ASTHMA AND CHIROPRACTIC
 
   

Asthma and Chiropractic

This section was compiled by Frank M. Painter, D.C.
Send all comments or additions to:
  Frankp@chiro.org

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Chiropractic Research Results for Asthma
 
   

Hold your horses! Before you wade into the Asthma Section, please read Dr. Nansel & Szlazak's fascinating JMPT article (see below), as it clarifies WHY chiropractic gets such dramatic results with a spectrum of purported diseases and disorders. You'll be glad you did!

  
Somatic Dysfunction and the Phenomenon of Visceral Disease Simulation:   A Probable Explanation for the Apparent Effectiveness of Somatic Therapy in Patients Presumed to be Suffering from True Visceral Disease
J Manipulative Physiol Ther 1995 (Jul);   18 (6):   379–397

The proper differential diagnosis of somatic vs. visceral dysfunction represents a challenge for both the medical and chiropractic physician. The afferent convergence mechanisms, which can create signs and symptoms that are virtually indistinguishable with respect to their somatic vs. visceral etiologies, need to be appreciated by all portal-of-entry health care providers, to insure timely referral of patients to the health specialist appropriate to their condition. Furthermore, it is not unreasonable that this somatic visceral-disease mimicry could very well account for the “cures” of presumed organ disease that have been observed over the years in response to various somatic therapies (e.g., spinal manipulation, acupuncture, Rolfing, Qi Gong, etc.) and may represent a common phenomenon that has led to “holistic” health care claims on the part of such clinical disciplines.


Manual Therapy For Childhood Respiratory Disease:
A Systematic Review

J Manipulative Physiol Ther. 2013 (Jan);   36 (1):   57–65

The use of manual techniques on children with respiratory diseases seems to be beneficial. Chiropractic, osteopathic medicine, and massage are the most common interventions. The lack of standardized procedures and limited variety of methods used evidenced the need for more studies on the subject.


The Use of Spinal Manipulative Therapy For Pediatric Health Conditions:
A Systematic Review of the Literature

J Can Chiropr Assoc. 2012 (Jun);   56 (2):   128–141 ~ FULL TEXT

Six clinical trials investigated the effectiveness of SMT on colic, two each on asthma and enuresis, and one each on hip extension, otitis media, suboptimal breastfeeding, autism, idiopathic scoliosis and jet lag. Studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to SMT, especially among children with asthma.


The Chiropractic Care of Patients with Asthma:
A Systematic Review of the Literature to Inform Clinical Practice

Clinical Chiropractic 2012 (Mar);   15 (1): 23–30

This systematic review found 2 previous reviews that concluded that chiropractic care provided benefit to asthmatic patients, [41] and [42] one review was neutral [40] while 3 reviews [7], [39] and [43] concluded that the addition of chiropractic care to usual medical care provided no benefit to asthmatic patients. From a chiropractic perspective, the dissenting reviews challenge the veracity of the chiropractic clinical experience. The sweeping conclusion by Ernst [7] that spinal manipulation is not effective in the treatment of asthma reflected his disinclination to critically and objectively appraise such studies. Alcantara et al. [56] challenged the veracity of Ernst's review by pointing out the same issues that Kaminskyj et al. [42] failed to consider in their systematic review.


Applied Kinesiology Methods For a 10-year-old Child
With Headaches, Neck Pain, Asthma, and Reading Disabilities

J Chiropr Med. 2010 (Sep);   9 (3):   138–145 ~ FULL TEXT

Chiropractic care, using applied kinesiology, guided evaluation, and treatment. Following spinal and cranial treatment, the patient showed improvement in his reading ability, head and neck pain, and respiratory distress. His ability to read improved (in 3 weeks, after 5 treatments), performing at his own grade level. He has remained symptom free for 2 years.


Changes in Asthma Symptoms and Bedwetting in a Four Year Old Child
Receiving Chiropractic Care: A Case Report

Chiropractic Journal of Australia 2010 (Mar);   40 (1):   34–36

A four-year-old child diagnosed with asthma and a history of allergies, bedwetting and disrupted sleep presented for chiropractic care. After a trial of chiropractic care the child no longer had asthma symptoms, bedwetting had ceased and a positive change in other presenting symptoms was noted. There are a growing number of case reports that describe improvements in childhood problems such as asthma and nocturnal enuresis in children receiving chiropractic care. Thus far clinical trials have failed to provide sufficient evidence to support the potential link between improvements in these childhood problems and chiropractic care. Further study is required to investigate the role chiropractors may play in caring for children with these disorders.


Chiropractic Care for Patients with Asthma:
A Systematic Review of the Literature

J Can Chiropr Assoc. 2010 (Mar);   54 (1):   24–32 ~ FULL TEXT

Results of the eight retrieved studies indicated that chiropractic care showed improvements in subjective measures and, to a lesser degree objective measures, none of which were statistically significant. It is evident that some asthmatic patients may benefit from this treatment approach; however, at this time, the evidence suggests chiropractic care should be used as an adjunct, not a replacement, to traditional medical therapy.


Chiropractic Care of a Pediatric Patient with Asthma,
Allergies, Chronic Colds & Vertebral Subluxation

Journal of Pediatric, Maternal & Family Health - Chiropractic 2009;   3:   1–7

A 7-year-old male was presented by his parents for chiropractic evaluation and possible care. The suffered from chronic colds, allergies, and asthma since the age of 5 months. At the time of initial evaluation, the patient was on a 1x/day dose of prescription Alavert for allergies and Albuterol for asthma. The patient was cared for using specific, low-force adjustments with the Activator Instrument to address areas of vertebral subluxation in the cervical, thoracic, and lumbosacral spine. Within two weeks of initiating chiropractic care, the patient was able to discontinue his allergy and asthma medications (as decided upon by his parents) and the use of his nebulizer.


Chiropractic Care for Nonmusculoskeletal Conditions: A Systematic
Review With Implications For Whole Systems Research

J Altern Complement Med. 2007 (Jun);   13 (5):   491–512 ~ FULL TEXT

(1) Adverse effects should be routinely reported. For the few studies that did report, adverse effects of spinal manipulation for all ages and conditions were rare, transient, and not severe.   (2) Evidence from controlled studies and usual practice supports chiropractic care (the entire clinical encounter) as providing benefit to patients with asthma, cervicogenic vertigo, and infantile colic.   Evidence was promising for potential benefit of manual procedures for children with otitis media and elderly patients with pneumonia.


Chiropractic Co-management of Medically Treated Asthma
Clinical Chiropractic 2005 (Sep);   8 (3):   140–144

This article presents three cases where patients, being treated by conventional pharmacological means, had chiropractic manipulation administered to the upper thoracic spine twice a week for a period of 6 weeks. Objective measurements were collected using a peak flow meter and subjective data using an asthma specific questionnaire. All three cases resulted in increased subjective and objective parameters and suggest the need for larger studies with appropriate methodology.


Self-reported Nonmusculoskeletal Responses to Chiropractic Intervention:
A Multination Survey

J Manipulative Physiol Ther 2005 (Jun);   28 (5):   294–302

Positive reactions were reported by 2% to 10% of all patients and by 3% to 27% of those who reported to have such problems. Most common were improved breathing (27%), digestion (26%), and circulation (21%).


Spinal Manipulation May Benefit Asthma Patients
Foundation for Chiropractic Education and Research (FCER)

Patients afflicted with asthma may benefit from spinal manipulation in terms of symptoms, immunological capacity, and endocrine effects, an audience was told on October 5 at the 9th International Conference on Spinal Manipulation in Toronto. The investigative team, headed by Ray Hayek, Ph.D., has been conducting a trial at 16 treatment centers in Australia involving 420 patients with an average age of 46 in an effort to find out what effects spinal manipulation has on symptoms, depression and anxiety, general health status, and the levels of immunity as reflected by the concentrations of both an immunoglobulin (IgA) and an immunosuppressant (cortisol).


Join Us in Documenting the Effects of Spinal Manipulative Therapy
(SMT) on Asthma

Anthony L. Rosner, Ph.D., Director of Research and Education for FCER

This project, conducted by researchers at Macquarie University in Sydney with 420 subjects, follows on the heels of preliminary observations which suggest that chiropractic management of spinal dysfunction in asthmatic subjects reduces symptoms, anxiety and cortisol levels.


Asthma Trial Update: Preliminary Data Encouraging
Vincent P. Lucido, D.C., President of FCER

This trial is of paramount importance in addressing the major flaws in a previous and unfortunately highly visible clinical trial published in The New England Journal of Medicine. [1] It also represents one of the few investigations that taps into the field of endocrinology — an area that must be addressed if one is to gain further insight into the systemic effects of spinal dysfunctions and their management by chiropractic care. This research represents only a handful of investigations that have addressed the consequences of manipulation involving chemical (as opposed to electrical) messengers within the body.


Response to the “Manual Therapy for Asthma” Cochrane Review
Anthony Rosner, PhD, FCER Director of Research

Hondras' recently published systematic review of randomized clinical trials 1 addressed to manual therapy represents a sincere effort to summarize those investigations in what is commonly regarded as the gold standard of clinical research. That said, however, one has to remain particularly vigilant against accepting randomized clinical trials at face value, particularly in those instances involving physical interventions, in which the complete blinding of practitioners [and most likely patients as well] in the traditional RCT design is all but impossible.


Effect of Chiropractic Treatment on the Endocrine and
Immune System in Asthmatic Patients

Proceedings of the 2002 International Conference on Spinal Manipulation. 2002 (Oct)

The broad aims of this FCER funded study is to determine whether stress is a factor in the pathophysiology of asthma and to determine if chiropractic management of asthmatics can alleviate stress induced asthma. More specifically for this meeting, our study aims to determine whether chiropractic treatment has beneficial effects on the endocrine system through measurement of salivary cortisol and on the immune system via salivary IgA determination.


Chronic Pediatric Asthma and Chiropractic Spinal Manipulation:
A Prospective Clinical Series and Randomized Clinical Pilot Study

J Manipulative Physiol Ther 2001 (Jul);   24 (6):   369–377

After 3 months of combining chiropractic SMT with optimal medical management for pediatric asthma, the children rated their quality of life substantially higher and their asthma severity substantially lower. These improvements were maintained at the 1-year follow-up assessment. You may also be interested in this follow-up letter to the authors which notes the continuing problems with the design of placebos in manual spinal trials.


Chiropractic Management of 47 Asthma Cases
Todays Chiropractic 2000 (Nov) ~ FULL TEXT

Over a seven-year period, 47 cases of asthma were managed in an outpatient setting. Every case was followed for a minimum of two years to observe effectiveness of care. The study group comprised 28 males and 19 females, ranging from 7 to 42 years of age. Of the 47 cases, 32 patients ranged in age from 7 to 19 years.


Manual Medicine Diversity:
Research Pitfalls and the Emerging Medical Paradigm

J Am Osteopath Assoc 2001;   101 (8) Aug:   441-444 ~ FULL TEXT

Recent studies published in leading medical journals have concluded that chiropractic treatment is not particularly helpful for relieving asthma and migraine symptoms because even though study participants showed notable improvement in symptoms, those subjects who received sham manual medicine treatments also showed improvement. Yet the sham treatment received by control groups in these studies is reminiscent in many ways of traditional osteopathic manipulation. This seems to represent not only a failure to recognize the value of many manual medicine techniques but also an ignorance of the broad spectrum of manual medicine techniques used by various practitioners, from osteopathic physicians to chiropractors to physical therapists.


An Example of Flawed Asthma Research


Comparison of Active and Simulated Chiropractic Manipulation as
Adjunctive Treatment for Childhood Asthma

New England Journal of Medicine 1998 (Oct 8);   339 (15):   1013–1020

This article raises an interesting question. Was the “Simulated Chiropractic Manipulation” sham treatment a confounder? How else to explain their findings that “Symptoms of asthma and use of {beta}-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups.” You may want to review the Problems with Placebos/Shams Page for a more in-depth discussion of this topic.


Anthony Rosner, Ph.D.'s response to the Balon NEJM Asthma Study
At a time when public interest in the application of alternative medicine is rising, it is regrettable that a study with such deep flaws should have found its way to the lead position in such a prominent journal. Major deficiencies of the study are summarized as follows. Thanks to FCER for permission to reproduce this article. Dr. Rosner is the FCER Director of Research.


Other Responses to This Article by the Chiropractic Academic
and Research Community

Here are comments from researcher Bill Meeker, D.C., Daniel Redwood, D.C., the Meridian Institute, Daniel Becker, D.C., DABCN, James Provoost, D.C., and the Pennsylvania Chiropractic Association.


   End of Flawed Asthma Research Articles   

An Impairment Rating Analysis Of Asthmatic Children
Under Chiropractic Care

Journal of Vertebral Subluxation Research 1997;   1 (4) Jul:   1–8

A self-reported asthma-related impairment study was conducted on 81 children under chiropractic care. The intent of this study was to quantify self-reported changes in impairment experienced by the pediatric asthmatic subjects, before and after a two month period under chiropractic care. Significantly lower impairment rating scores (improvement) were reported for 90.1% of subjects 60 days after chiropractic care when compared to the pre-chiropractic scores (p < 0.05) with an effect size of 0.96.


Osteopathic Manipulative Treatment Applications
for the Emergency Department Patient

J Am Osteopath Assoc 1996;   96 (7) Jul:   403–409

The emergency department (ED) setting offers osteopathic physicians multiple opportunities to provide osteopathic manipulative treatment (OMT) as either the primary therapy or as an adjunct to the intervention. In doing so, osteopathic physicians can decrease or eliminate the morbidity and symptoms associated with protracted dysfunction. Low back pain, chest pain, torticollis, asthma, and sinusitis are some of the illnesses in which OMT should be implemented as part of the management plan.


Chronic Asthma and Chiropractic Spinal Manipulation:
A Randomized Clinical Trial

Journal of Clinical and Experimental Allergy 1995 (Jan);   25 (1):   80–88

Objective lung function did not change during the study, but over the course of the study, non-specific bronchial hyperreactivity (n-BR) improved by 36% (P = 0.01) and patient-rated asthma severity decreased by 34% (P = 0.0002) compared with the baseline values.


Management of Pediatric Asthma & Enuresis
with Probable Traumatic Etiology

ICA Internat Rev Chiro 1995 (Jan):   37–40

On May 20, 1988 the child was seen for chiropractic examination and evaluation, and from that date to August 3, 1991 the child received 28 chiropractic adjustive/manipulative treatments. Dramatic improvement of asthma and enuresis followed chiropractic management.


A Wholistic Approach to the Treatment of Bronchial Asthma
in a Chiropractic Practice

Chiro J Aust 1993;   23 (1):   4–8

Three case studies involving two children and a mature adult with established diagnoses of bronchial asthma are presented. Management in each case involve chiropractic adjustments combined with a "clinical ecology" approach which has been found useful in identifying food and environmental allergens that may act as triggering factors for asthma attacks. This paper suggests that such a broad-based management approach may lead to higher rates of response to chiropractic treatment of asthma, as well as providing greater long-term relief for its victims.


Manipulative Therapy an Alternative Treatment for Asthma:
A Literature Review

Chiro: The J Chiro Res and Clin Invest 1992;   8(2):   40–42

This is a literature review of the effects of manipulative therapy as alternative treatment for asthma. Subjective studies show that manipulation of the spine relieves the patients' symptoms. However, objective findings have yet to be compiled using respiratory indices. We recommend an extensive study be performed to determine the effects of manipulation on bronchial asthma.


Review More Abstracts on Chiropractic and Asthma
Review abstracts about chiropractic and a variety of organic and visceral disorders at the wonderful International Chiropractic Pediatric Association (ICPA) website

 
   

Other Management Approaches for Asthma
 
   

Use of Multivitamin Supplements in Relation to Allergic Disease
in 8-y-old Children

American J Clinical Nutrition 2009 (Dec);   90 (6):   1693–1698 ~ FULL TEXT

Asthma Fact: — The incidence of asthma in children has nearly quadrupled over the last 30 years — That's one in ten children in the US (9.4%), and the fastest rate of growth in preschool-age children. The GOOD News: — Children who started taking a multivitamins BEFORE the age 4 had the lowest incidence of asthma and allergies. This study also found that starting multivitamin use later in life, once allergies had already taken hold, appear to have less impact.


The Etiologies, Pathophysiology, and
Alternative/Complementary Treatment of Asthma

Alternative Medicine Review 2001;   6 (1):   20–47 ~ FULL TEXT

Antioxidant nutrients, especially vitamins C and E, selenium, and zinc appear to be necessary in asthma treatment. Vitamins B6 and B12 also may be helpful. Omega-3 fatty acids from fish, the flavonoid quercetin, and botanicals Tylophora asthmatica, Boswellia serrata and Petasites hybridus address the inflammatory component. Physical modalities, including yoga, massage, biofeedback, acupuncture, and chiropractic can also be of help.


Research Perspectives in Asthma:   A Rationale for the Therapeutic Application of Magnesium, Pyridoxine, Coleus forskholii and Ginkgo biloba in the Treatment of Adult and Pediatric Asthma
The Internist 1998;   5 (3) Sept:   14–16 ~ FULL TEXT

Thanks to the American Chiropratic Association's Council On Family Practice for their permission to reprint this article exclusively at Chiro.Org!


Natural Asthma Relief
Asthma is best described as a chronic inflammatory condition rather than a respiratory disease. In fact, asthma's origins have more in common with arthritis than they do with emphysema or tuberculosis. Asthma is simply a chronic inflammation of the airway rather than the joints. People with asthma have inflamed, hyperreactive airways that produce excessive bronchial mucus. After repeated asthma attacks, the airway lining becomes scarred, and immune cells, which cause or exacerbate inflammation, proliferate there.2 Asthma eventually damages the airway permanently, making it more prone to inflammation and less functional overall.


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