Complementary and Alternative Medicine for Asthma
Many people with asthma are interested in learning about, and possibly trying, treatments and therapies that do not use prescription medicines. These include yoga, acupuncture, homeopathy, hypnosis, Buteyko and other breathing techniques, herbal medicines, ionizers, oxygen water, chiropractic manipulation and speleotherapy among others. These are generally referred to as complementary or alternative therapies. However, there is very little scientific evidence that these therapies have efficacy in asthma management for adults but in children they have not generally been researched and it does not follow that what is useful in adults is also useful in children. Efficacy in a medical context indicates that the desirable, beneficial and acceptable results of a therapeutic effect is as a consequence of a medical treatment (e.g. intake of a medicine, an operation, or a vaccination). This efficacy refers to a consensus that the proposed treatment is at least as good as other available interventions to which it will have ideally been compared to in a clinical trial.
GINA (The Global Initiative for Asthma) which is a World Health Organization supported initiative works with health care professionals and public health officials around the World to reduce the prevalence, morbidity and mortality of asthma. The Asthma Society of Ireland's policy on complementary or alternative therapies or treatments is in keeping with the views outlined in the GINA document. The GINA asthma guidelines have made the following statement about complementary and alternative medicine (www.ginasthma.org: Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2006) page 35:
Complementary and Alternative Medicines (GINA)
The roles of complementary and alternative medicine in adult asthma treatment are limited because these approaches have been insufficiently researched and their effectiveness is largely unproven. Generally, these therapies have not been validated by conventional standards. Although the psychotherapeutic role of the therapist forms part of the placebo effect of all treatments, this aspect is viewed as an integral part of the so-called holistic approach used by practitioners of complementary and alternative methods, and mitigates against performance of the large, multicenter, placebo-controlled randomized studies required to confirm efficacy. However, without these the relative efficacy of these alternative measures will remain unknown120. Complementary and alternative therapies include acupuncture, homeopathy, herbal medicine, dietary supplements, Ayurvedic medicine, ionizers, osteopathy and chiropractic manipulation, and speleotherapy among others. Apart from those mentioned below, there have been no satisfactory studies from which conclusions about their efficacy can be drawn. A single controlled trial of chiropractic spinal manipulation failed to show benefit of this therapy in asthma121, and a systematic review of homeopathy found only three relevant trials with inconclusive results. Several studies of breathing and/or relaxation techniques for asthma and/or dysfunctional breathing, including the Buteyko breathing method and the Papworth method 210, have shown improvements in symptoms, short-acting β2-agonist use, quality of life and/or psychological measures, but not in physiological outcomes. A study of two physiologically-contrasting breathing techniques, in which contact with health professionals and instructions about rescue inhaler use were matched, showed similar improvements in reliever and inhaled glucocorticosteroid use on both groups 122. This suggests that perceived improvement with breathing techniques may be largely due to factors such as relaxation, voluntary reduction in use of rescue medication, or engagement of the patient in their care. Breathing techniques may thus provide a useful supplement to conventional asthma management strategies, particularly in anxious patients or those habitually over-using rescue medication. The cost of some programs may be a potential limitation.
Side effects- Acupuncture-associated hepatitis B, bilateral pneumothorax, and burns have been described. Side effects of other alternative and complementary medicines are largely unknown. However, some popular herbal medicines could potentially be dangerous, as exemplified by the occurrence of hepatic veno-occlusive disease associated with the consumption of the commercially available herb comfrey. Comfrey products are sold as herbal teas and herbal root powders, and their toxicity is due to the presence of pyrrolizidine alkaloids.
References:
120. Hondras MA, Linde K, Jones AP. Manual therapy for asthma.
Cochrane Database Syst Rev 2005(2):CD001002.
121. Balon JW, Mior SA. Chiropractic care in asthma and allergy.
Ann Allergy Asthma Immunol 2004;93 (2 Suppl 1):S55-60.
122. Slater JW, Zechnich AD, Haxby DG. Second-generation
antihistamines: a comparative review. Drugs1999;57(1):31-47.
210. Holloway EA, West RJ. Integrated and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial. Thorax 2007 Dec;62(12): 1039-42.
Asthma Society of Ireland recommendation
Asthma cannot be cured but it can be managed and controlled with conventional and well researched therapies. However, if you are interested in trying one of the many complementary or alternative treatments you should speak to your doctor or asthma nurse first. However, it is important that you do not stop taking your normal asthma medicines with these other therapies unless your doctor advises you otherwise. In addition, you should learn more about the research that has been done with these therapies in both adults and in children if you are a parent.
