Is there a role for acupuncture in asthma therapy?

This statement appears difficult to defend when you consider that today we have more potent drugs with which we can treat asthma than ever before. We also know more about risk factors, causes and predisposing factors for asthma. In fact, this March, there was even a patent issued to a company, Magainin Pharmaceuticals, for a gene called Met-IL9; individuals who inherit it appear to be less susceptible to allergy and asthma.

As it is among the most common chronic conditions in the United States, affecting an estimated 15 million people, it seems that we do need safer and more effective treatment alternatives for asthma. But is acupuncture a reasonable alternative?

Dr. Jobst makes a convincing case for acupuncture based on the following criteria:

		Cure or durable symptomatic improvement and enhanced quality of life as judged by the patient.
		Verifiable subjective and objective changes.
		Improved patient management as measured by discontinuation or diminished use of medication, physiotherapy and other interventions.
		Acceptable side-effect profile.
		Cost-effectiveness of the therapy.

According to Dr. Jobst, evidence exists that in bronchial asthma, chronic bronchitis and chronic disabling breathlessness, acupuncture fulfills these criteria to varying degrees.

Among 21 published studies reviewed, according to Jobst, 16 were judged to be of good quality, and acupuncture was effective in 10 (62.5%). However, this assessment probably is conservative as a result of the use of "sham" acupuncture points, which were believed to be inactive but, according to traditional Chinese principles, are active in pulmonary disease. This lead to a reassessment of response by combining ''real'' with sham acupuncture vs. baseline values. Under these conditions, 13 of 16 studies (81%) showed significant improvement.

Pharmacologic treatment tended to have a greater effect than acupuncture alone. However, medication was significantly reduced when combined with acupuncture. Jobst concluded that although more well-designed studies are needed, there is no reason to withhold acupuncture treatment from patients with bronchial asthma and chronic obstructive lung disease (Jobst, 1995).

It seems clear that acupuncture alters the physiologic processes associated with an asthmatic attack. Patients with allergic asthma who are treated with acupuncture show significantly decreased concentrations of SIgA and total IgA (in saliva and in nasal secretions) and levels of IgE in sera after treatment (Yang et al, 1995). These results suggest that attacks of delayed and immediate allergic asthma could be effectively inhibited by acupuncture. However, the theory means little to a patient in the middle of an asthma attack.

What are we to make of a study that reports no objective evidence of improvement, but concludes that acupuncture is of value because patients report an improved quality of life? Biernacki and Peake at the Pontefract General Infirmary in the United Kingdom conducted a randomized, double-blind study of 23 nonsmoking adult asthmatics with forced expiratory volume (FEV1) 59±16% of predicted. Each patient received either real or sham acupuncture. Measurements were repeated within one hour of treatment and again after two weeks. Patients also recorded peak expiratory flow rate (PEFR) throughout the study. After two weeks, those who received real treatment on the first visit received sham treatment and vice versa.

Despite the fact that there was no improvement in any objective measure of respiratory function after either form of acupuncture, patients reported significant improvement in their quality of life plus a reduction in the use of bronchodilators.

The real issue presented in this research and in the literature review by Jobst is the confounding potential of "sham" acupuncture. Biernacki and Peake concluded that "the exact site of needle puncture on the chest is unimportant." This may be true. However, it is also possible that "sham" acupuncture is simply a flawed procedure. As Jobst suggests, acupoints may not be static locations on the body, but dynamic points of sensitivity that are able to initiate a physiological response when the conditions are right.

John Russo Jr., PharmD, is senior vice president of medical communications at Vicus.com. He is a pharmacist and medical writer with more than 20 years of experience in medical education.

Biernacki W, Peake MD. Acupuncture in treatment of stable asthma. Respir Med. 1998 Sept; 92(9):1143-5.

Davis PA, Chang C, Hackman RM, Stern JS, Gershwin ME. Acupuncture in the treatment of asthma: a critical review. Allergol Immunopathol (Madr). 1998 Nov-Dec; 26(6):263-71.

Jobst KA. A critical analysis of acupuncture in pulmonary disease: efficacy and safety of the acupuncture needle. J Altern Complement Med. 1995 Jan; 1(1):57-85.

Magainin Pharmaceuticals. Magainin issued additional patent for IL9 asthma gene. March 28, 2000.
http://www.magainin.com/home.htm. (see investor resources, press releases)

Yang Y, Chen H, Zhao C, Wang R. Studies on regulatory effects of acupuncture on mucosal secretory IgA in patients with allergic asthma. Chen Tzu Yen Chiu. 1995; 20(2):68-70.