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Objectives: To determine the prevalence and patterns of use of alternative medicine among urban Hispanics.Design: A cross-sectional survey. Settings/location: Churches located in the northern part of Los Angeles and outpatients and inpatients in a county hospital in southern California.Subjects: 179 Hispanic subjects.Outcome measures: The following issues related to alternative medicine were evaluated: frequency and reasons for its use; perceived efficacy; safety; costs; sources of information; overall satisfaction; and subject-physician interaction with respect to alternative medicine.Results: Sixty-three percent (63%) of respondents reported using or had used one or more types of alternative medicine. The majority of users were women (75%, 95% confidence interval [CI], 66%-83%). The most commonly reported alternative therapies were herbs (57%, 95% CI 47%-66%), prayer (43%, 95% CI 34%-53%), and dietary supplements (21%, 95% CI 14-30%). Compared to nonusers, users of alternative medicine had significantly lower yearly income, less proficiency in English language, and lower educational level. The main indications for using alternative medicine were pain (61.4%, 95% CI 51%-71%), lack of energy (38.6%, 95% CI 29%-49%), and overweight (22.8%, 95% CI 16%-33%). Only 5.2% of subjects (95% CI 2%-12%) believed that herbs are more effective than medications prescribed by physician. A majority of users (61%, 95% CI 50%-68%) had more confidence in their physicians than in their alternative medicine provider. Forty-five percent (45%) of users (95% CI 34%-56%) believed prescribed medication was safer than alternative medicine, whereas only 7% (95% CI 3%-15%) believed the reverse. Adverse effects related to herbs and dietary supplements were reported by ii users. The majority of participants (78.9%, 95% CI 69-87%) did not speak to their physicians about alternative therapy. The mean score of overall satisfaction with conventional medicine was significantly higher than with alternative medicine.Conclusions: Despite the common use of alternative medicine among Hispanics, the majority of users believe that conventional medicine is superior to alternative medicine. There is a significant gap in communication between physicians and patients with respect to alternative medicine. [ABSTRACT FROM AUTHOR]

Alternative therapies for allergic diseases may be prescribed by physicians or provided by other practitioners or selected by patients without resorting to consultation with a health advisor. The most popular alternative therapies include dietary manipulation and exaggerated avoidance of allergens. Established medical therapies include herbs (Western and Asian), homeopathy and acupuncture; many publications suggest they are of value in allergic disease management. However, most studies lack sufficient power, do not have adequate controls, fail to duplicate standard clinical practices, or utilize a heterogeneous group of subjects. Careful analysis suggest that popular alternative therapies might offer a minimal benefit over placebos, but further studies are required for more rigorous evaluation of outcomes. Numerous esoteric or non-specific methods of treating allergic diseases are also available which may be promoted by enthusiastic practitioners or supported by satisfied patients. The majority of such therapies will never be scientifically evaluated, and the results of such modalities will be difficult to separate out from those of true placebo treatments. It is evident that while the "prose" of scientifically established therapies is appealing to a declining number of patients, the "poetry" of complementary therapies resonates with an increasing majority of the public who believe in the magic of alternative medicine.

The mechanisms of actions of cough medicines are not always known. The problem is exacerbated for herbal medicines, where the effectiveness of the plant or its phytochemicals have rarely been carefully evaluated. Moreover, the most active phytomedicinal constituent is difficult to identify, and the expense and difficulty of such studies discourages sponsors who may not be able to benefit by subsequent exclusive marketing of the herbal remedy. Most popular herbs used as cough medicines appear to be demulcents whose action is confined to the oropharynx. It is probable that the vast majority of allegedly effective herbal cough medicines act as non-specific emetic-expectorants. The proof of activity of even marketed herbal derivatives such as guaifenesin and codeine is difficult to obtain. It is therefore likely that herbal cough medications will never be shown to be more active than placebos. Nevertheless, these plant products will continue to be popular remedies for patients and their health care advisors., (Copyright 2002 Published by Elsevier Science Ltd.)

Orthodox medical approaches to asthma and allergic respiratory diseases are provided in guidelines developed by professional societies and national or state organizations that represent organized medicine. Alternative therapies may include such orthodox medical therapies as obsolescent formerly used agents, unusual but accepted agents, and agents that are in favor for orthodox therapy in other countries. However, the current growth of complementary and alternative medicine is based on the use of nonorthodox remedies that are becoming increasingly popular with patients and that should be familiar to physicians. Asthma and allergies are frequently treated with such remedies by patients, either as part of self-therapy or on the advice of a complementary and alternative medicine practitioner. The most popular alternative medical treatments are herbs (Western and Asiatic), acupuncture, various types of body manipulation, psychologic therapies, homeopathy, and unusual allergy therapies. There is little evidence in favor of most of these unorthodox treatments, although they are very often reported on favorably by patients. The published evidence that might support some alternative medical practices is reviewed so as to help physicians select alternatives that could appropriately be integrated into orthodox practice.

The debate persists on the relative role of beta 2-agonists, corticosteroids, and other antiasthmatic drugs, in part because asthma can be so difficult to control. Exploration of the concerns about therapy is followed by practical recommendations.

Respiratory patients require psychotropic drug administration to treat pain, cough and respiratory distress or to treat insomnia, anxiety, depression or psychosis. Terminal patients require thoughtful and compassionate use of these drugs, even when there is an expectation that such therapy may lead to an earlier death. Most psychotropic agents can be used safely in patients with respiratory disease, and careful use of selected drugs should always be employed if indicated for treating distressful conditions that may be benefitted. Guidelines to appropriate choices and doses are provided.

Although chronic bronchitis was first named and described in 1808, the disease has been known since earliest time, and numerous drugs have been utilized in its therapy. The basic historic theories of human function have readily been applied to bronchitis; thus in Greek medicine, the disease was appreciated as one of excess phlegm. Early remedies included garlic, pepper, cinnamon, and turpentine, whereas later therapies of choice emphasized coffee, ipecac, and potassium nitrate. Most of the favored bronchodilator drugs of today are derived from the traditional folk remedies, ephedrine, atropine, and theophylline. The most interesting historical drugs, however, are those that have given rise to modern mucokinetic agents such as bromhexine and iodides.

The pharmacologic treatment of chronic obstructive pulmonary disease (COPD) differs from that of asthma in several respects. Oral therapy should be the keystone, using a long-acting theophylline or a beta 2-sympathomimetic agent. The addition of a metered dose inhalant aerosol provides additive benefit with low toxicity; either a sympathomimetic agent or ipratropium or both should be used. The antiinflammatory aerosols, cromolyn, and steroid drugs are usually of no value, and oral steroids are only indicated if there is an asthmatic component. Mucokinetic agents and antibiotics should be used selectively. The numerous other drugs that may be required by a COPD patient must be prescribed with consideration to the potential for adverse physiologic effects and untoward drug interactions.

The Scientific Board of the California Medical Association presents the following inventory of items of progress in chest diseases. Each item, in the judgment of a panel of knowledgeable physicians, has recently become reasonably firmly established, both as to scientific fact and important clinical significance. The items are presented in simple epitome and an authoritative reference, both to the item itself and to the subject as a whole, is generally given for those who may be unfamiliar with a particular item. The purpose is to assist busy practitioners, students, research workers, or scholars to stay abreast of these items of progress in chest diseases that have recently achieved a substantial degree of authoritative acceptance, whether in their own field of special interest or another.The items of progress listed below were selected by the Advisory Panel to the Section on Chest Diseases of the California Medical Association, and the summaries were prepared under its direction.

Optimal control of chronic obstructive airway disorders is usually achieved with therapy based on beta 2-adrenoceptor agonist administration. Aerosols are highly effective, have few side effects, allow for fine adjustment of dosage to titrate symptoms, and result in reduction in hyperreactivity. Equivalent bronchodilating doses of oral agents cause side effects that limit acceptability. With oral agents, cardiohemodynamic disturbances are usually minor, while tremor and restlessness diminish with continued drug use. In chronic regimens, an aerosol beta 2-adrenergic agent should be chosen whose overall incidence of side effects is less than 5%, and an oral agent that produces no more than a 10% incidence of tremor. Suboptimal oral dosages in combination with maximal dosages of beta 2-agonist aerosol, with or without other bronchodilator drugs, are advisable for chronic therapy. An optimal risk/benefit ratio with broxaterol therapy will probably be achieved by using an aerosol-oral combination. Thus, broxaterol, a new beta 2-agent, should be studied further to determine its value in chronic bronchospastic disorders.

A graphic analysis of the relationships among minute ventilation, arterial PCO2, and the ratio of physiologic dead space to tidal volume is presented for the bedside clinical evaluation of patients receiving continuous respiratory support. With simultaneous measurement of minute ventilation and arterial PCO2, the graph can be used to determine the patient's ratio of dead space to tidal volume. This information can subsequently be used (1) for respirator adjustments to obtain the desired arterial PCO2; (2) to assess the severity of ventilation/perfusion unevenness; and (3) to follow the patient's response to respiratory therapy. It provides the clinician with a conceptual tool with which he can assess the status of a patient's gas exchange and more accurately evaluate and plan his course of treatment.