Practitioner-based complementary and alternative therapies in the management of asthma in children and adolescents: a systematic review and meta-analysis

Abstract Background Asthma is a chronic inflammatory disorder affecting 334 million people worldwide. Conventional medicines are effective for managing asthma in children, but important concerns exist about potential side-effects, such as increased heartbeat, muscle shake, and hyperactivity. Consequently, many patients turn to complementary and alternative therapies to seek care with a more holistic approach. We systematically reviewed the available evidence on effectiveness of complementary therapies in the management of asthma in children and adolescents ( Methods We searched Medline, Embase, CINAHL, AMED, and the Cochrane Database of Systematic Reviews to identify articles in English published between Jan 1, 2000, and Dec 13, 2014. Keywords included 57 names of practitioner-based complementary therapies and were combined with "asthma" and either "randomised controlled trial" or "quasi-randomised trial". Identified abstracts were double screened. Primary outcome of interest was forced expiratory volume in 1 second (FEV 1 ). Heterogeneity was assessed with the I 2 statistic. Fixed-effect meta-analysis was done with RevMan software (version 5.2). Quality of the studies was assessed with the Cochrane Collaboration Risk of Bias Assessment Tool. Findings 1187 non-duplicate records were found, of which 62 full text articles were assessed for eligibility. 20 additional studies were identified from the bibliographies of studies found. Of these 82 articles screened, 12 trials covering eight therapies were eligible. The trials involved 605 patients, aged 5–17 years. Ten of the 12 studies were assessed to be at high risk of bias. Pooled data from two studies indicated that, compared with standard treatment, massage therapy significantly improved lung function (FEV 1 ) (standardised mean difference 0·43, 95% CI 0·04–0·82), and that, compared with placebo or standard treatment, acupuncture significantly improved quality of life (0·43, 0·05–0·81). The data could not be pooled for other outcomes. Results from individual trials showed that tai chi and osteopathy were beneficial for improving lung function, and art therapy for quality of life. Only one study assessed adverse events and found laser acupuncture to be safe and well tolerated. Interpretation Although meta-analysis from a small number of studies on massage and acupuncture showed some benefit for improving lung function and quality of life, most studies were small and of poor quality. Therefore, the evidence is insufficient to recommend that any of the practitioner-based complementary therapies should be used in the management of asthma in children and adolescents. Funding None.