Complementary, alternative, and integrative therapies for asthma
- Richard J Martin, MD
Richard J Martin, MD
- Professor of Medicine
- University of Colorado Denver, School of Medicine
- Section Editors
- Bruce S Bochner, MD
Bruce S Bochner, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Adult Allergy; Asthma
- Samuel M Feinberg Professor of Medicine
- Northwestern University Feinberg School of Medicine
- Robert A Wood, MD
Robert A Wood, MD
- Editor-in-Chief — Allergy and Immunology
- Section Editor — Pediatric Allergy
- Professor of Pediatrics
- Johns Hopkins University School of Medicine
The standard treatment of patients with asthma is based upon trigger avoidance combined with bronchodilator and anti-inflammatory therapy. Beta agonists, glucocorticoids, leukotriene modifiers, omalizumab, and, to a lesser extent, methylxanthines and anticholinergics all have a role in the conventional treatment of asthma. However, some patients do not achieve adequate control of their asthma with conventional therapy, experience adverse effects with conventional agents, or believe that complementary or alternative approaches may be better for them. For these patients, consideration may be given to the administration of nonstandard therapeutic regimens in order to ameliorate the acute or chronic manifestations of the disease.
Complementary, alternative, and integrative therapies for the treatment of acute and chronic asthma will be reviewed here. Standard and investigational treatment regimens for asthma are discussed separately. (See "An overview of asthma management" and "Management of acute exacerbations of asthma in adults" and "Investigational agents for asthma".)
Several nonpharmacologic approaches to asthma management have been proposed, including herbal medications, dietary interventions, behavioral therapies, acupuncture, massage, and speleotherapy. Evidence supporting the use of complementary and alternative medical approaches to improve asthma management is limited. A meta-analysis of 15 trials, many of which are discussed in the sections below, found insufficient evidence to recommend any of these interventions as a useful addition to standard asthma management . A subsequent systematic review reached the same conclusion .
●Complementary-alternative medicine – The term "alternative medicine" was initially used to describe therapies used in place of conventional care. The term "complementary-alternative medicine (CAM)" is preferred because it recognizes the history and experience of traditional remedies in many countries and the potential role of "complementary-alternative medicine" techniques in disease management, if they are demonstrated to be safe and effective.
Patients may turn to CAM therapists who offer them personal attention, hope, time, and therapies consistent with their values, world view, and culture.
- Markham AW, Wilkinson JM. Complementary and alternative medicines (CAM) in the management of asthma: an examination of the evidence. J Asthma 2004; 41:131.
- Passalacqua G, Bousquet PJ, Carlsen KH, et al. ARIA update: I--Systematic review of complementary and alternative medicine for rhinitis and asthma. J Allergy Clin Immunol 2006; 117:1054.
- George M. Integrative medicine is integral to providing patient-centered care. Ann Allergy Asthma Immunol 2015; 114:261.
- Engler RJ, With CM, Gregory PJ, Jellin JM. Complementary and alternative medicine for the allergist-immunologist: where do I start? J Allergy Clin Immunol 2009; 123:309.
- Ernst E. Adulteration of Chinese herbal medicines with synthetic drugs: a systematic review. J Intern Med 2002; 252:107.
- Jin GL, Su YP, Liu M, et al. Medicinal plants of the genus Gelsemium (Gelsemiaceae, Gentianales)--a review of their phytochemistry, pharmacology, toxicology and traditional use. J Ethnopharmacol 2014; 152:33.
- Nie Y, Dong X, He Y, et al. Medicinal plants of genus Curculigo: traditional uses and a phytochemical and ethnopharmacological review. J Ethnopharmacol 2013; 147:547.
- Gupta I, Gupta V, Parihar A, et al. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur J Med Res 1998; 3:511.
- Houssen ME, Ragab A, Mesbah A, et al. Natural anti-inflammatory products and leukotriene inhibitors as complementary therapy for bronchial asthma. Clin Biochem 2010; 43:887.
- Urata Y, Yoshida S, Irie Y, et al. Treatment of asthma patients with herbal medicine TJ-96: a randomized controlled trial. Respir Med 2002; 96:469.
- Chapman K, Holmes M, Seckl J. 11β-hydroxysteroid dehydrogenases: intracellular gate-keepers of tissue glucocorticoid action. Physiol Rev 2013; 93:1139.
- Monteleone CA, Sherman AR. Nutrition and asthma. Arch Intern Med 1997; 157:23.
- McKeever TM, Britton J. Diet and asthma. Am J Respir Crit Care Med 2004; 170:725.
- Martineau AR, MacLaughlin BD, Hooper RL, et al. Double-blind randomised placebo-controlled trial of bolus-dose vitamin D3 supplementation in adults with asthma (ViDiAs). Thorax 2015; 70:451.
- Misso NL, Brooks-Wildhaber J, Ray S, et al. Plasma concentrations of dietary and nondietary antioxidants are low in severe asthma. Eur Respir J 2005; 26:257.
- Trenga CA, Koenig JQ, Williams PV. Dietary antioxidants and ozone-induced bronchial hyperresponsiveness in adults with asthma. Arch Environ Health 2001; 56:242.
- Pearson PJ, Lewis SA, Britton J, Fogarty A. Vitamin E supplements in asthma: a parallel group randomised placebo controlled trial. Thorax 2004; 59:652.
- Castro M, King TS, Kunselman SJ, et al. Effect of vitamin D3 on asthma treatment failures in adults with symptomatic asthma and lower vitamin D levels: the VIDA randomized clinical trial. JAMA 2014; 311:2083.
- Han YY, Forno E, Holguin F, Celedón JC. Diet and asthma: an update. Curr Opin Allergy Clin Immunol 2015; 15:369.
- Milan SJ, Hart A, Wilkinson M. Vitamin C for asthma and exercise-induced bronchoconstriction. Cochrane Database Syst Rev 2013; :CD010391.
- Reisman J, Schachter HM, Dales RE, et al. Treating asthma with omega-3 fatty acids: where is the evidence? A systematic review. BMC Complement Altern Med 2006; 6:26.
- Mickleborough TD, Lindley MR, Ionescu AA, Fly AD. Protective effect of fish oil supplementation on exercise-induced bronchoconstriction in asthma. Chest 2006; 129:39.
- Anandan C, Nurmatov U, Sheikh A. Omega 3 and 6 oils for primary prevention of allergic disease: systematic review and meta-analysis. Allergy 2009; 64:840.
- Smith LJ, Kalhan R, Wise RA, et al. Effect of a soy isoflavone supplement on lung function and clinical outcomes in patients with poorly controlled asthma: a randomized clinical trial. JAMA 2015; 313:2033.
- Ma J, Strub P, Lv N, et al. Pilot randomised trial of a healthy eating behavioural intervention in uncontrolled asthma. Eur Respir J 2016; 47:122.
- Cheng J, Pan T, Ye GH, Liu Q. Calorie controlled diet for chronic asthma. Cochrane Database Syst Rev 2005; :CD004674.
- Stenius-Aarniala B, Poussa T, Kvarnström J, et al. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000; 320:827.
- Ziment I. Alternative therapies for asthma. Curr Opin Pulm Med 1997; 3:61.
- Kazaks AG, Uriu-Adams JY, Albertson TE, et al. Effect of oral magnesium supplementation on measures of airway resistance and subjective assessment of asthma control and quality of life in men and women with mild to moderate asthma: a randomized placebo controlled trial. J Asthma 2010; 47:83.
- Györik SA, Brutsche MH. Complementary and alternative medicine for bronchial asthma: is there new evidence? Curr Opin Pulm Med 2004; 10:37.
- Ritz T, Dahme B, Roth WT. Behavioral interventions in asthma: biofeedback techniques. J Psychosom Res 2004; 56:711.
- Huntley A, White AR, Ernst E. Relaxation therapies for asthma: a systematic review. Thorax 2002; 57:127.
- Lehrer PM, Vaschillo E, Vaschillo B, et al. Biofeedback treatment for asthma. Chest 2004; 126:352.
- Lahmann C, Nickel M, Schuster T, et al. Functional relaxation and guided imagery as complementary therapy in asthma: a randomized controlled clinical trial. Psychother Psychosom 2009; 78:233.
- Manocha R, Marks GB, Kenchington P, et al. Sahaja yoga in the management of moderate to severe asthma: a randomised controlled trial. Thorax 2002; 57:110.
- Cooper S, Oborne J, Newton S, et al. Effect of two breathing exercises (Buteyko and pranayama) in asthma: a randomised controlled trial. Thorax 2003; 58:674.
- Vedanthan PK, Kesavalu LN, Murthy KC, et al. Clinical study of yoga techniques in university students with asthma: a controlled study. Allergy Asthma Proc 1998; 19:3.
- Opat AJ, Cohen MM, Bailey MJ, Abramson MJ. A clinical trial of the Buteyko Breathing Technique in asthma as taught by a video. J Asthma 2000; 37:557.
- O’Connor E, Patnode CD, Burda BU, et al. Breathing Exercises and/or Retraining Techniques in the Treatment of Asthma: Comparative Effectiveness [Internet]. Rockville (MD): Agency for Healthcare Research and Quality (US); 2012 Sep. (Comparative Effectiveness Reviews, No. 71.) http://www.ncbi.nlm.nih.gov/books/NBK109355/ (Accessed on November 27, 2012).
- Raghavendra P, Shetty P, Shetty S, et al. Effect of high-frequency yoga breathing on pulmonary functions in patients with asthma: A randomized clinical trial. Ann Allergy Asthma Immunol 2016; 117:550.
- Singh V, Wisniewski A, Britton J, Tattersfield A. Effect of yoga breathing exercises (pranayama) on airway reactivity in subjects with asthma. Lancet 1990; 335:1381.
- Nagendra HR, Nagarathna R. An integrated approach of yoga therapy for bronchial asthma: a 3-54-month prospective study. J Asthma 1986; 23:123.
- Nagarathna R, Nagendra HR. Yoga for bronchial asthma: a controlled study. Br Med J (Clin Res Ed) 1985; 291:1077.
- Cramer H, Posadzki P, Dobos G, Langhorst J. Yoga for asthma: a systematic review and meta-analysis. Ann Allergy Asthma Immunol 2014; 112:503.
- Bowler SD, Green A, Mitchell CA. Buteyko breathing techniques in asthma: a blinded randomised controlled trial. Med J Aust 1998; 169:575.
- Holloway E, Ram FS. Breathing exercises for asthma. Cochrane Database Syst Rev 2004; :CD001277.
- Bruton A, Thomas M. The role of breathing training in asthma management. Curr Opin Allergy Clin Immunol 2011; 11:53.
- Thomas M, McKinley RK, Mellor S, et al. Breathing exercises for asthma: a randomised controlled trial. Thorax 2009; 64:55.
- Bott J, Blumenthal S, Buxton M, et al. Guidelines for the physiotherapy management of the adult, medical, spontaneously breathing patient. Thorax 2009; 64 Suppl 1:i1.
- Holloway EA, West RJ. Integrated breathing and relaxation training (the Papworth method) for adults with asthma in primary care: a randomised controlled trial. Thorax 2007; 62:1039.
- Cowie RL, Conley DP, Underwood MF, Reader PG. A randomised controlled trial of the Buteyko technique as an adjunct to conventional management of asthma. Respir Med 2008; 102:726.
- Yang ZY, Zhong HB, Mao C, et al. Yoga for asthma. Cochrane Database Syst Rev 2016; 4:CD010346.
- Jobst KA. Acupuncture in asthma and pulmonary disease: an analysis of efficacy and safety. J Altern Complement Med 1996; 2:179.
- Linde K, Jobst K, Panton J. Acupuncture for chronic asthma. Cochrane Database Syst Rev 2000; :CD000008.
- Shapira MY, Berkman N, Ben-David G, et al. Short-term acupuncture therapy is of no benefit in patients with moderate persistent asthma. Chest 2002; 121:1396.
- Medici TC, Grebski E, Wu J, et al. Acupuncture and bronchial asthma: a long-term randomized study of the effects of real versus sham acupuncture compared to controls in patients with bronchial asthma. J Altern Complement Med 2002; 8:737.
- McCarney RW, Brinkhaus B, Lasserson TJ, Linde K. Acupuncture for chronic asthma. Cochrane Database Syst Rev 2004; :CD000008.
- Balon J, Aker PD, Crowther ER, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 1998; 339:1013.
- Field T, Henteleff T, Hernandez-Reif M, et al. Children with asthma have improved pulmonary functions after massage therapy. J Pediatr 1998; 132:854.
- Carson KV, Chandratilleke MG, Picot J, et al. Physical training for asthma. Cochrane Database Syst Rev 2013; :CD001116.
- Beamon S, Falkenbach A, Fainburg G, Linde K. Speleotherapy for asthma. Cochrane Database Syst Rev 2001; :CD001741.
- Sokolova MIu, Ivanova NA, Shabalov NP. [Optimal therapy of children with bronchial asthma at Pyatigorsk spa]. Vopr Kurortol Fizioter Lech Fiz Kult 2007; :8.
- Chervinskaia AV. [The scientific validation and outlook for the practical use of halo-aerosol therapy]. Vopr Kurortol Fizioter Lech Fiz Kult 2000; :21.
- Maev EZ, Vinogradov NV. [Halotherapy in the combined treatment of chronic bronchitis patients]. Voen Med Zh 1999; 320:34.
- Chervinskaya AV, Zilber NA. Halotherapy for treatment of respiratory diseases. J Aerosol Med 1995; 8:221.
- Hedman J, Hugg T, Sandell J, Haahtela T. The effect of salt chamber treatment on bronchial hyperresponsiveness in asthmatics. Allergy 2006; 61:605.
- Sandell J, Hedman J, Saarinen K, Haahtela T. Salt chamber treatment is ineffective in treating eosinophilic inflammation in asthma. Allergy 2013; 68:125.
- TRADITIONAL CHINESE MEDICINE
- AYURVEDIC MEDICINE
- DIETARY CHANGES AND SUPPLEMENTS
- BEHAVIORAL THERAPIES
- Biofeedback and functional relaxation
- Breathing exercises
- PHYSICAL AND ENVIRONMENTAL TECHNIQUES
- Chiropractic manipulation
- Massage therapy
- Physical training
- Speleotherapy and halotherapy
- SUMMARY AND RECOMMENDATIONS