Summary of current evidence of effectiveness of complementary therapies in the treatment of people with asthma - I

A	Age group (children or adults), level of severity or control, concomitant medications.
B	3+ Strong evidence for effectiveness;	3- Strong evidence of lack of effect;
	2+ Probably effective;	2- Probably ineffective;
	1+ Possibly effective;	1- Possibly ineffective;
	+/- Equivocal evidence of effect;	0 No evidence for this outcome.
C	Including operator dependent, dose dependent and other adverse effects and potential interactions with other treatments.
D	Includes measures of quality of life and other subjective measures of asthma control.
E	In addition to the interventions listed here, there are several studies, not reviewed here, which have demonstrated that individuals with asthma and proven food chemical sensitivity benefit from avoidance of the specific food chemical(s) to which they are sensitive. There is no evidence that specific food avoidance is beneficial for people with asthma without proven food or food chemical sensitivity. Any advice on food avoidance should be given by health professionals with expertise in nutritional and dietary advice.

Therapy	Highest level of evidence available	Patient group^A	Effectiveness^B			Comments	Safety considerations^C
Therapy	Highest level of evidence available	Patient group^A	Symptoms^D	Lung function	Medication required	Comments	Safety considerations^C
Diet modification^E
Omega-3 fatty acids (fish oil)^{(4, 5)}	I: Cochrane Review	Adults and children with asthma	2-	2-	2-	Less than 200 subjects have participated in all 6 trials. Various doses	Toxic effects have been observed with some vitamin and mineral supplements when administered at high dosages
Selenium supplements⁽⁶⁾	II: RCT	Non-atopic patients with asthma	1+	1-	0	Single 14 wk trial in 24 pts. Clinical benefit in 6/12 Rx sodium selenite 100µg/d vs 1/12 placebo
Vitamin C supplementation⁽⁷⁾	I: Cochrane Review	Adults and children with asthma	0	+/-	0	Two single dose studies (2g and 500mg Vit C) only available for lung function outcome (total N = 46)
Vitamin C and E supplementation combined⁽⁸⁾	II: RCT	Children living in Mexico City (high ozone environment)	0	+/-	0	Attenuation of the negative effect of ozone on lung function
Oral magnesium supplements⁽⁹⁾	II: RCT	People with asthma on low Mg diet	1+	1-	1-	Dose was 400mg/day
Lactobacillus acidophilus⁽¹⁰⁾	II: RCT	Adults with asthma and atopy	1-	1-	0	Dose was 225g twice daily
Dietary salt⁽¹¹⁾	I: Cochrane Review	Adults with allergic asthma	0	+/-	+/-	Small numbers of subjects, no significant effect but wide confidence intervals
Physical therapies
Chiropractic (spinal manipulation to treat mechanical dysfunction of the joints with consequent effects on the nervous system)^{(12, 13)}	II: RCT	2 trials in adults and in children with persistent asthma	2-	2-	2-	Total 124 subjects in the two trials	No side effects reported by subjects in these trials
Massage⁽¹⁴⁾	II: RCT	Children with asthma	0	0	1+	Parent delivered 20-minute massage v progressive muscle relaxation therapy	None reported. Reduced anxiety in massage arm
Swimming⁽¹⁵⁾	II: RCT	Children with asthma	0	1-	1-	One trial in 14 subjects. Indoor swimming 2-3x/week for 3 months.
Physical training⁽¹⁶⁾	I: Cochrane Review	Adults and children with asthma	1-	2-	0	Physical training for 20-30 mins, 2-3 times/week for 4 weeks. Various programs. Cardiopulmonary fitness improved
Medicinal therapies: homeopathy
Homeopathy (remedies derived from plants and minerals, given in extremely diluted forms according to individual patient needs)^(17-19)	I: Cochrane Review	Adults and children with asthma on concomitant medication	+/-	1+	1+	N = 452