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R. Andrew McIvor, MD, FCCP
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From the Department of Medicine, McMaster University, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare.

Correspondence to: R. Andrew McIvor, MD, FCCP, McMaster University, Firestone Institute for Respiratory Health, St. Joseph’s Healthcare, T2127, 50 Charlton Ave E, Hamilton, ON, L8N 4A6, Canada; e-mail: amcivor@stjosham.on.ca


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(3):832-833. doi:10.1378/chest.11-1040
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To the Editor:

Complementary and alternative medicines (CAMs) are used by >80% of the world’s population and are becoming an increasing component of the US health-care system, with >70% of the population using CAM at least once and annual spending reaching as much as $34 billion.1 Few patients with asthma, however, disclose their CAM use to their providers, and most physicians also do not specifically inquire about CAM.

Although effective conventional remedies are available, a large population (highest among patients who are black, poor, less educated, and in children) exists that uses complementary medicines adjunctively to minimize the need for conventional therapies and avoid the side effects.1 New fads are bound to come along with extravagant claims for effectiveness, and while some alternative treatments may offer benefits for helping people with mild asthma, none can be recommended as a replacement for standard medical therapies, and none should be the sole treatment of acute symptoms. Our case of cupping for severe asthma described a young man who had been intubated for his asthma within the last 2 years.2 We reported both his dissatisfaction with conventional therapy for maintenance asthma therapy and his use of CAM during worsening of asthma.2

I was intrigued, and philosophically agree, with the comments about CAM from Dr Kim and colleagues. In specialist practice, we may focus too much on investigations and not spend much time in “hands-on” patient interaction, which, in contrast, may be the foundation of CAM therapy. There also remain significant issues with the actual diagnosis of asthma outside specialist care, with 30% of patients who reported physician-diagnosed asthma being found not to have asthma in a population-based study.3

Information on complementary remedies is extensive, but as of yet remains scientifically unclear because there are conflicting results about efficacy, and well-controlled trials with reliable data are limited. More independently funded replications of the isolated randomized controlled trials published are needed to confirm the accuracy and validity of the study findings. We have previously reported that a modest number of patients receiving placebo have changes in pulmonary function that might be interpreted as clinically significant.4 Properly designed randomized clinical trials that include objective efficacy outcomes as well as incorporate patient-reported outcomes would be a major step forward to unraveling the science of CAM and assisting in accepting those interventions that have passed not just the test of time but also the test of validation.

Mainardi T, Kapoor S, Bielory L. Complementary and alternative medicine: herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol. 2009;1232:283-294 [CrossRef] [PubMed]
 
Goodwin J, McIvor RA. Alternative therapy: cupping for asthma. Chest. 2011;1392:475-476 [CrossRef] [PubMed]
 
Aaron SD, Vandemheen KL, Boulet LP, et al; Canadian Respiratory Clinical Research Consortium Canadian Respiratory Clinical Research Consortium Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008;17911:1121-1131 [CrossRef] [PubMed]
 
Joyce DP, Jackevicius C, Chapman KR, McIvor RA, Kesten S. The placebo effect in asthma drug therapy trials: a meta-analysis. J Asthma. 2000;374:303-318 [CrossRef] [PubMed]
 

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References

Mainardi T, Kapoor S, Bielory L. Complementary and alternative medicine: herbs, phytochemicals and vitamins and their immunologic effects. J Allergy Clin Immunol. 2009;1232:283-294 [CrossRef] [PubMed]
 
Goodwin J, McIvor RA. Alternative therapy: cupping for asthma. Chest. 2011;1392:475-476 [CrossRef] [PubMed]
 
Aaron SD, Vandemheen KL, Boulet LP, et al; Canadian Respiratory Clinical Research Consortium Canadian Respiratory Clinical Research Consortium Overdiagnosis of asthma in obese and nonobese adults. CMAJ. 2008;17911:1121-1131 [CrossRef] [PubMed]
 
Joyce DP, Jackevicius C, Chapman KR, McIvor RA, Kesten S. The placebo effect in asthma drug therapy trials: a meta-analysis. J Asthma. 2000;374:303-318 [CrossRef] [PubMed]
 
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