PEDIATRIC ASTHMA, ALLERGY & IMMUNOLOGYVolume 12, Number 1, 1998Mary Ann Liebert, Inc.

Use of Complementary Therapies in Childhood Asthma

EDZARD ERNST

ABSTRACT

Complementary medicine is popular, particularly for conditions such as asthma where or¬

thodoxy does not offer a cure. Its prevalence in adult populations is fairly well establishedyet little is known about its use in children. Seventeen thousand members of the United King¬dom Asthma Campaign were invited to complete a questionnaire. This sample included anestimated 4000 caretakers of children with asthma. From them 1471 responses were received(response rate approximately 37%). Thirty-three percent of the respondents stated that theyhad tried complementary therapies for their child with asthma. Homeopathy, breathing tech¬niques, and herbalism were the most popular therapies. Twenty-six percent of respondentsfelt that complementary therapies had improved asthma symptoms to "a great" or "some"extent, and overall one could deduce that these therapies were perceived as moderately help¬ful. Seventy-one percent of respondents whose child had not used complementary therapieswould consider using complementary medicine in the future. The amount of money spenton complementary treatments was generally modest. It is concluded that complementarymedicine is frequently used for childhood asthma. Thus, its efficacy and safety seems to meritrigorous study. (Pediatr Asthma Allergy Immunol 1998;12[l]:29-32.)

INTRODUCTION

In industrialized countries, complementary medicine (CM) is used by approximately 25% to 50% ofthe general population/1-3' Its use in pediatrie populations is less well researched. One survey conducted

on approximately 500 children (or their caretakers) in the United Kingdom suggested that the prevalenceof CM use is between 15% (community subsample) and 25% (hospital subsample)/4' This level of preva¬lence compares well with the 25% figure obtained in the adult population in the United Kingdom/2'

Patients suffering from chronic diseases for which mainstream medicine has no cure to offer are partic¬ularly likely to try CM/1'3' Thus, one might speculate that asthmatic children might use CM more frequentlythan the general population of the same age. One small United States survey of caretakers of Puerto Ricanchildren with asthma suggested that 21% use "home remedies."'5' No comparable data about CM use forchildhood asthma in other countries or populations are available to date.

The present investigation was aimed at filling the gap. In particular, it addressed the following questions.How frequently is CM used? Which therapies are the most popular? Is CM perceived as useful? Who sup¬plies CM? How much is spent on CM? Would people consider using CM in the future?

Department of Complementary Medicine, Postgraduate Medical School, University of Exeter, Exeter, United King¬dom.

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ERNST

METHODS

A custom-designed questionnaire was sent out in January 1997 to 17,000 members of the National AsthmaCampaign (NAC), United Kingdom. The NAC estimated that 4000 of these members had children (definedfor this study as individuals under 16 years of age) with asthma. Parents or other caretakers were asked to

complete the questionnaire on each child's behalf and to return it directly to PMSI, UK Ltd, who had de¬signed the questionnaire. The questionnaire addressed the questions detailed below. The answers were eval¬uated descriptively by calculating the percentages of the total number of answers for each question. Not allrespondents answered all questions; therefore, the exact absolute numbers are provided in each case.

RESULTS

One thousand four hundred seventy-one questionnaires were returned from individuals with children whosuffer from asthma (estimated response rate 37%). Thirty-three percent of respondents had, at some stage,tried some form of CM for their children; 47% stated that they had never used CM; and 20% gave no an¬

swer to this question.Which complementary therapies have you ever used to treat your child's asthma?

All 1471 respondents answered this question. The most popular therapies were homeopathy (used by15%), breathing techniques (15%), herbalism (6%), and osteopathy (2%). Acupuncture, aromatherapy, di¬ets, and reflexology had all been tried by 1% of respondents. When these data were analyzed by regionswithin the United Kingdom, no major trends emerged except for the fact that CM use was most popular inthe Greater London area, where only 38% of respondents stated that they had never tried any form of CM.

To what extent did your child's asthma symptoms improve since using thecomplementary therapy?

Seven hundred seventy-seven parents answered this question by checking off one of the following fourchoices: 10% felt that symptoms had improved to a "great extent," 16% to "some extent," 18% to a "slightextent," and 16% "not at all." Forty-one percent did not check any of these answers. These data were alsoanalyzed by therapy (Table 1). Sample sizes were too small in some of these subanalyses for depictingtrends. It seems, however, that none of the treatments used were perceived to be more than moderately use¬

ful. For all three 'treatment modalities shown in Table 1, the percentages of those respondents who per¬ceived no improvement are larger than those who perceived great improvement. For homeopathy and herbal¬ism this ratio is less favorable than for breathing techniques.Who administered complementary therapies?

This question was also answered by 777 parents. The most frequently given answers were: private prac¬titioners (30%), self-administered (17%), and received through the NHS (11%). When these data are ana-

Table 1. Perceived Usefulness of Complementary Therapies

Improvement of symptoms

Type of 12 3 4 Ratio oftreatment great some slight none 1:4

Herbalism (n = 91) 11% 31% 33% 25% 1:2.3Homeopathy (n = 225) 18% 29% 17% 33% 1:1.8Breathing techniques (n = 210) 10% 27% 40% 12% 1:1.2

Treatments for which less than 80 answers were available are omitted. = number of replies.

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COMPLEMENTARY THERAPIES IN CHILDHOOD ASTHMA

lyzed by therapy, several cases stand out in relation to their risk potential: 3 cases of self-administration ofacupuncture, 37 of herbalism, and 5 of osteopathy.

Approximately how much did you spend on complementary therapies in the last year?Three hundred ninety-three answers to this question were received. Fifty-five percent of respondents

stated that they had spent £0 to 50; 9% had spent between £51 to 100; 7% between £101 and 500; and 1%had spent more than £500.

Would you consider using CM for your child in the future?Six hundred ninety-four responses were received from those whose children had not used complemen¬

tary treatments. A clear majority (71%) answered "yes."

DISCUSSION

This seems to be the first large-scale invest ition of CM use in childhood asthma. The only other sur¬

vey was one order of magnitude smaller in tei s of sample size and focused on "folk" rather than on com¬

plementary/alternative remedies/5' Although ne two categories may overlap, they are certainly not identi¬cal. The present results essentially suggest tnat CM use for childhood asthma is prevalent, perceived as

moderately effective, and normally associated with low costs. The prevalence of asthma in children amountsto 3% to 4% and seems to be increasing/6' Thus, the popularity of CM use in this population raises sev¬

eral fundamental questions.Is CM effective? There are no data on child populations to answer this question. Extrapolating from ev¬

idence gained from adult studies, there is some, albeit inconclusive evidence for homeopathy (eg, ref. 7],yoga/8' and several herbal remedies, (eg. ref. 9) For acupuncture and hypnotherapy the data are (even) lessconclusive/10,11' For all other forms of CM, the evidence is simply nonexistent. The present survey impliesthat herbalism, homeopathy, and particularly breathing techniques are perceived as moderately effective(Table 1). There are few differences between these judgements, but it is remarkable that the percentagesfor the perceived success of homeopathy as well as failure are highest. Data from a population of adultsfrom the United Kingdom seems to confirm the limited perceived effectiveness of these treatments that, inthis case, were all below the one for orthodox options/12'

Is CM safe? CM is often thought of as safe and therefore harmless/13' Compared with orthodox drugs,CM may be relatively safe, but the notion that it is free of adverse effects is a myth/14' The undeniabletruth relating to the safety of CM is that the issue is grossly under-researched. The possible risk associatedwith the few cases of CM self-administration uncovered in the present survey should not be overstretched,but few people would disagree with the urgent need for more research in this area.

Does CM cost extra money or will it save overall expenses for asthma care? There is virtually no ev¬idence for either notion. The present data imply that money spent on CM is usually very modest. It cer¬

tainly looks small compared with approximately $12 billion spent on CM in the United States in 1990/1'This survey therefore suggests that, for the United Kingdom, the cost issue is not of paramount impor¬tance.

Surveys usually serve to generate opinions or hypotheses rather than prove points or test hypotheses.They are often burdened with methodological flaws. This investigation is no exception. The sample is clearlyself-selected and the response rate is based on an estimate only. Thus, generalizations would be problem¬atic. Furthermore, the questionnaire was not validated. Notwithstanding these drawbacks, it is hoped thatthis study does provide some relevant information as a starting point for future investigations. The preva¬lence of childhood asthma seems to be increasing (eg, ref. 15) and so is the popularity of CM in general/1-3'We therefore can expect more and more asthmatic children to try CM of one type or another. With thisnrospect in sight, we should consider systematically investigating this area.

It is concluded that CM use for childhood asthma is frequent. CM is perceived as moderately helpful at cost. Future investigations should address the crucial questions of efficacy and safety.

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ERNST

ACKNOWLEDGMENT

The author is grateful for invaluable support from PMSI and the NAC, UK.

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Address reprint requests to:E. Ernst

Dept. of Complementary MedicinePostgraduate Medical School

University of Exeter25 Victoria Park Road

Exeter, EX2 4NT UK