Physicians should encourage discussions about alternative therapies

November 07, 2001

Physicians should encourage their patients to talk about their use of alternative and complementary therapies, says Esther Langmack, M.D. Dr. Langmack reviewed alternative therapies used for asthma and chronic obstructive pulmonary disease (COPD) in a talk Wednesday, November 7, at the annual meeting of the American College of Chest Physicians, in Philadelphia, PA.

Dr. Langmack says there is little scientific evidence to support the use of alternative therapies, such as homeopathy, herbs, and acupuncture, for asthma and COPD. In fact, there is growing evidence that some can cause harm. But she believes that physicians need to engage their patients in conversations about alternative therapies.

"If you ask patients why they use alternative or complementary medicines you can jump-start an important conversation," says Dr. Langmack, a pulmonologist at National Jewish Medical and Research Center. "You can learn about false impressions that complicate treatment and discover symptoms and side effects you may not have known about--crucial information for any good physician."

Talking to patients about alternative therapies is important, says Dr. Langmack, because increasing numbers of patients are using them, often without their physician's knowledge. While a number of therapies are probably harmless, others may pose considerable risk.

"In the past, many physicians have tended to dismiss any use of alternative medicines with a stern lecture. That kind of approach only makes it more difficult to learn what a patient is doing and why," says Dr. Langmack.

Asking why a patient wants to use alternative medications can not only lead to a better understanding of the patient, but also give the physician an opportunity to correct false impressions about both traditional and alternative therapies. Several respiratory patients have told Dr. Langmack that they sought alternative therapies because they wanted to avoid becoming addicted to oxygen. Oxygen is not addictive.

Dr. Langmack's review of the current scientific and medical literature convinced her that some alternative therapies, such as homeopathy, yoga and acupuncture, are probably safe. Trials of acupuncture have offered tantalizing, but inconclusive, evidence of positive effects in the treatment of respiratory disorders. Other alternative therapies, such as herbal medications, vitamin supplements, and restrictive diets pose greater risks to patients.

"You have to be really wary about herbal medications, because it is very hard to know what your patient is getting," says Langmack. "Although most are probably safe, a few have been reported to contain a variety of contaminants, ranging from aspirin, steroids and narcotics, to toxic substances such as lead, mercury, and arsenic." Langmack says that most adulterated or contaminated herbal medications have come from India or Southeast Asia.

Dr. Langmack reserved her strongest warnings for herbal preparations, such as ma huang, that contain ephedra. Some asthma and COPD patients have tried it probably because ephedra is a bronchodilator, which can open the airways. But it has several side effects that can lead to heart attacks, strokes and blood-pressure crises. Traditional bronchodilators, such as albuterol, have considerably fewer side effects.

Licorice, a plant used not only in flavoring but also in herbal mixtures, inhibits steroid metabolism. Dr. Langmack says that asthma and COPD patients who use licorice to reduce their steroid medications, are still exposing themselves to steroids and their potential systemic side effects. The amount of licorice used to flavor candy, however, poses little to no risk, says Dr. Langmack.

National Jewish Health

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