After being treated with a placebo inhaler or sham acupuncture, asthma patients reported significantly greater improvement in symptoms than they felt after receiving no treatment — and this improvement was similar to that reported after active treatment with an albuterol inhaler.

The 39 patients who completed the double-blind, crossover pilot study had been given one each of the three interventions as well as no intervention in random order during four sequential visits taking place three to seven days apart. This process was repeated until each patient had completed 12 visits. Spirometry was performed repeatedly over a period of two hours at each visit. The investigators measured maximum forced respiratory volume in 1 second (FEV1) and recorded the participants’ self-reported improvement ratings.

Only albuterol improved FEV1, producing a 20% increase in that measure. By comparison, placebo inhaler, sham acupuncture, and no intervention resulted in FEV1 increases of approximately 7%. However, the active drug provided no incremental benefit with respect to the self-reported outcomes.

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While acknowledging that patient self-reports should be interpreted with caution and that objective outcomes should be more heavily relied upon for optimal asthma care, the researchers noted that quality-of-life metrics, emergency-department visits, and other outcomes may be more clinically relevant to patients and their health-care providers.

Wechsler ME et al. N Engl J Med. 2011;365:119-126.