Osteopathy and Asthma


Before discussing the osteopathic management of patients with asthma, it is important to recognise that osteopathy does NOT cure asthma. However, osteopaths do treat people with asthma, focussing on alleviating the musculoskeletal effects of this respiratory condition. There is anecdotal evidence that osteopathic treatment can reduce the severity and duration of asthma attacks, but there is no reliable formal evidence (such as randomised clinical trials) supporting this.

What is Asthma?

Asthma is defined as “increased irritability of the bronchial tree with paroxysmal narrowing of the airways” [1]. Attacks are characterised primarily by difficulty breathing. Exhalation is more difficult than inhalation, so patients’ lungs will become distended. Severe attacks can result in death, but this is relatively rare. There are various forms of asthma, but these can be grouped into 2 main categories:

Extrinsic asthma is a type I hypersensitivity (allergic) reaction to an allergen in the environment – most commonly dust, pollen or certain foods, but can also include medicines such as aspirin, fungal spores such as aspergillus or inhaled chemicals at the work-place. This form of asthma accounts for approximately 90% of cases. It usually starts during childhood and there is generally a history of asthma within the family. It often reduces in severity or disappears altogether in later years and the development of associated conditions such as chronic bronchitis and emphysema is rare.

Intrinsic asthma is thought to be caused by abnormal regulation of the airways by the autonomic nervous system. This makes the airways unusually reactive, and triggers such as stress, exercise, cold air, dry air, smoke and viruses can result in an asthma attack. This form of asthma accounts for approximately 10% of cases. Unlike allergic asthma, there is generally no family history of asthma and onset is usually during adulthood. There are no recognised allergens and attacks tend to increase in severity. The development of associated conditions such as chronic bronchitis, nasal polyps and emphysema is common.

Medical Management of Patients with Asthma

The aim of medical treatment is to get the asthma under control and keep it that way [2]. This is achieved by (1) helping patients develop a personal action plan on what steps to take in case of an asthma attack, (2) prescribing medication to take to help prevent an attack, (3) prescribing medication to take to relieve an attack, and (4) an annual review of your condition, medication and action plan. Sometimes patients are provided with a peak flow meter to help them assess their condition on a regular basis.

Preventer inhalers deliver a corticosteroid into the lungs to help reduce local inflammation and reduce the risk of an attack. This medication is usually only prescribed if you have more than 2 asthma attacks a week, or your asthma wakes you up, or you feel the need to use the reliever inhaler more than twice a week. Reliever inhalers deliver a beta2-agonist into the lungs to relax the smooth muscle forming the airways – it is constriction of the airways by these muscles that results in the asthma symptoms. People with persistent or severe attacks that do not respond to these inhalers may be given longer lasting relievers or combined relievers/preventers or even oral steroids.

Side effects of reliever inhalers are uncommon unless the medication is over-used; they include mild shaking of the hands, headaches and muscle cramps, and are usually short-term. The main side-effect of preventer inhalers is oral thrush. However, long term or over-use of preventers and oral steroids are more severe, and patients will require regular medical checks for high blood pressure, diabetes and osteoporosis.

Osteopathic Management of Patients with Asthma

Osteopaths carry out a thorough examination of all patients. This includes a comprehensive clinical case history (eg. [3]) that addresses:

Patients rarely visit osteopaths looking for help specifically with asthma, although this does happen, but asthma is often identified during the clinical case history. Because osteopaths focus on the health and treatment of the individual, the relevance of the asthma to the presenting complaint will be accounted for in the overall management and treatment plan.

The key features of asthmatic patients that osteopaths take an interest in are the changes in the musculoskeletal system [4]. Because they have to work so hard, the primary respiratory muscles in the rib-cage (diaphragm and inter-costals) and the accessory muscles of respiration in the neck (mainly the scalenes and sternocleidomastoid) will often be shortened and tense, and therefore less effective. The rib-cage will typically be held in a position of relative inhalation and feel quite stiff. In some patients who have had asthma since an early age there may have developed a groove (Harrison’s sulcus) at the lower margin of the rib-cage. There will generally be stiffness in the upper back and an increased curvature of the neck.

The scale of these changes and the amount of ‘give’ in the muscles, the rib-cage and the upper back will vary from person to person, depending on their age, the length of time with asthma, the severity of attacks and the level of control with medication.

Osteopathic management of patients with asthma will, therefore, incorporate treatment of these structures to improve the mechanical function of the respiratory system. The specific techniques used will vary from individual to individual and depend on the scale of the changes, the age of the patient and the potential side-effects of long term steroid use (if applicable) on bone density.


[1] Underwood, J.C.E. (Ed), “General and Systematic Pathology”, 4th Edition.

[2] http://www.nhs.uk/Conditions/Asthma/Pages/Treatment.aspx accessed June 7th 2011.

[3] Munro, J.F., Campbell, I.W., (Eds), “Macleod’s Clinical Examination”, 10th Edition.

[4] Sammut, E., Searle-Barnes, P., “Osteopathic Diagnosis”.