A better understanding of asthma and its implications for osteopathic treatment and research protocols. A critical literature review.
Item
- Title
- A better understanding of asthma and its implications for osteopathic treatment and research protocols. A critical literature review.
- Author(s)
- Moralee, L
- Abstract
- Introduction: Though manipulative therapy is accepted as a treatment for low back pain, the evidence is less conclusive with regards to visceral conditions such as asthma, leading to criticism of manual therapy practitioners claiming they can treat such conditions. Much research has been conducted on asthma, and yet it remains poorly understood and is increasing in incidence. A proposed this explanation for this increase is the hygiene hypothesis, leading to an increase in allergic sensitisation. Other factors such as genetic predisposition are also implicated in the aetiology of asthma.Methods: Electronic searches were carried out using the ALICE system in the library at the European School of Osteopathy, Maidstone, and via the University of Greenwich student portal databases, namely; CINAHL (via the EBSCO Research Database interface), the Cochrane Library and Swetswise. Search terms used were "asthma" AND/OR "asthmatic" AND/OR "osteopathy" AND/OR "osteopathic" AND/OR "chiropractic" AND/OR "manual therapy". Reference lists of relevant articles were examined to identify further articles.Results: With regards to the pathophysiology of asthma, current evidence suggests that the driving force behind many of the cardinal features of asthma are of cholinergic origin, whether this be in the form of acetylcholine released from the parasympathetic supply to the lung, or from local non-'neuronal sources such as inflammatory cells and 'bronchial cells. In asthmatics, often there is an increase in inflammatory cells as a result of allergic sensitization and faults in the control feedback mechanisms which regulate the release and degradation of acetylcholine, thus prolonging its effects, namely,bronchoconstriction, mucus production and remade/ling. Damage to the epithelium by inflammatory products in the lungs of asthmatics can further sensitise the lungs by exposing sensory nerve ending whose antidromic actions also promote bronchoconstriction and mucus production as well as aiding the inflammatory process further by increasing permeability of blood vessels and recruiting further immune cells to the area. Bronchodilation, mediated by the adrenergic sympathetic nervous system and inhibitory non-adrenergic non'-cholinergic nerves do not appear to be able to ameliorate the cholinergic effects in the asthmatics lungs. Osteopathic treatment has focused on reducing somatovisceral reflexes, treating imbalance in the autonomic nervous system, reducing the inflammation and relieving the symptoms of asthma such as muscular lesions due to increased respiratory efforts. There is some evidence that various treatment modalities can affect somatovisceral reflexes, the autonomic system, the lymphatic system, and can increase lung function. Discussion: An inconsistency between smaller studies and larger randomised control trials exists, with smaller studies suggesting osteopathic treatment is effective for asthma and larger trials failing to support this view. Quality of evidence has a hierarchy. Systematic reviews are considered to be most reliable and informative, with robustly conducted randomised controlled trials roviding the data for these reviews. There are very few studies of robust methodological quality examining the effect of osteopathy or other manual therapies on asthma and as such a very limited pool of information on which systematic reviews can be conducted. Significant improvements in objective measures such as lung function have not routinely been observed in robustly conducted trials, other subjective measures such as patient rated quality of life have shown statistically significant improvements in some studies. Conclusion: The author considers that improvements in asthmatics symptoms reported in smaller studies does not have any reproducibility to the general asthmatic population, but that osteopathy may have a role in preventing further deterioration of the asthmatics lung function and suggests that methodologically robust prospective long term studies could be conducted to investigate this hypothesis.
- presented at
- European School of Osteopathy
- Date Accepted
- 2011
- Date Submitted
- 22.1.2013 16:23:36
- Type
- osteo_thesis
- Language
- English
- Submitted by:
- 62
- Pub-Identifier
- 15287
- Inst-Identifier
- 1229
- Keywords
- Asthma; Osteopathic approach.
- Recommended
- 0
- Item sets
- Thesis
Moralee, L, “A better understanding of asthma and its implications for osteopathic treatment and research protocols. A critical literature review.”, Osteopathic Research Web, accessed April 29, 2024, https://www.osteopathic-research.com/s/orw/item/778