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Asthma - the pros and cons of complementary treatments

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Asthma - the pros and cons of complementary treatments

Written by Professor Edzard Ernst, Department of Complementary Medicine, University of Exeter

Introduction

Complementary medicine is defined as diagnosis, treatment and/or prevention which complements mainstream medicine by contributing to a common whole, by satisfying a demand not met by orthodoxy or by diversifying the conceptual frameworks of medicine1.

Complementary medicine has become an important issue mainly because of its popularity. For example, a survey of 4741 UK asthma sufferers showed that 59 per cent of them had tried one or other form of complementary treatment for their condition2.

The pros and cons of specific complementary treatments for asthma are discussed below with reference to randomised controlled trials (RCTs). An RCT is a study in which people are allocated at random to receive one of several clinical interventions. One intervention is regarded as the standard of comparison, or control. Usually RCTs seek to measure and compare different events that are present or absent after the participants in the study receive the interventions. These events are called outcomes.

The complementary treatments discussed include:

acupuncture

homoeopathy

exclusion diets and other nutritional approaches

breathing techniques

hypnosis

relaxation techniques

chiropractic

herbal medicine

massage.

Acupuncture

A systematic review3 looking at the use of complementary medicine in the treatment of asthma and asthma-like symptoms assessed seven acupuncture studies. Two of these studies suggested that real acupuncture was superior to sham acupuncture (eg sticking needles into non-acupuncture points). The other five studies found no significant advantage and the authors therefore concluded that, 'it is not yet possible to make any recommendations'.

Considering that acupuncture is not associated with frequent risks (eg tissue trauma, such as pneumothorax, or infection, such as hepatitis); and that it possibly has a large and clinically relevant placebo effect because it is often associated with great expectations, the pros and cons depend on an individual's opinion. Someone who considers only evidence from trials would not advocate the use of acupuncture, whereas someone with a more practical clinical stance might believe that it is worth trying, if only for its placebo effect.

Homoeopathy

A systematic review4 of all RCTs on homoeopathy included only three studies. Two of them suggested a benefit beyond placebo on at least one outcome measure. The authors concluded that the evidence was insufficient to assess the possible role of homoeopathy in the treatment of asthma. Weighing the pros and cons of homoeopathy for asthma, one therefore arrives at much the same conclusions as for acupuncture.

Exclusion diets

About 2 to 6 per cent of asthma sufferers are hypersensitive to foods5 and experience worsening symptoms when they eat certain foods. It is reasonable therefore for these individuals to exclude the offending foodstuff from their diet. Curiously, the effectiveness of this approach has not been clearly confirmed through RCTs. On balance, it seems that this technique is worth trying in patients for whom hypersensitivity to foods has been established.

Other nutritional approaches

The role of vitamins, minerals and essential fatty acids in the management of asthma remains unclear. There are some data that suggest that the addition of such nutrients could have a positive effect. However, not enough trials have been done. As a result there is, at present, no compelling evidence that other nutritional approaches are effective in the treatment or prevention of asthma6.

Breathing techniques

Many breathing techniques (including yoga) are promoted for alleviating the symptoms of asthma. A systematic review of all the available trial evidence found some promising, albeit not compelling, evidence for yoga and conventional physiotherapeutic techniques7. Moreover, there is some (again, not compelling) evidence to suggest that the Buteyko technique is of some benefit8. This technique, developed over 50 years ago by Russian scientist Konstantin Pavlovich Buteyko, is a set of simple breathing exercises to encourage shallow breathing. On balance, therefore, these methods are worth trying with adequate supervision.

Hypnosis

Hardly any RCTs have tested the effectiveness of hypnosis for asthma9. Two small trials yielded encouraging results10,11 but it is unclear to what extent this benefit was due to placebo effects. Nonetheless, the balance of the evidence seems positive and so hypnosis, under adequate medical supervision, seems to be worth trying for suitable patients.

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