Is Tian Jiu Therapy effective in reducing asthma?
Date of publication of the systematic review: April 2015
Design
Systematic review of 6 randomized controlled trials (RCTs).
Participants
657 adults diagnosed with asthma according to clear diagnostic criteria (age range: 18 to 75 years, gender proportion: not reported).
Intervention
Tian Jiu Therapy was provided; in which selected Chinese herbal medicines associated with the lung meridian were pasted on selected acupoints on san fu tian (三伏天). Drugs and routine treatment were allowed during acute asthma attack.
Comparator
Comparison: Tian Jiu Therapy versus no treatment, placebo and traditional Chinese medicine and Western medication.
Major Outcomes
Outcome 1: Total effective rate;
Outcome 2: Immune related biomarker, IgE Test ;
Outcome 3: Immune-related biomarker, eosinophil Test.
Settings
The reviewers did not state whether the trials were conducted in inpatient or outpatient settings.
Comparison    Tian Jiu Therapy versus no treatment, placebo and traditional Chinese medicine and Western medication
Main Results
Compared to no treatment, placebo and traditional Chinese medicine and Western medication, Tian Jiu Therapy was more effective (pooled odds ratio (OR): 3.51, 95%CI: 2.05 to 6.00). Besides, Tian Jiu Therapy showed significant decrease in IgE level (pooled standardized mean difference (SMD): -1.40, 95% CI: -2.18 to -0.63) and eosinophil level (pooled SMD: -4.26, 95% CI: -6.28 to -2.23) among asthma adult patients.
Comparison: Tian Jiu Therapy versus no treatment, placebo and traditional Chinese medicine and Western medication among asthma adult patients
Outcomes (units) No. of studies (Total no. of participants) No. of events / No. of participants Heterogeneity test (I2) Pooled OR/ SMD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 4 (500) 228/ 250 189/ 250 18% OR: 3.51
(2.05 to 6.00)
Moderate
2 (NA) 3 (217) Not reported / 110 Not reported/ 107 85% SMD: -1.40
(-2.18 to -0.63)
Low
3 (NA) 2 (137) Not reported / 70 Not reported/ 67 91% SMD: -4.26
(-6.28 to -2.23)
Low
Keys: OR = odds ratio; SMD = standardized mean difference; CI = confidence interval.
Comparison    Tian Jiu Therapy versus no treatment, placebo and traditional Chinese medicine and Western medication
Main Results
Compared to no treatment, placebo and traditional Chinese medicine and Western medication, Tian Jiu Therapy was more effective (pooled odds ratio (OR): 3.51, 95%CI: 2.05 to 6.00). Besides, Tian Jiu Therapy showed significant decrease in IgE level (pooled standardized mean difference (SMD): -1.40, 95% CI: -2.18 to -0.63) and eosinophil level (pooled SMD: -4.26, 95% CI: -6.28 to -2.23) among asthma adult patients.
Comparison: Tian Jiu Therapy versus no treatment, placebo and traditional Chinese medicine and Western medication among asthma adult patients
Outcomes (units) 1 (NA) 2 (NA) 3 (NA)
No. of studies (Total no. of participants) 4 (500) 3 (217) 2 (137)
No. of events / No. of participants Intervention 228/ 250 Not reported / 110 Not reported / 70
Comparator 189/ 250 Not reported/ 107 Not reported/ 67
Pooled OR/ SMD (95% CI) OR: 3.51
(2.05 to 6.00)
SMD: -1.40
(-2.18 to -0.63)
SMD: -4.26
(-6.28 to -2.23)
Overall quality of evidence* Moderate Low Low
Keys: OR = odds ratio; SMD = standardized mean difference; CI = confidence interval.
Conclusion
Benefits
Compared to no treatment, placebo and traditional Chinese medicine and Western medication, Tian Jiu Therapy was more effective. The overall quality of evidence is moderate. Further research is fairly likely to have an important impact on our confidence in this estimate of effect. Besides, Tian Jiu Therapy showed significant decrease in IgE level and eosinophil level. However significant heterogeneity existed between the results of the included trials. The overall quality of evidence is low. Further research is likely to have an important impact on our confidence in this estimate of effect.
Harms
Two studies reported mild adverse events which included skin redness, swelling, fever, itching, pain or blisters.
Link to Original Article
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4403225/
The synopsis is based on the following article:
Chan CW, Lee SC, Lo KC, Wong HK, Li L. Tian jiu therapy for the treatment of asthma in adult patients: a meta-analysis. [Review] Journal of Alternative & Complementary Medicine. 2015 Apr. 21(4):200-7.


* Interpretation of quality assessment results:
• Very low: Further research is most likely to have an important impact on our confidence in this estimate of effect.
• Low: Further research is likely to have an important impact on our confidence in this estimate of effect.
• Moderate: Further research is fairly likely to have an important impact on our confidence in this estimate of effect.
• High: Further research is unlikely to have an important impact on our confidence in this estimate of effect.
• Very high: Further research is most unlikely to have an important impact on our confidence in this estimate of effect.

Details of assessment method can be found at Chung VC, Wu XY, Ziea ET, Ng BF, Wong SY, Wu JC. Assessing internal validity of clinical evidence on effectiveness of CHinese and integrative medicine: Proposed framework for a CHinese and Integrative Medicine Evidence RAting System (CHIMERAS). European Journal of Integrative Medicine. 2015 Aug 31;7(4):332-41.