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- Acupuncture treatment for asthma
The article:
Linde K, Jobst K, Panton J. Acupuncture for chronic asthma (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
The problem:
Many people today are seeking acupuncture as a way to enhance the effect of traditional medicine.
The study:
Members of the Cochrane Airways Group reviewed all clinical trials that investigated the role of acupuncture (1 to 12 weeks duration treatments) to control or alleviate the symptoms of patients with asthma. In total, 7 trials involving 174 patients were reviewed. All patients continued taking their prescribed asthma medication in conjunction with the acupuncture treatments. The types of acupuncture treatments and the outcome measures used in the individual studies varied.
The results:
The trials reviewed had variable quality and inconsistent results. No significant or clinically relevant effects were found for those patients who received acupuncture treatments.
The conclusion:
The reviewers concluded that the research on acupuncture for the treatment of asthma is very limited. The little data available suggest that acupuncture gives no significant additional benefit to patients who are taking asthma medication. The researchers also concluded that more and better studies on this subject are needed to confirm the findings of the studies available.
The conclusion:
The researchers concluded that the treatment of GORD in addition to regular asthma therapy provides no additional control of asthma symptoms. They suggest that further large-scale studies of adequate duration that use consistent measures need to be done to get a more definite answer.
- Asthma and coffee
The article:
Bara AI, Barley EA. Caffeine for asthma (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update software
The problem:
Theophylline, a bronchodilator, is a drug frequently used in the treatment of asthma. Since caffeine is chemically similar to theophylline, could caffeine also work to dilate the airway passages in the lung?
The study:
Researchers looked at all the published clinical trials studying the use of oral caffeine to treat asthma. They analysed only clinical trials that compared patients taking oral caffeine to those taking a placebo and evaluated the effect on lung function. Two studies used a 'low' caffeine dose of 5 mg per kg of body weight and four studies used a 'high' dose of 6-10 mg per kg of body weight. The average amount of caffeine per cup of coffee is between 30mg and 150 mg.
The results:
Six methodologically sound trials with a total of 55 patients were included in this review. All found that oral caffeine improved lung function measured by forced expiratory volume in 1 second (FEV1) and peak expiratory flow (PEF). FEV1 showed a small improvement up to two hours after caffeine. Mid-expiratory flow rates also showed a small improvement with caffeine and this was sustained for up to four hours. Adverse effects observed in patients taking high doses of caffeine were tremor, nervousness, agitation and changes in heart rate and blood pressure.
The conclusion:
The authors of this review of the literature found that caffeine was mildly effective in improving airway function. Results were so consistent that they felt asthmatics should avoid caffeine for 4 hours before any lung function test. However, they conclude that there is not enough evidence to determine if this improvement in lung function will reflect in improvements of asthma symptoms and quality of life.
- Asthma and fish oil
The article:
Woods, RK, Thien, FCK, Abramson, MJ, Dietary marine fatty acids (fish oil) for asthma (Cochrane Review). In: The Cochrane Library, Issue 3, 2000.
The problem:
Some studies suggest that environmental factors, lifestyle and diet may affect diseases that have an important inflammatory element. It has been suggested that diets high in fish oil (marine n-3 fatty acids) may improve asthma. Is there any evidence to support this theory?
The study:
The Airways Group of The Cochrane Collaboration found 7 clinical trials of sufficient quality that compared asthmatics taking marine n-3 fatty acids to those taking a placebo. They also included one other clinical trial that compared asthmatics taking low versus high doses of marine n-3 fatty acids. The effects of fish oil on asthma were assessed through changes in forced expiratory volume (FEV1), peak expiratory flow rate (PEFR), asthma symptoms, asthma medication use and bronchial hyper-reactivity.
The result:
None of the trials found a relationship between n-3 marine fatty acids and the outcomes measured. Seven compared fish oil with placebo whilst one compared high dose vs. low dose marine n-3 fatty acid supplementation. Only one study done on children, where both dietary changes and fish oil supplements were used, found improved PEFR and reduced asthma medication use. Fish oil did not produce any adverse effects.
The conclusion:
This review found little evidence to support the idea that marine n-3 fatty acids, either in the diet or in supplement form, improved asthma control. Equally, there was no evidence suggesting it was harmful for asthmatics to take marine n-3 fatty acids.
- Asthma and herbal medicines
- The article:
Huntley A, Ernst E, Herbal medicines for asthma: a systematic review. Thorax 2000;55: 925-929.
The problem:
Herbals medicines have been used to help to treat asthma and are still used by a large number of asthmatics to help alleviate their symptoms. It is important to find out if research shows evidence of herbal medicines clinical efficacy in treating asthma symptoms.
The study:
The authors found 17 randomised clinical trials that assessed the use of herbal preparations in the treatment of asthma. Six trials examined Chinese herbal medicines (Ginkgo biloba, L wallichii, SBR, RKISP, IKPA, and WTM) and eight investigated Indian preparations (P kurroa, S xanthocarpum/trilobatum, B. serrata, and T indica in five trials). One trial tested a Japanese herbal medicine (TJ-96), another two looked at the use of dried ivy leaf extract and marijuana. The benefit of each of these herbal preparations was assessed through lung function (FEV1 and Raw) and/or symptom scores.
The result:
Nine of the trials reported significant improvements in lung function and/or symptom scores. These trials included three Chinese remedies (Ginkgo liquor, IKPA tablets, and WTM), one Indian preparation in four separate trials (T Indica), the Japanese herbal preparation (TJ-96) and dried ivy leaf extract. However, the authors found that 14 of the trials had significant methodological flaws. Lastly, none of the trials discussed the adverse effects that could occur with use of these herbal medicines.
The conclusion:
Although some trials reported promising results, the low methodological quality of the trials made the results inconclusive. Until trials of high quality are carried out, the effect of herbal preparations on asthma symptoms and their safety will remain unclear. There is need for further research in this area.
- Breathing exercies for asthma
The article:
Holloway E, Ram FSF. Breathing exercises for asthma (Cochrane Review). In: The Cochrane Library,Issue 1, 2001. Oxford: Update Software.
The problem:
Many asthmatics wonder if learning to control their breathing through breathing exercises or respiratory therapy (also called ‘Buteyko therapy’) would help to lessen the symptoms of their disease. Patient interest in self-help measures and complementary therapies provided the motivation for this review that evaluated the effectiveness of breathing re-training in the treatment of patients with asthma.
The study:
A group of researchers from the Cochrane Collaboration reviewed all clinical trials that investigated breathing re-training or therapy in asthma patients of various ages. Five trials were included in the review, and most of these were small involving less than 50 patients. All studies included a control group that did not receive breathing re-training. The main requirement was that the studies included at least one group of asthmatic patients who had received at least one course of treatment consisting of some type of breathing re-training along with their regular asthma therapy, with breathing re-training being the main focus of the studyThe types of breathing intervention varied across studies. The duration of the studies varied also from 3 to 54 weeks.
The results:
The total number of patients studied in the 5 trials was 236. One study showed improvement in Peak Expiratory Flow (PEF), and one reported a significant improvement in quality of life (patients felt better). A significant reduction in the use of both reliever beta2-agonists and inhaled steroids was shown in 2 studies.
The conclusion:
The researchers concluded that breathing re-training might be helpful as part of the treatment of asthma, but that the data available are insufficient to prove it, due to the small number of studies, the small number of patients studied, the different types of interventions employed, and the inability to obtain further data from the authors. Further large-scale studies involving consistent methodology in breathing re-training in the treatment of asthma are required.
- Heartburn treatment and asthma symptoms
The article:
Gibson PG, Henry RL, Coughlan JL. Gastro-oesophageal reflux treatment for asthma in adults and children (Cochrane Review). In: The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
The problem:
Many asthmatics also suffer from gastroesophageal reflux, or heartburn, when they experience asthma symptoms. Previous studies disagree on whether or not heartburn is an asthma trigger. However, researchers have also considered the question of whether treatment for gastroesophageal reflux could alleviate asthma symptoms.
The study:
The Airways Group of the Cochrane Collaboration reviewed all the clinical trials that investigated the treatment of heartburn in asthmatic adults and children of various ages who also suffer from gastroesophageal reflux disease (GORD). All the patients continued with their regular course of asthma treatment. Various types of heartburn treatments such as behavior modification (e.g., drinking warm water after meals), medical (proton pump inhibitors and histamine antagonists ) and surgical interventions were studied. Measuring outcomes such as patients’‘ lung function and the required use of rescue medicine were used to assess the effect of the GORD treatment on asthma.
The result:
Nine clinical trials investigated the treatment of GORD on asthma in 328 patients.
Seven of the nine trials reported at least one significant outcome. The studies showed that treatment for gastroesophageal reflux in asthma patients did not improve lung function, asthma symptoms, nocturnal asthma or the use of asthma medications. However, there was no consistency in these effects. Not all the trials examined the same issues and outcomes, such as how the heartburn was treated, or how many trips to the hospital to treat asthma were necessary during the course of the study.
The conclusion:
The researchers concluded that the treatment of GORD in addition to regular asthma therapy provides no additional control of asthma symptoms. They suggest that further large-scale studies of adequate duration that use consistent measures need to be done to get a more definite answer.
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Notice
This site is intended for people who have been prescribed Symbicort. The information is provided for educational and informational purposes only. For specific questions relating to your own asthma you should talk to your doctor.
