A Double-Blind Crossover Study
Although acupuncture has been used for thousands L of years for many diseases, reports in the literature on beneficial effects of acupuncture on asthma are conflicting. While a number of workers have reported a significant benefit in the control of asthma following acupuncture, almost an equal number of workers failed to show any significant improvement in the control of asthma following acupuncture. Experimentally, in a controlled double-blind crossover study, Tashkin et al showed that acupuncture improved methacholine-induced bronchospasm to some extent. Fung et al showed that both real and placebo acupuncture, applied 20 min before exercise, attenuated exercise-induced asthma but that the benefit from real acupuncture was greater than that produced by placebo acupuncture. Increased bronchial reactivity to inhaled histamine is one of the characteristic features of asthma. Makino showed that the level of bronchial reactivity to histamine has a relationship to the symptoms and severity of asthma.
Although for treatment of bronchial asthma, the acupuncture is commonly given as chronic therapy, it is also given as single treatment for acute asthma. We undertook a double-blind crossover study in order to determine if prior treatment with acupuncture, as given for acute asthma, would attenuate bronchial hyperreactivity to histamine in a group of patients with moderately severe asthma.
Material and Methods
Sixteen patients, ten male and six female, with moderately severe asthma requiring regular treatment with bronchodilators, were included in the study. Their ages ranged from 11 to 60 years, with a mean of 39 years (Table 1). No patient was a current smoker. Four patients were ex-smokers who had ceased smoking 5 to 15 years prior to the study. Except for one patient, all had a history of atopy. No patient had a history of chronic productive cough suggestive of associated chronic bronchitis. The clinical history was typical of bronchial asthma as defined by the American Thoracic Society Criteria. The chest x-ray films were normal and FEV,-values had been shown during an unstable phase to improve by at least 20 percent after inhalation of a bronchodilator aerosol. At the time of the study, the measured FEV, value had to be greater than 75 percent of the predicted normal.
All subjects were taking regular inhaled beta* sympathomimetic bronchodilators for control of asthma. With one exception, all were taking inhaled beclomethasone dipropionate. Thirteen patients required additional treatment with oral theophylline. Five patients were also receiving treatment with sodium cromoglycate. No patient had received treatment with oral corticosteroids for at least one month. Based on the medication requirements and symptoms, asthma of all patients was in a stable phase at the time of the study. No patient had had any respiratory tract infection in the preceding month.
Treatment with oral theophylline, inhaled corticosteroids and sodium cromoglycate was ceased for at least 12 hs prior to the study. Treatment with these agents could not be withheld for any longer period for fear of making the patients susceptible to severe asthma and impairing the stability of asthma, which was an essential prerequisite for the study. Inhaled bronchodilators were withheld for at least 6 hs prior to each experimental session. All patients were advised not to take any antihistamines for at least one week prior to and for the duration of the study. Written consent from each patient or guardian was obtained prior to the study. All patients were studied on three separate days at one-week intervals and at the same time of the day. At the first study, a detailed history of atopy, seasonal variation and any variation in severity of asthma symptoms were taken.
Table 1—Anthropometric, Historical and Pulmonary Function Data
|Subject||AgeYears||Sex||SmokingHistory||Height(cm)||Age Onset Asthma||History of Atopy||FEV,,% Predicted||FVC,% Predicted||Deo,% Predicted||Control Day PC20 (mg/ml)|
|6||46||F||Ex-smoker, 5 yr||165||19||Yes||80||75||95||0.073|
|8||35||M||Ex-smoker, 15 yr||180||5||Yes||100||100||105||0.062|
|13||56||M||Ex-smoker, 15 yr||172||54||Yes||100||100||105||0.352|
|16||52||M||Ex-smoker, 8 yr||175||3||Yes||75||80||90||0.202|