Complementary Therapies for Asthma: What Patients Use

Asthma patients are prime candidates to employ complementary medicine (CM) for their conditions, yet little hard data exist on the prevalence of CM use by these patients. This survey was aimed at generating some information on this and related issues. Members of the UK National Asthma Campaign (17,000) were invited to complete a questionnaire and 4741 responded. Only 41% of the respondents had never tried CM. Breathing techniques, homoeopathy, and herbalism were the three most prevalent treatments. The majority of respondents perceived these therapies as moderately useful with only little difference between various treatments. In general, the money spent on CM was modest. It is concluded that CM is frequently used for asthma. Therefore, this area of healthcare would seem to warrant more rigorous investigation.     

Delivery of Asthma and Allergy Care in Europe

Background. There is no comprehensive information available concerning the way in which care is provided for those with allergic conditions in Europe. Objective. To determine who cares for those with asthma, allergic dermatitis, and rhinitis in Europe and to determine the involvement of primary care and other healthcare professionals and the use of patient education and guidelines. Methods. A questionnaire survey of colleagues in 43 institutions in 33 European countries with results being related to published sources of information regarding prevalence of allergic diseases in different countries and published data regarding availability of doctors and expenditure on healthcare. Results. A total of 33 of 43 institutions completed the survey (76.7%) with information being obtained from 26 of the 33 countries surveyed (78.7%). There are wide differences in the use of different healthcare professionals in different countries, with those for asthma, for example, being most likely to be cared for by an allergologist in some countries and by a primary care physician in many others. There was much greater awareness of guidelines for asthma and little reported usage of guidelines in the management of those with allergic skin diseases, and while self-management education was offered most to those with asthma, there was a wide variation in the usage of group education. Conclusions. Many of the differences revealed by this survey cannot be explained by the availability of different healthcare professionals nor by differences in healthcare expenditure, and such differences need further evaluation to determine their effect on outcomes and the economics of healthcare so that we may determine that which is optimal.     

Hypnosis and Asthma: A Critical Review

Asthma is among the most common chrome diseases of the western world and has significant effects on patients' health and quality of life. Asthma is typically treated with pharmaceutical products, but there is interest in finding nonphar-maceutical therapies for this condition. Hypnosis has been used clinically to treat a variety of disorders that are refractive to pharmaceutical-based therapies, including asthma, but relatively little attention has been given recently to the use of clinical hypnosis as a standard treatment for asthma. Significant data suggest that hypnosis may be an effective treatment for asthma, but it is premature to conclude that hypnosis is unequivocally effective. Studies conducted to date have consistently demonstrated an effect of hypnosis with asthma. More and larger randomized, controlled studies are needed. Existing data suggest that hypnosis efficacy is enhanced in subjects who are susceptible to the treatment modality, with experienced investigators, when administered over several sessions, and when reinforced by patient autohypnosis. Children in particular appear to respond well to hypnosis as a tool for improving asthma symptoms.     

The Use of Complementary Therapies in Inner-City Asthmatic Children

Use of complementary/alternative medicine (CAM) has been increasing, especially among patients with a chronic illness. Although asthma is the most common chronic illness affecting children in the United States, very little is known about the use of CAM in children with asthma. Our objective was to determine the prevalence and correlates of CAM use among inner-city children with asthma. A cross-sectional survey of parents of children with asthma attending an urban health center was performed. Parents were surveyed regarding CAM use over the past year, perceived efficacy of CAM, severity of child's asthma symptoms and demographic information. Differences in proportions were tested by chi-square or Fisher's exact test as appropriate. Three hundred ten parents participated, of whom 61% were Hispanic and 37% were African American. Parental mean age was 33 years and the mean age of the child was 7.2 years; 89% of parents had treated their child in the past year with some form of CAM. However, only 18% had informed a physician of doing so. The most common forms of CAM used were as follows: prayers (53%), rubs (53%), and massage (45%). Of those who used CAM, 59% perceived it to be at least as effective as pharmacotherapy, and 44% used CAM as first treatment of an asthma attack. Mild and moderate persistent asthmatics had significantly higher rates of CAM use than did mild intermittent and severe persistent asthmatics. We found a very high rate of CAM use among children with asthma in this inner-city population. Most importantly, a very high proportion of parents perceived the therapies to be effective, used them as first treatment of an acute exacerbation, and did not inform a physician of doing so. These findings have implications for the care of asthmatic children by pediatricians practicing in urban settings.     

The Use of Complementary Therapies in Inner-City Asthmatic Children

Use of complementary/alternative medicine (CAM) has been increasing, especially among patients with a chronic illness. Although asthma is the most common chronic illness affecting children in the United States, very little is known about the use of CAM in children with asthma. Our objective was to determine the prevalence and correlates of CAM use among inner-city children with asthma. A cross-sectional survey of parents of children with asthma attending an urban health center was performed. Parents were surveyed regarding CAM use over the past year, perceived efficacy of CAM, severity of child's asthma symptoms and demographic information. Differences in proportions were tested by chi-square or Fisher's exact test as appropriate. Three hundred ten parents participated, of whom 61% were Hispanic and 37% were African American. Parental mean age was 33 years and the mean age of the child was 7.2 years; 89% of parents had treated their child in the past year with some form of CAM. However, only 18% had informed a physician of doing so. The most common forms of CAM used were as follows: prayers (53%), rubs (53%), and massage (45%). Of those who used CAM, 59% perceived it to be at least as effective as pharmacotherapy, and 44% used CAM as first treatment of an asthma attack. Mild and moderate persistent asthmatics had significantly higher rates of CAM use than did mild intermittent and severe persistent asthmatics. We found a very high rate of CAM use among children with asthma in this inner-city population. Most importantly, a very high proportion of parents perceived the therapies to be effective, used them as first treatment of an acute exacerbation, and did not inform a physician of doing so. These findings have implications for the care of asthmatic children by pediatricians practicing in urban settings.     

Use of complementary and alternative medicine in children with asthma

BACKGROUND:

Because of the potential risk of interaction with, and underuse of, conventional medications, it is important to document the prevalence of the use of complementary and alternative medicines (CAMs) in asthmatic children.

OBJECTIVE:

To ascertain the prevalence and type of CAMs, and to identify factors associated with their use.

METHODS:

A cross-sectional survey of children who presented to the Asthma Centre of The Montreal Children’s Hospital (Montreal, Quebec) between 1999 and 2007 was conducted. At the initial consultation, parents completed a questionnaire inquiring, in part, about CAM use. Computerized health records provided information regarding patient characteristics and their condition.

RESULTS:

The median age of the 2027 children surveyed was 6.1 years (interquartile range 3.3 to 10.5 years); 58% were male and 59% of children had persistent asthma. The prevalence of CAM use was 13% (95% CI 12% to 15%). Supplemental vitamins (24%), homeopathy (18%) and acupuncture (11%) were the most commonly reported CAMs. Multivariable logistic regression analysis confirmed the association of CAM use with age younger than six years (OR 1.86; 95% CI 1.20 to 2.96), Asian ethnicity (OR 1.89; 95% CI 1.01 to 3.52), episodic asthma (OR 1.88; 95% CI 1.08 to 3.28) and poor asthma control (OR 1.98; 95% CI 1.80 to 3.31).

CONCLUSION:

The prevalence of reported CAM use among Quebec children with asthma remained modest (13%), with vitamins, homeopathy and acupuncture being the most popular modalities. CAM use was associated with preschool age, Asian ethnicity, episodic asthma and poor asthma control.     

Online Sources of Herbal Product Information

Herbal products are commonly used to treat clinical conditions and are often purchased online without the supervision of a healthcare provider. The use of herbals remains controversial because of widespread exaggerated claims of clinical efficacy and safety. We conducted an online search of 13 common herbals (including black cohosh, echinacea, garlic, ginkgo, ginseng, green tea, kava, saw palmetto, and St John's wort) and reviewed the top 50 Web sites for each using a Google search. We analyzed clinical claims, warnings, and other safety information. A total of 1179 Web sites were examined. Less than 8% of retail sites provided information regarding potential adverse effects, drug interactions, and other safety information; only 10.5% recommended consultation with a healthcare professional. Less than 3% cited scientific literature to accompany their claims. Key safety information is still lacking from many online sources of herbal information. Certain nonretail site types may be more reliable, but physicians and other healthcare professionals should be aware of the variable quality of these sites to help patients make more informed decisions.     

Asthma Caused by Human Seminal Plasma Allergy

Human seminal plasma allergy (HSPA) in women is a rare phenomenon and can be life-threatening. Hypersensitivity reactions occur during or immediately after coitus and are usually caused by sensitization to proteins in the seminal fluid. This can be very distressing for the patients and their partners. Young, married female patients with episodic asthma dating to their marriage with a history of difficulty in conceiving were specifically asked for local and systemic symptoms chronologically related to coitus. This methodology was adopted keeping in view our social conditions and sensitive nature of the information sought. Two patients thus detected were evaluated further. Condom usage, on our advice, abolished both local and systemic postcoital symptoms. Both patients tested positive to intradermal skin test with the seminal plasma antigen (SPA) derived from their respective husbands and, in patient 1, was accompanied by intense burning, irritation, and itching of the skin. Specific IgE against SPA was demonstrated in the serum of both patients. Elevated levels of total IgE were also detected. A high index of suspicion is needed to diagnose HSPA, especially the local forms, which can easily be overlooked due to patient embarrassment and lack of physician awareness.     

Allergy is associated with reduced risk of glioma: A meta-analysis

BackgroundIncreasing evidences suggest that allergy may reduce the risk of glioma, so it is necessary to perform an up-to-data literature search and investigate this relationship by meta-analysis.MethodsWe identified the included studies by searching PubMed and Web of Science and excluding irrelevant or ineligible articles. Nineteen studies from 15 articles, including 8435 cases and 118,719 controls, were selected for data extraction and synthesis.ResultsPooled outcomes showed that there was an inverse association between allergy and risk of glioma (OR = 0.64, 95% CI = 0.52–0.78, P < 0.001). Meanwhile, asthma and eczema would reduce the risk of glioma by 33% and 23% (OR = 0.67, 95% CI = 0.59–0.75, P < 0.001; OR = 0.77, 95% CI = 0.68–0.86, P < 0.001), respectively. Sensitivity analyses confirmed the stability of these findings. Besides, no publication biases were detected regarding all the investigations.ConclusionsOverall or specific allergy is protective against glioma. More prospective cohort studies or molecular laboratory experiments are warranted to elucidate the causation and key mechanism.     

Asthma and Allergy: Some Answers and More Questions

To evaluate the role of serum eosinophil cationic protein (ECP) concentration as a monitoring parameter in acute bronchial asthma, 11 children (mean age 10.2 years) were studied during an acute exacerbation of their disease. Under an appropriate anti-inflammatory therapy, FEV₁ increased significantly at day 1 (p < 0.05), day 14 (p < 0.05), day 28 (p < 0.03), and day 56 (p < 0.03) compared to baseline values at referral to hospital. Serum ECP concentration decreased in the group of patients significantly at day 28 (p < 0.02) and day 56 (p < 0.04). However, considering the individual serum ECP time courses, most of the patients did not show a uniform pattern of continuously decreasing values. From our data, we conclude that measuring serum ECP concentration during acute asthma episodes in children may play a role in some patients, whereas in others—probably those without acute eosinophil inflammation—monitoring by serum ECP concentration is of limited value.     

Prevalence and Impact of Asthma and Allergy on Daily Life,Health Outcomes and Use of Healthcare Services in Children: A Population-Based Study

IntroductionStudies on the prevalence of asthma and allergies often lack representation of the pediatric population, and their impact has not been examined using children without these diseases as a reference group. This study aimed to determine the prevalence of asthma and allergies in children under 14 years old in Spain and their impact on health-related quality of life, activities, healthcare utilization, and environmental and household exposure risk factors.MethodsData came from a Spanish population-based representative survey of children aged <14 years (N = 6297). A sample of controls (1:4) from the same survey was matched using propensity score matching. Logistic regression models and population-attributable fractions were calculated to determine the impact of asthma and allergy.ResultsThe population prevalence of asthma was 5.7% (95% CI: 5.0%, 6.4%), and of allergy was 11.4% (95% CI: 10.5%, 12.4. In children with lower percentiles of health-related quality of life (≤20th), 32.3% (95% CI, 13.6%, 47.0%) was attributed to asthma and 27.7% (95% CI: 13.0%, 40.0%) to allergy. Forty-four percent of restrictions in usual activity were attributed to asthma (OR: 2.0, p-value: <0.001), and 47.9% to allergy (OR: 2.1, p-value: <0.001). 62.3% of all hospital admissions were attributed to asthma (OR: 2.8, p-value: <0.001), and 36.8% (OR: 2.5, p-value: <0.001) of all specialist consults to allergy.ConclusionsThe high prevalence of atopic disease and its impact on daily life and healthcare utilization call for an integrated healthcare system focused on children and caregivers’ needs with continuity of care across education and healthcare settings.     

Asthma Training in Third-Year Medical Students

To assess the educational experiences of physicians-in-training with asthma patients, we had medical students complete asthma surveys at the beginning and end of their internal medicine clerkship (IMC). At the beginning of the IMC, all students received a 1-hr asthma lecture and half of the students received a compilation of pocket cards containing many of the algorithms from the National Heart, Lung, and Blood Institute asthma guidelines. We found that students had relatively few encounters with asthmatic patients during the IMC. Students were good judges of asthma severity but performed poorly on survey questions pertaining to asthma treatment. Confidence in treating and assessing patients improved by the end of the IMC, but remained low. We conclude that the usual 1-hr lecture and limited contact with asthma patients during the IMC may be inadequate to train students to care for patients with asthma.     

Advising patients who use dietary supplements

Public use of dietary supplements is quite prevalent, with an estimated 1 of 5 patients using such substances in an effort to maintain or promote their health. Despite their popularity, patients and physicians are often unaware of the limited regulation of these products as well as their potential risks and benefits. Lack of physician knowledge in these areas has the potential to strain the doctor-patient relationship. In this review, we present a 6-step approach to advising patients who are considering use of dietary supplements. Our framework includes a discussion of regulatory issues, efficacy and safety, potential supplement-drug interactions, and monitoring for adverse events and therapeutic effects.     

Complementary and Alternative Medicines (CAM) in the Management of Asthma: An Examination of the Evidence

Although individuals are using Complementary and Alternative Medical (CAM) therapies to help manage their asthma, there is no clear direction in the current guidelines for the use of CAM in asthma. This literature review undertakes to determine the current science regarding the use of CAM in asthma management. Electronic literature searched all EBM Reviews, Medline, OVID full text, and PubMed and National Complementary and Alternative Medication databases for Randomised Controlled Trials (RCT) published in English between 1997 and 2002 with keywords “asthma” and “complementary medicine” or “complementary therapy” or “alternative medicine” or “alternative therapy.” Abstracts (N = 197) were reviewed for inclusion in the review and duplicates discarded (N = 65). Abstracts of non-RCT studies, review articles, and surveys were also discarded (N = 66). Abstracts discussing environmental control measures and pharmaceutical alternatives to steroid therapy were discarded (N = 9). The 15 final studies were grouped within three categories: mind-body and relaxation, manual therapies, and diet and reviewed for statistical and clinical significance, suggesting some CAM therapies have shown minimally significant improvements in asthma quality of life (breathing exercises) or pulmonary function (relaxation) and immune function (relaxation and acupuncture) in select asthma populations. Although CAM therapy is being used in the management of asthma, these 15 studies show a tendency to little or no significant difference between placebo or sham therapy. This may be due, in part, to the enhanced placebo effect of sham therapies used as control and the small size of most studies. Although the changes in the immune function seen in two studies are provocative, these changes did not translate to changes in lung function. More research is needed to assist in determining the efficacy of CAM therapies in asthma management.     

Perspectives about complementary and alternative medicine in rheumatology

Complementary and alternative medical (CAM) treatments are considered nonmainstream therapies. The popularity and widespread usage of CAM reflects the inadequacies of the current understanding and management of rheumatic and musculoskeletal (and other) diseases despite significant progress. Better science in the future will relegate certain CAM therapies to the margins of medicine or to history and perhaps see the adoption of others into mainstream medicine. Despite the recent increased interest in CAM, particularly for rheumatic diseases, few clinically important contributions have emerged thus far.     

Complementary medicine use in rheumatology: A review

Complementary and alternative medicine (CAM) use is increasing worldwide; specifically it appears that these treatment modalities are popular among rheumatology patients. The most commonly reported CAM therapies are herbal medicines, homeopathy, chiropractic, acupuncture and reflexology. Despite high reported rates of CAM use, the number of patients disclosing use to their rheumatologists remains low. This review highlights rates of current CAM use in rheumatology in studies performed worldwide, and discusses potential reasons for nondisclosure of CAM use to clinicians.     

植物药在哮喘治疗中的作用

麻黄、白果（银杏）、人参、甘草、酸枣仁、大枣、桂枝、柴胡、黄芩、五味子、小青龙汤、蛤蚧抗喘丸、MSSM-002与Ashmi（爱吸美）及其它植物药能促进支气管扩张,增加肺活量,消除哮喘炎症介质,提高皮质类固醇水平。在一些植物药中已分离出能干扰哮喘和过敏反应发生的化学物质。植物药的副作用较少,有较好的依从性。通过对植物药作用机制的持续研究,可发现治疗哮喘和过敏反应的新方法。