using the Cochrane collaboration software program, Re- view Manager (RevMan) (RevMan 2008).
An inclusion and exclusion criteria was performed. Only literature reviews using data with low heterogeneity as stated by the author of the Cochrane literature review and meta-analysis were included.
A search of literature reviews, systematic reviews and meta-analysis using the pubmed and google scholar database was also performed. Since all the quantitative literature reviews for long acting beta agonists with the exception of Appleton, et al, had pooled results from both adults and children, the data compared in this study represent both children and adults.
RESULTS
For the comparison in non-pulmonary function measure- ments (quality of life and change in rescue medication use) between chiropractic treatment and long acting beta agonists the following was found: One review measured quality of life changes with chiropractic treatment, using the asthma quality of life questionnaire at four months of treatment WMD 0.31 (95% CI -0.12-0.74) while two reviews measured quality of life changes with long acting beta agonists using the asthma quality of life questionnaire with an average improvement of 0.34.
Finally, one review measured the changes in rescue bronchodilator medication use with chiropractic treatment -0.61 (95%CI -2.30, 1.08) while 4 reviews measured the changes in rescue bronchodilator medication use with long acting beta agonists with an average change of 0.52.
DISCUSSION
The plausibility of spinal manipulative treatment as an alternative treatment to long acting beta agonists for asthmatic patients who are unresponsive to conventional treatment was discussed in the introduction. Another plausible explanation has to do with the impact of chiropractic over bronchial hyper reactivity. Hondras, et al, conducted a literature review of randomized controlled trials where the effect of chiropractic treatment on bronchial hyperactivity was 0.15 and 0.21 after one and four months of treatment respectively.7
Regarding the practice patterns of chiropractors and asthma, one survey of 604 chiropractors in 2003 conducted by McDonald, et al, found that 75.5% of chiropractors had good clinical outcomes when performing spinal manipulative treatment to patients with allergic asthma.9 Another survey in 2005, conducted by Leboeuf, et al, involved 5,607 patients from different countries where
TABLE 1 Year Hondras, et al, 20087 Average 22
27% of patients reported improvements in breathing and 17% reported improvements with asthma.10
the Job Analysis of Chiropractic conducted by the Nation- al Board of Chiropractic Examiners in 2005 involving 2,167 chiropractors found that 70.7% of chiropractors co- managed asthma.21
Chiropractors are in a good position as alternative medicine physicians to provide nutritional supplementation in addition to spinal manipulative treatment. For women in late pregnancy who present with low back pain and have a medical history of extrinsic asthma, Omega 3 supplementation can be given for discogenic pain and as asthma prophylaxis for the unborn child since there is research supporting Omega 3 for asthma prophylaxis. 11 For children and adults with mild asthma, antioxidant therapy with vitamin C can be given to prevent exacerbations.12
with mild asthma, patient education on restricting acetaminophen intake may prevent asthma exacerbations.13
A topic not mentioned in this study is an alternative treatment for LABA in terms of pulmonary functions. Pulmonary functions tests include peak expiratory ow (PEF) and forced expiratory volume (FEV1). Recent systematic reviews indicate that the average improvement in PEF and FEV 1 percent for intravenous magnesium in patients with asthma exacerbations was 17.4L/min and 4.41 respectively.18
and FEV 1 for long acting beta agonists is 14.89 L/min and 4.39 respectively.16,17
number is similar to the one for intravenous magnesium. In 2001, Schenk, et al, conducted a randomized controlled trial and found that in the magnesium group, the change in bronchial hyperactivity was 0.48 whereas there was no change in the placebo group.19
substitution to LABA could be the combination of chiro- practic treatment and intravenous magnesium.
CONCLUSION
There is a lack of evidence to support the use of Chiropractic as an alternative to LABA for asthma patients with severe exacerbation in terms of non-pulmonary function tests. 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 conrm these ndings.
Reviews on Chiropractic Subjective Scores for Overall Quality of Life Improvement Using the Asthma Quality of Life Questionnaire
Inclusion # of Studies # of Patients Randomized controlled trials 1 Balon, et al, 1998 38
Result 0.31
0.31
THE ORIGINAL INTERNIST MARCH 2017 (Continued on next page)
Therefore, a possible
al, conducted a literature review of randomized controlled trials and found that through evaluation of 9 studies with a total of 1,181 patients the effect of long acting beta agonists over bronchial hyper-reactivity was 0.48.8
This
On the other hand, the average PEF Moreover, in 2003, Walters, et
Finally, for both adults and children According to
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