A controlled trial of real and simulated acupuncture in the management of chronic asthma

Tashkin, Donald P.; Kroening, Richard; Bresler, David E.; Simmons, Michael; Coulson, Anne H.; H, Kerschnar

doi:10.1016/0091-6749(85)90760-2

Cited by 66 publications

(52 citation statements)

References 17 publications

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“…For the five studies that measured FEV1, the standardised mean difference was 0.17 (95% CI of -0.05-0.39) while the mean FEV1 difference was 3.5 (95% CI 0.3-9.5). The discrepancy for this endpoint may have resulted from the inclusion of the study by TASHKIN et al [23]: it contributes negatively with a large weight in the estimation of the standardised differences between means, whereas its contribution to the pooled estimator of the differences between means is small. The reason for this is that the study by TASHKIN et al [23] shows the largest sample size with the largest variance.…”

Section: Discussionmentioning

confidence: 99%

“…In exploring hetereogeneity of effects across studies, the differences between studies with varying experimental Detrimental effect TASKIN [30] FUNG [26] TASKIN [23] CHOW [ TASKIN [30] FUNG [26] TASKIN [23] CHOW [ designs (crossover, unpaired comparison, paired comparison) and with varying quality in the presentation of the reports were assessed. Nevertheless, these sources of heterogeneity did not seem to affect the final conclusion.…”

Section: Discussionmentioning

confidence: 99%

“…Over 200 possible trials were identified but only 12 satisfied the inclusion criteria [1,2,6,[22][23][24][25][26][27][28][29][30]. One trial published in a Chinese journal [22] could not be recovered as the authors were only able to retrieve a poor translation of the abstract summarising the results, which did not provide the information needed to extract any useful summary data.…”

Section: Description Of the Clinical Trialsmentioning

confidence: 99%

“…Only two of the crossover trials considered the possibility of a period effect [23,24] and none took account of the possibility of a carry-over effect. Consequently, in the present analysis the authors did not assume that either period or carry-over effects were important in any of the trials.…”

Section: Description Of the Clinical Trialsmentioning

confidence: 99%

“…The standardised mean differences showed a slight increase in the heterogeneity statistic (QH=4.93, four df; p=0.29). [2] Parallel group UBM Noninduced DIAS [6] Parallel group UBM Noninduced ABM ABMP FUNG [26] Crossover ABMP Induced by exercise LUU [27] Parallel group UBM Noninduced ABM MITCHELL [1] Parallel group UBM Noninduced MORTON [28] Crossover ABM Induced by exercise TANDON [29] Crossover UBM Induced by histamine ABM TANDON [24] Crossover UBM Noninduced ABM TASHKIN [30] Crossover ABMP Induced by methacholine TASHKIN [23] Crossover ABMP Noninduced UBM: unadjusted; ABM: adjusted by baseline measures; P: reported as percentage of baseline value.…”

Section: Testing the Reliability Of The Estimationmentioning

confidence: 99%

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Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials

Martín¹,

Donaldson²,

Villarroel³

et al. 2002

European Respiratory Journal

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Contradictory results from randomised controlled trials of acupuncture in asthma suggest both a beneficial and detrimental effect. The authors conducted a formal systematic review and meta-analysis of all randomised clinical trials in the published literature that have compared acupuncture at real and placebo points in asthma patients.The authors searched for trials published in the period 1970-2000. Trials had to measure at least one of the following objective outcomes: peak expiratory flow rate, forced expiratory volume in one second (FEV1) and forced vital capacity. Estimates of the standarised mean difference, between acupuncture and placebo were computed for each trial and combined to estimate the overall effect. Hetereogeneity was investigated in terms of the characteristics of the individual studies.Twelve trials met the inclusion criteria but data from one could not be obtained. Individual patient data were available in only three. Standardised differences between means ranging from 0.071 to 0.133, in favour of acupuncture, were obtained. The overall effect was not conventionally significant and it corresponds to an approximate difference in FEV1 means of 1.7. After exploring hetereogenenity, it was found that studies where bronchoconstriction was induced during the experiment showed a conventionally significant effect.This meta-analysis did not find evidence of an effect of acupuncture in reducing asthma. However, the meta-analysis was limited by shortcomings of the individual trials, in terms of sample size, missing information, adjustment of baseline characteristics and a possible bias against acupuncture introduced by the use of placebo points that may not be completely inactive. There was a suggestion of preferential publication of trials in favour of acupuncture. There is an obvious need to conduct a full-scale randomised clinical trial addressing these limitations and the prognostic value of the aetiology of the disease. Eur Respir J 2002; 20: 846-852 Several randomised clinical trials have reported a benefit from acupuncture in the treatment of asthma [1,2], but generally results appear contradictory, suggesting both beneficial and detrimental effects [3,4,5,6]. The efficacy of acupuncture in asthma has not been proven beyond reasonable doubt [7]. This may be due to differences in trial design and mode of treatment or to the small size of the trials. In terms of design, the insertion of a needle prevents the use of blindness to remove the placebo effect and therefore needles are sometimes inserted in "placebo points" [8]. The wide range of outcomes measured using objective tests (peak flow rates) to perceived breathlessness or anxiety introduces another source of variation. Differences in the mode of treatment include a diversity of acupuncture points, periods of stimulation and methods of needle insertion [9]. The size of all the individual studies was only a fraction of the sample size given by a conventional power requirement: 550 patients would be required to detect a standardised d...

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Section: Discussionmentioning

confidence: 99%