Akupunktur bei Kindern und Jugendlichen mit Asthma bronchiale: Eine randomisierte kontrollierte Studie

Background

During rehabilitation children and adolescents with bronchial asthma suffer from physical and mental stress in spite of receiving their asthma medication, or demonstrate poor therapy compliance. The randomized controlled trial evaluates the effectiveness of acupuncture in the course of inpatient rehabilitation of children and adolescents with mild to severe persistent bronchial asthma.

Patients and methods

In a longitudinal study design (pre-, post-, 4 month-follow-up) the effects of additional acupuncture on symptom frequency and severity, lung function, medication, quality of life (PAQLQ), general and asthma specific level of anxiety (STAIK) were examined in 43 acupuncture and 42 control patients. Apart from asthma sport, climate therapy and behavioural training, the acupuncture group was given acupuncture treatment according to a standardized needle pattern (12 × 30′).

Results

After acupuncture the frequency of morning breathlessness and inhalation difficulty decreased significantly (p < .05) with equal or reduced medication. Patients treated with acupuncture also showed a tendency towards reduced anxiety levels . Patients of the acupuncture group with moderately persistent asthma demonstrated an additional decline of workload-induced obstruction (FEV₁ Diff. %).

Conclusion

Add-on acupuncture was able to achieve significant improvements in lung function, especially in severe asthma, as well as a sustained reduction of anxiety scores.     

Spezifische physiologische und unspezifische psychische Effekte bei der Akupunkturtherapie des Reizdarmsyndroms: Ergebnisse einer randomisierten kontrollierten Studie

Background and aims

The aim was to evaluate the efficacy of acupuncture (AC) in patients with irritable bowel syndrome (IBS). We investigated psychological and neuroendocrinological parameters to meet the demands of the psychosomatic paradigm. In addition, we wanted to examine the impact of perception of bodily sensations on treatment response.

Methods

43 patients with IBS were randomly assigned to receive either AC (n = 22) or sham acupuncture (SAC) (n = 21) using the ”Streitberger needle„. Primary outcome measure was quality of life (QoL) measured with the functional digestive diseases quality of life questionnaire (FDDQL) and a general quality of life questionnaire (SF-36). QoL was measured before AC treatment (t1), after ten treatment sessions (t2) and three months after treatment (t3). Secondary outcome measures were parameters of the autonomic nervous system (ANS) which were evaluated with tilt-table manoeuvres at t1 and t2. Additionally, salivary cortisol was measured at t1 ant t2. Perception of bodily sensation was measured at t1 with the ”Perception of Bodily Sensation„ (PBS) questionnaire.

Results

QoL improved in both groups (p = 0,022). However, there were no group differences in QoL improvements between AC and SAC. Salivary cortisol decreased in both groups (F = 10,55; p = 0,006). However, the decrease was more pronounced in the AC group (F = 4,07; p = 0,033). Heart rate response decreased during orthostatic stress in the AC group while it increased in the SAC group (group difference: F = 9,23; p = 0,005), indicating an increased parasympathetic tone in the AC group. Improvement of pain was positively associated with increased parasympathetic tone in the AC group (r² =0,40; F = 10,1; p = 0,006), but not in the SAC group. High PBS was associated with lower QoL before and after treatment (p = 0,033).

Conclusions

The psychosomatic study design made it possible to detect differentiated acupuncture effects. QoL improvement seems to be due to unspecific effects and physiological changes are likely to be induced specifically by AC. Thus, different mechanisms may be involved in sham and real-AC mediated improvements. Patients with high PBS show a more unfavourable course of treatment independently of the kind of acupuncture treatment.     

Chinesische Orthopädie: Teil 2: Behandlungskonzepte für die obere und die untere Halswirbelsäule

The locomotor system as a major field of acupuncture therapy offers a number of good indications for acupuncture outside the range of the large national acupuncture studies funded by German Health Insurances. Looking at the upper and the lower cervical spine the layers of the problem and a hierarchy of therapeutic goals are defined to match the effects of acupuncture, related techniques and further therapeutic modalities. The manual of acupuncture focuses on therapeutic effects and objectives first, and then goes on to sketch therapeutic strategies and finally complex approaches of acupuncture within the cervical region.     

Chinesische Orthopädie: Teil 1: Die Zukunft der Akupunktur in der Postmoderne

The locomotor system is one of the major fields of application for acupuncture. The results of the large acupuncture studies funded by German Health Insurances from 2000 until 2006 are impressive and repressive: they restrict acupuncture application by allocation of reimbursement and create the necessity of reorientation, since acupuncture can neither be adequately described nor prescribed solely on the basis of disease entities. Regarding these disease entities, it seems rather necessary to analyse the layers of problems and formulate a hierarchy of therapeutic goals instead. Only in this way the effects of acupuncture, related techniques and further therapeutic modalities can be matched with the set of objectives. The article presents general principles and follows their application from biological aspects to implications for the locomotor system and consequences for the application of physical therapy. The manual of acupuncture focuses on therapeutic effects and objectives first, and then goes on to sketch simple therapeutic strategies and finally complex approaches within acupuncture. These may encompass acupuncture, microsystem acupuncture and complex therapeutic modes.     

Akupunktur bei Patienten mit allergischer Rhinitis: Analyse der Studienintervention und Syndrommuster der randomisierten Multicenter Studie (ACUSAR)

Background

Acupuncture was efficient and superior to sham acupuncture and a control group in the ACUpuncture in Seasonal Allergic Rhinitis (ACUSAR) trial. The article aims to inform about the study intervention, the underlying therapeutic ideas and clinical consequences.

Design

Three-armed, randomized, controlled multi-center-trial with a 16-week follow-up during the SAR season in the first trial year and an 8 week follow-up during the SAR season in the following year.

Setting

Outpatient or private clinics in Germany.

Intervention

422 Patients with seasonal allergic rhinitis on birch and grass pollen have been randomized to fall into 3 groups: 12 sessions of semi-standardised acupuncture plus rescue medication (RM, Cetirizine) or 12 sessions of sham acupuncture plus RM or RM alone during the initial two months of the study. Study intervention was defined in a Delphi consensus procedure including five experts from two major German acupuncture associations and three experts on trial methodology and statistics. A consensus between the need for standardisation and individualisation was defined using a semi-standardised treatment in the acupuncture group: 4 obligatory acupuncture points, ≥ 3 out of 8 facultative basic points and ≥ 3 facultative local or distant acupuncture points. Sham acupuncture consisted in superficial needling of at least 5 of 7 predefined, bilateral, distant non-acupuncture points. Needling characteristics such as point location, needling time, manipulation and achieved ‘De Qi' had to be documented after each session.

Results

CM syndrome diagnoss reported most frequently were Wind-Cold invading the lung' and ‘Wind-Heat invading the lung' (37 % each). In the acupuncture group all basic obligatory points were used in 97 % of cases (LI 4, LI 11, LI 20, EX-HN 3 Yintang). The most frequently used basic optional acupuncture points were GB 20, LIV 3, ST 36, LU 7 and SP 6. The total number of needles used was higher in the acupuncture group (15.7 ± 2.5) compared to the sham acupuncture group (10.0 ± 1.6).

Conclusions

CM syndrome diagnoses and point selection in the acupuncture group of the trial corresponded to clinical experiences in CM treatment of SAR. Point location and a higher number of needles in the acupuncture group compared to the sham acupuncture group may have influenced the positive trial results.