The Chiropractic Care of Patients with Asthma: A Systematic Review of the Literature to Inform Clinical Practice
SOURCE: Clinical Chiropractic 2012 (Mar); 15 (1): 23–30
Joel Alcantara, Joey D. Alcantara, Junjoe Alcantara
International Chiropractic Pediatric Association,
Media, 327 N Middletown Rd,
Media, PA 19063, USA
Introduction Estimates place some 300 million people worldwide suffer from asthma with 180,000 deaths attributed to the disease. The financial burden from Asthma in Western countries ranges from $300 to $1,300 per patient per year. In the United States, asthma medication costs between $1 billion and $6.2 billion per annum. With an increasing prevalence of 50% every decade, there is no question that the burden of asthma is tremendous. The prevalence of complementary and alternative medicine (CAM) use amongst adult asthmatics ranges from 4% to 79% whilst, in children, it ranges from 33% to 89%. Of the various practitioner-based CAM therapies, chiropractic stands as the most popular for both children and adults. As with other chiropractors, the authors aspire to the principles of evidence-based practice in the care of asthma sufferers. Recent systematic reviews of the literature places into question the effectiveness of chiropractic. To assuage the discord between our clinical experience and those of our patients with the dissonant literature, we performed a systematic review of the literature on the chiropractic care of patients with asthma.
Methods Our systematic review utilized the following databases for the years indicated: MANTIS [1965–2010]; Pubmed [1966–2010]; ICL [1984–2010]; EMBASE [1974–2010], AMED [1967–2010], CINAHL [1964–2010], Index to Chiropractic Literature [1984–2010], Alt-Health Watch [1965–2010] and PsychINFO [1965–2010]. Inclusion criteria for manuscript review were manuscripts of primary investigation/report published in peer-reviewed journals in the English language involving the care of asthmatic patients.
Results The studies found span of research designs from non-experimental to true experimental studies consisting of 3 randomized controlled clinical trials (RCTs), 10 case reports, 3 case series, 7 cohort studies, 3 survey studies, 5 commentaries8 and 6 systematic reviews. The lower level design studies provide some measure of evidence on the effectiveness of chiropractic care for patients with asthma while a critical appraisal of 3 RCTs revealed questionable validity of the sham SMTs involved and hence the conclusions and interpretations derived from them. The RCTs on chiropractic and asthma are arguably comparison trials rather than controlled clinical trials per se.
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Conclusion Chiropractic may offer an alternative care approach for asthmatic patients. Future investigations of this conservative care approach for patients with asthma should pave the way for higher-level design studies such as randomized controlled clinical trials.
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The burden of asthma is tremendous. Prevalence estimates of asthma range from 7% in France and Germany to 11% in the United States and as high as 15–18% in the United Kingdom.  In Britain, asthma is the commonest chronic childhood disease.   In the United States, approximately 6.7 million children (or 9.1% of the pediatric population) have asthma. Some 10.6 million office visits to medical physicians are attributed to the symptoms of asthma. Deaths as a result of asthma have been estimated at approximately 1.2 deaths per 100,000 population.  Asthma medications alone have been placed at costing $1 billion per year in the United States. In 1985, the burden of asthma was placed at almost $4.5 billion and extrapolated to $6.2 billion in 1990 in the United States. Given the ever increasing prevalence of asthma since the 1990s, the cost to society undoubtedly enormous.