1Paul Richard Saunders, PhD, ND, 2Rich Barrett, ND
1Paul Richard Saunders, PhD, ND
Canadian College of Naturopathic Medicine
North York, ON
2Rich Barrett, ND
National College of Naturopathic Medicine
Portland, OR
ABSTRACT | This report summarizes the state of the science in naturopathic medicine with respect to treatment of asthma. It reviews use of botanicals, acupuncture, diet and nutrition, homeopathy and manipulation in order to suggest research priorities. Asthma has a high health, economic and societal burden. Naturopathic medicine has successes treating asthma, but the majority of these therapies are not adequately investigated.
INTRODUCTION
A survey of CAM (complementary and alternative medicine) use by asthma patients, based on 17,000 questionnaires with a response rate of 27.8% (4741), found 59% used CAM. Breathing techniques, homeopathy and herbs were the most commonly used. The majority of patients felt CAM was moderately useful. (1)
BOTANICALS
A review of English language papers on herbs and asthma and found positive effects on bronchodilation, pulmonary function tests, antagonism of asthma mediators (histamine, platelet activating factor (PAF), corticosteroid use and mucus clearance.(2) They concluded there was a lack of quantity and quality controls, fewer side effects than current conventional therapy and need for detailed investigation.
Solanum xanthocarpum and S. triblobatum (Solanaceae) are widely used in south India with significant effect on pulmonary function, but the mechanism requires detailed study.(3) Astragalus membrtanceus, Codonopsis pilosula and Glycyrrhiza uralensis significantly decreased airway responsiveness over a six week trial.(4) At least 58 plants are used in traditional Hawaiian medicine for asthma including Piper methysticum, Solanum americanum, Aleurite molucana, and Sophora chrysophylla.(5) Ayurvedic medicine herbs Tylophora ashmatica (indica) provide significant symptom relief (6,7,8) as does Boswellia serrata.(9,10,11) The Greek plant Petasites hybridus has been shown effective in quinea pig studies.(12,13)
Plant constituents such as quercitin are anti-inflammatory (14,15), and sterols:sterolins may increase Th1 while lessening Th2 response. (16,17)
Traditional botanicals for asthma such as Ephedra sinica (18,19), Lobelia inflata (20,21), and Capsicum frutescens.(22,23) are poorly studied. Eclectic botanicals such as Asclepias syriaca, Aspidosperma quebracho-blanco, Blatta orientalis, Cinnamomum camphora, Eucalyptus globulus, Grindelia robusta, Larrea mexicana, Peoonia officinalis, Symphlocarpus foetidus, and Tussilago farfara have not been studied.(24,25)
ACPUNCTURE
Martin et al (26) reviewed published acupuncture trials from 1970-2000, included 11, and concluded there was no evidence to support acupuncture in asthma when bronchoconstriction was induced. Medici et al. (27) conducted a real vs. sham acupuncture trial, found no significant effects except a significantly higher eosinophil count 10 months after the trial. Malstrom et al. (28) tested acupuncture vs mock-TENS with no significant effect on cold induced asthma. Shapira et al. (29) tested acupuncture vs sham-acupuncture without significant effect. Laser acupuncture on real and placebo points in children yielded no significant effect on cold air challenge (30).
NUTRITION
Baker and Ayres (31) concluded that supplementation studies of A, C, E, selenium and magnesium are needed to confirm the role of antioxidants, sub-optimal nutrient intake and food allergy on asthmatic inflammation. Ram et al. (32) in a meta-analysis of six randomized, controlled trials in children with a family history of atopy, found reduced risk with avoidance of cow milk protein compared to use of standard cow milk formula. Olge and Bullock (33) found 91% of children less than one year old with a respiratory allergy and negative inhalant skin tests had respiratory symptom improvement. Hodge et al. (34) concluded that elimination/challenge diets had the best success in identifying allergens and preventing asthma. Children with an average age of 12 years old placed on a vegetarian diet for 1 year had 71% improvement at 4 months and 92% at 1 year in objective lung variables.(35) Children with a fresh, oily fish diet had a significant reduction in current asthma.(36) Woods et al. (37) concluded there was little evidence to recommend people with asthma supplement with marine n-3 fatty acids. There are positive trials using probiotics for eczema, but none for asthma. (38)
Erythrocyte magnesium has been found to be lower in acute asthma.(39) Intravenous magnesium in emergency rooms for asthma from nine trials showed statistical benefit.(40) A meta-analysis of seven trials found it safe and beneficial for adults and pediatrics.(41) High oral magnesium supplementation reduced symptoms but did not improve objective scores.(42) Nebulized magnesium added to salbutamol compared to saline with salbutamol was positively significant for FEV1 at 90 min. (43)
Reduced intake of dietary antioxidants over the past 25 years may be a factor for increased asthma.(44) Vitamin C levels were inversely related to cough and wheeze in young smokers (45), coenzyme Q10 was reduced in asthmatics (46), lycopene reduced exercise-induced asthma (47), antioxidants were low in children with asthma (48), and beta-carotene reduced exercise induced asthma. (49) A Cochrane review of six vitamin C studies found insufficient evidence to recommend its use (50). Wright argues that frequent B12 IM is clinically effective (51) and Gaby (52) found IV cocktails of magnesium, calcium, B and C vitamins along with B12 IM provided clinical improvement.
MANIPULATION
A systematic review of 5 manipulation trials found no evidence to support its use.(53)
HOMEOPATHY
White et al (54) found no evidence for homeopathy in childhood asthma. Linde and Jobst (55) reviewed homeopathy trials and found two positive and one where the effect of homeopathy equaled placebo.
RESEARCH PRIORITIES
Many botanical medicines in daily use by naturopathic physicians are poorly studies and rely solely on historical and current clinical use results. Mechanisms of the best known or most often used are not understood, and the actions of some seem contradictory.
Acupuncture studies do not mimic individualized patient treatment in point selection and need better design before new trials are conducted.
Prospective studies of diet and supplementation are needed. Several essential nutrients appear to play a role with some showing more effect than others.
Manipulation therapy lacks positive outcomes to date.
Homeopathy has some positive evidence, but better trial design is required.
NDs should avoid areas such as environmental controls or mind-body interventions where other can do a better job of treatment and research.
Research on the whole practice of naturopathic medicine, including its integration of therapies, is need for both acute and chronic asthma.
SUMMARY
Asthma is a significant health and economic burden. Some botanical medicines have been studied, but those most commonly use by naturopathic physicians are poorly studied. Clinical trial data for the benefits of acupuncture and manipulation are absent while those for homoepathy are limited. Research supporting the use of nutrition is positive. There are currently no studies that have examined the integration of therapies as they are used in active naturopathic medical practice. Thus is opportunity for considerable quality research on the use of single and integrated CAM therapies for the treatment of asthma.
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