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March 11, 2022 12:14 PM EST

During her time working with underserved communities in southwest Philadelphia, Maureen George encountered many unconventional asthma treatments, including the use of homemade botanical teas or tonics.

“You find there’s a rich history of using these home remedies to manage asthma, in part because accessing traditional medicine has been difficult or resulted in disappointing interactions,” says George, a professor of nursing at Columbia University Medical Center in New York City.

George has published research on asthma self-management and the use of complementary or alternative medicine. Even when people don’t encounter barriers to supportive medical care, complementary approaches are commonplace. Some of George’s work has found that 84% of those with asthma prefer to manage their condition with a mixture of traditional and complementary therapies. “The things people use may differ based on race or income or where they live, but everywhere, you see this desire for an integrated approach,” she says.

Mind-body therapies such as yoga, mindfulness-based practices, and breath training are all popular complementary treatments. Even though some popular mind-body therapies such as yoga, mindfulness–based practices, massage, and breath training may provide quality-of-life benefits, the evidence does not suggest that any of these treatments can provide clinically meaningful improvements among those with severe asthma. “If you look at the evidence, which we have done many times, you find that actually nothing is convincingly effective,” says Dr. Edzard Ernst, professor emeritus of complementary medicine at the University of Exeter in the U.K.

Ernst allows that some treatments may provide indirect benefits for people with severe asthma. But he also sees risks. “Some alternative practitioners claim that they are a true alternative to conventional medicine—so you [the patient] can leave your inhaler at home or stop taking your medication,” he says. “I see a real danger there, because asthma is potentially deadly.”

Others reiterate these warnings—although they see a place for complementary approaches in the treatment of severe asthma. “There is no good evidence that these treatments can alter the immediate course of asthma, or, more importantly, cure the disease,” says Dr. Nicola Hanania, director of the Airways Clinical Research Center at Baylor College of Medicine.

On the other hand, Hanania says that quality of life is an important measure of patient outcomes, and there’s evidence that several treatments may improve it for people with severe asthma. He doesn’t discourage talk of such approaches when his patients bring them up. “When you get an asthma attack, it’s like drowning—it’s the worst feeling ever,” he says. Especially for those with severe asthma—a group that comprises roughly 10% of all asthma patients—the desire to do everything within one’s power to mitigate the condition is reasonable. “One thing that patients don’t want to hear is no for everything,” he says of complementary approaches. “If it’s not negatively affecting their well-being, or they’re not spending too much, I’m not dismissive.”

However, he says that any discussion of such treatments must emphasize that these should be used only as truly complementary therapies—meaning they should be employed alongside, never in place of, doctor-prescribed treatments or medications.

So what exactly does the research say? Here’s a rundown of the evidence on the most popular complementary approaches.

Mindfulness-based stress reduction

Mindfulness seems to be everywhere these days. The popular practice, which borrows much from various forms of Eastern meditation, attempts to train the mind to better attend to its present-moment thoughts, emotions, and experiences in a nonjudgmental way. Mindfulness-based stress reduction, or MBSR, is a form of group therapy developed at the University of Massachusetts that uses mindfulness techniques to help people manage stress in ways that may provide medical benefits.

For a 2012 study in the journal Thorax, researchers at UMass looked at the benefits of MBSR among people with asthma, including those with severe asthma. They found that eight weeks of mindfulness training did not result in any lung-function improvements, but it did produce “lasting and clinically significant” quality-of-life improvements. These included a reduction in activity limitations and asthma symptoms—improvements that were comparable to those prior research had linked to inhaled corticosteroids.

“One of the things mindfulness training does is it focuses people on their relationship with their internal experience in ways that can decrease anxiety or arousal,” says James Carmody, co-author of the study and a professor at the University of Massachusetts Medical School. MBSR may help people with asthma control their fear, stress, and other symptom-stoking thoughts or emotions, he says.

The people in his study underwent eight weeks of MBSR training composed of a 2.5-hour weekly education session, as well as daily solo practice. “It was a demanding program,” he says. “For a lot of people, that’s just not going to be feasible.” However, he says other research efforts—not on asthma specifically, but on MBSR—have found similar benefits with shorter or less-intensive interventions.

Breath training

Every runner knows that poor form can lead to injury. Proponents of some popular “breath work” programs have similar views about respiration. The big idea here is that by learning to breathe properly, a person can prevent or mitigate asthma attacks or other respiratory problems.

One of the most popular and closely examined of these breath-work practices is called Buteyko. It’s named for a Soviet doctor who developed its principles in the 1950s. “There are Buteyko clinics all over the U.S. and Europe, and there are books and videos online to teach people how to practice the method,” says Baylor’s Hanania.

In a nutshell, Buteyko believed that dysfunctional breathing habits—such as breathing through one’s mouth or breathing into the chest instead of the stomach—can cause problems, including asthma. His namesake technique teaches breathing practices and habits that some research has linked to asthma improvements, including a reduced need for inhaled corticosteroids and improved quality of life.

Read More: The Breathing Technique a Navy SEAL Uses to Stay Calm and Focused

Many of Buteyko’s techniques overlap with those of older breathing exercises, including pranayama—a method of controlled breathing closely linked with yoga. Another form of breath retraining known as the Papworth method uses similar methods, combined with relaxation training. Some research on these different practices has found evidence of symptom improvements among people with asthma.

“There is certainly some evidence for effectiveness,” says Columbia University’s George. However, she has found that practitioners of these methods often overpromise in ways that could be dangerous for people with severe asthma. “They’d be saying to patients that if you learn how to breath correctly, you can come off your corticosteroids,” she says.

Breath training holds promise as an adjunct therapy for asthma. Also, some clinical trials—including a 2008 study of Buteyko in Respiratory Medicine—have found no evidence of adverse effects. But more work is needed to substantiate the usefulness of these practices.

Acupuncture

Acupuncture has long been among the top alternative treatments for people with asthma. It has also been the subject of intense scientific scrutiny. According to a 2020 paper in the journal Medicine, some randomized clinical trials have found that acupuncture may relieve symptoms and improve quality of life in people with asthma by reducing immune-system activity and improving bronchial-muscle tone. Acupuncture also appears to be quite safe. However, some trials of acupuncture have found no benefit for people with asthma.

“I think one of the difficulties is that a lot of these studies are bedeviled by problems in methods,” says Ian Mitchell, professor emeritus of pediatrics at the University of Calgary in Canada. Mitchell has published work on acupuncture for asthma. He found that studies of the practice have tended to be small or poorly designed. True acupuncture has often failed to outperform sham acupuncture (needles inserted at random). While he allows that the practice may “desensitize” people to discomfort in ways that may lessen the burden of asthma, he says the research to date does not support acupuncture for the treatment of severe asthma.

Read More: Why Acupuncture Is Going Mainstream in Medicine

Manual therapy

Several acupuncture treatments involve touching or manipulating a person’s body in ways that are purported to be therapeutic. These include different osteopathic or chiropractic techniques, including craniosacral massage. During this treatment, a chiropractor or other practitioner gently touches a person’s upper body and head in order to monitor and correct the flow of fluids through the central nervous system.

“It’s a noninvasive type of hands-on body treatment,” explains Dr. Sharmilee Nyenhuis, an assistant professor of medicine at the University of Illinois, Chicago. Nyenhuis has conducted research on craniosacral massage among people with asthma. “The study found improvements in asthma-related quality of life,” she says. However, it detected no significant improvements in medication use, lung function, or measures of anxiety or stress. “I would say that these treatments need further study to see if they are beneficial in the treatment of asthma,” she says.

A 2019 research review in the journal Breathe came to similar conclusions about massage. While some research has turned up quality-of-life benefits, more work is needed, its authors concluded.

When it comes to other chiropractic treatments, some experts say people with asthma should stay away. “Chiropractic is by no means free of adverse events,” Ernst says. Some research has found that 42% of people who underwent chiropractic treatment experienced unpleasant aftereffects. “I see a real danger with uncritical promotion of this as a complementary treatment for asthma,” he says.

Yoga and tai chi

Both yoga and tai chi are traditional mind-body practices that combine breathing techniques with carefully coordinated movements. There’s some evidence that both may benefit people with asthma. A 2008 study in the journal Chest found that tai chi training improved exercise capacity among people with severe asthma. After six weeks of daily practice, bronchial hyper-reactiveness also seemed to improve, that study found.

The research on yoga for asthma is more robust. There, several good studies have found evidence of improved quality of life and reduced symptoms. However, some research reviews have found broadly mixed results.

Baylor’s Hanania has studied some yoga techniques for the treatment of chronic obstructive pulmonary disease, or COPD. He says he is “very supportive” if his asthma patients want to try yoga—mostly because it seems to be a low-risk and healthy form of exercise.

Read More: 5 Yoga Poses for Better Sleep

Better Conversations, Better Care

The research on some complementary treatments is promising. But whether any of these truly “work” is often beside the point, says George. “The fact is that people are going to try these either way,” she explains. “If conversations about them are met with hostility or derision, patients are going to make decisions on their own.”

She advises clinicians who treat people with asthma to ask their patients what they’re doing to manage their condition, and not to be dismissive of these types of treatments. “I think it’s critically important to be supportive of these,” she says. “If it makes the person feel better, and, most importantly, if it’s safe, I don’t care if there’s evidence to support it. Let’s build that into their management plan.”

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