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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 theres 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 dont encounter barriers to supportive medical care, complementary approaches are commonplace. Some of Georges 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, mindfulnessbased 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 medicineso 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 warningsalthough 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 theres evidence that several treatments may improve it for people with severe asthma. He doesnt discourage talk of such approaches when his patients bring them up. When you get an asthma attack, its like drowningits the worst feeling ever, he says. Especially for those with severe asthmaa group that comprises roughly 10% of all asthma patientsthe desire to do everything within ones power to mitigate the condition is reasonable. One thing that patients dont want to hear is no for everything, he says

of complementary approaches. If its not negatively affecting their well- being, or theyre not spending too much, Im 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? Heres 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 symptomsimprovements 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, thats just not going to be feasible. However, he says other research effortsnot on asthma specifically, but on MBSRhave 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. Its 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 Baylors Hanania.

In a nutshell, Buteyko believed that dysfunctional breathing habitssuch as breathing through ones mouth or breathing into the chest instead of the stomachcan 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.

Many of Buteykos techniques overlap with those of older breathing exercises, including pranayamaa 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.

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There is certainly some evidence for effectiveness, says Columbia Universitys George. However, she has found that practitioners of these methods often overpromise in ways that could be dangerous for people with severe asthma. Theyd 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 trialsincluding a 2008 study of Buteyko in Respiratory Medicinehave 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.

One of the most popular and closely examined of these breath-work practices is called Buteyko. Its 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 Baylors Hanania.

In a nutshell, Buteyko believed that dysfunctional breathing habitssuch as breathing through ones mouth or breathing into the chest instead of the stomachcan 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.

Many of Buteykos techniques overlap with those of older breathing exercises, including pranayamaa 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.

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There is certainly some evidence for effectiveness, says Columbia Universitys George. However, she has found that practitioners of these methods often overpromise in ways that could be dangerous for people with severe asthma. Theyd 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 trialsincluding a 2008 study of Buteyko in Respiratory Medicinehave 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.