Asthma

In 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.

Case study: eight year old female with chronic asthma. Peet JB. Chiropractic Pediatrics,1997; 3(2) 9-12.

• The patient had been diagnosed with asthma three years prior to presentation. BecloventT and Albyterol T were used one to three times per day. After eight chiropractic adjustments over a period of 2 ½ weeks, the mother stated that the child had not used her inhaler for two days, her wheezing had ceased and she could run without gasping. At the time of the publication of this article, the child has been free of asthmatic attacks for four months without medication.
  

Asthma in the Pediatric Patient. Fysh, P. Dynamic Chiropractic Sept. 25, 1995. P. 16.

• Case history of Benny, 3 years old who had suffered from bronchial asthma since infancy. On increasing doses of medication, attacks occurred several times a week. Subluxation a C1 and T3-4. Anterior saucering of the spine in the mid-scapular region first described by Pottinger in 1910. After one month of care Benny's asthma resolved. According to the author, "Benny's case is not an unusual one."
  

Chronic asthma: The side-effects of the chiropractic adjustment. Arno Burnier, D.C. Chiropractic Pediatrics Vol. 1 No. 4 May 1995.

• Case #1: J.P., 11-year-old male, Medical diagnosis: Chronic asthma . Medication: Theolair, Alupent Chiropractic results: Off asthma medication after first visit. Child is now a multidiscipline athlete with aspirations to become an Olympic athlete. Six years later, the child is still free of asthma and medication. Presenting Vertebral Subluxation: Occiput/C1 with an Atlas ASR. Original Adjustments: Structural manual adjustment of Atlas.
  
• Case #2: F.H., 9 year old male. Medical diagnosis: Chronic asthma. Medication: Nasalcron Chiropractic result: Off his medication at onset of care. Clear of symptoms since first adjustment eight years prior. Presenting vertebral subluxation: CO/C1 with atlas ASRP. Original Adjustment: Atlas in lateral flexion and rotation supine.
  

Case history of asthmatic child. Matthews, NC. Et al. A four year old female patient reported to the office . International Chiropractic Pediatric Association Newsletter. July 1996.

• "Since birth she had problems with her respiratory system...clinical diagnosis of asthma. She had shortness of breath, hard and labored breathing, inability to run from shortness of breath...had become reliant on antibiotics for constant respiratory infections...had taken lots of steroidal drugs. This 'conventional' drug therapy had not prevented her from spending every Christmas in the hospital on a breathing machine. "A complete chiropractic examination revealed vertebral subluxation of the atlas right, sixth cervical posterior, and right posterior sacrum. Specific chiropractic adjustment were given...patient responded to the care immediately and was able to suspend using the drugs within two weeks. Within two months, she was able to play with her friends with no symtomatology. Her 5th Christmas was the first at home in her life...I wonder if her asthma should have been diagnosed as SUBLUXATION. What would have happened to her if over the last two years she had been on steroids rather than chiropractic care?"
  

Asthma and chiropractic. Garde R. Chiropractic Pediatrics. Vol 1 No.3 Dec, 1994.

• From the abstract: Case review of a 6-year-old boy who has had asthma since 1991 and his condition since chiropractic intervention. Child was prescribed aerosol inhalers (Beclovert and Vertolin) using them every day, up to three times a day. Adjustments were delivered to the cervical, thoracic and lumbar areas. Significant progress. Could run during soccer games and "almost never used his inhaler." Slept more soundly. "Hardly ever had bouts with mucous clogged nasal passages." Nasal inhalant use stopped.
  
  
  

Case history: an eight year old asthmatic patient. Cohen E. Today's Chiropractic. Jan-Feb 1988, p.81.

• Improvement in care of an 8 year old asthmatic who developed the condition at age two and successful response after chiropractic care.

Adjustive treatment for chronic respiratory ailment in a five year old. Case reports in chiropractic pediatrics. Esch, S. ACA J of Chiropractic December 1988.

• This is the story of a 5 ½ year old girl with a four-year history of what the parents called "bronchial congestion." She had pneumonia "several times a year" since she was 18 months old. In addition to he attacks of "bronchitis" she suffered from congestion and was wheezy after running and upon waking up in the morning. The father and mother both reported having allergies. Chiropractic Examination reveal subluxations at C-2, T-4 and L-5.At the second adjustment two days after the first the mother reported the child was not coughing as much and by the third visit a week later the mother reporting the child was breathing normally. Twelve adjustments were given over three months and the chief complain did not recur. A follow-up call four years later revealed no recurrence.

Asthma and Enuresis  (Case Report #1374)  Zell, Paul,  ICPA Newsletter, May-June 1998

• History:  The pre-natal history was uneventful and the birth was a Cesarean type with high APGAR scores.  The inoculation history was limited to one Polio shot at age 2 and 1 Diphtheria/Tetanus shot because of a reaction to the Diphtheria/Tetanus shot.  At age 2, a congenital nevus was removed from the chin.  Prior to the surgery the patient was exposed to chicken pox and following the anesthesia, noted personality changes were seen along with several gastrointestinal bouts of the flu and chicken pox.  There were reported treated with Homeopathy.  At age 3, asthma began to occur, along with many colds and flu's.  With age her resistance to colds and flu's were improving, however the asthma was getting worse.  It was triggered by virus, bacteria or allergies.  The asthma required one hospitalization for 3 days, and a series of trips to the emergency room due to the severe effects of the asthmatic attacks.  Medication included Intal twice daily. Proventil at onset of an episode, and the constant company of a  nebulizer for the exacerbated episodes when the breathing was labored or became a crisis.  The mother reports her daughter would cough up a ball of phlegm following each episode.  Also reported was the frequent amount of bloody noses she has experienced.

• Examination:  A thorough chiropractic examination, full spine films were taken and analyzed.  Differential instrumentation, motion palpation and static palpation verified the presence of vertebral subluxation complexes (VSC) at C-2, T-5, T-12, right Ilium and second sacral tuberosity.  Postural analysis showed a left high head tilt, right high shoulder and left high ilium indicating the body was adapting to the stresses of the multiple VSC's.

• Care Plan:  Recommendations at 3 times per week for 12 weeks were made due to the chronicity of the subluxations and the severity of the symptoms.  Progress of the VSC healing was monitored on each visit and schedule changes made accordingly.

• Progress:  The patient improved following the first adjustment and after the fifth adjustment, the asthma and bedwetting ceased.  The stabilization of the VSC took 6 months at 3 times per week. Care was reduced to 2 times per week for 6 months and now the patient is checked once a week in the wellness phase to maintain the corrections of the VSC and wellness.

• Discussion:  Initially the mother was hopeful that her daughter could be helped with chiropractic care.  However, due to the duration and severity of the asthma, the mother was extremely guarded in the progress of the condition. She reports having to carry all of the mediation and Nebulizer wherever they went just in case it was needed.  It has taken almost a year  to start  feeling comfortable that her little girl did not need mediation or a machine.  Today the patient is an extremely active child playing soccer and  participating in all activities a young person enjoys.  She continues to get adjusted on a regular basis for wellness, allowing her body to heal itself as only it knows how to do.
  
  
  

Additional Articles:

The asthmatic patient. Cessna R. American Chiropractor April1989;48-50.

• Discusses chiropractic success with asthmatics.
  
  

Asthma in a chiropractic clinic: a pilot study. Jamison JR, Leskovec K, Lepore S, Hannan P. J Aust Chiropractic Association 1986; 16(4): 137-43.

Chiropractic response in the pediatric patient with asthma: a pilot study. Peet JB, Marko SK, Piekarczyk. Chiropractic Pediatrics 1995; 1(4)9-12.

Chiropractic treatment of asthma - a controlled clinical trial. Bronfort G, Nielsen N, Bendix T, Madsen F, Weeks B. Proceedings of the 1989 International Conference on Spinal Manipulation. Washington, DC. Published by FCER Arlington, VA.

Management of pediatric asthma and enuresis with probable traumatic etiology. Bachman TR, Lantz CA Proceedings of the National Conference on Chiropractic and Pediatrics (ICA), 1991: 14-22.

• A 34-month-old boy with asthma and enuresis had not responded to medical care. More than 20 emergency hospital visits had taken place for the asthma attacks during a 12 month history. Three chiropractic adjustments were administered over an 11 day period and the asthma symptoms and enuresis ceased for more than 8 weeks. The asthma and enuresis reoccurred following a minor fall from a step ladder but disappeared after adjustments. After a two year follow-up, the mother reports no reoccurrence of the asthma or the enuresis.
  

Mechanisms and Chiropractic Management of Bronchial Asthma. Monti R. Digest of Chiropractic Economics Sep-Oct 1991;48-51.

• Describes the pathophysiology of asthma and the author's chiropractic results.
  

Chiropractic and visceral disease: a brief survey. Wiles R, Daikow P. J Calif Chiro Assoc, 16(4): 137-143, 1986.

• A survey of 17 D.C.s of whom 15 had cared for asthmatics. Areas of the spine adjusted C0- C2 47%, C3-C7 33%, T1-T6 80%, T7-T1240%,Lumbar 7%, Sacro-iliac 13%,.
  

A wholistic approach to the treatment of bronchial asthma in a chiropractic practice. Lines DH. Chiro J Aust 1993;23:4-8.

• A comparison of the effect of chiropractic treatment on respiratory function in patients with respiratory distress symptoms and patients without.  Hviid C;  Bull Eur Chiro Union 1978; 26: 17-34 / Mantis ID: 3222 76.5% of patients with bronchial asthma said they benefited from chiropractic treatment. Peak flow rate and vital capacity increased after the third treatment.
  
  

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