***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
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    ***EXAMPLES*** 
    Input: A prospect i ve r and omised single-blind study of the effects of real and sham acupuncture on  exercise-induced asthma  was conducted in nineteen children .  Forced expiratory flow in 1st second ( FEV1 ) , forced vital capacity ( FVC ) , and peak expiratory flow rate ( PEFR ) were measured throughout acupuncture and after treadmill exercise . Neither real nor sham acupuncture affected the basal bronchomotor tone but both , when applied 20 min before exercise , attenuated exercise induced asthma : mean maximum percentage falls in FEV1 , FVC , and PEFR were 44.4 % , 33.3 % , and 49.5 % without acupuncture ; 23.8 % , 15.8 % , and 25.9 % after real acupuncture ; and 32.6 % , 26.1 % , and 34.3 % after sham acupuncture . Real acupuncture provided better protection against exercise-induced asthma than did sham acupuncture ( p less than 0.05 ) The present multicentre study evaluates the differences in efficacy between a 3 month rehabilitation programme including drug treatment , and a 3 month control period of drug treatment only , for asthmatic patients and patients with chronic obstructive pulmonary disease ( COPD ) . The programme was run by physiotherapists in eight local practice s , and included exercise training , patient education , breathing retraining , evacuation of mucus , relaxation techniques , and recreational activities . In a r and omized controlled trial with a cross-over design , the effects of rehabilitation were evaluated 3 and 6 months after baseline measurements in terms of exercise tolerance and quality of life ( QOL ) . Exercise tolerance was assessed using submaximal cycle ergometer tests and 6 min walking tests .  QOL was evaluated by means of the Chronic Respiratory Disease Question naire ( CRDQ ) . After 3 months , the patients who started with rehabilitation showed significant improvements in endurance time ( 421 s ) and cardiac frequency ( 6 beats.min-1 ) during cycling , walking distance ( 39 m ) , and total CRDQ score ( 17 points ) compared to the control group . These improvements were still significant after 6 months . Additional analysis indicated that the asthmatic patients and the patients with COPD responded to rehabilitation in a similar way , with the exception that there was a greater improvement in walking distance for asthmatics . Improvements in exercise tolerance were not significantly correlated with improvements in QOL .  Rehabilitation of patients with asthma or chronic obstructive pulmonary disease in local physiotherapy practice s improves exercise tolerance and quality of life A small , controlled trial of joint treatment of childhood asthma by a doctor , a physiotherapist , a psychologist , and a social worker , working together in the family setting , demonstrated an improvement in ventilatory capacity . The limited scope of this trial does not permit more general conclusions as to the effect of such treatment on the severity and frequency of attacks , but the observation that some measurable physiological improvement occurred suggests that the place of multidisciplinary nonpharmaceutical management of childhood asthma should be investigated in more detail Many asthma patients seek alternative or adjunctive therapies . One such modality is reflexology , whereby finger pressure is applied to certain parts of the body . The aim of the study was to examine the popular cl aim that reflexology treatment benefits bronchial asthma . Ten weeks of active or simulated ( placebo ) reflexology given by an experienced reflexologist , were compared in an otherwise blind , controlled trial of 20 + 20 out patients with asthma . Objective lung function tests ( peak flow morning and evening , and weekly spirometry at the clinic ) did not change . Subjective scores ( describing symptoms , beta2-inhalations and quality of life ) and also bronchial sensitivity to histamine improved on both regimens , but no differences were found between groups receiving active or placebo reflexology . However , a trend in favour of reflexology became significant when a supplementary analysis of symptom diaries was carried out . It was accompanied by a significant pattern compatible with subconscious unblinding , in that patients tended to guess which treatment they had been receiving . No evidence was found that reflexology has a specific effect on asthma beyond placebo influence The effects of chest physical therapy in acute severe asthma in children have been studied in 38 children aged 6 to 13 years in a r and omized placebo controlled trial . The study began between 6 and 24 hours after admission to hospital ; 19 children received chest physical therapy ( PT ) and 19 children received placebo visits . Each child had 4 treatments over 2 days which were preceded by nebulized salbutamol .  Lung volumes and flow rates were measured in a body plethysmograph before salbutamol and before and after either PT or placebo on the first and fourth treatments . Throughout the study st and ard asthma drug therapy was given . In both groups characteristics such as sex , race , age , height , weight , severity , and baseline lung function were similar . Taking into account the baseline , lung function at the end of the study was similar in both groups . Three 12 year old children in the PT group showed improvements in flows above those seen in any children in the placebo group . We conclude that chest PT , when combined with asthma drug therapy , does not improve lung function in most children in this age group with acute severe asthma The purpose of this r and omized patient‐ and observer‐blinded cross‐over trial was to evaluate the efficacy of chiropractic treatment in the management of chronic asthma when combined with pharmaceutical maintenance therapy . The trial was conducted at the National University Hospital 's Out‐patient Clinic in Copenhagen , Denmark . Thirty‐one patients aged 18–44 years participated , all suffering from chronic asthma controlled by bronchodilators and /or inhaled steroids . Patients , or who had received chiropractic treatment for asthma within the last 5 years , who received oral steroids and immunotherapy , were not eligible . Patients were r and omized to receive either active chiropractic spinal manipulative treatment or sham chiropractic spinal manipulative treatment twice weekly for 4 weeks , and then crossed over to the alternative treatment for another 4 weeks . Both phases were preceded and followed by a 2‐week period without chiropractic treatment . The main outcome measurements were forced expiratory volume in the first second ( FEV1 ) , forced vital capacity ( FVC ) , daily use of inhaled bronchodilators , patient‐rated asthma severity and non‐specific bronchial reactivity ( n‐BR ) . Using the cross‐over analysis , no clinical ly important or statistically significant differences were found between the active and sham chiropractic interventions on any of the main or secondary outcome measures . Objective lung function did not change during the study , but over the course of the study , non‐specific bronchial hyperreactivity ( n‐BR ) improved by 36 % ( P= 0.01 ) and patient‐rated asthma severity decreased by 34 % ( P= 0.0002 ) compared with the baseline values . The results do not support the hypothesis that chiropractic spinal manipulative therapy is superior to sham spinal manipulation in the management of pharmaceutically controlled chronic asthma in adults when administered twice weekly for 4 weeks The therapeutic effectiveness of classic Chinese acupuncture was compared with " placebo " acupuncture in 15 patients with stable bronchial asthma . The patients received treatments with real and placebo acupuncture in a r and omly ordered , subject and evaluator-blind crossover fashion twice weekly for five weeks . Both real and placebo treatment periods were preceded by three week periods when no acupuncture was administered . Five patients felt better on real treatment , five patients preferred placebo and five did not feel any improvement on either of the two treatments . Treatment with real acupuncture when compared with no treatment and placebo treatment failed to provide any improvement in daily peak flow rates , asthma symptom scores , number of puffs of beta 2-agonist aerosol use , and pulmonary function results Physiotherapy is an established treatment in asthmatic children . One purpose is to increase tolerance towards physical activity , decrease broncho-obstruction and promote elimination of secretions . A positive effect of physical training in asthmatic children has been reported in many studies . An improved working capacity has e.g. been shown after supervised physical training at least twice a week for a period of three months ( 1 ) . This was not a realistic level of training intensity in our clinical practice . Therefore , the goal of this study was to test whether physiotherapy combined with physical training once a week had any effect on working capacity or lung function tests in asthmatic children Thirty patients with proved bronchial asthma receiving treatment with inhaled steroid in dosages of less than 1,000 micrograms daily were subdivided at r and om into two groups of 15 patients . One group received foot zone therapy and the other merely uniform clinical care but without " placebo foot zone therapy " . The " active " group received a total of ten foot zone therapy sessions of one hour at intervals of one week . The asthmatic symptoms , consumption of medicine and the objective pulmonary function parameters were followed-up during the subsequent six months . Decrease in consumption of beta-2-agonists and increase in peak-flow levels were observed in the group which had received foot zone therapy , but the same changes were observed in the control group . The authors do not find that this investigation demonstrates that foot zone therapy is of effect on the disease bronchial asthma . They conclude , however , that the favourable effect in both of the groups are due to increased care and control which occurred in both patient groups BACKGROUND Chiropractic spinal manipulation has been reported to be of benefit in nonmusculoskeletal conditions , including asthma . METHODS We conducted a r and omized , controlled trial of chiropractic spinal manipulation for children with mild or moderate asthma . After a three-week base-line evaluation period , 91 children who had continuing symptoms of asthma despite usual medical therapy were r and omly assigned to receive either active or simulated chiropractic manipulation for four months . None had previously received chiropractic care . Each subject was treated by 1 of 11 participating chiropractors , selected by the family according to location . The primary outcome measure was the change from base line in the peak expiratory flow , measured in the morning , before the use of a bronchodilator , at two and four months . Except for the treating chiropractor and one investigator ( who was not involved in assessing outcomes ) , all participants remained fully blinded to treatment assignment throughout the study . RESULTS Eighty children ( 38 in the active-treatment group and 42 in the simulated-treatment group ) had outcome data that could be evaluated . There were small increases ( 7 to 12 liters per minute ) in peak expiratory flow in the morning and the evening in both treatment groups , with no significant differences between the groups in the degree of change from base line ( morning peak expiratory flow , P=0.49 at two months and P=0.82 at four months ) . Symptoms of asthma and use of 3-agonists decreased and the quality of life increased in both groups , with no significant differences between the groups . There were no significant changes in spirometric measurements or airway responsiveness . CONCLUSIONS In children with mild or moderate asthma , the addition of chiropractic spinal manipulation to usual medical care provided no benefit A 5-day , non-residential exercise and living course for children with asthma is described as a feature of a programme of outpatient physiotherapy .  Eleven children undertaking such a course were compared with 10 asthmatic children in a control group . The subject group showed , in the short term at least , an improvement in bronchial lability , peak flow rates , nocturnal and daytime wheeze , and activity compared with the controls . These findings were statistically significant . There was no difference between the groups in the number of days on which extra medication was taken . A short , sharp course is of benefit physically , socially and psychologically to children with asthma In this pilot study , the authors evaluated the immediate effects of osteopathic manipulative procedures compared with sham procedures on 10 subjects who were diagnosed with chronic asthma . The research followed a pretest-posttest crossover design wherein each subject served as her own control . Blinded examiners recorded respiratory excursion , peak expiratory flow rates , and subjective measures of asthma symptoms . Measurements of both upper thoracic and lower thoracic forced respiratory excursion statistically increased after osteopathic manipulative procedures compared with sham procedures . Changes in peak expiratory flow rates and asthma symptoms were not statistically significant OBJECTIVES The first objective was to determine if chiropractic spinal manipulative therapy ( SMT ) in addition to optimal medical management result ed in clinical ly important changes in asthma-related outcomes in children . The second objective was to assess the feasibility of conducting a full-scale , r and omized clinical trial in terms of recruitment , evaluation , treatment , and ability to deliver a sham SMT procedure . STUDY DESIGN Prospect i ve clinical case series combined with an observer-blinded , pilot r and omized clinical trial with a 1-year follow-up period . SETTING Primary contact , college outpatient clinic , and a pediatric hospital . PATIENTS A total of 36 patients aged 6 to 17 years with mild and moderate persistent asthma were admitted to the study . OUTCOME MEASURES Pulmonary function tests ; patient- and parent- or guardian-rated asthma-specific quality of life , asthma severity , and improvement ; am and pm peak expiratory flow rates ; and diary-based day and nighttime symptoms . INTERVENTIONS Twenty chiropractic treatment sessions were scheduled during the 3-month intervention phase . Patients were r and omly assigned to receive either active SMT or sham SMT in addition to their st and ardized ongoing medical management . RESULTS It is possible to blind the participants to the nature of the SMT intervention , and a full-scale trial with the described design is feasible to conduct . At the end of the 12-week intervention phase , objective lung function 
    Output:
    
REVIEW ER 'S CONCLUSIONS There is insufficient evidence to support the use of manual therapies for patients with asthma .
Currently , there is insufficient evidence to support or refute the use of manual therapy for patients with asthma