A comparison of active and simulated chiropractic manipulation as adjunctive treatment for childhood asthma

Background Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions, including asthma, Methods We conducted a randomized, controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma, After a three-week base-line evaluation period, 91 children who had continuing symptoms of asthma despite usual medical therapy were randomly assigned to receive either active or simulated chiropractic manipulation for four months. None had previously received chiropractic care. Each subject was treated by 1 of 11 participating chiropractors, selected by the family according to location. The primary outcome measure was the change from base line in the peak expiratory flow, measured in the morning, before the use of a bronchodilator, at two and four months. Except for the treating chiropractor and one investigator (who was not involved in assessing outcomes), all participants remained fully blinded to treatment assignment throughout the study. Results Eighty children (38 in the active-treatment group and 42 in the simulated-treatment group) had outcome data that could be evaluated. There were small increases (7 to 12 liters per minute) in peak expiratory flow in the morning and the evening in both treatment groups, with no significant differences between the groups in the degree of change from base line (morning peak expiratory flow, P=0.49 at two months and P=0.82 at four months). Symptoms of asthma and use of P-agonists decreased and the quality of life increased in both groups, with no significant differences between the groups. There were no significant changes in spirometric measurements or airway responsiveness. Conclusions In children with mild or moderate asthma, the addition of chiropractic spinal manipulation to usual medical care provided no benefit. (N Engl J Med 1998;339:1013-20.) (C) 1998, Massachusetts Medical Society.