions difficult. Nevertheless, the high rates of CAM use reported in some studies indicate that CAM use should be taken into account when managing patients with asthma.

Psychological interventions for children with asthma

BACKGROUND

Asthma is a chronic disease of inflammation and smooth muscle dysfunction, including bronchoconstriction. These symptoms are usually associated with widespread but variable airflow obstruction that is often reversible either spontaneously or with treatment. Psychological factors may influence the symptoms and management of asthma in children in many ways, for example, evidence suggests that emotional stress can either precipitate or exacerbate both acute and chronic asthma.

OBJECTIVES

To assess the efficacy of psychological interventions in improving health and behavioural outcomes for children with asthma.

SEARCH STRATEGY

The Cochrane Airways Group Specialised Register and PsycINFO were searched with pre-defined terms up until March 2005.

SELECTION CRITERIA

Randomised controlled trials published in any language assessing the effects of a psychological intervention compared with a control intervention in children and adolescents with asthma were included in the review. Cross-over trials were considered inappropriate for studies using psychological interventions and were therefore excluded from this systematic review.

DATA COLLECTION AND ANALYSIS

Two reviewers assessed the relevance of abstracts identified by electronic searching and retrieved agreed studies for further scrutiny. The studies that met the inclusion criteria were assembled and data extracted.

MAIN RESULTS

Twelve studies (588 children) were included in the review. Study quality was poor and sample sizes were frequently small. A meta-analysis was possible on two studies only examining the effects of relaxation therapy on PEFR which favoured the treatment group (32 L/min, 95% CI 13 to 50 L/min). No other meta-analysis could be performed due to the diversity of interventions and the outcomes assessed. In addition, many studies reported insufficient data.

AUTHORS' CONCLUSIONS

This review was unable to draw firm conclusions for the role of psychological interventions for children with asthma. This review demonstrates the absence of an adequate evidence base and highlights the need for well-conducted and reported randomised trials in this area.

Views of pediatric health care providers on the use of herbs and dietary supplements in children

Herbs and dietary supplements (HDS) are widely used by adults for treating illnesses and/or preserving good health, and many parents use HDS for their children as well. Previous reports suggest parents will not divulge HDS use to health care providers for fear of their skepticism or disapproval. Yet the views of pediatric health care providers on HDS use in children are not well known. This study investigated the attitudes and practices of pediatric nurses and physicians regarding HDS use in children, in order to identify those characteristics associated with a high degree of confidence in initiating a dialogue on the topic of HDS with families in their practice. A written survey on attitudes and practices toward HDS was developed, piloted, revised, and then administered to a convenience sample of practitioners attending a regional postgraduate course in general pediatrics. Only 42% of 204 pediatric health care providers sampled felt confident in initiating discussions about the therapeutic use of herbs and dietary supplements with families in their practice. Confidence in discussing HDS with families correlated with both personal use of an HDS (OR 3.22; p=0.033) and length of time in practice less than 10 years (OR 8.26; p=0.007). Less than 18% felt that HDS were safe for children under 6 months of age; and only 35% felt they were safe for use in children < 24 months old. Only 7% felt that parents should be allowed to give their hospitalized child an herb or dietary supplement they had brought with them from home, although this increased to 35% if the herb or dietary supplement had been prescribed by a physician. Ninety-two percent of practitioners thought that HDS should be more closely regulated by the FDA. Only a minority of pediatric community practitioners felt confident in discussing HDS with families of children in their practice. Those who had been in practice for a shorter time and who had used HDS themselves were more likely to report confidence in initiating such discussions. The provision of more postgraduate educational opportunities to learn about herbs and dietary supplements may alleviate some practitioners' concerns about their own competency in discussing HDS with families in their practice.

Non‐conventional approaches to allergy testing: reconciling patient autonomy with medical practitioners’ concerns

It may be difficult for patients to distinguish current concepts of immune function from other, non-conventional explanations of illness.

Survey of complementary and alternative medicine use at a tertiary children's hospital

OBJECTIVE

The use of complementary and alternative medicine (CAM) within the Australian community is common. The objective of this study was to determine the prevalence and pattern of CAM usage in children attending a tertiary children's hospital.

METHODS

We conducted a cross-sectional survey of children attending the Royal Children's Hospital, Melbourne. Children were identified by consecutive acute admissions and attendance at outpatient clinics. A structured questionnaire with items about the use of CAM in the preceding year was administered by means of a face-to-face interview.

RESULTS

Based on the 503 children surveyed, 51% reported CAM use in the preceding year. Forty-three percent had used at least one CAM medication. The most common medicinal CAM used were multivitamins, vitamin C, herbal remedies and homeopathic treatments. Non-medicinal CAM was used by 23% of the participants. The most commonly used therapies were chiropractic, naturopathy, aromatherapy, therapeutic massage and dietary restriction. The main reasons stated for CAM usage included promotion of general health and treatment of colds. Sixty-three percent of those reporting CAM use had not discussed this with their treating doctor.

CONCLUSION

The use of CAM by children is common. Complementary and alternative medicine is particularly used for the treatment of common illnesses and conditions of childhood. Importantly, use is not always conveyed to treating physicians. Given the potential risk of adverse events associated with the use of CAM or interactions with conventional management, doctors should ask about their use as a part of routine history taking.

Adolescent use of complementary therapies

PURPOSE

Interest in alternative/complementary therapies (A/CTs) is on the rise, yet little is known about adolescents' use of A/CTs. The study purpose was to examine A/CT utilization patterns among a clinic-based sample of adolescents.

METHODS

A cross-sectional survey of 401 adolescents, aged 12-18 years, was conducted in one Midwest urban adolescent ambulatory clinic in 2002.

RESULTS

Overall, 68.1% of the adolescents reported using one or more A/CT; most commonly, herbal medicines (27.2%), massage therapy (26.7%), and megavitamins (21.7%). Use by friends and family was the primary influence for adolescent A/CT use; lack of familiarity was the greatest reason for nonuse (53.9%). Alleviation of physical pain (66.3%) was the most common desired health outcome. Few adolescents (13.8%) disclosed A/CT use to their health care providers. Insurance coverage was provided for 10.2% of the therapies and out-of-pocket costs averaged 67 dollars/month. Age, race/ethnicity, having a health condition, taking medications, health responsibility, and work status were associated with overall A/CT use in bivariate analyses. Of these, only associations between A/CT use and race/ethnicity and health responsibility remained statistically significant after adjusting for the other variables.

CONCLUSIONS

Use of A/CTs was common among these adolescents, yet very few disclosed their use to health care providers. Providers must ask about A/CT use to gain a more complete understanding of health practices among adolescents in clinical settings. Future research is needed to better understand representative patterns of A/CT use.

Defining complementary and alternative medicine in allergies and asthma: benefits and risks

In this review, the current literature discussing complementary/alternative medicine (CAM) interventions, the prevalence and pattern of use, examples of specific modalities and the risks of CAM for asthma and atopic disease are discussed. The specific risks of CAM interventions associated with the use of these modalities, omission of traditional therapeutic modalities, and the liability risk for physicians who either provide or counsel their patients regarding CAM interventions are also discussed.

Use of alternative therapies by patients presenting to a pediatric emergency department

Complementary and alternative medicine (CAM) is used by some patients to supplement their health care. Information on the use of CAM in children who are not chronically ill is sparse. We conducted a survey of caregivers presenting to a tertiary pediatric Emergency Department to determine CAM use in this population. Six hundred twenty questionnaires (77.6% of those distributed) were available for analysis. Approximately 13% of caregivers reported using CAM for their child. The most common CAM therapies used were homeopathy (20%), prayer/spiritual approaches (19.7%), and massage therapy (16.7%). Age of child greater than 1 year was associated with CAM use (p < 0.05), as was parental higher education (p < 0.0001). Income, ethnicity, parental age, and chronic illness were not correlated with CAM use. CAM therapies are infrequently used in pediatric patients presenting to the Emergency Department.

Dietary supplement use is prevalent among children with a chronic illness

OBJECTIVE

To determine the nature and prevalence of dietary supplement use among chronically ill children.

DESIGN

This descriptive study used a self-report questionnaire.

SUBJECTS

A convenience sample of parents of 505 chronically ill children and adolescents seen in subspecialty medical clinics in Salt Lake City, UT. The medical conditions studied included asthma, cystic fibrosis, diabetes, cancer, liver and renal transplantations, seizures, and rheumatological and neurobehavioral disorders. Statistics Sample characteristics were described using frequencies, percentages, means, and standard deviations. chi 2 tests were used to compare sex, ethnicity, parental education level, and dietary supplement use variations among the various diagnostic categories. Analysis of variance with Bonferroni correction for multiple comparisons was used to determine differences among diagnosis groups for continuous variables, and the Kruskal-Wallis test was used to test categorical variables.

RESULTS

The population sampled was predominately white (88.5%), with a mean age of 9.9+/-5.3 years. Sixty-two percent of the population used dietary supplements, and 30% used nonprescribed supplements. Significant differences were noted among diagnosis groups, with the highest nonprescribed use reported in children with cancer (solid tumors=46%; leukemia=44%), cystic fibrosis (35%), neurobehavioral disorders (35%), and rheumatological disorders (34%). Only 20% of those using nonprescribed dietary supplements had discussed this use with the health care provider.

CONCLUSIONS

Dietary supplement use is prevalent among chronically ill children, especially among those with a poor prognosis or for whom there are limited medical treatments. Few pediatric health care providers are aware of their patients' use of nonprescribed supplements. This is a concern because of the unknown effects of many supplements on growth and development and the potential for adverse drug interactions.

Use of complementary and alternative medicines by children and adolescents with inflammatory bowel disease

OBJECTIVES

The use of complementary and alternative medicines (CAM) appears increasingly prevalent in children and adolescents. Individuals with chronic illness may have patterns of greater usage. This questionnaire-based study aimed to ascertain the frequency of use by a group of children with proven inflammatory bowel disease (IBD) and to consider the reasons for their use.

METHODS

A questionnaire was sent by mail to the parents of patients currently attending a paediatric IBD clinic. Parents were asked to describe their child's usage of alternative and probiotic therapies and to comment on a number of aspects of such therapies.

RESULTS

Forty-six (77%) of 60 mailed questionnaires were returned. The mean age of the children was 10.9 (+/- 4.1) years and they were taking an average of 1.7 (+/- 0.8) prescribed medications. Thirty-three (72%) of the children were said by their parents to be having CAM, with four having five or more such therapies (average 2.4 +/- 1.3 agents per child). The most commonly used agents were probiotics (78%) and fish oils (56%). A minority (12%) of respondents reported that their child's CAM was very effective, although many (50%) noted partial benefits. The 13 children who had never used any CAM therapies ('non-users') did not differ from the 'users' in terms of gender, age, disease or duration of disease. As expected, non-users expressed greater concerns about use of CAM and described different attitudes towards such therapies.

CONCLUSION

Complementary and alternative medicines, especially probiotic therapies, frequently are administered to children and adolescents with inflammatory bowel disease. Often this appears to be due to parental frustration with managing their child's chronic illness. Practitioners caring for children and adolescents with IBD need to be aware that their patients may be using alternative therapies and adopt an open attitude in this situation.

Complementary and alternative medicines (CAM) in the management of asthma: an examination of the evidence

Although individuals are using Complementary and Alternative Medical (CAM) therapies to help manage their asthma, there is no clear direction in the current guidelines for the use of CAM in asthma. This literature review undertakes to determine the current science regarding the use of CAM in asthma management. Electronic literature searched all EBM Reviews, Medline, OVID full text, and PubMed and National Complementary and Alternative Medication databases for Randomised Controlled Trials (RCT) published in English between 1997 and 2002 with keywords "asthma" and "complementary medicine" or "complementary therapy" or "alternative medicine" or "alternative therapy." Abstracts (N=197) were reviewed for inclusion in the review and duplicates discarded (N=65). Abstracts of non-RCT studies, review articles, and surveys were also discarded (N=66). Abstracts discussing environmental control measures and pharmaceutical alternatives to steroid therapy were discarded (N=9). The 15 final studies were grouped within three categories: mind-body and relaxation, manual therapies, and diet and reviewed for statistical and clinical significance, suggesting some CAM therapies have shown minimally significant improvements in asthma quality of life (breathing exercises) or pulmonary function (relaxation) and immune function (relaxation and acupuncture) in select asthma populations. Although CAM therapy is being used in the management of asthma, these 15 studies show a tendency to little or no significant difference between placebo or sham therapy. This may be due, in part, to the enhanced placebo effect of sham therapies used as control and the small size of most studies. Although the changes in the immune function seen in two studies are provocative, these changes did not translate to changes in lung function. More research is needed to assist in determining the efficacy of CAM therapies in asthma management.

The use of complementary therapies in inner-city asthmatic children

Use of complementary/alternative medicine (CAM) has been increasing, especially among patients with a chronic illness. Although asthma is the most common chronic illness affecting children in the United States, very little is known about the use of CAM in children with asthma. Our objective was to determine the prevalence and correlates of CAM use among inner-city children with asthma. A cross-sectional survey of parents of children with asthma attending an urban health center was performed. Parents were surveyed regarding CAM use over the past year, perceived efficacy of CAM, severity of child's asthma symptoms and demographic information. Differences in proportions were tested by chi-square or Fisher's exact test as appropriate. Three hundred ten parents participated, of whom 61% were Hispanic and 37% were African American. Parental mean age was 33 years and the mean age of the child was 7.2 years; 89% of parents had treated their child in the past year with some form of CAM. However, only 18% had informed a physician of doing so. The most common forms of CAM used were as follows: prayers (53%), rubs (53%), and massage (45%). Of those who used CAM, 59% perceived it to be at least as effective as pharmacotherapy, and 44% used CAM as first treatment of an asthma attack. Mild and moderate persistent asthmatics had significantly higher rates of CAM use than did mild intermittent and severe persistent asthmatics. We found a very high rate of CAM use among children with asthma in this inner-city population. Most importantly, a very high proportion of parents perceived the therapies to be effective, used them as first treatment of an acute exacerbation, and did not inform a physician of doing so. These findings have implications for the care of asthmatic children by pediatricians practicing in urban settings.

Patterns and perceptions of complementary/alternative medicine among paediatricians and patients' mothers: a review of the literature

For many families and their children, the use of complementary/alternative medicine (CAM) is an accepted adjunct or alternative to conventional therapy, even if data available in the literature regarding risks and adverse drug reactions (ADRs) pertaining to childhood populations are scarce. Moreover, despite widespread and increasing use of CAM, there are limited data on how paediatricians communicate with mothers and/or patients about CAM. Therefore, we report the studies available in the literature in the paediatric field and summarise what is known about ADRs and risks of CAM, taking into account in particular problems related to interactions between phytotherapy and conventional medicines and to counselling.

CONCLUSION

from the analysis of the literature, some interesting aspects emerge: (1) the extent of CAM use in the paediatric field is increasingly sought by parents of children with chronic illnesses; (2) most parents who choose CAM medicine for their children believe that these therapies are "natural" and thus "safe" and (3) physicians often feel to know too little about CAM and wish to learn more for different reasons including "to dissuade whether the alternative method is unsafe and/or ineffective". Therefore, paediatricians should be prepared to discuss alternative therapies with parents, since talking about CAM may help to minimise the risks and to restrain parental misconceptions and doubts. Educational interventions for parents should also be performed to bring about a more aware use of traditional and alternative medicines.

Use of complementary/alternative medicine among paediatric patients

The use of complementary/alternative medicine (CAM) is increasing. The aim was to characterise the use of CAM among patients in a paediatric department. All patients (aged 0-18 years), out-patients or hospitalised, in contact with the Department of Paediatrics, Odense University Hospital during a 2 week period in the autumn of 2001 were asked to participate. In total, 622 (92%) patients participated. The data were collected in an interviewer administered questionnaire during a short structured interview with the patient and parents. CAM was divided into herbal medicine (herbal drugs or dietary supplements) (HM), alternative therapy (AT) (i.e. acupuncture) or chiropractic (CHI). Of all patients, 53% had tried CAM at least once and 23% had tried CAM within the last month (15% HM, 7% AT and 2% CHI). There was no correlation between use of CAM and gender, age or if the patient was out-patient or hospitalised. The users were pre-school children. HM (Bio-Strath and Echinacea) was especially used to strengthen the immune system. Among AT, reflexological treatment was the most popular treatment. The most frequent users of CAM were patients with asthma, eczema or allergy plus patients suffering from gastrointestinal diseases or hospitalised for observation. More than 50% of the users experienced positive effects and 6% had side-effects from AM. Of the CAM users, 11% or 2% of the total paediatric population used CAM instead of conventional medicines.

CONCLUSION

Of the paediatric patients, 53% had tried complementary/alternative medicine, which was used as a supplement to conventional medicine although we did not know how long it was used. Paediatric patients should be interviewed about their use of complementary/alternative medicine with regard to side-effects, interactions or lack of compliance with conventional medicine.

Use of complementary and alternative medicine by pediatric rheumatology patients

OBJECTIVE

To assess how often the patients in The Hospital for Sick Children's rheumatology clinic use complementary and alternative medicine (CAM), and the type of CAM used.

METHODS

Cross-sectional descriptive survey study in a tertiary care referral center.

RESULTS

We found that 90 (64%) of 141 respondents used at least 1 form of CAM; 45 (50%) of these 90 used more than 1 form. Duration of illness was positively associated with the use of CAM; the difference in the mean length of illness between users (4.12 +/- 3.60 years) and nonusers (2.82 +/- 3.23 years) was 1.3 years (P = 0.04). Of the 41 respondents with more than 1 illness, 32 used CAM, compared with 57 of 96 who had only 1 illness (P = 0.036).

CONCLUSION

Health care providers must be aware of their patients' possible use of CAM, especially those with more than 1 illness.

Use of complementary and alternative therapies and probiotic agents by children attending gastroenterology outpatient clinics

OBJECTIVES

Complementary and alternative medicines (CAM) and probiotic therapies appear to be increasingly accepted and used. This questionnaire-based study aimed to ascertain the frequency of use and the acceptance of these therapies by children attending outpatient gastroenterology clinics.

METHODS

Parents accompanying children to their appointments were asked to complete a questionnaire in order to determine usage of probiotic and alternative therapies. Questions also ascertained relevant background information and parental acceptance of alternative therapies.

RESULTS

Ninety-two questionnaires were completed. The ages of the children varied from 6 months to 16 years (mean +/- SD; 6.5 +/- 4.3 years) and they had been prescribed an average of 1.7 +/- 1.3 (range 0-6) conventional medications. Thirty-three children (35.9%) were taking CAM and 98.6% of parents answered that they would be prepared to administer CAM to their child. Symptomatic improvements were attributed to CAM by the parents of 24 out of 33 children given these therapies. In addition, probiotic therapies were utilized by 23.8% of children, and 93.0% of parents would administer probiotic agents if recommended for their child's condition.

CONCLUSION

Complementary and alternative medicines and probiotic therapies are used frequently by children attending gastroenterology clinics and are accepted widely by their parents.

Respiratory and allergic diseases: from upper respiratory tract infections to asthma

Patients with asthma and allergic rhinitis may benefit from hydration and a diet low in sodium, omega-6 fatty acids, and transfatty acids, but high in omega-3 fatty acids (i.e., fish, almonds, walnuts, pumpkin, and flax seeds), onions, and fruits and vegetables (at least five servings a day). Physicians may need to be more cautious when prescribing antibiotics to children in their first year of life when they are born to families with a history of atopy. More research is needed to establish whether supplementation with probiotics (lactobacillus and bifidobacterium) during the first year of life or after antibiotic use decreases the risk of developing asthma and allergic rhinitis. Despite a theoretic basis for the use of vitamin C supplements in asthmatic patients, the evidence is still equivocal, and long-term studies are needed. The evidence is stronger for exercise-induced asthma, in which the use of vitamin C supplementation at a dosage of 1 to 2 g per day may be helpful. It is also possible that fish oil supplements, administered in a dosage of 1 to 1.2 g of EPA and DHA per day, also may be helpful to some patients with asthma. Long-term studies of fish oil and vitamin C are needed for more definite answers. For the patient interested in incorporating nutritional approaches, vitamin C and fish oils have a safe profile. However, aspirin-sensitive individuals should avoid fish oils, and red blood cell magnesium levels may help in making the decision whether to use additional magnesium supplements. Combination herbal formulas should be used in the treatment of asthma with medical supervision and in collaboration with an experienced herbalist or practitioner of TCM. Safe herbs, such as Boswellia and gingko, may be used singly as adjuncts to a comprehensive plan of care if the patient and practitioner have an interest in trying them while staying alert for drug-herb interactions. No data on the long-term use of these single herbs in asthma exist. For the motivated patient, mind-body interventions such as yoga, hypnosis, and biofeedback-assisted relaxation and breathing exercises are beneficial for stress reduction in general and may be helpful in further controlling asthma. Encouraging parents to learn how to massage their asthmatic children may appeal to some parents and provide benefits for parents and children alike. Acupuncture and chiropractic treatment cannot be recommended at this time, although some patients may derive benefit because of the placebo effect. For patients with allergic rhinitis, there are no good clinical research data on the use of quercetin and vitamin C. Similarly, freeze-dried stinging nettle leaves may be tried, but the applicable research evidence also is poor. Further studies are needed to assess the efficacy of these supplements and herbs. Homeopathic remedies based on extreme dilutions of the allergen may be beneficial in allergic rhinitis but require collaboration with an experienced homeopath. There are no research data on constitutional homeopathic approaches to asthma and allergic rhinitis. Patients with COPD are helped by exercise, pulmonary rehabilitation, and increased caloric protein and fat intake. Vitamin C and n-3 supplements are safe and reasonable; however, studies are needed to establish their efficacy in COPD. On the other hand, there are convincing data in favor of N-acetyl-cysteine supplementation for the patient with COPD at doses ranging between 400 and 1200 mg daily. Red blood cell magnesium levels may guide the use of magnesium replacement. The use of L-carnitine and coenzyme Q10 in patients with COPD needs further study. The addition of essential oils to the dietary regimen of patients with chronic bronchitis is worth exploring. Patients with upper respiratory tract infections can expect a shorter duration of symptoms by taking high doses of vitamin C (2 g) with zinc supplements, preferably the nasal zinc gel, at the onset of their symptoms. Adding an herb such as echinacea or Andrographis shortens the duration of the common cold. The one study on Elderberry's use for the flu was encouraging, and the data on the homeopathic remedy Oscillococcinum interesting, but more studies should be performed. Saline washes may be helpful to patients with allergic rhinitis and chronic sinusitis. Patients also may try the German combination (available in the United States) of elderberry, vervain, gentian, primrose, and sorrel that has been tested in randomized clinical trials. Bromelain is safe to try; the trials of bromelain supplementation were promising but were never repeated. The preceding suggestions need to be grounded in a program based on optimal medical management. Patients need to be well educated in the proper medical management of their disease and skilled at monitoring disease stability and progress. Asthmatic patients need to monitor their bronchodilator usage and peak flow meter measurements to step up their medical treatment in a timely manner, if needed. Patients welcome physician guidance when exploring the breadth of treatments available today. A true patient-physician partnership is always empowering to patients who are serious about regaining their function and health.

Survey of the use of complementary medicines and therapies in children with asthma

OBJECTIVE

To survey the frequency of use of complementary medicines (CM) and complementary therapies (CT) in asthmatic children.

METHODOLOGY

A 3-month survey of asthmatic inpatients and outpatients of a teaching hospital respiratory paediatrician was undertaken. Parents answered a structured questionnaire about their past and present usage and opinions of CM and CT. Parents and the physician independently assessed overall asthma control. 'Users' and 'non-users' of CM and CT were compared for characteristics of asthma, usage of conventional medications and parental demographics.

RESULTS

One hundred and seventy-four children with 331 parents were enrolled in the study. All of the children were on bronchodilators and 150 (86.2%) were on disodium cromoglycate or inhaled steroids. Control was assessed by a physician as good in 95 children (54.6%), fair in 65 (37.4%) and poor or very poor in 13 (7.5%). Ninety (51.7%) of the children had used at least one CM in their lifetime. Out of the 145 preparations used, 90 (62.1%) were in current use. Vitamins and minerals (53.2%) and herbal preparations (29%) were used most commonly. Only 47.8% of parents had told their doctors about the use of CM. Costs ranged from $A2-$A200 (median $A10) per month. Forty-three (24.7%) of the children had been taken to an alternative practitioner at a cost of $A25-$A400 (median $A40) per month. Users of CM and CT were significantly more likely than non-users to have persistent asthma (P < 0.02), be on high-dose inhaled or oral steroids (P < 0.05), to have poor or very poor control of symptoms (P < 0.04), and more frequent doctor visits (P < 0.05). They also had more adverse reactions to relieving bronchodilators (P < 0.02) and were significantly older than non-users (P < 0.02). The most common reasons for using CM and CT were dissatisfaction with conventional therapies and concerns about steroid side-effects.

CONCLUSIONS

Health professionals should be aware of the high rates of usage of CM and CT in asthmatic children and of parental attitudes to conventional and alternative therapies.

Chronic pediatric asthma and chiropractic spinal manipulation: a prospective clinical series and randomized clinical pilot study

OBJECTIVES

The first objective was to determine if chiropractic spinal manipulative therapy (SMT) in addition to optimal medical management resulted in clinically important changes in asthma-related outcomes in children. The second objective was to assess the feasibility of conducting a full-scale, randomized clinical trial in terms of recruitment, evaluation, treatment, and ability to deliver a sham SMT procedure.

STUDY DESIGN

Prospective clinical case series combined with an observer-blinded, pilot randomized clinical trial with a 1-year follow-up period.

SETTING

Primary contact, college outpatient clinic, and a pediatric hospital.

PATIENTS

A total of 36 patients aged 6 to 17 years with mild and moderate persistent asthma were admitted to the study.

OUTCOME MEASURES

Pulmonary function tests; patient- and parent- or guardian-rated asthma-specific quality of life, asthma severity, and improvement; am and pm peak expiratory flow rates; and diary-based day and nighttime symptoms.

INTERVENTIONS

Twenty chiropractic treatment sessions were scheduled during the 3-month intervention phase. Patients were randomly assigned to receive either active SMT or sham SMT in addition to their standardized ongoing medical management.

RESULTS

It is possible to blind the participants to the nature of the SMT intervention, and a full-scale trial with the described design is feasible to conduct. At the end of the 12-week intervention phase, objective lung function tests and patient-rated day and nighttime symptoms based on diary recordings showed little or no change. Of the patient-rated measures, a reduction of approximately 20% in beta(2) bronchodilator use was seen (P =.10). The quality of life scores improved by 10% to 28% (P <.01), with the activity scale showing the most change. Asthma severity ratings showed a reduction of 39% (P <.001), and there was an overall improvement rating corresponding to 50% to 75%. The pulmonologist-rated improvement was small. Similarly, the improvements in parent- or guardian-rated outcomes were mostly small and not statistically significant. The changes in patient-rated severity and the improvement rating remained unchanged at 12-month posttreatment follow-up as assessed by a brief postal questionnaire.

CONCLUSION

After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. There were no important changes in lung function or hyperresponsiveness at any time. The observed improvements are unlikely as a result of the specific effects of chiropractic SMT alone, but other aspects of the clinical encounter that should not be dismissed readily. Further research is needed to assess which components of the chiropractic encounter are responsible for important improvements in patient-oriented outcomes so that they may be incorporated into the care of all patients with asthma.

Complementary and alternative medicine use in children

OBJECTIVE

Adults frequently use complementary and alternative medicines (CAM). Few studies have reported how often CAM therapies are used to treat children. The purpose of this study is to describe the use of alternative therapies by children visiting an emergency department (ED) and to identify sociodemographic factors that may influence the decision to use such therapies.

DESIGN

Survey of families using a self-administered questionnaire.

SETTING

An urban, tertiary care pediatric emergency department.

PARTICIPANTS

Convenience sample of families presenting to the ED for acute care.

MAIN OUTCOME MEASURE

Use of CAM therapies to treat children. Secondary measures include the type of therapies used, types of medical problems the therapies were used for, reasons for using such therapies, use of such therapies by the child's caretakers, and sociodemographic characteristics of the children and families.

RESULTS

A review of 525 completed surveys identified 63 caretakers (12%) who acknowledged that they had used at least one form of CAM therapy to treat any of their children. Homeopathic and naturopathic remedies were the most common therapies used. Parents most often used CAM therapies to treat respiratory problems in their children and were most influenced by word-of-mouth. Children who were treated with CAM therapies were more likely to have a caretaker who used such therapies. Twelve (40%) of 30 families who reported using either an herbal or homeopathic remedy, also used a prescription or over-the-counter medication at the same time to treat their child. Thirty-nine of 55 families (70.9%) reported informing their child's physician of their use of CAM therapies.

CONCLUSION

CAM therapies are frequently used to treat children. Most parents who use CAM therapies to treat their children use such therapies themselves. Large proportions of children who are taking herbal supplements are also taking prescription or over-the-counter medications concurrently.

Shosaiko-to and other Kampo (Japanese herbal) medicines: a review of their immunomodulatory activities

The use of alternative medicine, including consumption of herbal products and dietary supplements, has been increasing substantially both in the United States and in Western Europe. One area that is garnering increased attention is the use of Oriental Medicine including Kampo, or Japanese herbal medicine. Herein, we review representative examples of research available on the most common use of Kampo medicinals, namely to improve the immune response. We also provide an extensive background on the history of Kampo. There are more than 210 different Kampo formulae used in Japan and most uses of Kampo are to modulate the immune response, i.e. to improve immunity. We have extracted data on seven common Kampo medicinals, and the data are reviewed with respect to in vitro and in vivo activities for both humans and experimental animals; the ingredients as well as the problems with classification of these materials are presented. Research suggests that Kampo herbals are biologically active and may have therapeutic potential. While it is believed that Kampo medicines have few side effects, there is a paucity of data on their toxicity as well as a relative lack of knowledge of the bioactive constituents and potential drug interactions of these agents.

Recent advances in alternative therapies

Complementary and alternative medicine (CAM) is becoming more popular, and CAM remedies are used instead of, or integrated with, orthodox allopathic therapies by many patients with asthma. Although most CAM remedies may have no discernible effects when analyzed by conventional medical techniques, some double-blind controlled studies do suggest that a meaningful benefit can be obtained with acupunture and homeopathic management in asthma. Herbal medicine is more popular, despite little evidence that the vast majority of herbs for asthma have any useful effects other than a nonspecific expectorant action. Dietary adjustment may benefit a small percentage of patients with asthma, but extreme measures are very rarely indicated. Formal pyschologic approaches can help some patients by reducing anxiety. Although most CAM approaches are harmless, the lack of benefit of many remedies and the potential harm from some of them must be recognized.