Complementary and Alternative Medicine for Bronchial Asthma
Purpose of Review: Complementary and alternative medicine is widely used in bronchial asthma. Data on efficacy of these treatment modalities are lacking.
Recent Findings: Studies published since June 2002 on complementary and alternative medicine in bronchial asthma were systematically reviewed.
Summary: Studies do not support the use of homeopathy, air ionizers, manual therapy, or acupuncture for asthma. These methods bear some risks to patients related to undertreatment and side effects. There might be a possible, but so far not clearly established, role for antioxidant dietary supplementation, and some natural antiinflammatory and immunomodulatory remedies. However, their effect size compared with the classical treatment and side-effect profile is not clearly established. Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma. Breathing exercises could improve lung function and quality of life in different studies. Psychotherapy-related methods such as relaxation, hypnosis, autogenic training, speleotherapy, and biofeedback might have a small effect in selected cases, but have not proven to be superior to placebo. Nevertheless, more randomized controlled trials of good methodological quality are required to allow firm conclusions.
The use of complementary and alternative medicine (CAM) is very popular. According to Blanc et al., Ernst et al., Schafer et al., and Ng TP et al., 59% of patients with asthma or rhinosinusitis in the United Kingdom, 41% in the United States, 26.5% in Germany, and 27.2% in Singapore are reported to use CAM. The only exception is the study of Partridge et al., reporting only 6% of asthma patient in the United Kingdom using CAM. In contrast to its popularity stands the lack of evidence of efficiency of these methods in asthma and the absence of recommendations by the current asthma guidelines.
It is important to apply safe, efficient, and cost-effective treatments to patients, and the same rules should apply for all different treatment modalities including CAM.
What is the recent evidence supporting CAM in asthma?
A Swiss study on the economic effects of CAM estimated that it will cost about 350 million Swiss francs (approximately 240 million Euro) per year to cover the expenses related to the recently introduced compulsory reimbursement by health insurances of CAM methods. In their review, Pelletier et al. found increasing interest by insurance companies in offering CAM to their clients. Market demand was their primary motivation without review of cost effectiveness. A survey by Eisenberg et al. concluded that 42% of adults in the United States consult alternative medical practitioners and spend an estimated 27 billion dollars annually on alternative medical therapies.
An important reason for the lack of evidence for the efficacy (or inefficacy) of CAM is the large proportion of underpowered, methodologically unreliable, and very heterogeneous trials in this field. Linde et al. reviewed the methodological quality of 207 randomized controlled trials (RCTs) in homeopathy, herbal medicines, and acupuncture using the Jaded scale. The methodological quality was highly variable, and the majority had important shortcomings in reporting or methodology or both. Ethical oversight committees could play an important role in verifying the design of such studies in the future.
Another problem in interpreting evidence on CAM is cultural barriers. Many reports have been published in Chinese, and it is nearly impossible to cover these publications in reviews including the present. In addition, there are many different ways to define asthma, for example, cold and hot asthma in traditional Chinese medicine. Also, the expectations from patients and the outcome measures and study endpoints vary significantly.
Furthermore, there is a striking lack of information about the safety of CAM. In a survey of 601 patients with asthma by Blanc et al., the use of herbal medicine was associated with increased risk of hospitalization in the last 12 months (odds ratio 2.5, 95% CI 1.1 to 5.6). This could be because of a lack of control of airway inflammation in herbal remedy users.
The current article systematically reviews new scientific evidence of studies published from June 2002 to September 2003.
Purpose of Review: Complementary and alternative medicine is widely used in bronchial asthma. Data on efficacy of these treatment modalities are lacking.
Recent Findings: Studies published since June 2002 on complementary and alternative medicine in bronchial asthma were systematically reviewed.
Summary: Studies do not support the use of homeopathy, air ionizers, manual therapy, or acupuncture for asthma. These methods bear some risks to patients related to undertreatment and side effects. There might be a possible, but so far not clearly established, role for antioxidant dietary supplementation, and some natural antiinflammatory and immunomodulatory remedies. However, their effect size compared with the classical treatment and side-effect profile is not clearly established. Strategies influencing breathing technique or perception, such as breathing or retraining exercises, need to be studied over the next few years to establish their additive role in the treatment of asthma. Breathing exercises could improve lung function and quality of life in different studies. Psychotherapy-related methods such as relaxation, hypnosis, autogenic training, speleotherapy, and biofeedback might have a small effect in selected cases, but have not proven to be superior to placebo. Nevertheless, more randomized controlled trials of good methodological quality are required to allow firm conclusions.
The use of complementary and alternative medicine (CAM) is very popular. According to Blanc et al., Ernst et al., Schafer et al., and Ng TP et al., 59% of patients with asthma or rhinosinusitis in the United Kingdom, 41% in the United States, 26.5% in Germany, and 27.2% in Singapore are reported to use CAM. The only exception is the study of Partridge et al., reporting only 6% of asthma patient in the United Kingdom using CAM. In contrast to its popularity stands the lack of evidence of efficiency of these methods in asthma and the absence of recommendations by the current asthma guidelines.
It is important to apply safe, efficient, and cost-effective treatments to patients, and the same rules should apply for all different treatment modalities including CAM.
What is the recent evidence supporting CAM in asthma?
A Swiss study on the economic effects of CAM estimated that it will cost about 350 million Swiss francs (approximately 240 million Euro) per year to cover the expenses related to the recently introduced compulsory reimbursement by health insurances of CAM methods. In their review, Pelletier et al. found increasing interest by insurance companies in offering CAM to their clients. Market demand was their primary motivation without review of cost effectiveness. A survey by Eisenberg et al. concluded that 42% of adults in the United States consult alternative medical practitioners and spend an estimated 27 billion dollars annually on alternative medical therapies.
An important reason for the lack of evidence for the efficacy (or inefficacy) of CAM is the large proportion of underpowered, methodologically unreliable, and very heterogeneous trials in this field. Linde et al. reviewed the methodological quality of 207 randomized controlled trials (RCTs) in homeopathy, herbal medicines, and acupuncture using the Jaded scale. The methodological quality was highly variable, and the majority had important shortcomings in reporting or methodology or both. Ethical oversight committees could play an important role in verifying the design of such studies in the future.
Another problem in interpreting evidence on CAM is cultural barriers. Many reports have been published in Chinese, and it is nearly impossible to cover these publications in reviews including the present. In addition, there are many different ways to define asthma, for example, cold and hot asthma in traditional Chinese medicine. Also, the expectations from patients and the outcome measures and study endpoints vary significantly.
Furthermore, there is a striking lack of information about the safety of CAM. In a survey of 601 patients with asthma by Blanc et al., the use of herbal medicine was associated with increased risk of hospitalization in the last 12 months (odds ratio 2.5, 95% CI 1.1 to 5.6). This could be because of a lack of control of airway inflammation in herbal remedy users.
The current article systematically reviews new scientific evidence of studies published from June 2002 to September 2003.
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