Comparison of Real and Placebo Acupuncture in Histamine-Induced AsthmaA 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
Patients

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)
1 11 M Nonsmoker 156 25 Yes 95 97 105 0.89
2 51 F Nonsmoker 168 19 Yes 75 80 95 0.72
3 47 F Nonsmoker 152 30 Yes 90 95 98 1.117
4 12 M Nonsmoker 160 Birth Yes 98 95 105 2.215
5 15 M Nonsmoker 170 4 Yes 105 98 98 0.0335
6 46 F Ex-smoker, 5 yr 165 19 Yes 80 75 95 0.073
7 60 F Nonsmoker 158 55 No 80 85 90 0.79
8 35 M Ex-smoker, 15 yr 180 5 Yes 100 100 105 0.062
9 42 M Nonsmoker 165 Birth Yes 80 85 95 0.454
10 36 M Nonsmoker 170 Birth Yes 95 100 105 0.68
11 39 F Nonsmoker 160 24 Yes 85 90 95 0.1625
12 48 M Nonsmoker 170 34 Yes 95 100 100 0.104
13 56 M Ex-smoker, 15 yr 172 54 Yes 100 100 105 0.352
14 57 M Nonsmoker 175 55 Yes 95 100 110 0.114
15 19 F Nonsmoker 160 5 Yes 100 100 105 0.185
16 52 M Ex-smoker, 8 yr 175 3 Yes 75 80 90 0.202
Mean 39.13     166 19.84   89.87 92.62 99.75 0.382