Review of Systematic Reviews for Chiropractic as a Possible Alternative to Long Acting Beta Agonists in Asthma Patients Who Are Unresponsive to Conventional Therapy


Alone by: Adrian Isaza, DC, DACBN, CCAP


ABSTRACT: In 2010, Salpeter, et al, conducted a liter- ature review that included 36,588 participants and found that long-acting beta-agonists increased catastrophic events 2-fold. The review concluded that long-acting beta- agonists increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant inhaled corticosteroids


OBJECTIVE: This study evaluated whether chiropractic treatment was an alternative to long acting beta agonists in terms of improving quality of life and reducing rescue bronchodilator use.


METHODS: Chiropractic and long acting beta agonists were compared in non-pulmonary function measure- ments including quality of life scores and changes in rescue medication use. An inclusion and exclusion criteria was performed. Only data with low heterogeneity from cochrane literature reviews and meta-analysis were included. The reviews were found using the Revman 2008 software and by a search of the Pubmed and Google Scholar electronic database.


RESULTS: Chiropractic and long acting beta agonists showed similar scores for quality of life improvement (0.31/0.34) and in changes in rescue medication use (0.61/0.52).


CONCLUSION: There is a lack of evidence to support the use of Chiropractic as an alternative to LABA for asthma patients with severe exacerbation. However, the evidence supporting Chiropractic treatment for the improvement of quality of life and reduction of rescue medications is promising. Further randomized controlled trials evaluating the impact of chiropractic adjustments over non-pulmonary function measurements are needed to conrm these ndings.


KEY WORDS: manual, therapy, long acting beta-agonist, safety, acute, asthma.


INTRODUCTION


The national asthma education and prevention program reported the guidelines for the diagnosis and management


THE ORIGINAL INTERNIST MARCH 2017


of asthma in 2007. In their protocol, the treating physician should consider adjunct therapies for patients with a severe exacerbation or an FEV1 less than 40%.


In 2010, Kaminsky, et al, conducted a systematic review of eight articles and found that some asthmatic patients may benet from chiropractic.1


al, conducted a systematic review of pediatric conditions and found that studies that monitored both subjective and objective outcome measures of relevance to both patients and parents tended to report the most favorable response to chiropractic therapy, especially among children with asthma.2


In 2007, Cazzola, et al, conducted a literature review and concluded that the salmeterol multi-centre asthma research trial (SMART) found more asthma deaths (13 vs 3) and life-threatening asthma events (37 vs 22) in the salmeterol-treated asthmatic patients, although it was documented that among African-Americans, ve times as many deaths and near-deaths from asthma occurred in those given salmeterol than in those given placebo, and among patients with asthma not using an inhaled corticosteroid (ICS) as a preventive (controller) medication, again more deaths and near-deaths from asthma occurred in those given salmeterol than in those given placebo.4


A few studies discussed the safety burden of long acting beta agonists in the treatment of asthma or COPD and one cohort study questioned their efcacy. In 2006, Salpeter, et al conducted a meta-analysis on the safety of long act- ing beta-agonists. The meta-analysis included 19 trials with 33,826 participants and found that long-acting beta- agonists increased exacerbations requiring hospitaliza- tion, and life-threatening exacerbations compared with placebo.3


Salpeter, et al, conducted another literature review that included 36,588 participants and found that long-acting beta-agonists increased catastrophic events two-fold. The review concluded that long-acting beta-agonists increase the risk for asthma-related intubations and deaths, even when used in a controlled fashion with concomitant in- haled corticosteroids.5


al, conducted a retrospective cohort study at 421 U.S. hospitals of patients hospitalized with exacerbations of COPD. The study concluded that long acting beta agonists are not associated with better clinical or economic outcomes.6


While the aforementioned studies discuss the safety bur- den and even the efcacy of long acting beta agonists as adjunct therapy for the treatment of asthma, none of these studies propose a safe and equally efcient treatment pro- tocol.


The purpose of this study is to evaluate whether chiro- practic treatment is a possible alternative to long acting beta agonists as adjunct therapy in the treatment of asthma.


METHODS


Chiropractic and long acting beta agonists were compared in non-pulmonary function measurements including qual- ity of life scores and changes in rescue medication use. A search of literature reviews for the treatment of asthma using chiropractic and long acting beta agonists was made


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Finally, in 2014, Lindenauer, et In 2010, In 2012, Gleberzon, et


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