Alternative and complementary medicine for asthma

Laser acupuncture in treatment of childhood bronchial asthma

Laser acupuncture is widely used as an alternative treatment for chronic illnesses.

OBJECTIVE

to evaluate the effect of biostimulation by low-level power laser on the traditional Chinese acupuncture points for Egyptian asthmatic children.

METHOD

Thirty asthmatic boys and 20 asthmatic girls 7-18 years (10.6±2.8) were randomly selected from the outpatient chest clinic of Ain Shams University, Children hospitals, and National Research Center outpatient Clinic of Acupuncture, from April 2009 to March 2010. Patients' symptoms, medications, asthma control questionnaire (ACQ), and spirometric values were recorded before and 1 month after completion of 10 laser acupuncture sessions. Each patient received 10 laser sessions (3 sessions/week) on traditional Chinese acupoints.

RESULTS

Started with 36 patients suffering daytime and nocturnal symptoms, ended with two patients suffering nocturnal symptoms (p < 0.001). Also, 48 patients reported better exercise tolerance (p < 0.001). Forced expiratory volume in the first second, forced vital capacity, and peak expiratory flow % increased from 81.8±25.2, 85.4±21.5, and 71.8±22.9 to 98.5±28.1, 104.3±26.2, and 84.3±24.1, respectively (p < 0.001). ACQ improved from 13.9±3.8 to 23.3±3.6 (p < 0.001), 92% of patients became well controlled. Inhaled steroids dose decreased from 200-450 to 0-200 μg/day and all patients stopped short acting B2 agonist (SABA) rescue (p < 0.01, 0.001).

CONCLUSION

low-intensity laser acupuncture can be safe and effective treatment in asthmatic children.

Effect of Moringa oleifera Lam. seed extract on toluene diisocyanate-induced immune-mediated inflammatory responses in rats

Moringa oleifera Lam. is a small tree cultivated throughout India. We have investigated the effect of ethanolic extract of seeds of Moringa oleifera (MOEE, an herbal remedy) on the potential prevention of immune-mediated inflammatory responses in toluene diisocyanate (TDI as antigen)-induced asthma in Wistar rats. Rats were divided into five different groups (n = 8/group): Group-I = unsensitized control; Group-II = TDI control/vehicle; Group-III = dexamethasone (DXM) 2.5 mg/kg; and, Groups IV and V = 100 mg/kg and 200 mg/kg body weight [BW] of MOEE, respectively. All rats (except unsensitized controls) were sensitized by intranasal application of 10% TDI to induce airway hypersensitivity. Animals in Groups II-V were given their respective drug treatment per os from 1 wk prior to initiation of sensitization until the day of final provocation with 5% TDI. After this last challenge, all rats were examined for hyperreactivity symptoms and then sacrificed to determine their total and differential leucocytes in blood and bronchoalveolar (BAL) fluid and levels of TNF proportional, variant, IL-4, and IL-6 in their BAL and serum. Homogenates of one lung lobe from each animal were utilized to assess oxidative stress; a separate lobe underwent histologic examination to assess airway inflammatory status. The results suggest that asthmatic symptoms were found in TDI control rats only, while both MOEE- and DXM-treated rats did not manifest any airway abnormality. In MOEE- and DXM-treated rats, neutrophil and eosinophil levels in the blood were decreased significantly; levels of total cells and each different cell in their BAL fluid were markedly decreased as compared to those in TDI controls. TNF alpha, IL-4, and IL-6 were predominant in serum as well as in BAL fluids in TDI controls, but these levels were reduced significantly by MOEE treatment. The antioxidant activity in relation to antiinflammatory activity of the extract and histopathological observations also reflected a protective effect. Based on the above findings and observations, it can be concluded that Moringa oleifera may possess some beneficial properties that act against chemically stimulated immune-mediated inflammatory responses that are characteristic of asthma in the rat.

Laser acupuncture and probiotics in school age children with asthma: a randomized, placebo-controlled pilot study of therapy guided by principles of Traditional Chinese Medicine

Traditional Chinese Medicine (TCM) postulates an interaction between the lung as a Yin-organ and the large intestine as a Yang-organ. The aim of this pilot study was to investigate in asthmatic school age children whether treatment with laser acupuncture and probiotics according to TCM portends a clinical benefit to standard medical treatment performed according to pediatric guidelines. Seventeen children aged 6-12 yr with intermittent or mild persistent asthma were enrolled in this randomized, placebo-controlled, double-blind pilot study. Eight patients received laser acupuncture for 10 wk and probiotic treatment in the form of oral drops (living non-pathogenic Enterococcus faecalis) for 7 wk. Nine patients in the control group were treated with a laser pen which did not emit laser light and were given placebo drops. Peak flow variability (PFV) and forced expiratory volume in 1 s (FEV(1)) were measured and Quality of Life was assessed by a standardized questionnaire. Laser acupuncture and probiotics significantly decreased mean (standard deviation) weekly PFV as a measurement of bronchial hyperreactivity by -17.4% (14.2) in the TCM group vs. 2.2% (22.5) in the control group (p = 0.034). No significant effect was detected for FEV(1), Quality of Life criteria and additional medication. As an exploratory result, patients in the TCM group had fewer days of acute febrile infections when compared with the control group [1.14 (1.4) vs. 2.66 (2.5), p = 0.18]. In conclusion, this pilot study generates the hypothesis that the interactive treatment of lung and large intestine according to TCM by laser acupuncture and probiotics has a beneficial clinical effect on bronchial hyperreactivity in school age children with intermittent or mild persistent asthma and might be helpful in the prevention of acute respiratory exacerbations. These results should be confirmed by further studies.

Double blind randomised controlled trial of two different breathing techniques in the management of asthma

BACKGROUND

Previous studies have shown that breathing techniques reduce short acting beta(2) agonist use and improve quality of life (QoL) in asthma. The primary aim of this double blind study was to compare the effects of breathing exercises focusing on shallow nasal breathing with those of non-specific upper body exercises on asthma symptoms, QoL, other measures of disease control, and inhaled corticosteroid (ICS) dose. This study also assessed the effect of peak flow monitoring on outcomes in patients using breathing techniques.

METHODS

After a 2 week run in period, 57 subjects were randomised to one of two breathing techniques learned from instructional videos. During the following 30 weeks subjects practised their exercises twice daily and as needed for relief of symptoms. After week 16, two successive ICS downtitration steps were attempted. The primary outcome variables were QoL score and daily symptom score at week 12.

RESULTS

Overall there were no clinically important differences between the groups in primary or secondary outcomes at weeks 12 or 28. The QoL score remained unchanged (0.7 at baseline v 0.5 at week 28, p = 0.11 both groups combined), as did lung function and airway responsiveness. However, across both groups, reliever use decreased by 86% (p<0.0001) and ICS dose was reduced by 50% (p<0.0001; p>0.10 between groups). Peak flow monitoring did not have a detrimental effect on asthma outcomes.

CONCLUSION

Breathing techniques may be useful in the management of patients with mild asthma symptoms who use a reliever frequently, but there is no evidence to favour shallow nasal breathing over non-specific upper body exercises.

The effects of a single acupuncture treatment in horses with severe recurrent airway obstruction

REASONS FOR PERFORMING STUDY

Acupuncture may be recommended for horses with 'heaves' because it is being increasingly applied to treat human asthma. Therefore, its efficacy was investigated in horses with this asthma-like disease.

OBJECTIVE

To evaluate the efficacy of a single acupuncture treatment for the relief of airway obstruction in heaves-affected horses.

METHODS

The efficacy of a single acupuncture treatment was tested in 10 heaves-affected horses, and the effect of removal from the dusty stall environment in 5 heaves-affected horses. Before treatment, horses were stabled to induce airway obstruction and, apart from trips to the laboratory for pulmonary function measurements, they remained stabled for the duration of each treatment. The severity of airway obstruction was quantified by measurement of lung function before treatment (baseline), and at 20, 60, 120 and 240 mins and 24 h after the following treatments administered in random order: halter restraint and patting, a single acupuncture treatment by an experienced acupuncturist, and a single acupuncture treatment using predetermined points (recipe) by a veterinarian with no acupuncture training. In a second study, horses were untreated and remained either in their stall or in a paddock for all measurements of lung function, after baseline readings were made.

RESULTS

In the first study, after all treatments, there was a temporal improvement in maximal change in pleural pressure, pulmonary resistance, dynamic compliance, respiratory rate, and tidal volume that lasted less than 24 h. There was no specific effect of acupuncture treatment. In the second study, removal from the dusty environment did not produce an improvement in lung function in the first 6 h. We conclude that most of the improvements in lung function observed in the study were due to handling.

CONCLUSIONS

Assessed objectively, a single acupuncture treatment during an attack of heaves causes no more improvement in lung function than does handling the horse.

POTENTIAL RELEVANCE

Acupuncture should not replace conventional medical treatments for heaves.

The use of complementary and alternative medicine by asthma patients

BACKGROUND

Use of complementary and alternative medicines (CAM) by asthmatic patients is increasing. Data on the prevalence of CAM use in asthma are limited, and the motivation for patients to seek CAM therapy is uncertain.

AIM

To determine the prevalence and pattern of use of complementary therapies in adults treated for asthma in primary care in Singapore, and the demographic and clinical factors associated with their use.

DESIGN

Cross-sectional study.

SETTING

Five primary care clinics in Singapore.

METHODS

Adult patients with asthma (n = 802) received a structured questionnaire interview and clinical assessment that included demographic and clinical variables (clinical status, patient's knowledge, self-care and healthcare-seeking behaviour, and spirometric measurements) and detailed information on CAM use in the past one year.

RESULTS

CAM use in the past year was reported by 27.2%, including animal food products (12.3%), herbs (10.3%), herbal-based proprietary medicines (3.2%), and acupuncture or reflexology (1%). The use of CAM was significantly associated with Chinese ethnicity, longer disease duration, moderate and severe persistent asthma, FEV(1)/FVC < 80%, lack of positive response to treatment in the past year, higher patient knowledge score, and multiple sources of care providers.

DISCUSSION

The use of CAM is highly prevalent in Asian patients treated for asthma in primary care, and is associated with cultural and clinical factors reflecting a need to improve care.

Complementary and alternative medicine in children with asthma

BACKGROUND

The popularity of complementary and alternative medicine (CAM), particularly for chronic conditions such as asthma, is growing rapidly, but little is known about its use in asthmatic children.

OBJECTIVE

To evaluate the extent, characteristics, and possible predictors of CAM use in a group of Turkish children with asthma.

METHODS

The parents of asthmatic children were invited to participate in a questionnaire-based survey of 13 worldwide and 5 local methods of CAM. Current asthma treatment, asthma exacerbations, emergency admittances and hospitalizations due to exacerbations, and parental education levels were investigated as predictors that influenced the use of CAM.

RESULTS

Of the 304 asthmatic children (mean +/- SEM age, 10.5 +/- 0.2 years; range, 1-16 years), 49% (n = 150) had used some form of CAM previously, and 38% had used CAM within the previous year. The most popular forms of CAM were quail eggs (79%), herbal medicine (31%), Turkish wild honey (26%), speleotherapy (5%), and royal jelly (5%). The respondents learned about CAM through friends (61%), relatives (25%), the media (9%), and physicians (6%). Age, sex, and mother's and father's education levels were insignificant between the groups that used and did not use CAM (P = 0.40, P = 0.18, P = 0.15, and P = 0.09, respectively). The use of regular asthma treatment, the use of inhaled corticosteroids, asthma exacerbations, emergency admittances, and treatment score were significantly high in the CAM group (P = 0.006, P = 0.03, P = 0.008, P = 0.02, and P = 0.02, respectively). A significantly high percentage of respondents in the CAM group had considered using CAM for their child's asthma in the future (P = 0.001).

CONCLUSIONS

Asthmatic children in whom the disease is not well controlled are more likely to use CAM as complementary therapy.

Perceptions of asthma in South Asians and their views on educational materials and self-management plans: a qualitative study

Asians with asthma have higher hospital admission rates than whites without any evidence of increased asthma severity. There is limited information as to whether these differences are due to language or communication difficulties, variable knowledge and cultural attitudes to asthma or deficiencies of medical care. A qualitative study with 60 participants (12 participants with asthma for semi-structured interviews and 48 participants for focus groups) was designed to explore knowledge about asthma, attitudes, perceptions, health beliefs and health needs of those from Pakistan and India (South Asians). Overall, most of the patients with asthma were aware of the symptoms and trigger factors of asthma and were well informed about the 'reliever' and 'preventer' properties of their inhalers. They were also well informed about alternative/complementary therapies and were willing to try them should the treatment provided by their general practitioner (GP) fail to resolve their symptoms. Most were dissatisfied with the asthma care provided by their GPs e.g. delays in making the diagnosis and deficiencies in providing both verbal and written information on asthma. There was lack of awareness about self-management plans although when explained, the concept of self management was well received and there was approval for the concept of written action plans. All the focus group participants seemed to know something about asthma and amongst those with the condition (or with relatives with the condition), knowledge of the disease and its treatment seemed to be good. It was concluded that improved dissemination of written and verbal information on all aspects of asthma and increased awareness, training and support for adoption of written self-management (action) plans is needed to provide a more efficient and effective service for South Asian patients with asthma.

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.

Children with difficult asthma: a practical approach

Many open studies investigating the effects of innovative treatments for steroid-dependent asthma demonstrate some benefit. This is also true of the majority of placebo arms in placebo-controlled trials. This suggests that children with difficult asthma benefit from the high level of input that is typically provided in clinical trials, with or without additional medication. Such intensive management of patients, with the emphasis on establishing the diagnosis, improving adherence, and identifying provoking factors, is the key to optimizing asthma control for these children. For patients with genuinely severe asthma, despite high doses of conventional treatment, a greater understanding of the pathological basis of persistent symptoms is needed. Identification of different pathological subtypes of severe asthma should allow for more rational prescribing of asthma therapy, as well as the design of further trials of potential steroid-sparing treatments.

Complementary/alternative medicine in the treatment of asthma

OBJECTIVE

This review will familiarize clinical allergists/immunologists with the common forms of complementary/alternative medicine (CAM) that are being used frequently by their patients. It reviews reasons that patients seek alternative health care therapies and the most common illnesses that are treated with this form of medicine. Cultural differences in CAM are also reviewed. The article focuses on specific therapies used to treat asthma and reviews the efficacy of these therapies based on the available scientific literature. The reader will also learn about views of other physicians on CAM and how this topic is being addressed in US medical schools.

DATA SOURCES

Computer-assisted MEDLINE searches for articles on "complementary/alternative medicine" or "herbal therapy" and "asthma" or "atopy."

STUDY SELECTION

Pertinent abstracts and articles in the above areas were selected. Articles selected for detailed review included review articles of the subjects along with randomized, double-blind placebo-controlled studies in animals and humans.

RESULTS

Complementary/alternative medicine is commonly used by patients with chronic conditions including asthma. One-third of the US population has tried CAM. The literature supporting the efficacy of these therapies is lacking. Some reports elucidate the mechanism of action of certain herbal therapies that could possibly be helpful in the treatment of allergic diseases. There are, however, few well-controlled studies that support the efficacy of CAM in the treatment and clinical improvement of human subjects with asthma or atopic disorders.

CONCLUSION

Available scientific evidence does not support a role for CAM in the treatment of asthma. The studies in the literature often have significant design flaws that weaken the conclusions such as insufficient numbers of patients, lack of proper controls, and inadequate blinding. Further studies are needed to prove or disprove the efficacy of CAM. Physicians often find CAM intimidating because they are unaware of the clinical evidence and feel uncomfortable advising their patients on its efficacy. There is definitely a need for more education among physicians in this area. It is also important that physicians inquire and discuss the use of CAM with their patients since the majority of patients are using some form of CAM.

Hypnosis and asthma: a critical review

Asthma is among the most common chronic diseases of the western world and has significant effects on patients' health and quality of life. Asthma is typically treated with pharmaceutical products, but there is interest in finding nonpharmaceutical therapies for this condition. Hypnosis has been used clinically to treat a variety of disorders that are refractive to pharmaceutical-based therapies, including asthma, but relatively little attention has been given recently to the use of clinical hypnosis as a standard treatment for asthma. Significant data suggest that hypnosis may be an effective treatment for asthma, but it is premature to conclude that hypnosis is unequivocally effective. Studies conducted to date have consistently demonstrated an effect of hypnosis with asthma. More and larger randomized, controlled studies are needed. Existing data suggest that hypnosis efficacy is enhanced in subjects who are susceptible to the treatment modality, with experienced investigators, when administered over several sessions, and when reinforced by patient autohypnosis. Children in particular appear to respond well to hypnosis as a tool for improving asthma symptoms.

Increased perception of dyspnea by inhalation of short acting beta2 agonist in patients with asthma of varying severity

BACKGROUND

Poor perception of dyspnea in asthma may lead to a delay in starting appropriate treatment which is probably one of the factors contributing to death from asthma.

OBJECTIVE

This study was carried out to determine whether impaired perception of dyspnea in patients with asthma of varying severity can be corrected by inhalation of short acting beta2 agonist treatment.

METHODS

We enrolled 20 patients with asthma of varying severity. Forced expiratory volume in one second (FEV1) was measured before and 10 minutes after two puffs of salbutamol administered by metered dose inhaler. Perception of dyspnea was scored on the Borg scale during breathing through an inspiratory muscle trainer.

RESULTS

After inhalation of short acting beta2 agonist treatment, the baseline Borg score was decreased significantly from 2.20 +/- 0.32 to 1.80 +/- 0.31 (P < .01). The Borg score during breathing with the highest resistance, on the contrary, was increased significantly from 6.25 +/- 0.35 to 6.90 +/- 0.35 after inhalation of short acting beta2 agonist treatment (P < .01). Highest resistance-induced score difference from the baseline value (highest resistance-load score) was increased significantly from 4.10 +/- 0.46 to 5.25 +/- 0.42 (P < .01). There was no relationship between the change of Borg score from baseline value at each resistive load and the % change of FEV1 after inhalation of short acting beta2 agonist treatment.

CONCLUSION

These studies demonstrate that inhalation of short acting beta2 agonist treatment decrease dyspnea, but increase perception of dyspnea induced by a resistive load in patients with asthma, and the mechanism of the increased perception may not be related to the increased airflow rate. It may be due to some local or central effects of bronchodilator drug on perception of asthma.

A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma

BACKGROUND

Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions, including asthma.

METHODS

We conducted a randomized, controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma. After a three-week base-line evaluation period, 91 children who had continuing symptoms of asthma despite usual medical therapy were randomly assigned to receive either active or simulated chiropractic manipulation for four months. None had previously received chiropractic care. Each subject was treated by 1 of 11 participating chiropractors, selected by the family according to location. The primary outcome measure was the change from base line in the peak expiratory flow, measured in the morning, before the use of a bronchodilator, at two and four months. Except for the treating chiropractor and one investigator (who was not involved in assessing outcomes), all participants remained fully blinded to treatment assignment throughout the study.

RESULTS

Eighty children (38 in the active-treatment group and 42 in the simulated-treatment group) had outcome data that could be evaluated. There were small increases (7 to 12 liters per minute) in peak expiratory flow in the morning and the evening in both treatment groups, with no significant differences between the groups in the degree of change from base line (morning peak expiratory flow, P=0.49 at two months and P=0.82 at four months). Symptoms of asthma and use of 3-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups. There were no significant changes in spirometric measurements or airway responsiveness.

CONCLUSIONS

In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.

Qigong Yangsheng as a complementary therapy in the management of asthma: a single-case appraisal

OBJECTIVES

Qigong Yangsheng, the health-promoting method of traditional Chinese medicine that combines movement, mental exercise, and breathing technique, is used in China for the therapy of bronchial asthma, and for some time now has been enjoying an ever-widening acceptance in the Western world as well. This pilot study investigates if Qigong Yangsheng could be used as a complementary therapeutic measure to treat asthma patients in a Western industrialized country.

DESIGN

Thirty asthma patients, with varying degrees of illness severity, were taught Qigong Yangsheng under medical supervision. They were asked to exercise independently, if possible, on a daily basis and to keep a diary of their symptoms for half a year including peak-flow measurements three times daily, use of medication, frequency and length of exercise as well as five asthma-relevant symptoms (sleeping through the night, coughing, expectoration, dyspnea, and general well-being). The concept of this study was based on a single-case research design series with baseline, one teaching phase, a phase of self-practice and a refresher teaching course. A 4-week follow-up period was carried out in the same season as the original baseline phase 52 weeks later.

RESULTS

An improvement was indicated if subjects showed a decrease of at least 10 percent in peak-flow variability between the 1st and the 52nd week. This occurred more frequently in the group of the exercisers (n = 17) than in the group of nonexercisers (n = 13) (p < 0.01 chi-square with Yates correction). When comparing the study year with the year before the study, there was improvement also in reduced hospitalization rate, less sickness leave, reduced antibiotic use and fewer emergency consultations resulting in reduced treatment costs.

CONCLUSION

Qigong Yangsheng is recommended for asthma patients with professional supervision. An improvement in airway capability and a decrease in illness severity can be achieved by regular self-conducted Qigong exercises.

Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial

The purpose of this randomized patient- and observer-blinded cross-over trial was to evaluate the efficacy of chiropractic treatment in the management of chronic asthma when combined with pharmaceutical maintenance therapy. The trial was conducted at the National University Hospital's Out-patient Clinic in Copenhagen, Denmark. Thirty-one patients aged 18-44 years participated, all suffering from chronic asthma controlled by bronchodilators and/or inhaled steroids. Patients, or who had received chiropractic treatment for asthma within the last 5 years, who received oral steroids and immunotherapy, were not eligible. Patients were randomized to receive either active chiropractic spinal manipulative treatment or sham chiropractic spinal manipulative treatment twice weekly for 4 weeks, and then crossed over to the alternative treatment for another 4 weeks. Both phases were preceded and followed by a 2-week period without chiropractic treatment. The main outcome measurements were forced expiratory volume in the first second (FEV1), forced vital capacity (FVC), daily use of inhaled bronchodilators, patient-rated asthma severity and non-specific bronchial reactivity (n-BR). Using the cross-over analysis, no clinically important or statistically significant differences were found between the active and sham chiropractic interventions on any of the main or secondary outcome measures. Objective lung function did not change during the study, but over the course of the study, non-specific bronchial hyperreactivity (n-BR) improved by 36% (P = 0.01) and patient-rated asthma severity decreased by 34% (P = 0.0002) compared with the baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)

A critical analysis of acupuncture in pulmonary disease: efficacy and safety of the acupuncture needle

Criteria for therapeutic efficacy and safety include significant amelioration of symptoms and, ideally, cure (i.e., patients' belief in effective improvement of symptoms and quality of life, durable impact on symptoms, verifiable subjective and objective changes); improved patient management (e.g., diminishing, or ceasing medication, physiotherapy, and other interventions); safety for patient and practitioner and an acceptable side effect profile; cost-effectiveness of the therapy in practice and to teach to others. There is evidence that in bronchial asthma, chronic bronchitis, and chronic disabling breathlessness the use of acupuncture fulfills these to varying degrees. It can facilitate reducing pharmacologic medication and is safe, suggesting that acupuncture as an adjuvant in the treatment of respiratory disease might be safer than prolonged pharmaceutical maintenance therapy alone. Its cost-effectiveness has yet to be adequately researched. Twenty-one papers in English were obtained and 16 were further evaluated; eight were double-blind, five single-blind, and three unblinded. The remaining five, and most of the Chinese literature, were excluded on account of their poor quality. Acupuncture was effective in four of eight of the double-blind, three of five single-blind, and three of three unblinded studies (i.e., 10 of 16 [62.5%] overall). A previously unreported confounding variable was identified and concerned the designation of sham points. Most sham points were believed to be inactive but, according to traditional Chinese principles, many are active in pulmonary disease. Reappraised accordingly, the unequivocally positive studies were summed with those in which "real" and "sham" acupuncture were not significantly different but in which the combined effect of all acupuncture (i.e., real + sham) on breathlessness was significantly different from baseline. This yielded 13 of 16 (81%) [corrected] studies in which acupuncture led to significant improvement. In most studies, current pharmacologic treatment had a greater effect than acupuncture alone. However, in the 11 studies in which it was evaluated, medication could be significantly reduced by acupuncture in 10 (91%). Twenty-three of the 320 patients in the 16 studies (7%) reported minimal side effects, none requiring intervention. Current published evidence reveals no reason to withhold acupuncture as a safe and potentially effective treatment in patients with bronchial asthma and chronic obstructive lung disease. Further, more appropriately designed studies are urgently required. This would be facilitated in the United States by licensing the acupuncture needle as a therapeutic agent and might lead to important new insights and therapeutic opportunities.

Nasal continuous positive airway pressure in chronic heart failure with sleep-disordered breathing

Nasal continuous positive airway pressure (NCPAP) has been reported to improve daytime symptoms in patients with sleep disordered breathing due to heart failure. To examine this in a controlled manner, eight men with stable chronic heart failure (mean left ventricular ejection fraction 18% and mean frusemide dose 160 mg) were entered into a controlled trial of domiciliary nocturnal NCPAP. At polysomnography (with sleep apnea quantified as the number of > 4% dips in arterial saturation per hour), seven had nocturnal Cheyne-Stokes respiration (SaO2 dip rate 3 to 27/hr), and one both central and obstructive apneas (SaO2 dip rate 8/hr). After 2 wk nocturnal domiciliary NCPAP at < 1.5 cm H2O (placebo) and 7.5 cm H2O (active) in random order, bicycle exercise tolerance and heart failure symptoms (modified Likert questionnaire) were assessed by an observer unaware of the patients' NCPAP status. Pulse oximetry (all subjects) and radionuclide estimated left ventricular ejection fraction (three subjects) were also measured at the end of each period. Two subjects withdrew from the study because of worsening heart failure during active NCPAP (7.5 cm H2O), and one of these subjects died. In the remaining six subjects exercise tolerance, symptom scores, and the severity of sleep apnea were similar on active NCPAP compared with placebo. When it was measured, resting left ventricular ejection fraction was lower on active therapy than on placebo. These data exclude a 25% improvement in exercise tolerance with 95% confidence and suggest that a study of 160 subjects would be needed to exclude a 10% change in symptom score.(ABSTRACT TRUNCATED AT 250 WORDS)