Asthma is a common chronic disease worldwide. Annually, the WHO has estimated that 15 million disability-adjusted life-years are lost and 250 000 asthma deaths are reported worldwide.
Among pediatric populations, complementary and alternative medicine interventions are reportedly used by 2 to 20–30% of patients.
Acupuncture has traditionally been used in asthma treatment in China and is increasingly being used in western countries.
Laser therapy has increasingly been applied as the method for stimulation of acupuncture points over the last two decades.
The two groups of the study were formed of group A included 11 females and nine males (55 and 45%, respectively) and group B included 10 females and 10 males (50 and 50%, respectively). Group A received laser sessions besides conventional medical treatment; each patient was subjected to 12 laser acupuncture sessions at a rate of three sessions per week (1 month duration) on the basis of a specific acupuncture points schedule according to TCM using a laser device (power=100 mW and wave length=780 nm for 1 min to give 5 J/cm2 for each point). Group B was followed up on their conventional medical treatment only for 1 month as group A.
In group A, there was an improvement in entry pulmonary functions at follow-up (after 1 month of laser acupuncture sessions); the differences were statistically significant in VC act (P≤0.001), VC cent (P≤0.001), FVC act (P=0.003), FVC cent (P=0.002), FEV1 act (P=0.002), FEV1 cent (P≤0.001), FEF25 75 cent (P=0.086), best FVC cent (P=0.008), best FEV1 act (P=0.003), best FEV1 cent (P=0.013), PEF act (P≤0.001), and PEF cent (P=0.016). This indicates that laser acupuncture may have led to an improvement in airway inflammation and edema.
In group B, there was no significant improvement in basal pulmonary functions at follow-up (after 1 month of receiving medications only).
No significant differences were observed between the two groups (group A and group B) in the entry pulmonary functions at the start of the study, but there were statistically significant differences in improvements in pulmonary functions in group A than in group B at the 1 month later (follow-up) for the following parameters: VC act (P=0.011), VC cent (P≤0.001), best FVC act (P=0.093), best FVC cent (P=0.021), and best FEV1 cent (P=0.038).
On clinical assessment, no patients were free from attacks at the beginning of the study in both groups A and B.
In group A, after laser acupuncture sessions (follow-up), all patients were free from attacks. In the patients in group B, on follow-up (1 month), we found that 11 (55%) patients still had attacks after receiving medications only.
According to disease severity in group A, three (15%) patients had persistent mild severity and 17 (85%) patients had persistent moderate severity at follow-up (1 month); seven (35%) patients were free from attacks, 10 (50%) patients had mild intermittent severity, and three (15%) patients had mild persistent severity. In group B, two (10%) patients had mild persistent asthma and 18 (90%) patients had moderate persistent asthma at the beginning of the study. At follow-up, one (5%) patient had persistent mild asthma and 19 (95%) patients had persistent moderate asthma. On comparing both groups A and B, there were no statistically significant differences at the start of the study in the severity, but there were statistically significant differences at follow-up.
The improvements reported in our study may have been because of the immediate flare reactions caused by peripheral vasodilatation in the skin at the acupoint site 13. This vasodilatation effect can be caused by the release of calcitonin gene-related peptide (CGRP) upon stimulation of axonal fibers 14. The local release of β-endorphin could be responsible for the short-term analgesic effect, whereas the neuropeptide-induced release of anti-inflammatory cytokines could have arisen from lymphocytes and secondary activating cells, such as macrophages. In the periphery, the actual level of CGRP is of crucial importance. Usually, CGRP (released from nerve endings) exerts a potent anti-inflammatory action at low doses 15.
The results obtained by Nedeljković et al. 16 in their study proved the effectiveness of the combined application of conservative drug therapy and laser acupuncture in the treatment of acute bronchial obstruction in asthmatic children; application of laser acupuncture for 5 days led to less improvement than that found in our study in large bronchi (FEV1) and small-sized airways (FEF25 75%) because of the short duration of their sessions.
Milojević and Kuruc 17 used the same points that we applied for 10 sessions of low-power laser stimulation of acupuncture points in patients with bronchial asthma, and they found an improvement in both lung functions and gas exchange parameters; also, they concluded in their study that the positive effects of laser treatment in patients with bronchial asthma were achieved in a short time and they remain for several weeks.
Choi et al. 18 conducted a trial that aimed to evaluate the feasibility of estimating the effectiveness of acupuncture in asthmatic patients under conventional medical management and concluded that active acupuncture leads to additional clinically significant improvement in the quality of life and symptoms of dyspnea in asthmatic patients who are under therapeutic management, but we used laser acupuncture application on the acupoints to stimulate them as laser is a more safe and noninvasive technique and suitable for children.
Suzuki et al. 19 found that acupuncture was effective in improving or eliminating asthma symptoms, and pulmonary functions; moreover, there were improvements in airway obstruction on assessment of FEV1%. However, there was an absence of night attacks, although their duration of therapy was longer than ours, but with fewer acupuncture sessions (10 weeks involving 10 sessions) of acupuncture treatment (once per week). The points selected were almost the same as those in our study.
Zhang et al. 20 reported results that were in agreement with our study; in the conclusion of their study, they reported that the use of acupuncture for 12 days resulted in a significant improvement in all pulmonary functions, except the FEV1/FVC ratio in patients with moderate and severe asthma.
Ailioaie and Ailioaie 21 concluded in their study that there was a decrease in clinical symptoms (nocturnal and early morning symptoms) in asthmatic children in the group that received low-level laser therapy than the group that used inhaled salmeterol only and the other group that used theophylline was improved, which is in agreement with our study of improvement in both clinical condition and asthma severity in group A, which received laser acupuncture plus conventional medical treatment, than group B, which received medication only.
Application of laser acupuncture sessions besides conventional medical treatment results in greater improvement in the pulmonary functions and degree of severity in asthmatic children.
Conflicts of interest
There are no conflicts of interest.
1. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA); 2006. Available at: http://ginasthma.org
. [Accessed 2008].
2. Salama AA, Mohammed AA, El Okda ESE, Said RM. Quality of care of Egyptian asthmatic children: clinicians adherence to asthma guidelines. Ital J Pediatr 2010; 36:33.
3. Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma (GINA); 2014. Available at: http://ginasthma.org
. [Accessed 2014].
4. Schünemann HJ, Jaeschke R, Cook DJ, Bria WF, El-Solh AA, Ernst A, et al.ATS Documents Development and Implementation Committee. An official ATS statement: grading the quality of evidence and strength of recommendations in ATS guidelines and recommendations. Am J Respir Crit Care Med 2006; 174:605–614.
5. Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med 2004; 11:10–18.
6. Levy ML, Quanjer PH, Booker R, Cooper BG, Holmes S, Small IGeneral Practice Airways Group. Diagnostic spirometry in primary care: proposed standards for general practice compliant with American Thoracic Society and European Respiratory Society recommendations: a General Practice Airways Group (GPIAG)1 document, in association with the Association for Respiratory Technology amp; Physiology (ARTP)2 and Education for Health3 1 www.gpiag.org
. Prim Care Respir J 2009; 18:130–147.
7. National Institutes of Health. Acupuncture2012 Consensus Development Conference Statement”. 3–5 November 1997. Retrieved -02-28. “… Even more elusive is the scientific basis of some of the key traditional Eastern medical concepts such as the circulation of Qi, the meridian system, and other related theories, which are difficult to reconcile with contemporary biomedical information but continue to play an important role in the evaluation of patients and the formulation of treatment in acupuncture”.
8. Liu G, Ma HJ, Hu PP, Tian YH, Hu S, Fan J, Wang K. Effects of painful stimulation and acupuncture on attention networks in healthy subjects. Behav Brain Funct 2013; 9:23.
9. [No authors listed]. Acupuncture. NIH Consens Statement 1997; 15:1–34.
10. Adams D, Cheng F, Jou H, Aung S, Yasui Y, Vohra S. The safety of pediatric acupuncture: a systematic review. Pediatrics 2011; 128:e1575–e1587.
11. Hsieh CW, Wu JH, Hsieh CH, Wang QF, Chen JH. Different brain network activations induced by modulation and nonmodulation laser acupuncture. Evid Based Complement Alternat Med 2011; 2011:951258.
12. Yeom M, Kim SH, Lee B, Zhang X, Lee H, Hahm DH, et al.. Effects of laser acupuncture on longitudinal bone growth in adolescent rats. Evid Based Complement Alternat Med 2013; 2013:424587.
13. Kaptchuk TJ. Acupuncture: theory, efficacy, and practice. Ann Intern Med 2002; 136:374–383.
14. Brain SD, Newbold P, Kajekar R. Modulation of the release and activity of neuropeptides in the microcirculation. Can J Physiol Pharmacol 1995; 73:995–998.
15. Raud J, Lundeberg T, Brodda Jansen G, Theodorssen E, Hedqvist P. Potent anti-inflammatory action of calcitonin gene-related peptide. Biochem Biophys Res Commun 1991; 180:1419–1435.
16. Nedeljković M, Ljustina-Pribić R, Savić K. Innovative approach to laser acupuncture therapy of acute obstruction in asthmatic children. Med Pregl 2008; 613–4123–130.
17. Milojević M, Kuruc V. Low power laser biostimulation in the treatment of bronchial asthma. Med Pregl 2003; 569–10413–418.
18. Choi JY, Jung HJ, Kim JI, Lee MS, Kang KW, Roh YL, et al.. A randomized pilot study of acupuncture as an adjunct therapy in adult asthmatic patients. J Asthma 2010; 47:774–780.
19. Suzuki M, Yokoyama Y, Yamazaki H. Research into acupuncture for respiratory disease in Japan: a systematic review. Acupunct Med 2009; 27:54–60.
20. Zhang WP. Zhen ci yan jiu (2007), Acupuncture Research/[Zhongguo yi xue ke xue Yuan Yi xue Qing bao yan jiu suo Bian ji] [, 32(1):42-48] Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov’t, English Abstract (lang: chi).
© 2014 Medical Research Journal
21. Ailioaie C, Ailioaie L. Treatment of bronchial asthma with low-level laser in attack-free period at children. Proc SPIE 2000; 4166:303–308.