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The improvement in asthma severity and pulmonary functions after laser acupuncture application in asthmatic children

Mohamed, Nagwa H.a; Shaaba, Hala H.b; Soliman, Mona M.c; Dabbous, Ola A.c; Ahmed Kamel, Inas E. M.a

doi: 10.1097/01.MJX.0000457178.59145.b5
ORIGINAL ARTICLES
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Objective Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. Acupuncture is one of the complementary and alternative medicine modalities and is a key component of traditional Chinese medicine. Laser acupuncture is an interesting modality of low-level laser therapy, a noninvasive form of phototherapy.

Patients and methods The present study is a randomized clinical trial conducted on 40 asthmatic children receiving conventional medical treatment divided randomly into two groups. Group A included 20 children who received a laser acupuncture session three times per week for 4 weeks and group B (control group) received conventional medical treatment only. Pulmonary functions were measured and the clinical condition of the patients was assessed before and after the study.

Results Pulmonary functions at follow-up were higher in group A than in group B; the differences were statistically significant in vital capacity (VC) act, VC cent, best forced vital capacity (FVC) act, best FVC cent, and best forced expiratory volume in 1 s cent. The frequency of asthmatic attacks reduced in group A at follow-up. The clinical severity of children in group A improved significantly at follow-up. The clinical severity of the children in group B did not change significantly at follow-up.

Conclusion Application of laser acupuncture sessions besides conventional medical treatment results in greater improvement in pulmonary functions and severity in asthmatic children.

aDepartment of Researches and Applications of Complementary Medicine, National Research Centre

bDepartment of Pediatric, Cairo University

cDepartment of Laser Applications in Medicine, National Institution of Laser Science, Cairo, Egypt

Correspondence to Prof Dr Nagwa H. Mohamed, Department of Researches and Applications of Complementary Medicine, National Research Centre, El-Bohouth Street, Dokki, PO Box 2311, 12111 Cairo, Egypt Tel: +20 122 221 4290; e-mail: drnagwa@hotmail.com

Received June 1, 2014

Accepted July 15, 2014

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Introduction

Asthma affects an estimated 300 million individuals worldwide. The prevalence of asthma is increasing, especially in children 1. In Egypt, the overall prevalence of wheezing in 2010 was 14.7% and that of physician-diagnosed asthma was 9.4%. Asthma is relatively common and probably underdiagnosed and undertreated, particularly among children from poor families 2. Asthma is a heterogeneous disease, usually characterized by chronic airway inflammation. It is defined by a history of respiratory symptoms such as wheeze, shortness of breath, chest tightness, and cough that vary over time and in intensity, together with variable expiratory airflow limitation 3. Patients can experience episodic flare-ups (exacerbations) of asthma that may be life-threatening and place a significant burden on the patients and the community 4.

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Diagnosis

The clinician should establish whether the patient has any of the following symptoms: wheezing, nonproductive cough and nonparoxysmal, cough at night or with exercise, shortness of breath, chest tightness. A history of tightness or pain in the chest may be present with or without other symptoms of asthma 5.

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Pulmonary functions

Lung function testing should be carried out by well-trained operators with well-maintained and regularly calibrated equipment (spirometry) 6.

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Acupuncture

The long-term uses of medications and its side effects lead the patient to try other alternative and complementary treatments 7. Acupuncture is a complementary and alternative medicine modality and is a key component of traditional Chinese medicine (TCM) 8. Acupuncture describes a family of procedures aiming to correct imbalances in the flow of qi by stimulation of anatomical locations on or under the skin (usually called acupuncture points or acupoints) 9. There are various methods for the stimulation of specific acupoints along the skin of the body such as the application of heat, pressure, or laser or penetration of thin needles 10. Laser acupuncture is one of the interesting modalities of low-level laser therapy, a noninvasive form of phototherapy, which is defined as the stimulation of traditional acupoints with low-intensity, nonthermal laser irradiation 11. The noninvasive and painless nature of treatment makes it particularly useful for providing children with holistic healthcare. Despite the use of low-level, nonthermal laser irradiation instead of needles, it has the same principles of traditional acupuncture and leads to the same biological effect as needle acupuncture 12.

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Aim

The aim of our work was to evaluate the added effect of laser acupuncture application on the severity of asthma and pulmonary functions in asthmatic children under conventional treatment.

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Patients and methods

Study population

The present study is a randomized clinical trial conducted in the acupuncture and laser clinic of the medical excellence center of the National Research Centre of Egypt.

Forty asthmatic children under conventional medical treatment were recruited from the outpatient clinic of asthma and allergy for children in the Abu-Elrish Hospital (pediatric hospital) of Cairo University according to the following criteria inclusion criteria:

  • Age range from 7 to 14 years, to be able to perform the pulmonary function test properly.
  • Established clinical history of asthma.
  • Partially controlled and uncontrolled asthma according to the GINA criteria (2012).
  • Receiving their conventional medical treatment for not less than 3 months.
  • Free from other major health problems.
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Ethical committee

Informed consents were obtained from the parents before starting the study according to the scientific ethical committee rules of the National Research Centre and Hospitals of Cairo University.

All patients included in the study were subjected to the following before and after the laser acupuncture sessions:

  • Asthma history sheet.
  • Thorough clinical examination:
    • General examination.
    • Chest examination.
  • Pulmonary function testing accessed by spirometer Fukuda Denshi Spirosift SP-5000 (Spirometer, Taiwan) to measure the following:
  • Vital capacity percent (VC%), forced vital capacity percent (FVC%), forced expiratory volume in 1 s (FEV1), forced expiratory flow rate (FEF%) (25, 50, 75) percents, forced expiratory flow 25–75% (FEV25–75%), and peak expiratory flow (PEF).

The 40 patients recruited were divided randomly into two groups; each group included 20 patients. Group A (study group) received 12 laser acupuncture sessions besides their conventional medical treatment and group B (control group) received conventional medical treatment only.

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Laser acupuncture sessions

Group A: 20 children were subjected to a laser acupuncture session three times per week for 4 weeks by applying a laser device according to the following criteria:

Diode laser (gallium–aluminum laser) device, wave length 780 nm, and power 100 W. Nineteen acupoints were selected according to TCM for bronchial asthma (Lu-4, Lu-7, Lu-9, LI-4, Bl-13, Bl-23, Ren-17, St-36, and Sp-6); the duration of laser application was 1 min. Energy applied to each acupuncture point was 5 J/cm2, according to the World Association of Laser Therapy recommendation (The Diode laser has no maximum Jules that can be applied on the body as it is safe for children and adults according to World Association of Laser Therapy.).

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Results

Table 1 and Fig. 1 show that there was no significant difference between the study groups in sex.

Table 1

Table 1

Fig. 1

Fig. 1

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Pulmonary function of the studied cases

Table 2 shows that there was no significant difference between the study groups in entry pulmonary function.

Table 2

Table 2

Table 3 shows that pulmonary functions at follow-up were higher in group A than in group B; the differences were statistically significant in VC act, VC cent, best FVC act, best FVC cent, and best FEV1 cent.

Table 3

Table 3

Table 4 shows that there was an improvement in entry pulmonary function at follow-up, but the differences were statistically significant only in VC act, VC cent, FVC act, FVC cent, FEV1 act, FEV1 cent, FEF25 75 act, best FVC act, best FVC cent, best FEV1 act, best FEV1 cent, PEF act, and PEF cent.

Table 4

Table 4

Table 5 shows that there was no significant improvement in basal pulmonary function at follow-up.

Table 5

Table 5

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Clinical condition of the studied cases

Table 6 shows that the frequency of asthmatic attacks reduced in group A at follow-up.

Table 6

Table 6

Table 7 shows that the clinical severity in group A improved significantly in follow-up. The clinical severity in group B did not change significantly in follow-up (Table 8).

Table 7

Table 7

Table 8

Table 8

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Discussion

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.

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Conclusion

Application of laser acupuncture sessions besides conventional medical treatment results in greater improvement in the pulmonary functions and degree of severity in asthmatic children.

Figure

Figure

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Acknowledgements

Conflicts of interest

There are no conflicts of interest.

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References

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 2 www.artp.org 3 www.educationforhealth.org.uk. 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).
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.
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