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

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
Medicinal therapies: traditional Chinese herbal medicines^{(20, 21)}
Ginkgo biloba extract (ginkgolides BN 52021 and BN 52063)^(22-24)	II: 2 RCTs	People with asthma aged 13-48 years	+/-	1+	0	One study was in 61 people for 8 weeks; the second in 8 atopic adult asthmatics with effects measured immediately	Reports of headache, nausea, dizziness, palpitations and allergic skin reactions; rare reports of bleeding (AusDI, 2003) Drug interactions likely (AusDI, 2003)
Ligusticum wallichii (also called chuan xiong in China and senkyu in Japan)⁽²⁵⁾	II: 1 RCT	Adults with moderate to severe asthma	1-	1+	0	Measured at one month
Chanbei Kechuanping (CBKCP)⁽²⁶⁾	II: 1 RCT	People with asthma	0	1+	0	Effects measured immediately
Xuan Fei Ding Chuan Wan and Xiao Chuan Gu Ben Wan⁽²⁷⁾	II: 1 RCT	People with asthma	+/-	1+	0
Reinforcing kidney and invigorating spleen decoction⁽²⁸⁾	II: 1 RCT	‘Severe’ asthma taking inhaled steroids	1-	1-	0	4-6 months
Invigorating kidney for preventing asthma tablets⁽²⁹⁾	II: 1 RCT	Adults with asthma taking inhaled corticosteroids	+/-	1+	0	3 months
Strengthening body decoction mahuang Ephedra sinica mixture⁽³⁰⁾	II: 1 RCT	‘Cold and heat type’ adult asthmatics	1-	1+	0	Two weeks	mahuang is ephedrine 30-90% Reports of headache, nausea, irritability, motor restlessness, insomnia, tachycardia (AusDI, 2003) Rare case reports of hepatotoxicity (Am J Gastroenterol 1996; 96: 1436-8)
mahuang (Ephedra) Wenyang Tongulo mixture (WTM)⁽³¹⁾	II: 1 RCT	Adults with asthma	1-	1+	0	8 weeks Comparison was with oral salbutamol and inhaled corticosteroid
Chinese herbal medicines⁽³²⁾	Ill: non-randomisd CT	Children with asthma	+/-	+/-	0	Some TCM medicinals contain ephedrine, a sympathomimetic amine, which may be responsible for observed effects
Medicinal therapies: traditional Ayurvedic (Indian) medicines^{(20, 21)}
Boswellia serrata⁽³³⁾	II: 1 RCT	Adults with asthma	1+	1+	0		2/40 patients reported epigastric discomfort on Boswellia
Coleus forskohlii (forskolin)⁽³⁴⁾	II: RCT	People with asthma	0	1+	0	Immediate effect tested. Less effective than ß agonist but more than placebo
Picrorrhiza kurroa⁽³⁵⁾	II: 1 RCT		1-	1-	0	Over 14 weeks
Solanum xanthocarpum/ S. trilobatu (kantakari)^{(36, 37)}	II: 1 RCT	Adults with asthma and with COPD	1+	1-	0	Single dose study
Tylophora Indica^(38-43)	II: 5 RCTs	Adults with asthma, generally on no other treatment	2+	1+	0	Effects reduced after several weeks	Sore mouth, nausea and vomiting, loss of taste
Medicinal therapies: traditional Japanese medicines^{(20, 21)}
Tsumura saiboku-to (TJ-96)^{(44, 45)}	II: 2 RCTs	Adults with asthma	2+	2+	1+ (oral steroids)
Medicinal therapies: herbs (miscellaneous)^{(20, 21)}
Ivy leaves (dried) (Hedera helix L.)^{(46, 47)}	II: 5 RCTs	Adults and children with chronic airway obstruction due to asthma	+/-	+/-	0	Only one trial was placebo controlled
Breathing and yoga
Buteyko breathing technique (system of breathing exercises focusing on nasal route of breathing, hypoventilation and avoidance of deep breaths)^{(48, 49)}	II: 5 RCTs	Short-term studies in adults	2+	0	2+
Yoga (ancient Indian practice using physical postures, discipline of breathing, and concentration during practice)^(50-54)	II: 4 RCTs	Patients with asthma	+/-	0	+/-	Two studies showed reduced airway hyper-responsiveness
Breathing exercises⁽⁵⁵⁾	I: Cochrane Review		0	1+	1+	5 studies reviewed including one study on Buteyko. No standard breathing technique used