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

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

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

Adrienne Kaminskyj, BKin, DC, Michelle Frazier, BA, DC, Kyle Johnstone, BGS, DC, Brian J. Gleberzon, BA, DC*

* Corresponding author: Professor and Chair, Department of Applied Chiropractic, Canadian Memorial Chiropractic College, 6100 Leslie St, Toronto, ON M2H 3J1. Tel: 416 482 4476. Email: bgleberzon@cmcc.ca


OBJECTIVE:   To provide a review of the literature and rate the quality of published studies regarding chiropractic care, including spinal manipulation, for asthmatic patients.

METHODS:   A multimodal search strategy was conducted, including multiple database searches, along with reference and journal hand-searching. Studies were limited to those published in English and in peer-reviewed journals or conference proceedings between January 1980 and March 2009. All study designs were considered except personal narratives or reviews. Retrieved articles that met the inclusion criteria were rated for quality by using the Downs and Black checklist. A brief summary was also written for each retrieved study.

RESULTS:   Eight articles met the inclusion criteria of this review in the form of one case series, one case study, one survey, two randomized controlled trials (RCTs), one randomized patient and observer blinded cross-over trial, one single blind cross study design, and one self-reported impairment questionnaire. Their quality scores ranged from 5 to 22 out of 27.

CONCLUSION:   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.


From the FULL TEXT Article

Introduction

Chiropractic is among the three most commonly utilized complementary and alternative medicine (CAM) therapies. [1] As a result, practitioners in this realm of health care are certain to encounter a vast array of clinical conditions ranging from common to obscure. According to the World Health Organization, asthma is now a serious public health problem with over 100 million sufferers worldwide. [2] It can be expected that chiropractors, along with other CAM practitioners, will be treating asthmatic patients. Sources of management and treatment guidelines mention pharmaceutical interventions and trigger avoidance as key items; however, many of these sources fail to mention CAM therapies.

Many chiropractors have experienced success in the treatment of non-musculoskeletal conditions, dating back to the very first adjustment. In this day and age, the scope of chiropractic care ranges from traditional spinal manipulation, to nutritional advice, to exercise prescription. The clinical question, however, is whether CAM interventions can benefit the asthmatic, and whether chiropractors should be the primary health care providers or provide co-management. Moreover, it must be determined if the chiropractic care provided to asthmatic conditions is directed at improving asthma-related symptoms (i.e. breathing) or if it is targeted towards the spinal symptoms (i.e. pain, stiffness, lose of motion) secondary to the asthma.

Towards that end, a number of studies have been aimed towards analyzing the effects of spinal manipulative therapy (SMT) in relation to forced expiratory volume (FEV), quality of life, self reported asthma severity, medication dependency and other measures, without consideration of the complete chiropractic encounter. The purpose of this systematic review of the literature was to rate the quality of the existing evidence for the chiropractic care of patients with asthma.


Discussion

In treating asthmatic patients, the objective of chiropractic spinal manipulative therapy (high amplitude, low velocity thrusts) is to increase the motion of the thoracic cage, mobilize the ribs, enhance arterial supply and lymphatic return, and to affect nervous system activity, all in hope of reducing symptomatology of the patient.

To the knowledge of the authors, this is the first systematic review of the literature specifically examining chiropractic care for the treatment of asthma. For the purposes of this review, chiropractic care encompassed spinal manipulative therapy, mobilizations, soft tissue therapy and/ or breathing exercises. Although the studies evaluated for this review showed some patient improvement with chiropractic care, the quality of this evidence was, at times, questionable and for this reason it is insufficient in determining direct therapeutic benefit. Assessing the effectiveness of chiropractic treatment of patients with asthma is multifactorial and an array of outcome measures exist, both subjective and objective.

Subjective measures varied amongst the selected literature, including reported number of asthma attacks, medication use, quality of life, patient-reported changes in asthma symptomatology, modified Oswestry rating scale, and asthma diary logs. A noticeable trend of improvement in these measures was recognized across the reviewed literature, although none were statistically significant.

Spirometry readings were the main objective measures used in the selected literature. These included peak expiratory flow, vital capacity and forced expiratory volume. Some improvements in these objective measures were noted, however, as with the subjective measures, none were statistically significant.

The main limitation amongst the selected literature was the lack of detail regarding the location and type of manipulative technique used. This lack of information hinders the reproducibility of the study design. With this being stated, chiropractors are trained to locate and manipulate restricted vertebral segments in the attempt to induce motion. Whether or not certain types of chiropractic manipulations are more beneficial than others is a pertinent question that should be explored in further investigations.

It is encouraging to note that, in the two articles that commented on it, no patients were reported to experience any worsening of symptoms or injuries while under care. Although it is tempting to attribute this to the care provided, it is equally possible that, since these children were being medicated during the time they received chiropractic care, any worsening of their condition would have been masked by their drugs. Additionally, although it is encouraging that many of the children in the studies referred to in these articles were able to experience a decrease in their medication use, it is possible that these same children were being over-medicated initially.

No statistical significances were obtained with chiropractic care during the treatment of children with asthma. However, positive clinical changes were seen in a number of subjects leading to the conclusion that spinal manipulative therapy may be sought as an adjunct to medical management. In stating this, it is important to note that there is a chance that this treatment modality may be of little to no benefi t for certain patients and therefore the authors recommend a trial of care to identify whether or not chiropractic care should be included in the overall management of their condition.


Conclusion

Despite a paucity of evidence supporting the successful management of patients with asthma under chiropractic care, and despite the fact that the evidence that does exist is heterogeneous with respect to its quality strength, there is nonetheless some indication that patients experience positive subjective and at times positive objective results while under chiropractic care. The approaches described in many of the manuscripts reviewed refl ect common clinical practice activities used by chiropractors, including an array of different outcome measures. That said, more evidence is required before any defi nitive statements can be made with respect to the clinical effectiveness of chiropractic care for patients with asthma and with respect to the most appropriate role chiropractors should play in the management of these patients. Such studies may benefi t from the use of a valid and reliable outcome measure such as the Pediatric Asthma Health Outcome Measure (PAHOM). [18]

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