SAN FRANCISCO—As patients take more active roles in managing their health, they often use treatments other than prescription drugs without clinical supervision. Many alternative therapies—herbal remedies, homeopathy, acupuncture, massage, aromatherapy, reflexology—have not been proved effective when subjected to rigorous study, but their popularity appears undiminished. For example, a recent study from Blanc et al[1] found that alternative therapy use for asthma and rhinosinusitis is common.

“Health care providers need to be aware that the patients under their care are likely to be combining prescribed therapies with a variety of self-treatments,” said lead author Paul Blanc, MD, MSPH, in an interview with RESPIRATORY REVIEWS. “These treatments may have benefits but may also carry risks, directly or indirectly,” added Dr. Blanc, Professor and Chief of the Division of Occupational and Environmental Medicine at the University of California, San Francisco.

The study cohort comprised 300 adult residents of northern California who, during a telephone interview, reported having a physician diagnosis of asthma or rhinosinusitis (eg, allergic rhinitis, sinusitis, hay fever, or chronic postnasal drip). The asthma group included 125 patients with concomitant rhinosinusitis, but the rhinosinusitis group, which had 175 participants, did not include patients with asthma. Data collection took place for eight weeks from late spring to early summer of 1999.

The study authors segregated therapies into three categories for analysis: herbal treatments; caffeine; and homeopathy, acupuncture, aromatherapy, or massage. Overall, 42% of the participants reported using some type of alternative therapy to treat breathing or nasal symptoms in the prior year. Herbal treatments were the most common; their use was reported by 24% of the participants. Ephedra-containing products were specifically identified by 42% (30 of 72) of the herbal therapy users.

In addition, 18% of the participants said that they used caffeine to treat asthma or rhinosinusitis; 22% used homeopathy or one of the other alternative therapies. The use of caffeine specifically for breathing and nasal symptoms was about twice as common among asthma patients (26%) as it was among those with rhinosinusitis (12%). No statistical difference between asthma patients and rhinosinusitis patients was found for use of any of the other alternative therapies.

Many patients reported using more than one alternative therapy. For example, 47% of the herbal therapy users said that they also used homeopathy, acupuncture, aromatherapy, or massage for their symptoms.

WHO USES ALTERNATIVE THERAPY?

Women were more likely than men to use homeopathy, acupuncture, and massage. Younger people were more likely than older patients to use caffeine as a self-treatment. Low income and Hispanic ethnicity were associated with a decreased prevalence of herbal use. No substantial association was found between insurance status and alternative therapy use. However, 74% of the participants who reported using any alternative practice were also taking prescription drugs to control their conditions. Dr. Blanc recommends, “Ask about all treatments, not just those prescribed by doctors.”

—Martha L. Heckel