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Chiropractic Treatment for Asthma? You Bet!

We read with great interest the editorial by Dr. Edzard Ernst entitled, “Chiropractic Treatment for Asthma?” (1). The overwhelming support by chiropractors and their patients for chiropractic spinal manipulative therapy (SMT) for asthma is a reflection of their clinical observations in everyday practice. That is, patients with asthma under chiropractic care report subjective improvements, overall improved quality of life, and decreased medication use. Similar to a previous article he authored on the subject of spinal manipulation for asthma (2), Ernst is of the opinion that chiropractic SMT is not an effective treatment for asthma and there is risk of harm. Contrary to Ernst’s interpretation, the most recent Cochrane Review on manual therapy for patients with asthma concluded that, “Currently, there is insufficient evidence to support or refute the use of manual therapy for patients with asthma” (3). The clinical trial by Balon and colleagues (4) compared the effects of active SMT versus simulated or sham SMT in children with mildmoderate asthma and concluded that, “In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit.” However, upon closer examination and critical appraisal of the Balon study, the pitfalls and limitations inherent in designing a clinical trial involving SMT are revealed. First, Balon and colleagues failed to demonstrate (prior to implementation) that their simulated/sham SMT was truly inert (i.e., no effect on asthma patients). Clinicians well versed in SMT (i.e., chiropractors and osteopaths) would find the simulated SMT reminiscent of both chiropractic and osteopathic techniques (5). Secondly, prior to providing the simulated SMT, massage was performed on these patients. Massage has been shown to have salutary effects for asthma patients (6, 7). Third, the chiropractors knew the difference between active versus simulated SMT and hence there are issues with blinding. Fourth, the patients maintained their medical care. From an ethical perspective, this is understandable but nonetheless medical care becomes a confounder. Given the above considerations, the Balon study may be more adequately described