> Please describe this possible variant of normal asthma in a small sample and
> how spinal manipulation can alter its natural history ?
> Preston H. Long
I can't because I have not seen it. I believe that there are three reasonable explanations for how an asthma patient can appear to have a positive outcome after manipulative care.
1. As you had suggested a temporary remission that is natural history.
2. Placebo
3. A variant of normal asthma that does respond to manipulation.
Maybe there is another explanation but there are cases that chiropractors, osteopaths, and medical doctors who use manipulation have described of patients seemingly "cured" of asthma after manipulation. I suspect that the responders (if there is such a group) are very small percentage of the asthma population. I do not believe that there is a way, at this point in time, to determine who these patients are prior to treatment. I believe that this is worthy of research to determine if these patients actually do respond to manipulation or instead just spontaneously go into temporary or permanent remission or respond to placebo.
Although there have been a few studies which have found that manipulation is no better than placebo (1-3). I know that others are underway.
Remember this was started by my question how does one convince both doctor and patient that the effect that they believe they have observed (profound improvement in symptoms and elimination of any medication to control the asthma) that this is only placebo or natural history.
1. Bronfort G, Evans RL, Kubic P, Filkin P. Chronic pediatric asthma and chiropractic spinal manipulation: A prospective clinical series and randomized clinical pilot study. J Manipulative Physiol Ther 2001;24(6):369-77.
2. Balon J, Aker PD, Crowther ER, Danielson C, Cox PG, O'Shaughnessy D, et al. A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma. N Engl J Med 1998;339(15):1013-20.
3. Nielsen N, Bronfort G, Bendix T, Madsen F, Weeke B. Chronic asthma and chiropractic spinal manipulation: a randomized clinical trial. Clin Exper Allergy 1995;25:80-88.
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Stephen M. Perle, D.C.
Associate Professor of Clinical Sciences
University of Bridgeport College of Chiropractic
Bridgeport, CT 06601
www.bridgeport.edu/~perle
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"Be ashamed to die until you have achieved some
victory for humanity."
Horace Mann
