The Effectiveness of Chiropractic and Acupuncture Treatment on Asthma
A Review Paper for the General Asthmatic Population
Tara Brodene and Sara Quehrn
Fall 2005
A paper for any current event magazine (non-scientific)
In Western Society today, in addition to traditional medical practices, we are seeing an increase in the use of alternative medicine. These therapies are used to treat many diseases and symptoms with out real knowledge of how or if they work. This review will examine the use of chiropractic and acupuncture therapy, specifically chiropractic manipulation and acupuncture, in the treatment of asthmatic symptoms.
Asthma is a common chronic condition that has long plagued our population. According to the Asthma and Allergy Foundation of America, over 20 million Americans suffer from asthma. Many turn to over the counter or prescription medications while some look for alternatives. This subject is important to our society as a whole today. Substantial numbers of patients are seeking “unconventional” health care in addition to medical care rather than a replacement for it. Some reasons why people might be pursuing these avenues may include expense of traditional medicine, possible side effects, or even ineffectiveness. Whatever the reason, chiropractic and acupuncture has been thought to be an empowerment to the patient. It gives them an avenue to be more actively involved in the decision making and thus having overall control of their condition.
Many different studies have been conducted in search of an answer to the question, “Do alternative therapies such as chiropractic manipulation or acupuncture have a positive effect on asthmatic patients?” To date there is conflicting data in support of both sides of the issue for both kinds of treatment. Some studies have shown that there is a benefit to chiropractic manipulation while others show no improvement, or no improvement when compared to sham treatment (Table 1). A similar trend is seen when looking at studies involving acupuncture (Table 2). This review will look at many studies and evaluate the data in order to come to a better conclusion on this issue.
Chiropractic care is aimed at promoting the health and well-being of the patient allowing the body to regenerate itself rather than treating the illness directly. In the diagnosis and treatment of their patients, Chiropractic Physicians are trained to evaluate all body symptoms, not just a localized illness site. The evaluation of the musculoskeletal system and the recognition of its roles in a patient’s total well-being are essential to this technique. Many studies have been done and show conflicting results. The Chiropractic technique that was used in the studies that we examined is defined as the following: spinal manipulations consisting of the joints of the spine and pelvis. The manual spinal treatment will be carried out with a high velocity, low amplitude thrust, most commonly by means of a short-lever technique. The sham treatment included hands on procedure without adjustment or manipulation.
Acupuncture is an ancient Chinese medicine that has been in practice for thousands of years. Its main goal is to restore the yin and yang energies via stimulation of nodal points, occurring along 12 body meridians, each corresponding to an organ or function. This means that through stimulation on certain points of the body as well as hands on contact and relaxation, the acupuncturist hopes to balance energies in the body to result in a better physiological functioning throughout. Through stimulation of these nodes, traditionally by needles and more recently by electrical or laser stimulation, the acupuncturist as well as the patient, hope to see a beneficial change in physiological outcomes such as lung function, bronchial responsiveness and overall well being. Real acupuncture is defined as treatment (via needles, electrical or laser stimulation) performed on loci selected by a standardized acupuncture formula used to treat asthma. Sham treatment was stimulus provided in areas not included in the standardized acupuncture formula. Other than the location of the stimulus the procedure is the same, giving the illusion that the patient is receiving real acupuncture.
This paper is based on 14 articles; 4 reviews and 10 studies. The years covered range from 1991-2005. The studies and reviews were divided into two main categories. First, chiropractic manipulation or acupuncture has a positive effect on the treatment of asthmatic patients and second, chiropractic manipulation or acupuncture has no effect on the treatment of asthmatic patients. There are three different methodologies. First the review articles looked at electronic databases and compared and contrasted previous studies. Second, some studies compared the outcome of treatment with chiropractic manipulation or acupuncture therapy to the absence of treatment with alternative therapy. Third, the remaining studies compared the outcome of either chiropractic manipulation or acupuncture therapy treatment compared to the outcomes of the placebo treatment. All patients are asthmatic patients with symptoms ranging from mild to severe and ages ranging from 7.5-adult. We have only one study that showed that there is a benefit in the use of Chiropractic therapy for asthmatic patients, two that showed a benefit of acupuncture and the rest of our studies showed no benefit in the use of either of these therapies.
After evaluation of the data available to date, we have come to the conclusion that chiropractic treatment has the ability to improve quality of life but does not improve lung function or hyper responsiveness. The patients included in the majority of the studies examined rated their quality of life substantially higher and their asthma severity substantially lower from the use of chiropractic manipulation. These improvements were maintained at the one year assessment. Similarly, when evaluating the data currently available for the use of acupuncture as a treatment tool for asthmatic symptoms, we see two things. First, it is seen that physiologically acupuncture has no effect on lung function or hyper responsiveness. Secondly, in opposition to this, we see an improved quality of life reported by the patients. Because of these opposing results seen in both studies, it seems that both chiropractic manipulation and acupuncture elicit a placebo effect rather than a physiological change. In the evidence examined there were a small number of studies that contradicted these beliefs. These studies said that both chiropractic and acupuncture did have a strong physiological benefit.
There are three main reasons why we have come to the conclusion that chiropractic and acupuncture have no benefit above and beyond the improvement of quality of life. The first reason is that there is more evidence to show that there is no physiological benefit to these therapies. The second reason is that the studies in support of our argument were stronger clinically; they had fewer limitations than the other studies. Thirdly in the case of acupuncture and chiropractic both short-term and long term studies have shown no physiological effect.
The first reason why we concluded that chiropractic has no physiological effect on asthmatic patients but does increase quality of life is because when each study is broken down, there is clearly more evidence in support of this. Out of the studies that were examined all of them insisted that there was an improvement in quality of life. This was concluded by the studies that suggested improvement in asthmatic symptoms and those studies that did not conclude that there was an improvement in symptoms (Table 1).
The second reason we have concluded that chiropractic treatment has no physiological benefit but does increase quality of life is because the studies in support of this theory were much more scientifically regulated than the others. Our stronger studies picked their patients by asthma severity measured thru peak expiratory flow rates rather than thru questioners (Table 1). They also took into consideration the severity of the asthmatic patients and tried to create a balanced look at varying severities. This was done through lengthy baseline evaluations of each participant. The studies than took the groups mean data and adjusted in according to base-line differences between the groups. In particular Balon et al used these methods in his study on the effect of chiropractic treatment. He found that after 4 months of treatment three days a week the improvements that were seen was in the decrease use of the patient’s bronchodilator (inhaler) and the increase in overall satisfaction, but lacked an increase in lung function (Table 1). This study is a very strong argument for the increase in quality of life from the use of chiropractic treatment.
The third reason that the conclusion has been made that chiropractic treatment has no physiological benefit is that both short term and long term studies have come to this conclusion. This is important because it shows that the lack of benefit is the case no matter what length of time you commit to this form of treatment. Balon et al looked at short term chiropractic use and found that there was no increase in lung function and therefore no physiological benefit (Figure 1). Another study looked at the use of chiropractic on a more long term time table. Bronfort et al conducted a 3 month treatment program with both active and Sham therapies and also included a one year follow up report from participating patients. This was a double blind study that was performed on children between the ages of 5and 17. Stratification by age (5-12 and 13-17) was performed with block randomization to ensure that equal numbers of participants were in each age group giving them a way to combat the speculations of childhood asthma. Certified pulmonary technicians were used to test lung function. These pulmonary technicians went through specialized training in order to recognize the important aspects of lung function. The tests for lung function included spirometry, forced volume loop, lung volume, plethysmography, and non specific bronchial challenge. This study, even with all of the added length and technology, showed no significant improvement in lung function and at the one year evaluation there was still no increase in lung function (Figure 1). Both of these studies concluded that neither real nor sham chiropractic therapy had benefits as to lung function.
The argument that chiropractic care increases quality of life but has no effect on pulmonary function has its own limitations. First, the chronic nature of this disorder needs to be considered. The lack of effect on pulmonary function could be due to the fact that patients often enroll in studies when their symptoms are most severe. Even though in the study conducted by Bronfort et al required participants to go through a two-month base-line period this factor still needs to be considered. It is also possible that the positive effects of the spinal manipulation could have been masked by the use of medications. Ethical considerations prevent the assessment of spinal manipulation alone in mild to moderate chronic asthmatics. The asthmatics that have been evaluated to date needed to be in enough distress to be able to show improvement. Chiropractic is not a guarantee to the subjects as a relief of symptoms, they need to be able to still function in everyday life. So the use of medications during the time the study was conducted was a must.
Although these studies show that no physiological benefit comes from the use of chiropractic treatment all of the studies were able to show an increase in quality of life and a decrease in the use of a bronchodilator. This improvement suggests a placebo effect and is present even when physiological benefit is not.
The argument that chiropractic care does have benefit to asthmatic patients does put forth some evidence to back up the claim. But after examining the information and comparing it to all the other information we see that this claim does not have strong backing. First, out of all of the studies looked at only one said that chiropractic care benefited and increased lung function (Table 1). Secondly the study that was looked at (Guiney et al.) for this argument was not as strong as the others. While it was a long-term study, it did not have a long-term follow-up assessment to see whether or not their values were maintained. This study had some very significant limitations. The physicians used to record lung function were not blind to the patient’s treatment group. Therefore the physician might have unconsciously affected the patient’s Peak Flow Rate with subtle acts of encouragement or discouragement. Also more than one chiropractor treated a single patient at one time. This is a major source of error since chiropractic manipulation and technique can vary greatly from one practitioner to another. Also this study did not conduct a full evaluation of pulmonary function by spirometry. If this was done researchers would be provided with a better indication of the exact physiological aspect of pulmonary function that has been altered by the chiropractic manipulation.
The first reason we believe that acupuncture has no physiological benefit on asthmatic symptoms, but may help improve quality of life, is because there is simply more evidence suggesting this. Out of nine articles covering acupuncture (7 studies and 2 reviews), all but two say that there is no physiological change (Table 2). Of the two articles that do say acupuncture has a physiological benefit one looked at actual lung functions, while the other looked at immune functions benefits, which they then in turn related to a physiological benefit to asthmatic symptoms. Of the seven studies, five stated a quality of life improvement, one didn’t take any quality of life data, and one reported no benefit to quality of life.