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Alternative Asthma Treatments Gain Fans

Alternative Asthma Treatments Gain Fans


By Francie Scott

When he was a respiratory student in 1989, Marcell Frey, RRT, consulted a chiropractor about his asthma. At that time, his disease had spun out of control. He had been hospitalized 32 times in one year and intubated twice the following year. The Riverhead, N.Y., therapist desperately wanted better health.

A fellow respiratory student steered him to a chiropractor who had successfully treated her asthma, and Frey decided he had nothing to lose.

The chiropractor manipulated vertebrae near Frey's thoracic cavity, a maneuver designed to integrate the nervous system and relax the muscles in the thoracic cage. Frey said his asthma symptoms improved, and he continued his treatments two or three times a week. He also took his medication and has been hospitalized only three times in the past nine years.

Frey's skepticism melted when his asthma stabilized, and he has since delved into chiropractic science himself. Convinced of its merits, Frey enrolled in the New York Chiropractic College, graduating last year. He is currently taking licensing exams and hopes to integrate chiropractory and traditional respiratory care in the future.

"I felt it should be incorporated as a mainstay in the treatment of asthmatics," he said, carefully noting, "It's not the sole treatment, but it should be incorporated."



Frey is not alone in his pursuit of alternative treatments for asthma and other diseases. Some studies estimated that patients spend $14 to $20 billion per year on alternative medicine. Medical schools are catching on. A 1996 survey conducted by the Association of American Medical Colleges reported that one third of medical schools now offer instruction in alternative medicine. Even the venerable National Institutes of Health has established a center of alternative medicine.

As clinicians evaluate the efficacy of modalities like acupuncture and chiropractic medicine, they seek data from randomized, double blind, clinical trials, but medical literature has been scant on these topics. Patients, on the other hand, may settle for anecdotes and personal experience.

Lisa Marino, a 22-year-old chemist from Philadelphia, struggled with severe asthma for almost 10 years. She depended on a bronchodilator, an anti-inflammatory agent and an inhaled steroid, but her symptoms persisted. "It was just getting annoying having to carry around three different inhalers," she said.

Marino decided to try acupuncture and made an appointment with Jia Nadia Guo, a Chinese physician who practices the ancient art in the Philadelphia suburb of Bryn Mawr. Marino has taken weekly treatments since October and believes her life changed direction.

"I was definitely dependent on my Preventil, but now I am not dependent," she said. "I have increased my exercise and everything is fine. Before (acupuncture), I wouldn't have had the energy to start exercising."



Caregivers may also be convinced without the science. Rosalba Courtney, DO, of Brisbane, Australia, was impressed by what she saw when she evaluated Buteyko, a breathing method named for the Russian physician who developed the technique.

"I was struck by the dramatic changes I saw in a few people," she said during a recent visit to California. "I just kept seeing people with real, real bad asthma get better."

However, Courtney recognizes the importance of data and intends to plant her version of eucapneic Buteyko breathing on the medical map with good science.

Even when the science is absent and the symptoms persist, alternative medicine may provide an ingredient that can help patients recover hope. Mary Weick of Phoenixville, Pa., watched her 16-year-old son, Nathan, struggle with asthma symptoms since he was four. She had tried medications, diet, herbs and vitamins to manage Nathan's debilitating asthma. Last summer, he suffered such a severe exacerbation, his doctor said he could have died. Weick decided to explore other options and took Nathan to Guo for acupuncture treatments. Now, six months later, his symptoms have improved.

"Although Nathan is not cured at this moment, he has received hope from her," Weick said. "It's the first hope he has had all his life that he can be a normal person without having to carry inhalers around and be afraid."

Advocates of alternative treatments for potentially life-threatening diseases like asthma need more than anecdotes to convince the average clinician their field has merits.



"Where's the physiology?" many caregivers ask when they evaluate alternative therapies. They also worry patients will neglect tried and tested therapies when they pursue alternative cures. A new breed of clinicians is trying to bridge the gap between the two worlds with an approach they call "integrated medicine," seeking to employ the best of both disciplines.

Take chiropractic medicine as an example. David Wickes, DC, vice president for academic affairs at the National College of Chiropractic in Chicago, said he and his colleagues believe they can help asthmatics by manipulating their spines.

"It's a matter of trying to get the thoracic muscles to relax and restore motion to the thoracic cage," he explained. "Those muscles become chronically tight in children with asthma."

If muscles are tight, patients can't take deep breaths. They can't exhale forcibly and this exacerbates their condition. Wickes and his colleagues may also offer their asthma patients nutritional counseling or direct them to acupuncture. "We tend to be familiar with other alternative care providers," he said.

Wickes stressed asthma patients may need their bronchodilators and anti-inflammatory agents. "We share the responsibility (for care) with another physician," he said. "We recognize when patients need medication and make sure they get it."



Wickes advocates an integrated approach for the tough cases. "We might not be able to get a person entirely off medication, but we get them to respond to a lower dose by combining therapies," he said.

Courtney also acknowledges the importance of medications when asthma is out of control.

Like chiropractors, Buteyko enthusiasts focus on respiratory muscles. They believe hyperventilation and hypocapnia contribute to bronchospasm, and they teach their patients to "normalize" breathing. Advocates want to change the way their patients breathe rather than just teach a technique to employ when they wheeze.

"My feeling is, unless you can actually work to change breathing, those muscle restrictions will occur," said Courtney who begins treatment with massage to release the accessory respiratory muscles in the diaphragm. She then focuses on restoring "normal diaphragmatic function" through breathing exercises. She also teaches "progressive breath holding exercises," to maintain a healthy ventilation-to-perfusion ratio.

Several clinical trials completed in Australia were published. One randomized study of 39 patients with a strong history of asthma compared Buteyko breathing with conventional breathing exercises. Results within six weeks of a three-month trial showed "unprecedented" improvements in symptoms and medication usage in the Buteyko group.

Buteyko patients reported less breathlessness. Improvement in their daily symptom score was three times higher than those in the control group. End tidal CO2 demonstrated another difference, with Buteyko patients increasing from 33 mm hg to 35 mm hg. Investigators found no end tidal CO2 change in the control group.

Patients in both groups were told to use their bronchodilators to relieve symptoms, and Buteyko patients were also instructed to use the breathing techniques. The Buteyko group members used 90 percent less medication during the six-week period, compared with members of the control group, who lowered their usage by 3 percent.

The study, funded by the Asthma Foundation of Australia, was published in Australian Journal of Osteopathic Medicine (Vol. 7, No. 1: 1995).

Courtney now conducts workshops in the U.S. several times a year, basing her practice at the Alive & Well Institute of Conscious Body Work Inc. in San Anselmo, Calif. She is looking forward to launching some research projects in the U.S., where "resources are greater."



Kent Kulow, RRT, of Cleveland, Ohio, discovered Buteyko breathing through the Internet and follows the research with interest. Kulow can usually control his own asthma with medication, but his asthmatic three-year-old son had a few exacerbations this winter.

"She sounded legit," Kulow said of Courtney. He described Buteyko as a rebreathing technique to be used for life. "They don't tout it as a wonder technique," he added.

Acupuncture also claims a physiologic basis for treating asthma. Guo said needles inserted at acupuncture points stimulate the body's own chemicals to alleviate symptoms by sending messages to the brain.

The brain responds by releasing neurotransmitters and neuromodulators like endorphin. In the case of an asthma attack, Guo believes acupuncture modulates cell metabolism and enzyme synthesis that relax the smooth muscle and reduce IgE levels.

"It's a science," Guo said. "It's been in China for 5,000 years and people are still using it."


Francie Scott is an ADVANCE associate editor.


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