Maureen George worked with the underserved in Southwest Philadelphia and encountered an array of unconventional treatments for asthma, such as homemade herbal teas or tonics.
“You find there’s a rich history of using these home remedies to manage asthma, in part because accessing traditional medicine has been difficult or resulted in disappointing interactions,” says George, a professor of nursing at Columbia University Medical Center in New York City.
George published research about asthma self-management, and alternative or complementary medicine. Even when people don’t encounter barriers to supportive medical care, complementary approaches are commonplace. Some of George’s work has found that 84% of those with asthma prefer to manage their condition with a mixture of traditional and complementary therapies. “The things people use may differ based on race or income or where they live, but everywhere, you see this desire for an integrated approach,” she says.
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All of the popular mind-body treatments such as breath training, mindfulness-based practice, yoga and mindfulness-based therapies are very well-known. Even though some popular mind-body therapies such as yoga, mindfulness–based practices, massage, and breath training may provide quality-of-life benefits, the evidence does not suggest that any of these treatments can provide clinically meaningful improvements among those with severe asthma. “If you look at the evidence, which we have done many times, you find that actually nothing is convincingly effective,” says Dr. Edzard Ernst, professor emeritus of complementary medicine at the University of Exeter in the U.K.
Ernst admits that certain treatments can provide some indirect benefits to severe asthma sufferers. He also acknowledges that there are risks. “Some alternative practitioners claim that they are a true alternative to conventional medicine—so you [the patient] can leave your inhaler at home or stop taking your medication,” he says. “I see a real danger there, because asthma is potentially deadly.”
Others reiterate these warnings—although they see a place for complementary approaches in the treatment of severe asthma. “There is no good evidence that these treatments can alter the immediate course of asthma, or, more importantly, cure the disease,” says Dr. Nicola Hanania, director of the Airways Clinical Research Center at Baylor College of Medicine.
On the other hand, Hanania says that quality of life is an important measure of patient outcomes, and there’s evidence that several treatments may improve it for people with severe asthma. He doesn’t discourage talk of such approaches when his patients bring them up. “When you get an asthma attack, it’s like drowning—it’s the worst feeling ever,” he says. Especially for those with severe asthma—a group that comprises roughly 10% of all asthma patients—the desire to do everything within one’s power to mitigate the condition is reasonable. “One thing that patients don’t want to hear is no for everything,” he says of complementary approaches. “If it’s not negatively affecting their well-being, or they’re not spending too much, I’m not dismissive.”
However, he says that any discussion of such treatments must emphasize that these should be used only as truly complementary therapies—meaning they should be employed alongside, never in place of, doctor-prescribed treatments or medications.
But what does this research tell us? Here’s a rundown of the evidence on the most popular complementary approaches.
Mindfulness-based Stress reduction
It seems that mindfulness is everywhere nowadays. This popular meditation borrows heavily from Eastern meditation and aims to teach the mind how to be more present in its moment. Mindfulness-based stress relief, also known as MBSR at the University of Massachusetts, uses mindfulness techniques to assist people in managing stress.
A 2012 study was published in the journal. Thorax,UMass research examined the effects of MBSR on asthma patients, both severe and mild. They found that eight weeks of mindfulness training did not result in any lung-function improvements, but it did produce “lasting and clinically significant” quality-of-life improvements. These included a reduction in activity limitations and asthma symptoms—improvements that were comparable to those prior research had linked to inhaled corticosteroids.
“One of the things mindfulness training does is it focuses people on their relationship with their internal experience in ways that can decrease anxiety or arousal,” says James Carmody, co-author of the study and a professor at the University of Massachusetts Medical School. He believes that MBSR can help asthmatics control fear and stress.
Eight weeks of MBSR training was completed by the participants in his study. It consisted of a weekly 2.5-hour education session as well daily solo practice. “It was a demanding program,” he says. “For a lot of people, that’s just not going to be feasible.” However, he says other research efforts—not on asthma specifically, but on MBSR—have found similar benefits with shorter or less-intensive interventions.
Breath Training
Poor form is a sign of injury for runners. Proponents of some popular “breath work” programs have similar views about respiration. It is believed that by practicing proper breathing, one can avoid or reduce asthma attacks.
Buteyko, one of the most studied and popular of these breathing-work methods is highly regarded. It’s named for a Soviet doctor who developed its principles in the 1950s. “There are Buteyko clinics all over the U.S. and Europe, and there are books and videos online to teach people how to practice the method,” says Baylor’s Hanania.
In a nutshell, Buteyko believed that dysfunctional breathing habits—such as breathing through one’s mouth or breathing into the chest instead of the stomach—can cause problems, including asthma. It is named after the technique that teaches you how to breathe properly and improves your quality of life.
Many of Buteyko’s techniques overlap with those of older breathing exercises, including pranayama—a method of controlled breathing closely linked with yoga. The Papworth method is another type of breath retraining. It uses similar methods and includes relaxation training. Research has shown that these practices can improve asthma symptoms in people who have had it.
“There is certainly some evidence for effectiveness,” says Columbia University’s George. She has discovered that these practitioners often make false promises that can be harmful for severe asthma sufferers. “They’d be saying to patients that if you learn how to breath correctly, you can come off your corticosteroids,” she says.
The adjunct therapy of asthma can be used with breath training. Also, some clinical trials—including a 2008 study of Buteyko in Respiratory Medicine—have found no evidence of adverse effects. However, more research is required to confirm the effectiveness of these methods.
Acupuncture
Asthma sufferers have long considered acupuncture to be one of the best alternative therapies. This has led to intense scientific investigation. A 2020 paper published in the journal. Medicine,Some randomized clinical trials found that acupuncture could relieve the symptoms of asthma and improve quality-of-life for people suffering from it. It reduces immune-system activity, and increases bronchial-muscle tone. Also, acupuncture appears safe. A few trials with acupuncture did not show any benefits for those suffering from asthma.
“I think one of the difficulties is that a lot of these studies are bedeviled by problems in methods,” says Ian Mitchell, professor emeritus of pediatrics at the University of Calgary in Canada. Mitchell’s work has been published on the topic of acupuncture as a treatment for asthma. His research revealed that the majority of studies of this practice were small and poorly done. Sham acupuncture, which is a random insertion of needles at random, has frequently failed to perform better than true acupuncture. While he allows that the practice may “desensitize” people to discomfort in ways that may lessen the burden of asthma, he says the research to date does not support acupuncture for the treatment of severe asthma.
Manual Therapy
Several acupuncture treatments involve touching or manipulating a person’s body in ways that are purported to be therapeutic. There are many osteopathic and chiropractic methods, such as craniosacral massaging. During this treatment, a chiropractor or other practitioner gently touches a person’s upper body and head in order to monitor and correct the flow of fluids through the central nervous system.
“It’s a noninvasive type of hands-on body treatment,” explains Dr. Sharmilee Nyenhuis, an assistant professor of medicine at the University of Illinois, Chicago. Nyenhuis conducted studies on craniosacral therapy for asthma patients. “The study found improvements in asthma-related quality of life,” she says. It did not find any significant changes in asthma-related quality of life, such as a decrease in medication, improved lung function or anxiety, stress or other measures. “I would say that these treatments need further study to see if they are beneficial in the treatment of asthma,” she says.
The journal publishes a 2019 review of research BreatheSimilar conclusions were reached about massage. The authors of the study concluded that although some research shows benefits to quality-of life, there is still much work needed.
Experts advise people suffering from asthma to avoid other chiropractic treatment. “Chiropractic is by no means free of adverse events,” Ernst says. Research has shown that chiropractic treatments can have unpleasant side effects in 42% of patients. “I see a real danger with uncritical promotion of this as a complementary treatment for asthma,” he says.
Yoga and Tai Chi
Traditional mind-body exercises that incorporate breathing techniques and coordinated movements are yoga and tai Chi. There’s some evidence that both may benefit people with asthma. The journal published a 2008 study. Chest Study found that people suffering from severe asthma were able to exercise more effectively by tai-chi. This study also found that bronchial hyperreactivity improved after six weeks of practice.
Yoga for asthma research is stronger. Numerous studies supporting yoga for asthma have shown that it can improve quality of life, and reduce symptoms. However, there have been mixed results from some reviews.
Baylor’s Hanania has studied some yoga techniques for the treatment of chronic obstructive pulmonary disease, or COPD. He says he is “very supportive” if his asthma patients want to try yoga—mostly because it seems to be a low-risk and healthy form of exercise.
More Conversations = Better Care
Research on complementary therapies is encouraging. But whether any of these truly “work” is often beside the point, says George. “The fact is that people are going to try these either way,” she explains. “If conversations about them are met with hostility or derision, patients are going to make decisions on their own.”
She advises clinicians who treat people with asthma to ask their patients what they’re doing to manage their condition, and not to be dismissive of these types of treatments. “I think it’s critically important to be supportive of these,” she says. “If it makes the person feel better, and, most importantly, if it’s safe, I don’t care if there’s evidence to support it. Let’s build that into their management plan.”
