Placebo As Good As Asthma Drug, Say Patients

Editor's Choice
Academic Journal
Main Category: Respiratory / Asthma
Also Included In: Complementary Medicine / Alternative Medicine
Article Date: 13 Jul 2011 - 17:00 PDT


Who is right when patients say they get the same relief from placebos for their asthma symptoms as their prescription drug, while clinical tests find that only the medication has any significant effect? These surprising findings were reported by Harvard University researchers in the latest issue of NEJM (New England Journal of Medicine).

Symptoms of wheezing and coughing, according to participating stable asthma patients, improved with placebo inhalers (inhalers with dummy drugs in them) and fake acupuncture, to the same extent as with an albuterol inhaler, the patients reported.

In this double-blind, crossover pilot study, 46 patients were randomly selected into four groups:

• Albuterol inhaler group
• Placebo inhaler group
• Sham acupuncture group
• No intervention group

The degree of symptoms relief listed below surprised the researchers:

• Inhalation of albuterol - 50%
• A placebo inhaler - 45%
• Sham acupuncture - 46%
• No intervention - 20%

The authors wrote:

"Placebo effects can be clinically meaningful and can rival the effects of active medication in patients with asthma."

However, when testing lung function, the researchers only detected a significant improvement among those given albuterol - it had a strong objective effect on airflow - a mean 20% improvement in forced expiratory volume in 1 second, compared to the 7% boost in the placebo and sham acupuncture groups.

However, the scientists warned:

"The patients could not reliably detect the difference between this robust effect of the active drug and the effects of inhaled placebo and sham acupuncture."

Subsequent studies should focus on this mind-body interaction so that doctors and researchers can determine what exactly goes on during a placebo effect.

What should a doctor do? Should they ignore the patients' subjective feedback and rely entirely on the objective clinical test results? The authors advise doctors to interpret patient feedback with caution and still rely more on objective results. However, they add that a patient's subjective description of his/her experience should not be seen simply as wrong because they clash with the test results.

The human mind obviously plays an important part in how an asthma patient responds to various types of treatments. Doctors should become more aware of this and understand that showing that you are really trying to help the patient may go a long way to making them feel better.

"Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma"
Michael E. Wechsler, M.D., John M. Kelley, Ph.D., Ingrid O.E. Boyd, M.P.H., Stefanie Dutile, B.S., Gautham Marigowda, M.B., Irving Kirsch, Ph.D., Elliot Israel, M.D., and Ted J. Kaptchuk
N Engl J Med 2011; 365:119-126July 14, 2011

Written by Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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