The Immediate, Intermediate, and Long-Term Effects of Osteopathic Manipulative Treatment on Pulmonary Function in Adults With Asthma
Conditions: Asthma
Sponsor: Des Moines University

 
 
 
The Immediate, Intermediate, and Long-Term Effects of Osteopathic Manipulative 
Treatment on Pulmonary Function in Adults with Asthma 
IRB Approval Date: January 8, 2019 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 

Objective 
To examine the immediate, intermediate and long-term effects of OMT on the objective pulmonary 
function of adults with a diagnosis of asthma, as well as the subjective long-term effects. 
Design  
The study design for the present study was approved by the institutional review board at Des Moines 
University in Des Moines, IA. Written informed consent was obtained from all participants. Participants 
were recruited by email, class announcements, and word of mouth targeting Des Moines University 
(DMU) students and faculty. Inclusion criteria for participation in the study included being 18 years of 
age or older and having a diagnosis of asthma, regardless of whether spirometry was used in the 
diagnosis. Exclusion criteria included being a current smoker, having any other respiratory disease 
besides asthma, and receiving Osteopathic Manipulative Medicine (OMM) from a licensed physician or 
chiropractic or massage treatment for 30 days prior to and during the study. 
Methods 
Timeline 
The study was conducted over a period of eight weeks.  During week 0, participants completed a form 
regarding their age, sex, height, ethnicity, exercise habits, and current asthma medications. They 
completed the initial AQLQ and performed baseline spirometry testing. 
During weeks 1, 2, and 3 of the study, a standard OMT protocol, detailed below, was performed on each 
participant, followed by spirometry testing to measure the immediate effect. Spirometry testing was 
then performed again three days later to measure the intermediate effect of OMT. 
During week 7, participants completed the post-OMT AQLQ and performed spirometry testing once 
more to measure the long-term effect of OMT. 
 
Asthma Quality of Life Questionnaire 
Participants completed the Asthma Quality of Life Questionnaire with Standardized Activities (AQLQ(S)) 
to subjectively measure asthma severity. The AQLQ is a 32-item survey which asks participants to recall 
their experiences during the previous two weeks as they relate to four domains (symptoms, activity 
limitations, emotional function, and environmental stimuli). Each item is rated on a 7-point Likert scale, 
with 1 being severely impaired and 7 being not impaired at all. This was taken in week 0 to establish a 
subjective baseline value as perceived by the participant. Participants completed this questionnaire 
again in week 7 to be used as a subjective measurement of their asthma severity after OMT. We 
compared the mean scores for each item, each domain, and the overall average.  
 
Pulmonary Function Measurements 
Pulmonary function testing was done using a portable spirometer (McKesson LUMEON, Andover, MA, 
USA). Testing was conducted by one member of the research team, after training with a licensed 
pulmonologist. Subjects were required to perform three trials deemed acceptable by the spirometry 
software (Easy on-PC), and the trial with the best overall effort as determined by the highest FVC was 
used for analysis. The spirometric measures used to assess participants’ pulmonary function included 
forced expiratory volume in one second (FEV1), forced vital capacity (FVC), the FEV1/FVC ratio, and peak 
expiratory flow (PEF).  
 
 

OMT Protocol 
An OMT protocol was derived from a survey of the DMU OMM Department faculty as well as 
current and past DMU OMM Fellows. The survey included questions regarding the approach each 
participant would use when treating an asthmatic patient with OMT. Based on the survey results, the 
current undergraduate OMM Fellows of DMU developed the standardized OMT protocol used during 
each of the three OMT sessions. These sessions lasted 21.3 ± 3.6 minutes. The protocol included the 
following techniques: supine OA joint balanced ligamentous tension (BLT), supine cervical spine Still 
technique, supine thoracic inlet MFR, stimulatory supine rib raising soft tissue, supine respiratory rib 
BLT, supine abdominal diaphragm MFR, seated thoracic spine Still technique, and seated posterior rib 
Still technique. 
After the undergraduate OMM Fellows (AJ, ST, EK, AB) completed the treatment protocol, all 
participants were rechecked for somatic dysfunction resolution by one of 2 board-certified OMM/NMM 
physicians (JP, KH). If inadequate resolution at a specific body region was found, that region was 
retreated using the same technique included in the protocol. The retreatment lasted, on average, 6.3 
minutes. The final step before spirometry was performed involved one minute of stimulatory 
tapotement, or rhythmic tapping of the tissues, applied to the paraspinal region at the levels of the first 
through sixth thoracic vertebrae to target the lung viscerosomatic reflex area and potentially temper 
parasympathetic cholinergic tone to decrease contraction of airway smooth muscle.  
 
 
Statistical Analysis Plan 
Changes in FEV1, FVC, the FEV1/FVC ratio, and PEF were determined by calculating the 
arithmetic mean for all participants at each time point. The immediate effect of OMT was determined by 
comparing the measurements taken immediately after the first treatment to baseline, and the previous 
week’s measurements to those taken immediately after the subsequent treatment. The intermediate 
effect was determined by comparing the measurements three days after treatment to baseline as well 
as the previous week’s three-days-post-OMT measurements. The long-term effect was determined by 
comparing the measurements four weeks after the final OMT session to baseline. Each comparison was 
analyzed using a repeated-measure ANOVA on random subjects. The Westfall method was used to 
adjust p-values. 
Changes in participants’ survey results were determined by calculating the arithmetic mean for 
the overall scores and for each of the four domains, then comparing the post-OMT values to the pre-
OMT values. These values were analyzed using paired t-tests.  
Statistical analysis was performed using IBM SPSS ® Software, with the guidance of Chunfa Jie, 
PhD and Simon Geletta, PhD of the Des Moines University Research and Public Health Department, 
respectively.