Guest Blog by Sara Castoldi MSc (Hons) Ost
Childhood asthma is one of the most common respiratory disorders worldwide with increased prevalence in Western societies. According to World Health Organization (WHO, 2011) it is the most common chronic disease among children and in early childhood males are more susceptible to asthma than females (Tantisira et al, 2008). In particular, male preterm infants have higher rates of asthma incidence and chronic lung diseases (Drevenstedt et al, 2008). A number of factors have been implicated in the cause of childhood asthma. These include genetic predisposition, environmental stimuli during prenatal and early childhood that include allergens, maternal infection and smoking during pregnancy, tobacco smoke, mode of birth delivery, viral respiratory illness, obesity, diet, hygiene and toxic exposures.
Breastfeeding is strongly associated with reduction of respiratory illness in later childhood and adolescence. Maternal milk apart from its nutritional components has been shown to have a protective role in the newborn infant and also play an important role in the early acquired immune programming (Hanson et al, 1990). Furthermore, chronic respiratory complaints, such as rhinitis and asthma, may be attributed to food allergy (James, 2003).
In the last decade there has been a dramatic increase in the incidence of childhood asthma. The modern industrialised lifestyle appears to be a significant contributor to asthma exacerbation rather than the genetic factors. In modern societies improved hygiene in combination with vaccination and early use of antibiotics (Murk et al, 2011), result in a reduced incidence of infection that would normally stimulate the infant’s immune system (McRae and Wong, 2002).
It is also important to consider the role of psychosocial factors such as emotional stress of both mother and infant, maternal anxiety or depression and ineffective maternal responsive caregiving in early infancy are strongly associated with childhood asthma and allergies (Dieter, 2011).
A difficult diagnosis
To date, evidence suggests that early intervention is important (NHLBI, 2007). However, diagnosing pre-school children is difficult and often results in undertreatment of asthmatics and overtreatment of transient wheezes (Brand et al, 2008). The diagnosis is a clinical one and, consequently, it is largely based on reported symptoms. However, many symptoms that support an asthma diagnosis in young children are not necessarily “asthma specific” (Cave and Atkinson, 2014). For example, cough and wheezing may be seen in healthy children or are characteristic of other paediatric diseases (Bush, 2007).
Osteopathic treatment can be used in treating patients with childhood asthma as it is a safe and non-invasive means of enhancing treatment. An osteopath aims to affect therapeutic responses via three distinct physiologic mechanisms, which are part of three main osteopathic models.
Firstly, the evaluation and treatment of the musculoskeletal system and a recognition of its role in patients’ well-being are essential. Although pharmacologic agents have been proven effective improving asthma symptoms, the structural component of respiration is clearly not addressed by pharmacologic therapy. Because it is an integral component of the respiratory mechanism, it follows that maximization of its efficiency allows for improved respiratory function (Guiney et al, 2005).
In patients with asthma, techniques that focus on the thoracic structures can be employed to maximize the effectiveness of the respiratory cycle. A fully effective respiratory cycle can be achieved by increasing the mobility of the thoracic cage and the thoracic spine to allow for full excursion of the ventilatory mechanism (Guiney et al, 2005). Patients with asthma who have suffered exacerbations that result in overuse injuries to the respiratory muscles and joints will benefit from releasing those strains.
The second physiologic mechanism intended to affect therapeutic response in the patient is the normalization of autonomic nervous system function. Branches of the nervus vagus provide parasympathetic innervation to pulmonary structures and the respiratory diaphragm. The sympathetic supply originates in the first four or five thoracic spinal cord segments and the synapse to the costovertebral junctions in the upper thorax. Therefore, treatments that restore motion to the occipitoatloid and upper thoracic regions will improve responsiveness to adrenergic stimuli (Szentivaneji and Goldman, 1997).
In addition, asthma itself produces a self-sustaining cycle of viscerosomatic and somatovisceral reflexes long recognized in the osteopathic medical literature (Beal and Morlock, 1984). As a result of this conventional approach to treating asthma, breathing efficacy is not maximized and destructive somatovisceral pathways are allowed to continue their negative facilitative influence on the chronic cycle of recurrent asthma.
Finally, osteopathic treatment can facilitate lymphatic flow to and from the bronchial tree. Tissues become oedematous and metabolic waste products accumulate when lymphatic flow is impeded, adversely affecting cellular function and contributing to disease. Treatment to release strains in the myofascia, the support structure of lymphatic vessels, reduces congestion in the airways of patients with asthma (Degenhardt and Kuchera, 1996).
Based on these mechanisms, osteopathic manipulative techniques have been shown to increase vital capacity and rib cage mobility, improve diaphragmatic function, enhance the clearing of airway secretions and possibly enhance autoimmune function (Rowane, 1999).
Notable improvements in patients’ peak expiratory flow rates have been reported following the use of osteopathy (Paul e Buser, 1996). This positive effect has been attributed to several factors, including a decrease in patients’ levels of anxiety, autonomic nervous system changes that relax the airways and smooth muscle tone and, importantly, a mechanically improved chest wall motion.
Bockenhauer et al (2002) found that thoracic cage excursion with forced respiration increased significantly after a single brief intervention using osteopathic techniques.
Guiney et al (2005) conducted a randomized controlled trial attempting to demonstrate the therapeutic relevance of osteopathic treatment in the paediatric asthma population. Results for experimental group showed a statistically significant improvement for peak expiratory flow rates.
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