Complementary or Alternative Asthma Treatments

There is no good reason to take a chance on risky alternative medicines when proven medical treatment is available that can keep you symptom-free.

The only proven way to control asthma is by using prescription medications and avoiding triggers. Alternative treatments for asthma usually mean treatments that do not use drugs prescribed by doctors. The Expert Panel Report 3 (2007) does not recommend any other kind of treatment for asthma, based on a thorough review of scientific studies. However, surveys show that many people with chronic diseases, including asthma, are using treatments other than prescription drugs and trigger avoidance to try to control their asthma.

Anyone thinking about trying an alternative treatment should talk it over with his or her doctor first. These treatments are not only unproven, but can also be harmful. It is important to keep using treatments as prescribed unless your doctor either tells you to stop taking the medication or to change your current prescribed dose. Using an alternative treatment may worsen your asthma symptoms and might even lead to other health problems. It is possible that some treatments, like relaxation techniques, could be used complementary (in addition) to your prescribed medication. Your doctor may tell you that it is okay to practice this kind of treatment.

The following statements represent the opinions of the Expert Panel (2007) regarding common Complementary and Alternative Medications (CAMs) used in the treatment of asthma (EPR-3, p. 240):

ACUPUNCTURE

The Expert Panel does not recommend the use of acupuncture for the treatment of asthma.

Acupuncture involves the insertion of thin needles along acupuncture points or acupoints on the body. (Acupressure is an different way of stimulating the same acupoints.) Two Cochrane reviews (Linde et al. 2000; McCarney et al. 2004) of randomized trials with hundreds of participants using real acupuncture and sham acupuncture to treat asthma or asthma-like symptoms found no clinical improvement for acupuncture compared to sham acupuncture. Both reviews stated that there is not enough evidence to make recommendations about the value of acupuncture in asthma treatment. Additional studies published between 1970–2000, comparing real acupuncture with sham acupuncture, found no evidence of acupuncture reducing asthma symptoms (Martin et al. 2002).

In addition, people can become very sick after acupuncture treatment. These people usually became sick because of infected needles or puncture injuries.

CHIROPRACTIC THERAPY

The Expert Panel concludes that there is not enough evidence to recommend the use of chiropractic or related techniques in the treatment of asthma.

Chiropractic therapy and other forms of spinal or bodily manipulation or massage have been reported to benefit some patients who have asthma. However, systematic reviews of chiropractic techniques in asthma (Balon and Mior 2004) and related therapies, such as the Alexander technique (Dennis 2000), found few randomized, controlled studies (studies that use scientific methods to prove something works or doesn’t work). Those studies, where available, showed mixed results, with perhaps some benefit in symptoms or health-related quality-of-life measures but no absolute improvement on more objective measures of asthma outcomes (such as improved spirometry tests).

HOMEOPATHY AND HERBAL MEDICINE

The Expert Panel concludes that there is not enough evidence to support the value of homeopathy or herbal products for the treatment of asthma, and that more scientific studies are needed. Furthermore, because herbal products are not made in a uniform way by all companies, one must be aware that some products may have harmful ingredients, and that some may interact with other medications that the patient may be taking.

Homeopathy deals with the use of diluted substances, which cause symptoms when used at full strength. A review of homeopathy studies showed that they were of uneven quality and used different homeopathic treatments, which made it hard to reliably assess the possible role of homeopathy in asthma (McCarney et al. 2004). A variety of herbal products have been used alone and as additional therapy for asthma with positive results in small trials that have not been copied (Gupta et al. 1998; Khayyal et al. 2003; Lee et al. 2004; Urata et al. 2002). The National Center for Complementary and Alternative Medicine of the National Institutes of Health encourages the development of well designed studies to find the role of herbal products.

BREATHING TECHNIQUES

The Expert Panel concludes there is not enough evidence to suggest that breathing techniques have clinical benefit for patients who have asthma.

Scientific studies have been done with breathing exercises (Holloway and Ram 2004), inspiratory (inhale) muscle training (Ram et al. 2003; Weiner et al. 2002), and Buteyko breathing (Cooper et al. 2003) (raising blood PCO2 through hypoventilation). Seven studies on breathing exercises (Holloway and Ram 2004) showed that treatment interventions and outcome measurements varied greatly. So, although there was a suggestion of improvement in things like quick-relief inhaler use, quality of life, and flare-ups in persons who have asthma, no reliable conclusions about the use of breathing exercises for treatment of asthma in clinical practice could be found (Holloway and Ram 2004).

Inspiratory muscle training studies have also been scientifically reviewed (Ram et al. 2003), and in three studies in which the maximum inspiratory pressure (PImax) was reported, it was significantly improved compared to controls (those who did not do the training). In another study of breathing techniques, outcomes suggests that, in mild persistent asthma, using the techniques before using a quick-relief inhaler might curb overuse of the quick-relief inhaler, and that the process of practicing breathing techniques may be more important than the type of breathing technique used (Slader et al. 2006). Larger studies are needed to confirm study findings.

RELAXATION TECHNIQUES

The Expert Panel concludes that, despite some encouraging data from small studies, more positive data from randomized, controlled studies is needed before relaxation techniques can be recommended in the treatment of asthma.

Recent controlled studies have been done to find whether relaxation techniques, including biofeedback and hypotherapy, may be helpful in asthma. Early data suggest that relaxation techniques may help improve not only symptoms (which in studies appeared to improve generally) but also lung function (Lehrer et al. 2004; Loew et al. 2001). Due to the smallness of the study and other concerns, these studies would need more confirmation.

A systematic review of scientific studies of relaxation techniques (Huntley et al. 2002) stated that there was a lack of data from well-done studies of relaxation therapies to recommend them in the treatment of asthma. This review did find some support, however, for muscle relaxation techniques in particular, which may lead to improvements in lung function.

YOGA

There are not enough well-controlled studies on the effects of yoga on asthma.

A recent, well-controlled pilot study of one type of yoga (Iyengar) showed no major results for health-related quality-of-life measures (Sabina et al. 2005).