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RESEARCH LIBRARY - DOCUMENT [111]

Category: Case Studies
Date 29-jul-2007
Case Title Upper Cervical Chiropractic Care of A Pediatric Patient with Asthma
Author Julie Mayer Hunt, D.C., D.I.C.C.P.
Main Condition/ Disease  Asthma
Source Journal of Clinical Chiropractic Pediatrics, Volume 5, No. 1 2000
Abstract Objective: To discuss observations of the effects of chiropractic care on asthma symptomology in a four-year-old female patient over a period of three years.

Clinical features: A four-year-old female was diagnosed with asthma at 21/2 years of age. Treatment consisted of utilization of a humidifier and Ventalin inhaler. By the time the patient was 31/2 years old. the Ventalin inhaler was not controlling her symptoms. The patient was taken to a hospital emergency room and after one dose of nebulizer her symptoms were relieved. Approximately one year later the nebulizer was no longer effective and the patient was nearly hospitalised. The patient sought chiropractic care in March 1996 just prior to her fifth birthday.

Intervention and Outcome: Following a two-month reduction based treatment frequency plan. the patientís asthma symptoms steadily improved and overall growth rate distinctly progressed. The patient's mother reports only one mild episode since treatment was initiated.

Conclusion: This case report illustrates chiropractic management of asthma symptoms. Chiropractic care was approached with the hypothesis that reduction of the upper cervical subluxation complex may result in improved function of the respiratory system.
Summary INTRODUCTION

Asthma is the most common chronic condition in children. It is characterized by recurring episodes of coughing, wheezing, dyspnea, and chest tightness. 1.2 The majority of children who have asthma experience their first episode by the time they are four to five years old. The severity and rate of recurrence of these episodes is influenced by a number of factors. These factors include physical and mental fatigue, exposure to irritants/allergens, endocrine changes, stress and emotional situations.3 Common irritants/allergens that trigger adverse reactions in children are cigarette smoke, dust mites, pet dander, molds, cockroach allergens, pollens and various foods. 4, 5,6,7,8 Endocrine changes that effect asthma include pregnancy, menses, and thyroid dysfunction.9 Additionally, symptoms have been triggered by certain medications such as aspirin, beta-adrenergic antagonists, sulfating agents, NSAIDS, ACE inhibitors and tartrazine, a coloring agent. 1,2,9,10
When an asthma attack is initiated, the airways are narrowed, due to bronchospasm, swelling of the mucus membranes, and mucus production. The response is an overreaction of tracheobronchial tree to the stimuli. 1, 2 These obstructive changes in the respiratory airways may lead to hypoxemia, carbon dioxide retention, respiratory acidosis and even respiratory failure. 4,5, 6, 11
The incidence of this condition has risen dramatically over the past ten years. It has been estimated that four to five percent of the United States population is affected by this episodic disease.4, 5, 6 Of those affected, approximately 4.8 million are under the age of eighteen. Asthma has been cited as the reason for one quarter to one third of all missed school days.12, 13, 14 Even more serious is that hospitalizations and mortality rates have increased.12, 13, 14, 15, 16 0ver the past several years, hospitalisations have increased 10% in the 15 and younger population. The mortality rates have increased 30% over the last ten years.l0, 12, 13, 14 This is possibly due to underestimation of the severity of an attack and lack of timely and adequate treatment. 4, 5, 6 as well as in- creased toxins in the environment. These deaths are largely preventable.12, 13, 14
This condition is normally treated in the medical community in the following manner. The patient is instructed to avoid contact with known or suspected irritants. This may include the removal of carpeting and drapery, use of a humidifier to condition the air, etc. The patient, or parent of the patient, is educated about the course of the condition for a more thorough understanding of how serious an attack can become. It is recommended that the patient remain adequately hydrated in order to facilitate the expectoration of mucus. Medications that may be used include bronchodilators such as theophylline and adrenergic drugs, and anti-inflammatory drugs such as corticosteroids and cromolyn sodium. And, if indicated by evidence of infection, an antibiotic may be prescribed.4, 5, 6, 17

CASE

This case study involves a four-year-old girl who accompanied her mother for chiropractic evaluation following a motor vehicle accident. The patient's history included normal gestation and relatively quick delivery that included the administration of pitosin and demoral. The child suffered a fractured collarbone during the birthing process. The child received the regular immunizations and was breast-fed for six months with supplementation during the last three months. When the child was approximately 6 months old she began to experience difficulty breathing. The parents purchased a humidifier that seemed to help the child's condition. At one year of age the child was taken to her pediatrician for difficulty in breathing and congestion. The pediatrician prescribed an over the counter decongestant {Robitussin) and the child experienced a severe reaction to it, including a dramatic increase in heart rate accompanied by shallow breathing. The pediatrician recommended discontinuance of the medication and instead suggested using vapor rubs in conjunction with the humidifier.
The child suffered an injury to her leg at fifteen to sixteen months of age after slipping on the kitchen floor. The parent initially thought the child had broken her leg because she did not walk for one week after the incident. X-ray examination demonstrated no evidence of fracture.
Approximately one year later, the child woke up with croup. After examining the child the physician diagnosed her with asthma and prescribed a Ventalin inhaler.
Following the recommendations of her doctor a steam inhaler was purchased and environmental measures were taken. These measures included removal of all carpeting, having no pets, and cleaning the air conditioning unit.
Another trauma occurred in October 1994 when the child fell and lacerated her chin, which required three stitches. The next winter (1994), the child was taken to the emergency room in respiratory distress. The Ventalin inhaler was not controlling her symptoms. Following one dose of nebulizer, the child's symptoms were relieved.
In July 1995, the child was a backseat passenger in a motor vehicle accident. She was crouched on her knees and wearing a seatbelt when the accident occurred. The impact caused her to strike her head on the back of the front seat. In November of 1995 the four-and-a-half year old child was nearly hospitalized after receiving 3 doses of nebulizer, which was ineffective in controlling her symptoms. In January 1996, she was again taken to the hospital in distress. Following this episode the pediatrician prescribed steroid medication for two to three months and an inhaler for the management of her asthma.

EXAMINATION AND CHIROPRACTIC CARE

The mother sought care at this office for injuries sustained in the November 1995 accident. The child accompanied her mother to her office visits. However in the absence of any head/neck complaints, the author hesitated to initiate any x-ray examination and treatment for the child. In March 1996, a senior associate doctor had a discussion of the child's recent attack of asthma with the mother during her regular visit. Consequently, on March 5, 1996, the mother chose to initiate chiropractic care for her child.
Positive findings of objective testing suggested mild articular pillar pressure C2 right with mild to moderate muscular spasms and loss of vertebral motoricity. Cervical spine x-rays were essentially negative for fracture, dislocations and intrinsic bone disease. The loss of the normal cervical lordosis was noted. Orthospinology technique films (nasium and vertex) were suggestive of vertebral dysponesis. The analysis suggested atlas right one degree with anterior rotation of three degrees, Axis measured right one degree with spinous rotarion of right one degree. The lower cervical angle (C6 level) measured left one degree. These measurements were formulated into a line of correction and Upper Cervical Specific adjustments were initiated. The diagnosis arrived at was segmental dysfunction of the occipito-atlanto-axial region.
Chiropractic orthospinology adjustments were per- formed utilizing the Laney instrument contacting the right transverse process in the side-Iying position. The care plan frequency was twice weekly for two weeks, once weekly for seven weeks, then once biweekly for two months.

OUTCOME

The parent related that the patient has had one minor episode of mainly nasal congestion since treatment was initiated. As of fall/winter 1998, there have been no further episodes. The parent observed that when the patient experienced a mild to moderate trauma or after 'rough housing' she would begin to sniffle, sneeze or wheeze. On January 22,1997, rough housing with her father the previous evening brought on symptoms of sneezing and wheezing. May 1, 1998, the patient was pulled out of a play tube and landed on her head and back. She began wheezing on May 3, 1998. Another incident occurred on September 10, 1998, when the little girl fell off a stool in the bathroom and hit her head. A little while later she began wheezing. The parent related that she believed the chiropractic adjustments allowed the symptoms to subside before they became a full-blown asthma attack. A study by Lee and Arroya investigated the accuracy of parental monitoring of asthma symptoms. The parent was taught to recognize wheezing by listening to their child's breathing. The study compared results from the parents with the physician's. The study concluded that parents could learn how to better detect wheezing and that these skills would assist them in making decisions involving care and medications for their child.25 This parent had been successful in monitoring her child's symptoms.
Another observance in the improvement in the child's health was the increase in the child's height and weight percentiles. According to the Ross laboratories physical growth NCHS percentiles chart, the patient's height rose from approximately 35% before treatment to approximately 60% in 1998, an increase of 25%. The weight percentiles showed a 20% increase from 25% at the beginning of care to 45% in 1998.
The child's overall health and quality of life appear to have been significantly improved since initiating chiropractic care. The asthma symptoms have all but completely disappeared. The patient's mother recognizes the need for check ups, particularly when symptoms of sniffling and/ or wheezing begin. The parent also states that when the child was growing up she had to constantly run the humidifier and there is no need to do that now.


DISCUSSION
Although asthma is a common disorder, the pathogenesis is unclear. A popular hypothesis is one involving decreased airway passages after exposure to an irritating stimulus that causes an intense local inflammatory reaction. 1, 2, 17 This reaction is an exaggerated response that could be influenced by neurological dysfunction of the parasympathetic nervous system, sympathetic nervous system or both.15, 18, 19, 20 A survey conducted by Vallone and Fallon discussed protocols of chiropractic for children with asthma. Of the 33 doctors who participated, all initiated spinal adjustments primarily to the thoracic spine, and Cl/ C2 region.21 The sympathetic nervous system is affected by the thoracic spine; especially T2 to T7 and a subluxation here could lead to decreased sympathetic impulses. The parasympathetic nervous system would be affected by subluxation from occiput to C5, sacrum or ilium. Particularly of note would be the location of respiratory centers in the brainstem and the brainstem's close proximity to the upper cervical region.22, 23, 24 The facilitation of respiratory parasympathetic impulses causes cholinergic tone to be out of balance. The sympathetic nervous system regulates the cholinergic tone, opens the airways, and reduces mucus secretion and edema.18, 19, 20 If this delicate balance is not maintained, symptoms such as we see in asthma, could manifest. This case presents several accounts of exacerbation of asthma symptoms following traumas of various severities. After adjustments of the upper cervical spine the symptoms resolved .
The patient's condition had been progressively worsening prior to chiropractic care. After adjustments of the upper cervical spine were initiated, the patient's symptoms significantly decreased.

CONCLUSION

This study describes chiropractic care of a pediatric patient with asthma. If the nervous system integration is altered to the respiratory system, then it stands to reason that the function of that system would be adversely affected. If this interference is removed by the reduction of the vertebral misalignment, the function of that system may improve.
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4. Canny GJ, Levinson H. Childhood asthma: A rational approach rorrearmenr. Ann Allergy 1990;64:406.
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11. Wiles MR. Visceral disorders related to the spine. In: Gatterman MI. Chiropractic Management of Spine Related Disorders. Baltimore, MD: Williams & Wilkins, 1990; 391-393.
12. American Academy of Pediatrics, Provisional Committee on Quality Improvement. Practice parameters: the office manage- ment of acute asthma exacerbations in children. Pediatrics 1994; 93:119-127.
13. Buist AS and Vollmer WM. Preventing deaths from asthma. N EnglJ Med 1994; 331:1584-1585.
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18. Carr E, Donahue J. The notes: Gonstead seminar notes. Mt Horeb, WI: Gonstead Seminar of Chiropractic (no copyright date).
19. Kaliner M, et al. Autonomic nervous system abnormalities and allergy. Annals oflnternal Medicine 1982; 96(3): 349-357,
20. Weiss EB. Bronchial asthma. CIBA Clinical Symposia 1975;27(1&2).
21. Vallone S, Fallon J. Treatment protocols for the chiropractic care of common pediatric conditions: otitis media and asthma. JClin Chiropractic Pediatrics 1997; 2(1): 113-115.
22. Vernon LF, Vernon GM. A scientific hypothesis for the efficacy of chiropractic manipulation of the pediatric asthmatic patient. Chiropractic Pediatrics 1995; 1 (4):7-8.
23. Killinger LZ. Chiropractic care in the treatment of asthma. Palmer Journal of Research 1995; 2(3):74-77.
24. Barr M, Kierman J. The Human Nervous System: An Anatomical Viewpoint 6th Ed. Philadelphia, PA: Lippincott, 1993: 373-4.
25. Lee H, Arroya A, Rosenfeld W. Parents' evaluations of wheezing in their children with asthma. Chest 1996; 109(1):91-3.
Keywords Asthma, respiratory disorders, upper cervical chiropractic, Orthospinology
 

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