Chiropractic Management of 47 Asthma Cases
Today's Chiropractic , November 2000
by William Amalu, DC.
EXCERPTS FROM "Chiropractic Management of 47 Asthma Cases"
Over a seven-year period, 47 cases of asthma were managed in an outpatient setting. Every case was followed for a minimum of two years to observe effectiveness of care. The study group comprised 28 males and 19 females, ranging from 7 to 42 years of age. Of the 47 cases, 32 patients ranged in age from 7 to 19 years.
All of the cases presented with an incoming medical diagnosis of asthma and corresponding classification level. Medical specialists monitored these patients for objective respiratory improvement and medication changes. A thorough initial history and physical examination was performed to corroborate the diagnosis. The chronicity of this condition ranged from 2 to 23 years. Patients with intermittent or exercise-induced asthma were excluded from this study due to the ease of care response in most cases. Of the 47 cases, 11 were classified as mild persistent, 28 as moderate persistent and 8 as severe persistent. Each patient's progress was assessed on every office visit by rating the intensity of the symptoms along with the frequency of their acute medication usage.
Upon stabilizing the upper cervical spine, determined by consistently presenting normal paraspinal infrared images, objective improvement in all 47 asthmatic cases was 87-100 percent. The total time of care to reach this point ranged from 3 to 9 months, with a mean time of 16 weeks. The most common initial care frequency used was 3 times per week with tapering frequency after 4-8 weeks. Total care visits ranged from 14 to 44, with a mean of 26 office visits to stabilization. All 47 patients reported maintaining their improvements at two years or more of follow-up care. The sole care method rendered consisted of corrections of aberrant arthrokinematic function of the occipito-atlanto axial complex, via adjusting with Applied Upper Cervical Biomechanics procedures.
From the 47 subjects in this study, a case of severe persistent asthma has been selected for this report. The patient's presenting symptomatology, profile and case outcome is representative of most of the patients in this classification group. A 12-year-old male was referred to our clinic with the chief complaint of chronic severe persistent asthma. The onset of the patient's symptoms began around 2 years of age. By the age of 4, he was diagnosed as severe persistent. His mother noted that almost anything from dust to cold drafts could trigger an asthmatic attack.
At the onset of care, the patient was using oral medication twice a day and three different inhalers four times per day each for a total of 24 inhalations per day. Even with this level of medication, the patient experienced daily attacks, almost constant wheezing, and a persistent tight and heavy chest. The patient was unable to engage in any physical activities that demanded more than walking. The severity of his condition prompted emergency room treatment approximately five times per year. The patient's mother described countless hours of sleep lost each week due to her son's attacks. His medical specialist advised that, if his condition persisted, by age 30 he would be diagnosed with chronic obstructive lung disease and would be confined to a wheelchair with oxygen by age 45. This dim prognosis, implying a significantly decreased life span, brought his mother to tears as she described her son's condition.
Upon examination, the patient presented with early chest barreling, a mildly increased respiratory rate and persistent inspiratory and expiratory wheezing. His other vital signs, along with ear, nose and throat examinations, were unremarkable.
Orthopedic examination revealed significant palpatory hypertonicity and tenderness of the left C0-C4 paraspinal musculature. A 26 percent overall decrease in cervical active and passive ROM's was noted, along with left paraspinal pain in four of six ranges. Cervical orthopedic tests were found positive for facet joint irritation. Six-axis palpatory spinal joint examination revealed biomechanical abnormalities in the cervical and thoracic spine. The remainder of the patient's orthopedic spinal evaluation was unremarkable. Gross neurological examination was also found to be unremarkable. A high-resolution digital paraspinal infrared imaging analysis (via the Tytron C-3000 paraspinal IR imaging system) was performed in accordance with thermographic protocol. A continuous paraspinal scan consisting of approximately 362 infrared samples was taken from the level of S1 to the occiput. The data were analyzed against established normal values and found to contain wide thermal asymmetries indicating autonomic neuropathophysiology. Since abnormal thermal emissions were noted in the cervical spine, a focused scan was performed with approximately 72 infrared samples taken from T1 to the occiput. For the purpose of ruling out other pathologies, a digitized high-resolution infrared camera study (Inframetrics Forensic System 520) was also performed in accordance with accepted protocols. The scans included all surface aspects of the face, neck, upper extremities and posterior thorax. The posterior neck and thorax image showed disruption of the normal thermal gradient, significant thermal asymmetries, large hypothermic zones and a loss of normal central spinal heat. These images were indicative of long-term abnormal sympathetic regulation as denoted by the areas of thermal loss. As such, these findings are consistent with the clinical representation of long-standing respiratory disturbance.
The physical and infrared imaging examination indicated abnormalities in the upper cervical spine. Consequently, a precision upper cervical radiographic series was performed for an accurate analysis of specific segmental biomechanics. Neutral lateral, AP, APOM and BP films were taken using an on-patient laser-optic alignment system to precisely align the patient to the central ray.
A specialized method of radiographic analysis using mensuration and arthrokinematics was performed. Biomechanical dysfunction was noted at the atlanto-occipital and atlanto-axial articulations.
Executing the Care Plan
Correction of the C1 segment was chosen first, due to the accumulated degree of aberrant atlanto-occipital biomechanics. Before care was rendered, the patient and his parents were advised that exacerbations in symptomatology might occur as part of the normal response to neural reintegration. The patient was placed on a specially designed knee-chest table with the posterior arch of atlas at the contact point. An adjusting force was introduced using a specialized upper cervical adjusting procedure.
The patient was then placed in a post-adjustment recuperation suite for 15 minutes as per thermographic protocol. Correction of the subluxation was determined by resolution of the patient's presenting neuropathophysiology on the post-adjustment paraspinal scans. All subsequent office visits included an initial cervical scan and, if care was rendered, another scan was performed to determine if normal neurophysiology was restored. Since care was focused in the upper cervical spine, only cervical paraspinal scans were taken during normal visits, with full spine scans performed at 30-day re-evaluation intervals. The patient reported a noticeable reduction in his symptoms during the first two weeks of care. Wheezing, along with chest tightness and heaviness began to subside. His mother noticed an increase in the patient's activity levels without the usual increase in symptoms. She also reported that his inhaler use was also slightly decreased.
By the end of the fourth week of care, the patient had reduced his inhaler use from 24 to four times per day. The frequency of his attacks had diminished to tone time per week at the most. The patient's mother couldn't believe the changes seen in her son. From an initial activity level of only walking, he was now participating in running sports.
A reevaluation was performed at this time. The patient's mother noted an 85 percent overall improvement in his condition. The examination revealed significant improvement in all of his initial findings. A full spine paraspinal infrared scan was performed at this time, noting total resolution of the patient's presenting neuropathophysiology.
Continued improvement was seen through week six. The patient had been scheduled for a checkup with his respiratory specialist in order to clear him for school sports. By the time, the patient was using his inhaler on an as needed basis of approximately two times per week. His medical examination revealed a significant improvement in respiratory function. The physician prescribed a 50 percent reduction in the patient's oral medication and cleared the patient for physical activities.
By the end of week eight, the patient was training for his school's 1-mile turkey trot. He was experiencing no asthma attacks, wheezing or chest symptoms. His mother reported that the only time he used his inhaler was during and/or after his training. She also noted a 95 percent overall improvement in his son's condition. All of his initial examination findings had resolved. The frequency in which the patient was presenting with normal paraspinal infrared scans indicated that stabilization of the upper cervical joint complex was occurring. Consequently, frequency of care was decreased at this time.
Over the next four weeks, the patient continued to improve. The only asthmatic symptom reported was mild chest tightness after running. Only one daily dose of oral medication was being used by this time. A digitized high-resolution infrared camera re-evaluation was performed with the images indicating a return of the thoracic thermal gradient and normalization of autonomic neurophysiology. On the day of the turkey trot, he not only finished without using his inhaler, but came in first place.
The patient continued to improve over the next two months. His medical checkups noted a steady improvement in respiratory function. Within six months from the onset of care, the patient was no longer using medication. Close to one year after initiating care, his mother called to tearfully inform me that they had just returned from a checkup with his medical specialist. She reported that the specialist couldn't believe how much respiratory improvement had occurred and that the patient had been diagnosed as non-asthmatic.
For more information on upper cervical chiropractic care, please contact Dr. Erin Elster in Kahului, HI at 808-866-6551 or www.erinelster.com.