AsthmaIn the United States asthma is now epidemic. This once rare disease causes more time to be lost from school than any other pediatric disorder.
Chiropractic Care and Asthma in a 7 year old child
Read the abstract here: www.jvsr.com/abstracts/index.asp?id=319
Effect of Chiropractic Treatments on the Endocrine and Immune System in Asthmatic Patients
Proceedings of the 2002 International Conference on Spinal Manipulation, Toronto Ontario, Canada, Oct 2002: 57-8
Conclusion: the FCER funded study aims to determine the effects of chiropractic treatment of the endocrine and immune system of asthmatic patients. We have determined from the data thus far that direct chiropractic treatment (6 weeks) reduces salivary cortisol levels over the 14-week period of this trial. We do however note an initial increase associated with the first 2-3 weeks of treatment. This could either be due to anxiety associated with visiting a clinic or due to the physical nature of the chiropractic treatment. That some patients showed a slight increase 2-3 weeks into clinic visit suggest the former. However full analysis of the data at the conclusion of the trial with respect to individual patient changes versus treatment regime received will be required to finalize this question. There is no indication at this stage that the reduction in cortisol after chiropractic treatment is due to the well characterized placebo effect as both group B and Group C cortisol values remained unchanged from the start to the end of the trial.
In support of our hypothesis outlined above we show an increase in salivary IgA levels for group A patients. We expect this to be partly responsible for the decrease in the severity and number of asthmatic attaches experienced by these patients. The most striking feature was the decrease in the erratic nature of IgA levels for group A patients. We attribute this to an increase in basal IgA levels associated with decreased cortisol and hence a better ability of patients to ward off potential pathogenic invasion (or the like) which ultimately shows the increasing /decreasing erratic IgA patterns we observe.
Whether chiropractic treatment effects both the endocrine and immune systems independently or one system through the other requires further analysis of our biochemical data and questionnaire data for individual patients. Full analysis of our data, which we plan at the conclusion of this trial, will also have the benefit of answering a large number of questions related to the efficacy of chiropractic treatment regimes. It is the comprehensive nature of this trial that will make this possible. Our results strongly suggest somatovisceral mechanisms are involved in chiropractic treatment.
Role of Chiropractic and Sacro Occipital Technique in Asthma Blum, CL, Journal of Chiropractic Medicine, Mar 2000;1(1):16-22.
Asthma is a multifactorial dysfunction of the respiratory system. Nutritional, environmental, genetic, and emotional factors all play an important part in the etiology of this condition. One form of chiropractic, Sacro Occipital Technique (SOT), offers some conservative alternatives to the treatment of asthma. SOT expands the chiropractic armamentarium of techniques available, allowing methods putatively affecting the viscera, vertebra, post and preganglionic reflexes, as well as cranial and sacral influences on the primary respiratory mechanism. Though more research is needed to evaluate the efficacy of chiropractic care of asthma, the conservative nature of chiropractic care with its minimal side effects,
warrants patient and a health practitioner's consideration prior to embarking
on any course of treatment that might have serious side effects.
Role of Chiropractic and Sacro Occipital Technique in Asthma,Blum, CL,, Chiropractic Technique, Nov1999; 10(4): 174-180. Chiropractic Technique, Nov1999; 10(4): 174-180.
An impairment rating analysis of asthmatic children under chiropractic care. Graham, RL and Pistolese RA. Journal of Vertebral Subluxation Research 1997: 1 (4): 1-8
Eighty one children under chiropractic care took part in this self-reported asthma related impairment study. The children were assessed before and two months after chiropractic care using an asthma impairment questionnaire. Significantly lower impairment rating scores (improvement) were reported for 90.1% of subjects 60 days after chiropractic care in comparison to their pre-chiropractic scores. In addition, 30.9% of the children voluntarily decreased their dosage of medication by an average of 66.5% while under chiropractic care. Twenty four of the patients who reported asthma attacks 30-days prior to the study had significantly decreased attacks by an average of 44.9%. Six different chiropractic techniques were used by the different chiropractors who participated in this study.
Chiropractic response in the pediatric patient with asthma: a pilot study. Peet, JB. Marko SK, Piekarczyk W. Chiropractic Pediatrics Vol. 1, No. 4, May 1995, pp. 9-13.
From the abstract: This paper reviews the correlation between reducing/correcting vertebral subluxations in the asthmatic pediatric patient utilizing Chiropractic Biophysics Technique (CBP) and symptomology generally associated with this condition. A further objective will be to determine what areas of vertebral subluxation, if any, are commonly seen in this group. The children used for this study had never received any chiropractic care or manipulative care prior to participation in this study. Seven of the eight patients who completed the study were able to reduce/discontinue medication. All participants showed measurable improvement on radiographs, which correlated with an improvement in asthma symptoms in seven of the eight cases. This paper also includes an interesting discussion on the innervation of the lungs and its relationship to the vertebral subluxation complex.
Treatment protocols for the chiropractic care of common pediatric conditions: otitis media and asthma. Vallone S and Fallon JM Journal of Clinical Chiropractic Pediatrics Vol 2, No.1 1997. P. 113-115
This paper's purpose presents the results of a survey of chiropractors enrolled in the first year of a three year postgraduate course in chiropractic pediatrics. The survey sought to establish if consensus existed with respect to the modalities these doctors used to treat two of the most common childhood disorders seen by chiropractors: otitis media and asthma. Thirty-three doctors of chiropractic participated in the survey. "Of the primary therapeutic modalities employed by the chiropractor, spinal adjusting was the most commonly used for both asthma and otitis media. Certain areas of the spine were addressed most frequently for each of the two conditions.
Chiropractic care in the treatment of asthma. Killinger LZ. Palmer Research Journal 1995; 2(3):74-7.
This is the case report of an 18 year old subject with a two year history of asthma and monitored for a five year period. The subject received Palmer Upper cervical Specific technique adjustments. The result was marked improvement in the subject's health status. The greatest improvements were reported in the weeks following the chiropractic adjustments. This was an unusual case because trauma to the cervical vertebrae coincided with the occurrence of asthma and spinal care was directed to the traumatized segments.
Treatment of visceral disorders by manipulative therapy. Miller WD. In: Goldstein M, Ed. The Research Status of Spinal Manipulative Therapy. Bethesda: Dept. HEW. 1975:295-301.
Patients with chronic obstructive pulmonary disease were treated with osteopathic manipulation. 92% of the patients stated they were able to walk greater distances, had fewer colds, experienced less coughing, and had less dyspnea than before treatment. 95% of patients with bronchial asthma said they benefited from chiropractic care. Peak flow rate and vital capacity increased after the third treatment.
Specific upper cervical chiropractic care and lung function. Kessinger, R CRJ 1997; 27/ Mantis ID 38010
A study was conducted on 58 patients to determine whether the upper cervical knee chest adjustment, influenced pulmonary function. FEV-1 and FVC were measured before care and two weeks after care on a computerized auto-spiro spirometer. Analysis of the spirometry measurements revealed predictable statistically significant changes in FVC and FEV-1. Of the 58 patients, 57% of the subject population were considered to have "abnormal" lung function before care. The abnormal group showed the greatest increases in FVC and FEV-1 over the two-week study. Forty-two percent of the abnormal patient population actually tested within normal limits after the two-week study. The "normal" subject population also showed predictable increases in tendency to return to normal was clearly observed in just two weeks under specific chiropractic care.
Chiropractic adjustment in the management of visceral conditions: a critical appraisal. Jamison JR, McEwen AP, Thomas SJ. J Manipulative Physiol Ther. 1992 (Mar-Apr);15 (3): 171-180
In this a survey of chiropractors in Australia, more than 50% of the chiropractors stated that asthma responds to chiropractic adjustments; more than 25% felt that chiropractic adjustments could benefit patients with dysmenorrhea, indigestion, constipation, migraine and sinusitis.
A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. Balon J, Aker PD, Crowther ER, et al. N Engl J Med. 1998 (Oct 8);339 (15): 1013-1020
This study prompted the following response from Anthony L. Rosner, Ph.D., the Director of Research for the Foundation for Chiropractic Education and Research (FCER).
A casual reading of the Balon and Aker study, published in the October 8, 1998 issue of The New England Journal of Medicine suggests that chiropractic spinal manipulation provides no benefit to patients. What is overlooked are the facts that the design of the study is such that the outcome is all but guaranteed in advance and the benefits of chiropractic manipulation in the management of asthma (suggested in several previously published case studies and clinical trials) are obscured and therefore judged to be nonexistent. At a time when public interest in the application of alternative medicine is rising, it is regrettable that a study with such deep flaws should have found its way to the lead position in such a prominent journal.
There were also these responses from the academic and research community. This study raises serious issues with the design of a truly inert placebo, as well as issues for the design of future randomized trials for "manual", "manipulative", or "physical medicine" types of trials. This is discussed in length in the Problems with Placebos Page
Asthma in a chiropractic clinic: a pilot study. Jamison J et al J Aust Chiro Assoc., 16(4):137-143, 1986.
In this study of 15 patients under chiropractic care, six patients reduced their medications and one stopped them entirely. This represents a 46.67% decrease in the need for medication while under chiropractic care.All patients reported satisfaction with their chiropractic care. However the lead author, Dr. Jamison concluded that respiratory function appeared to be unaffected by chiropractic adjustments.
Prognostic factors in bronchial asthma in chiropractic practice. Nilssen N. Christiansen B. J Aust Chirop Assoc 1988;18:85-7.
In this study of 79 subjects, those most likely to report the best benefit had less severe asthma, were younger and responded within one month (and had an average of five adjustments in one month)
A holistic approach to the treatment of bronchial asthma in a chiropractic practice. Lines DA. Chiropractic J of Australia 1993;23(1):4-8.
Chiropractic care of two children and one adult (two-year-old, five-year-old and thirty-year old) with asthma. Thoracic adjusting was used in two cases and lumbar adjusting was used in two cases. The patients remained asthma free six months to two years at the writing of the paper.
The author's remarks are well stated: "With counting evidence that current medical bronchodilator and inhaled steroid intervention may be contributing to the rising mortality, the conservative, holistic, chiropractic approach presented here may well provide (a)...more effective alternative intervention to present allopathic (medical) therapy....It appears that the currently accepted allopathic (medical) management regimes still remain consensus-based rather than having been founded on actual clinical trials."
Chronic asthma and chiropractic spinal manipulation - a randomized clinical trial Nielsen NH, Bronfort G, Bendix T et al Clin Exp Allergy. 1995 (Jan);25 (1): 80-88
This blinded, randomized study of 31 patients aged 18-44 who were all on bronchodilators and/or inhaled steroids was conducted at the National University Hospital's Out-patient Clinic in Copenhagen, Denmark. They received either sham or real manipulations. Interestingly, non-specific bronchial hyperreactivity (n-BR) improved by 36% and patient rated asthma severity decreased by 34% in both groups.
From the abstract: "The results do not support the hypothesis that chiropractic spinal manipulative therapy is superior to sham spinal manipulation in the management of pharmaceutically controlled chronic asthma in adults when administered twice weekly for 4 weeks."
Dr. Koren's comment: These conclusions appear at variance with over a hundred years of clinical observation of chiropractic's effectiveness with asthmatics. Upon study of the paper, we notice a number of weakness: subjects were all adults on medication for years. Medication was continued during the course of spinal adjustment. A total of 8 adjustments (2x per week) were performed. So this paper shows that adult asthma sufferers, who are full of meds get as much relief as sham adjustments after 8 "manipulations." Perhaps the sham manipulation was more manipulation than sham? Perhaps the technique used was defective or not specific enough for asthmatic sufferers? Further, many asthmatic sufferers in the real world discontinue or decrease their medications under chiropractic care. In this hospital study that was not permitted as part of the protocol. This research was poorly designed and not worthy of the term chiropractic research.
Chiropractic Case Studies:
"There are possibly millions of asthmatic children who are destined to a life dependent upon medication; these children may never have the chance to see if chiropractic spinal adjustments can help their asthma and provide them with a better quality of life." Peter Fysh, D.C. San Jose, California. Dynamic Chiropractic. Sept. 25, 1995. p.16.