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Ask an expert - body - chest - asthma

4 questions

Bronchial asthma is one of a small number of conditions where we have prepared review papers which are more comprehensive than our customary factsheets, and the one for asthma can be found at:
 
http://www.acupuncture.org.uk/arrc/public-review-papers/bronchial-asthma-and-acupuncture-the-evidence-for-effectiveness.html
 
As you can see from this, the jury is still out in terms of claims for clinical efficacy. The evidence is not conclusive, and although we could make a great deal of the inappropriateness of the accepted research criteria for acupuncture (the randomised double blind control trial which only truly works for drug trials), the fact is that even a badly designed trial should show a trend towards treatment having an impact, and some trials have failed to do this.
 
That said, asthma has existed since the birth of Chinese medicine well over 2000 yeras ago, and there are a number of very well-established protocols for understanding the various ways in which asthma can be classified and for making sense of these within the system of Chinese medicine. In practice few of us do not believe that we can make a difference, but we all run up against a major limiting factor, and this is the accepted western treatment with steroids and bronchodilators.
 
We are always very clear that there are a significant number of medications which are vital to life and good functioning, and our members are trained neither to suggest stopping them nor to encourage patients to stop them, even passively by not speaking up against someone's stated intention. There are a number of western medications, however, where there is a rather problematic position in which patients sometimes find themselves. In the case of asthma, and sometimes epilepsy, a patient may be taking medications for years without suffering an attack, and not unreasonably ask whether they could stop taking the medications because the underlying problem has resolved and the drugs are no longer necessary. There is evidence, however, that the body achieves over time an effective balance with the medications, and their withdrawal can cause an attack. In the case of asthma there is documented evidence that rebound attacks after steroids have been withrawn can be very serious, and for this reason our members are advised to refer patients who want to question their medication back to their doctors for further discussion. Few doctors, in our experience, will let someone come off anti-asthma medication because of the theoretical risk of a fatal or serious attack.
 
However, you did talk about 'having an impact', and there is no doubt that anecdotally we hear of many cases where a patient's use of and reliance on bronchodilators reduces over time. Most asthmatics manage, rather than banish, their condition with the aid of medications, and we are sure that over time the use of bronchodilators in particular will be shown by research to fall after acupuncture treatment. We are also treating people, not simply their conditions, and we find that treatment often helps people to cope better with long-term health problems over and above any relief it brings to the problem itself.
 
Each prospective patient is unique and different, though, and the best advice we can give is that you contact a BAcC local to you and seek a brief face to face assessment with them of whether acupuncture treatment might be suitable for your own case.  

Q: My 34 year old daughter has suffered with asthma and eczema to a greater or lesser degree for most of her life.   She has also had a skin condition for a year or so which I understand is called Prurigo Nodularis.   She is having perscribed treatment under the NHS which involves medication and UV light treatment.  In particular her main discomfort is the itchyness particularly at night time. I wonder if acupunture could improve this situation ?

A: We have been asked about prurigo nodularis a couple of times, and our most recent answer was:
 

 

Can acupuncture help in treating prurigo nodularis

 

There is not a great deal of evidence that acupuncture has been used successfully for treating this condition. This becomes very clear when you undertake any searches for evidence. There is a single paper for the use of acupuncture and hypnotherapy ('hypnopuncture')

 

http://www.ncbi.nlm.nih.gov/pubmed/21598842

 

which is cited over and over again without any further additions, a certain sign that there is no other evidence. We are sure that there are probably a large number of trials which have been undertaken in China, but the great majority of these have not been translated and are often regarded in the West as methodologically flawed.

 

However, skin diseases are as old as mankind, and the systems of Chinese medicine do have ways of interpreting the signs and symptoms of diseases like prurigo within its framework. These often use terms like 'invasions' of 'heat', 'wind' or 'damp' which sound alien to the western ear but describe the effects of climate (as experienced by a largely agrarian population) on the flow of energy, called 'qi', especially where this disrupted the flow, rhythm and balance near the skin surface. Everyone is aware of the short term effects of exposure to extremes of climate, and from a Chinese medicine perspective, whether this is the primary cause of a problem, or whether there is an underlying weakness which makes particular people vulnerable, the skill of the practitioner lies in assessing the overall balance as well as the presenting symptoms, and attempting to restore balance.

 

The best advice that we can give you is that you visit a BAcC member local to you for a brief face to face assessment of the problem. Crucial  to this assessment will be whether the problem is local or widespread. In broad terms, the more localised, the more treatment options there are. We would also recommend that you might want to see advice from someone who also does Chinese herbal medicine. The majority of the members of the Register of Chinese Herbal Medicine are also BAcC members. We say this because herbal medicine has developed a very good reputation over the years for treating skin conditions, the daily dose of herbs helping to maintain a treatment momentum. It may be that a combination of acupuncture and herbal medicine may prove a more potent force in helping your problem, but to what extent would depend on a more thorough assessment than we can give here.

 

We would not want to add anything to this advice about the prurigo, but the fact that it has appeared against a longstanding backdrop of asthma and skin problems suggests that it may be quite a difficult condition to influence. As our review paper on the use of acupuncture for the treatment of asthma shows

 

 

 

there is a growing body of evidence that acupuncture may be of benefit. However, there is a close correlation between ashma and ezcema in Chinese medicine which suggests a constitutional weakness which may impact on how successful treatment may be. That said, there are a number of what we call 'empirical points', points which have been discovered over the years to have specific effects no matter what the underlying constutional position may be, and one or two of these have been shown to be highly effective at reducing itching across the body, especially where this is impacting on someone's sleep.

Q:  I have mild asthma but I believe this is well controlled. Related problems centre on excesss mucus production which means I have a permanent cough. This excess mucus production appears to relate to particulate matter e.g. dust, smoke, and chemicals e.g. scented candles, perfumes. Allergy tests show I have no problems with most biological materials e.g. cat, dog, feathers etc but a mild allergy to grass pollen. Could acupuncture help me?

 

A:  There is a growing body of research which indicates that acupuncture in conjunction with conventional treatment may significantly improve the symptoms of allergic rhinitis. Our factsheet please click here
 
 
gives details of a number of studies which show very encouraging results, although at this stage there are not enough nor enough of sufficient size to warrant an unqualified claim for benefit.
 
One of the great strengths of Chinese medicine, however, is that it is premised on understanding symptoms within the context of the functioning of the body as a whole. That is not to say that conventional medicine doesn't, but quite often specialisation means that the focus on problems and their treatment is quite narrow. In Chinese medicine excess mucus production in an area of the body is seen in its wider context, and very often as a problem which manifests in one place but is actually a consequence of a systemic weakness. The practitioner's aim would be to establish whether this was the case, and if so treat the underlying problem, without doing which local treatment would sometimes not achieve sustainable results.
 
Our best advice is to visit a BAcC member local to you and seek their advice on whether acupuncture could be of benefit to your specific circumstances. It may simply be that the tissues in the upper respiratory tract have become hyper-sensitive over the years to the kinds of allergens which cause you problems, and the research trials seem to indicate that the mixture of acupuncture and conventional medication can help to bring this under control. If, however, there are broader patterns of imbalance the practitioner can advise you more accurately based on what is going on within your system as a whole.
 

We're not entirely sure what you mean by 'modern acupuncture'? This can either mean western medical acupuncture of a kind used most often by doctors, or it can mean traditional acupuncture used in a way which is aimed at a specific condition rather than using it in a traditional way which sees named conditions as the manifestation of a deeper pattern of disharmony.

 

 

The research which has been done has used both types. We have summarised the information in a Review Paper to be found here but this is a fairly dense piece of information in comparison with our fact sheets which are a little easier to access. The summary of findings is encouraging but not conclusive. This is not a surprise to us, though; the format for running trials of acupuncture for asthma are not particularly sensitive to the way acupuncture is practised in everyday use. There is a long history of treating asthma-related conditions in Chinese medicine, and we hope that in time this is validated by research which meets the current western models of best practice.

The one factor which it is very important to bear in mind is that doctors are reluctant to encourage people to come off the long term medications which they are taking for asthma, especially steroids. We encourage our members to be careful only to talk in terms of reducing the medications over which patients can exercise some choice, the 'puffers' like salbutamol/ventolin.