Homeopathy for asthma

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Related Summaries :

Overview :

homeopathy is a complementary or alternative healing system used to treat specific symptoms with diluted substances known to cause such symptoms when given in undiluted doses to healthy persons

homeopathy is based on guiding principle that "like cures like"

insufficient evidence to assess possible role of homeopathy in treatment of asthma, based on Cochrane review of 6 randomized trials

homeopathy appears no better than placebo for childhood or adolescent asthma (level 2 [mid-level] evidence), based on systematic review of 2 randomized trials

Description of Homeopathy

Description :

homeopathy is a complementary or alternative healing system used to treat specific symptoms with diluted substances known to cause such symptoms when given in undiluted doses to healthy persons⁽1)
- homeopathy is based on guiding principle that "like cures like"
- homeopathy may be considered a "package of care effect" with effect resulting from combination of intervention and consultation⁽¹⁾

Types of homeopathy :

4 types of homeopathy differentiated in Cochrane review⁽1)
- classical homeopathy - tailoring treatments to individual based on subjective symptom patterns
- clinical homeopathy - using same agent/remedy for patients presenting with similar pathologies or constellations of symptoms
- isopathy - using dilution of causative agent (that is, allergy-causing agent)
- complex homeopathy - using fixed combinations of several homeopathic remedies (complex remedies) for limited number of conditions

Definitions :

potentising - greatly diluting substances⁽1)
potency - serial dilution⁽¹⁾
- homeopathic remedies are considered more potent as active ingredient becomes more dilute
- D is used for decimal dilutions, for example, D6 = 6 dilution steps of 1 part diluted agent to 10 parts diluent
  - DynaMed commentary -- many sources use "X" for decimal dilutions
- C is used for centesimal dilutions, for example, C6 = 6 dilution steps of 1 part diluted agent to 100 parts diluent
succussion - vigorous shaking

Systematic Reviews

insufficient evidence to assess possible role of homeopathy in treatment of asthma
based on Cochrane review
systematic review of 6 randomized placebo-controlled trials with 556 patients evaluating varying types of homeopathy for treatment of stable chronic asthma
meta-analyses not possible due to use of different homeopathic regimens
no trial reported significant differences on validated symptom scales
Reference - systematic review last updated 2003 Jul 23 (Cochrane Library 2004 Issue 1:CD000353)
homeopathy appears no better than placebo for childhood or adolescent asthma (level 2 [mid-level] evidence)
- based on systematic review with limited evidence
- systematic review of randomized trials evaluating alternative interventions for prevention or treatment of childhood or adolescent ailments
- 2 trials evaluated homeopathy (standardized and individualized) for asthma
- no between-group differences in intensity, frequency or duration of asthma attacks nor in active quality of living as measured by Childhood Asthma Questionnaire
- Reference - Mayo Clin Proc 2007 Jan;82(1):69 full-text

Randomized Trials

homeopathic immunotherapy for asthmatics allergic to dust mite does NOT appear effective (level 2 [mid-level] evidence)
- based on randomized trial without intention-to-treat analysis
- 242 patients with asthma and positive skin prick test for house dust mite had 4-week baseline assessment and were randomized to oral homeopathic immunotherapy vs. placebo for 16 weeks
- 202 patients completed clinic-based assessments (FEV₁, quality of life, mood)
- 186 patients completed diary-based assessments (peak expiratory flow, asthma severity, quality of life, daily mood)
- no differences in most outcomes
- different patterns of change occurred for morning peak expiratory flow, visual analog scale of asthma severity, and mood with significant worsening in homeopathic immunotherapy group at 3 weeks
- Reference - BMJ 2002 Mar 2;324(7336):520 full-text, editorial can be found in BMJ 2002 Mar 2;324(7336):498 full-text, commentary can be found in BMJ 2002 Jul 6;325(7354):41 full-text, J Fam Pract 2002 Jul;51(7):602, J Fam Pract 2002 Nov;51(11):984
addition of homeopathic remedies to conventional treatment does NOT appear effective in children (level 2 [mid-level] evidence)
- based on randomized trial with 80% follow-up rate
- 93 children aged 5-15 years with mild to moderate asthma randomized to individualized homeopathic remedies vs. placebo as adjunct to conventional treatment
- 74 (80%) completed quality of life evaluation
- 89 (96%) included in primary analysis
- follow-up 12 months
- no clinically relevant or statistically significant differences in qualify of life scores
- relative improvement in severity was small
- Reference - Thorax 2003 Apr;58(4):317 PDF, commentary can be found in Thorax 2003 Sep;58(9):826, Thorax 2003 Sep;58(9):827
- DynaMed commentary -- this trial included in systematic review noted above which also stated no significant differences in another randomized trial in 86 children (Rev Homeopat (Sao Paulo) 1995;60:26)
homeopathic therapy may reduce symptom intensity in selected patients with allergic asthma (level 2 [mid-level] evidence)
- based on small randomized trial
- 28 patients with allergic asthma (most were sensitive to house-dust mite) were randomized to oral homeopathic immunotherapy to their principal allergen vs. placebo in addition to conventional care
- overall symptom intensity assessed via daily visual analog scale
- homeopathic immunotherapy appeared beneficial within 1 week and benefit persisted for up to 8 weeks
- Reference - Lancet 1994 Dec 10;344(8937):1601, commentary can be found in Lancet 1995 Jan 28;345(8944):251, Lancet 1995 Jan 28;345(8944):251, Lancet 1995 Jan 28;345(8944):251, Lancet 1995 Jan 28;345(8944):252
homeopathic therapy may improve some measures of pulmonary function (level 3 [lacking direct] evidence)
- based on small trial without clinical outcomes
- 40 patients aged 24-48 years with steroid-dependent asthma treated with combination homeopathic preparation subcutaneously every 5-7 days vs. placebo
- homeopathic group had improvement in peak expiratory flow rate, forced vital capacity and forced expiratory volume and decreased steroid dose
- clinically important outcomes not reported
- Reference - Biol Ther Int J Integrated Med 1997;15:70 in Altern Ther Health Med 1997 Nov;3(6):111

References including Reviews and Guidelines

General references used :

1. McCarney RW, Linde K, Lasserson TJ. Homeopathy for chronic asthma. Cochrane Database Syst Rev. 2004;(1):CD000353.
MEDLINE search 2008 Oct 13 using PubMed Clinical Queries (therapy) for "homeop* and asthma"
- Click here to repeat MEDLINE search
- 6 studies included in this summary
  - White A, Slade P, Hunt C, Hart A, Ernst E. Individualised homeopathy as an adjunct in the treatment of childhood asthma: a randomised placebo controlled trial. Thorax. 2003 Apr;58(4):317-21.
  - Lewith GT, Watkins AD, Hyland ME, et al. Use of ultramolecular potencies of allergen to treat asthmatic people allergic to house dust mite: double blind randomised controlled clinical trial. BMJ. 2002 Mar;324(7336):520.
  - Rothwell PM. Is the evidence for homoeopathy reproducible? Lancet. 1995 Jan;345(8944):251; author reply 252-3.
  - Reilly D, Taylor MA, Beattie NG, et al. Is evidence for homoeopathy reproducible? Lancet. 1994 Dec;344(8937):1601-6.
  - Aulas JJ. Is the evidence for homoeopathy reproducible? Lancet. 1995 Jan;345(8944):251
  - Kahn MF. Is the evidence for homoeopathy reproducible? Lancet. 1995 Jan;345(8944):251
- 1 study not included in this summary
  - McCarney RW, Lasserson TJ, Linde K, Brinkhaus B. An overview of two Cochrane systematic reviews of complementary treatments for chronic asthma: acupuncture and homeopathy. Respir Med. 2004 Aug;98(8):687-96.

Reviews :

review of integrative medicine and asthma can be found in Pediatr Clin North Am 2007 Dec;54(6):1007
review of alternative therapies for treating asthma can be found in J Fam Pract 2007 May;56(5):385 full-text
review of complementary and alternative treatment in patients with asthma can be found in Tuberk Toraks 2006;54(2):189 [Turkish]
review of complementary and alternative medicine for the treatment and diagnosis of asthma and allergic diseases can be found in Monaldi Arch Chest Dis 2005 Mar;63(1):47

Guidelines :

American Academy of Pediatrics (AAP) recommendations for pediatricians who discuss alternative complementary and unproven therapies with their families can be found in Pediatrics 2001 Mar;107(3):598 full-text, correction can be found in Pediatrics 2001 Aug;108(2):507
National Heart, Lung and Blood Institute (NHLBI) National Asthma Education and Prevention Program (NAEPP) Expert Panel Report 3 (2007) guidelines on diagnosis and management of asthma can be found at NHLBI PDF or in J Allergy Clin Immunol 2007 Nov;120(5 Suppl):S94, correction can be found in J Allergy Clin Immunol 2008 Jun;121(6):1330
- NHLBI guidelines state "The Expert Panel concludes that there is insufficient evidence to recommend herbal products for treating asthma. Furthermore, because herbal products are not standardized, one must be aware that some may have harmful ingredients and that some may interact with other pharmaceutical products that the patient may be taking (Evidence D)."

Patient Information

Patient information :

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Acknowledgements

DynaMed topics are created and maintained by the DynaMed Editorial Team.
Over 500 journals and evidence-based sources (DynaMed Content Sources) are monitored directly or indirectly using a 7-Step evidence-based method for systematic literature surveillance. DynaMed topics are updated daily as newly discovered best available evidence is identified.

Special acknowledgements :

Hansie Wong, MD (Greater Lawrence Family Health Center, Lawrence, Massachusetts, USA) provides peer review.
Dr. Wong has declared no financial or other competing interests related to this topic.