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3.5 CoMPleMentAry And AlternAtive MediCine
Successive reviews have concluded that the evidence to support any recommendations on
complementary or alternative medicine is lacking. 252 It is recognised that a lack of evidence
does not necessarily mean that treatment is ineffective and high quality research, conducted in
the same rigorous and objective fashion as that for conventional therapy, is required.
3.5.1 ACUPUNCTURE
A Cochrane review of 21 trials highlighted many methodological problems with the studies
reviewed. Only seven of the trials in 174 patients employed randomisation to active (recognised
in traditional Chinese medicine to be of benefit in asthma) or sham acupuncture points (with
no recognised activity) for the treatment of persistent or chronic asthma. Blinding was a major
problem in the assessment of the results and there were considerable inconsistencies in
methodology. The review concluded that there was no evidence for a clinically valuable benefit
for acupuncture and no significant benefits in relation to lung function. 253 A later systematic
review and meta-analysis of 11 randomised controlled trials found no evidence of an effect
in reducing asthma severity but a suggestion that where broncho-constriction was induced to
establish efficacy of acupuncture there was a beneficial effect. Concern was expressed about
potential preferential publication in favour of positive outcome studies. 254 Two other trials of
acupuncture in relation to induced asthma were also negative. 255,256
3.5.2 AIR IONISERS
Ionisers have been widely promoted as being of benefit for patients with asthma. A Cochrane
review of five studies using negative ion generators and one with a positive ion generator found
no evidence of benefit in reducing symptoms in patients with asthma. 257 One study demonstrated
an increase in night-time cough to a level which approached statistical significance. 258
A Air ionisers are not recommended for the treatment of asthma.
3.5.3 BREATHING ExERCISES INCLUDING yOGA AND THE BUTEyKO BREATHING
TECHNIQUE
The principle of yoga and Buteyko breathing technique is to control hyperventilation by lowering
respiratory frequency. A Cochrane review of breathing exercises found no change in routine
measures of lung function. 259 One study showed a small reduction in airway responsiveness to
histamine utilising pranayama, a form of yoga breathing exercise. 260
The Buteyko breathing technique specifically focuses on control of hyperventilation and any
ensuing hypocapnia. Four clinical trials suggest benefits in terms of reduced symptoms and
bronchodilator usage but no effect on lung function. 261-264
B Buteyko breathing technique may be considered to help patients to control the
symptoms of asthma.
3.5.4 HERBAL AND TRADITIONAL CHINESE MEDICINE
3 non-PhArMAColoGiCAl MAnAGeMent
A Cochrane review identified 17 trials, nine of which reported some improvement in lung
function but it was not clear that the results would be generalisable .265 A more recent double blind
placebo controlled trial of a Chinese herb decoction (Ding Chuan Tang) showed improvement
in airway hyper-responsiveness in children with stable asthma. 266 It is difficult to disentangle
the effects of multiple ingredients; Ding Chuan Tang for example contains nine components.
In a second study,100 children with asthma found that a five-herb mixture gave some benefits
in relation to lung function and symptoms compared with placebo. 267
The conclusions of these trials of Chinese herbal therapy are not generalisable due to variations
in the herbal mixtures and study designs. There are likely to be pharmacologically active
ingredients in the mixtures and further investigations are warranted. There is a need for large
appropriately powered placebo controlled studies.
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