Yes, some are. Acupuncture relieves subjective symptoms of asthma and reduces medication use in mild to moderate asthma (strength of recommendation [SOR]: A, based on systematic review of randomized controlled trials [RCTs] of variable quality). Herbal medications, such as Ginkgo biloba, appear to improve lung function, while herbs such as Tylophora indica and Tsumura saiboku-to may decrease asthma symptoms (SOR: B, based on systematic review of RCTs with poor methodology). No evidence, however, supports the use of room air ionizers, manual therapy, homeopathy, or mind-body therapy for treatment of asthma (SOR: A, based on systematic reviews and meta-analyses of RCTs and individual RCTs)

Buckley, David

Hayes, Meg

Judkins, Dolores Zegar

University of Missouri: MOspace

	 vol	56,	No	5	/	may	2007	 385www.jfponline.comCliniCal INquIrIes From the Family Physicians Inquiries Network  Are any alternative therapies  effective in treating asthma?yes,	some	are.	acupuncture	relieves	subjective	symptoms	of	asthma	and	reduces	medication	use	in	mild	to	moderate	asthma	(strength	of	recommendation	[sor]:	A,	based	on	systematic	review	of	randomized	controlled	trials	[rCTs]	of	variable	quality).	Herbal	medications,	such	as	Ginkgo biloba,	appear	to	improve	lung	function,	while	herbs	such	as Tylophora indica	and	Tsumura	saiboku-to	may	decrease	asthma	symptoms	(sor:	B,	based	on	systematic	review	of	rCTs	with	poor	methodology).	No	evidence,	however,	supports	the	use	of	room	air	ionizers,	manual	therapy,	homeopathy,	or	mind-body	therapy	for	treatment	of	asthma	(sor:	A,	based	on	systematic	reviews	and	meta-analyses	of	rCTs	and	individual	rCTs).Though this research is interesting,we should adhere to current guidelines Guidelines	for	the	diagnosis	and	management	of	asthma	are	widely	disseminated	by	the	National	asthma	education	and	Prevention	Program	through	its	expert	Panel	reports	(updated	in	2002).1	Nevertheless,	nearly	500,000	hospitalizations,	2	million	emergency	department	visits,	and	5000	deaths	were	reported	annually	in	the	us	among	those	who	have	asthma.2	Furthermore,	a	significant	difference	in	asthma	prevalence,	health	care	use,	and	mortality	was	found	among	different	ethnic	groups.1		 Poor	patient	understanding	of	asthma	control,	nonadherence	to	medication	regimens,	cultural	beliefs,	and	disparity	of	access	to	the	health	care	system,	together	with	physicians’	lack	of	close	monitoring	and	inadequate	compliance	with	national	asthma	guidelines,	contribute	to	suboptimal	control	of	chronic	asthma.	Family	physicians	must	guide	and	empower	their	patients	with	the	knowledge	and	responsibility	of	how	to	manage	their	asthma.	For	now,	we	should	adhere	to	current	national	guidelines	of	management	of	asthma	and	avoid	routine	recommendation	of	any	complimentary	alternative	treatments.	Vincent lo, MDsan	Joaquin	General	Hospital,	French	Camp,	Califz Evidence summaryAlthough complementary and alterna-tive medicine (CAM) therapies are wide-ly used, the overall body of research into CAM for asthma is still small and of limited quality. Interpreting the research is hampered by lack of standardized therapeutic approaches, lack of accepted methods for appropriate trials, and the fact that many CAM treatments are used as part of a multi-pronged, individualized approach to treatment in actual practice. Meg Hayes, MD,  David Buckley, MD, and  Dolores Zegar Judkins, MlSOregon Health and Sciences University, PortlandClinical commentaryEvidence-based answerfast trackNo evidence  supports use of room air ionizers, homeopathy, or mind-body therapy for the treatment of asthmaCoNT INueDCopyright® Dowden Health Media  For personal use onlyFor mass reproduction, content licensing and permissions contact Dowden Health Media.fast track386 vol	56,	No	5	/	may	2007		ThE JournAl of fAmily PrACTiCECliniCal INquIrIesOur search found 4 good-quality system-atic reviews of RCTs, 1 good-quality sys-tematic review of randomized trials, and 1 small additional pilot RCT of various CAM treatments for asthma.Acupuncture and herbals  provide some benefitWhile a Cochrane review of 11 RCTs with variable trial quality and a total of 324 participants found that acupuncture had no significant effect on pulmonary function or global assessment of well- being, the review noted that some stud-ies reported significant positive changes in daily symptoms, reductions in medi-cation use, and improved quality of life. This suggests that some patients with mild to moderate asthma may benefit from acupuncture.3 In 1 RCT, improve-ment in general well-being was reported by 79% of 38 patients receiving acupunc-ture compared with 47% of 18 patients in the control group.4When it comes to herbal remedies, a good-quality systematic review5 of 17 trials, with overall poor methodological quality and a total of 1445 participants, reported significant improvements in clinically relevant measures with 6 differ-ent herbal medicines. •  Ginkgo biloba liquor increased forced expiratory volume in 1 second (FEV1) by 10% at 4 weeks and by a more clinically relevant 15% at 8 weeks (significantly greater than placebo, P<.05). •  Invigorating Kidney for Prevent-ing Asthma (IKPA) tablets increased FEV1 by 30% at 3 months compared with 17% in controls (P<.05). •  Wenyang Tonglulo Mixture (WTM) improved FEV1 by 30% at 8 weeks compared with a 16% increase in the control group using oral salbutamol and inhaled beclomethasone (P<.05). •  Dried ivy extract, thought to work as both a secretolytic and bronchospas-molytic, reduced airway resistance in children by 23.6% compared with placebo (P=.036). •  Tylophora indica (a rare herb also known as Indian ipecac) provided significant improvement in nocturnal dyspnea when compared with con-trols (P<.01) in a study that relied on patients’ symptom diaries.•  Tsumura saiboku-to (TJ-96) provided patients in one RCT with significant, but unspecified, asthma symptom relief when compared with those in a control group (P<.01).5Other therapies didn’t quite make the gradehomeopathy. A Cochrane review of 6 RCTs of mixed quality, with a total of 556 patients, concluded the evidence is insufficient to evaluate the possible role of homeopathy for the treatment of asthma, due to heterogeneity of interventions, patient populations, and outcome assessments. Each study evaluated a different homeopathic remedy, making any overall assessment difficult. The review notes there have been only limited attempts to study a com-plete “package of care,” which includes the in-depth, one-on-one consultation, treatment, and follow-up that charac-terizes most homeopathic treatment in practice.6room air ionizers. A Cochrane review of 6 good-quality trials with a total of 106 participants reported no significant effect of room air ionizers on pulmo-nary function measures, symptoms, or medication use.7manual therapy.  A Cochrane review8 of 3 moderate- to poor-quality RCTs with 156 participants reported no significant effect of chiropractic spinal manipulation (2 trials) or massage ther-apy (1 trial) on lung function, asthma symptoms, or medication use.mind-body therapy. A pilot RCT9 with 33 adults found a nonsignificant reduction in medication use among the subjects practicing mental imagery, but no overall effect on lung function or quality-of-life measures.Some patients with mild to  moderate asthma may benefit from acupunctureCoNT INueDRecommendations from othersThe New Zealand Guideline Group (NZGG)10 gives a Grade B recommenda-tion for Buteyko Breathing Techniques as an intervention that may be helpful in reducing acute exacerbation medication use and improving patient quality of life. However, the NZGG did not find other benefits to this intervention and noted that it might be costly for the patient to obtain training in these techniques. The NZGG further recommends as a good practice point that healthcare profession-als be open to the use of CAM therapies and that such therapies be tried by pa-tients who are interested in them, with monitoring and self-assessment to assist patients in determining which therapies are of value.  nreferences	 1.	 	Guidelines	 for	 the	 diagnosis	 and	 management	 of	asthma.	update	 on	 selected	 topics	 2002.	 available	at:	 www.nhlbi.nih.gov/guidelines/asthma/index.htm.	accessed	on	march	30,	2007.	 2.	 	mannino	Dm,	Home	DW,	akinbami	lJ,	morrman	Je,	Guynn	C,	redd	sC.	surveillance	of	asthma—1980–1999.	MMWR Surveill Summ	2002;	51:1–13.	 3.	 	mcCarney	rW,	Brinkhaus	B,	lasserson	TJ,	linde	K.	acupuncture	for	chronic	asthma.	Cochrane Da-tabase Syst Rev	2004;	(1):CD000008.		 4.	 	Joos	s,	schott	C,	Zou	H,	Daniel	v,	martin	e.	 Im-munomodulatory	 effects	 of	 acupuncture	 in	 the	treatment	of	allergic	asthma:	a	 randomized	con-trolled	study.	J Altern Complementary Med	2000;	6:519–525.	 5.	 	Huntley	a,	ernst	e.	Herbal	medicines	for	asthma:	a	systemic	review.	Thorax 2000;	55:925–929.	 6.	 	mcCarney	rW,	linde	K,	lasserson	TJ.	Homeopa-thy	 for	 chronic	 asthma.	Cochrane Database Syst Rev 2004;	(1):CD000353.		 7.	 	Blackhall	 K,	 appleton	 s,	 Cates	 FJ.	 Ionisers	 for	chronic	 asthma.	 Cochrane Database Syst Rev 2003;	(3):CD002986.		 8.	 	Hondras	ma,	Jones	lK,	Jones	aP.	manual	therapy	for	asthma.	Cochrane Database Syst Rev 2005;	(2):CD001002.		 9.	 	epstein	GN,	Halper,	 JP,	Barrett,	 ea,	 et	 al.	 a	pilot	study	of	mind-body	changes	in	adults	with	asthma	who	practice	mental	imagery.	Alternative Therapies 2004;	10:66–71.		10.	 	New	 Zealand	 Guidelines	 Group	 (NZGG).	 The	 di-agnosis	 and	 treatment	 of	 adult	 asthma.	 Best	Practice	 evidence-Based	 Guideline.	 Wellington,	NZ:	NZGG;	 2007.	 available	 at:	www.nzgg.org.nz/guidelines/0003/Full_text_Guideline.pdf.	accessed	on	march	30,	2007.alternative therapies for asthma

Are any alternative therapies effective in treating asthma?

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