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

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
Other therapies
Acupuncture (laser or fine needles used to puncture the skin at defined points)^{(56, 57)}	I: 2 systematic reviews (1 Cochrane)		+/-	+/-	+/-	Short-term studies. Questionable use of sham acupuncture as comparator. 7 trial of 174 people reviewed by Cochrane
Hypnotherapy (creating a trance-like state)^(58-63)	I: Systematic review	Adults and older children with severity ranging from mild-moderate/severe	+/-	+/-	+/-	Dependent on hypnosis ‘susceptibility’. Several published studies have not provided sufficient detail to assess effect.
Ionisation (instrumentally boosting the positive and negative ion content of the air)^(64-68)	II: RCT	Adults and children with asthma	2-	0	2-	Total N = 92	One trial demonstrated positive ionisation aggravated EIA
Meditation (techniques used to calm the mind and body)⁽⁶⁹⁾	II: 1 RCT	Adults with ‘stable’ asthma	0	1+	0	Only half the respondents completing the full trial. Airways resistance decreased
Music therapy⁽⁷⁰⁾	II: 1 RCT	Stable asthmatics	1+	1-	0	Data from a single trial (n = 72) with relaxation and no treatment as the comparator
Osteopathy (physical manipulative therapy used to adjust misalignments of the muscles, joints and bones)^{(71, 72)}	II: 1 pilot RCT and 1 controlled comparative study	Adults with asthma. Comparative group in second trial included non-asthmatics	1-	+/-	0	Total number of participants = 18
Reflexology (application of pressure, usually to the feet, to produce therapeutic effects on other parts of the body)^{(73, 74)}	II: 2 RCTs	Adults with asthma	+/-	1-	+/– (SABA use decreased)	Total N = 70 Peak flows increased in one study, but neither study showed improvements in FEV1.
Speleotherapy (use of subterranean environments as a therapeutic measure)⁽⁷⁵⁾	I: Cochrane Review (3 RCTs)	Children with asthma	0	1+	1+	Results may vary from cave to cave Total N = 118 Lung function effects were described as transient
Relaxation therapy^(76-82)	I: 1 systematic review and other RCTs	Adults and children with asthma ranging from mild to severe	2-	+/-	2-	May be of greatest benefit for those with asthma exacerbated by anxiety. Has also been demonstrated to be useful in acute attacks