Chiropractic Treatment for Asthma?

Most of us see chiropractic spinal manipulation as an intervention for back pain and other musculoskeletal problems. However, this view neglects the fact that many chiropractors treat far more than that. When D.D. Palmer “invented” chiropractic (in September 1895), his first patient was suffering from deafness and his second from heart disease. According to Palmer, virtually all human diseases were caused by spinal subluxations that needed correction by spinal manipulation or “adjustments,” as chiropractors often call it ([1]).

Today 64% of UK chiropractors believe that asthma patients “can benefit from chiropractic management” ([2]). Many chiropractic organizations state that chiropractic is a valid treatment for asthma ([3], [4], [5], [6]). The British Chiropractic Association, for instance, insists on its website ([7]) that “there is evidence to show that chiropractic care has helped children with … asthma …”. The worldwide web is full of information for patients from chiropractors trying to convince patients that their manipulations are an effective treatment for asthma; a simple Google search of “chiropractic asthma” generated 1,350,000 hits (date: September 2008).

But what does the most reliable evidence tell us? A Cochrane review failed to provide good evidence that any type of manual therapy (not just chiropractic manipulation) is an effective treatment for asthma ([8]). The most rigorous study of chiropractic manipulation for asthma included 80 asthmatic children who received either real or sham manipulations. The authors concluded that “chiropractic spinal manipulation … provided no benefit” ([9]). In other words, there are few trials, but the best of those that are available demonstrate the ineffectiveness of chiropractic.

Why then are chiropractors so convinced of the contrary? One part of the answer was already hinted earlier: they view chiropractic as a panacea ([1]). The other part could be that even the General Chiropractic Council (GCC), the body that regulates chiropractors in the UK and sets standards for the profession, promotes chiropractics for asthma. On the GCC's website there is a section on “frequently asked questions.” Question 4 is “Can chiropractic care help me?” And the answer states “You may also see an improvement in some types of asthma…” ([10]).

With such clear support from their peers, it is hardly surprising that chiropractors advise patients accordingly. Posing as a patient, we sent e-mails to 350 UK chiropractors asking whether they would advise an asthma patient on long-term corticosteroids to use chiropractic treatment for asthma ([11]). Of the respondents, 72% recommended chiropractic treatment. Only 17% of the respondents mentioned adverse effects, which could, of course, be serious, particularly for an osteoporotic patient ([1]).

I would argue that the attitude of chiropractors and chiropractic organizations represents a serious risk to patients with asthma. We should urgently consider addressing this situation.