A Critical Analysis of Acupuncture in Pulmonary Disease: Efficacy and Safety of the Acupuncture Needle

Abstract

Criteria for therapeutic efficacy and safety include significant amelioration of symptoms and, ideally, cure (i.e., patients' belief in effective improvement of symptoms and quality of life, durable impact on symptoms, verifiable subjective and objective changes); improved patient management (e.g., diminishing, or ceasing medication, physiotherapy, and other interventions); safety for patient and practitioner and an acceptable side effect profile; cost-effectiveness of the therapy in practice and to teach to others. There is evidence that in bronchial asthma, chronic bronchitis, and chronic disabling breathlessness the use of acupuncture fulfills these to varying degrees. It can facilitate reducing pharmacologic medication and is safe, suggesting that acupuncture as an adjuvant in the treatment of respiratory disease might be safer than prolonged pharmaceutical maintenance therapy alone. Its cost-effectiveness has yet to be adequately researched. Twenty-one papers in English were obtained and 16 were further evaluated; eight were double-blind, five single-blind, and three unblinded. The remaining five, and most of the Chinese literature, were excluded on account of their poor quality. Acupuncture was effective in four of eight of the double-blind, three of five single-blind, and three of three unblinded studies (i.e., 10 of 16 [62.5%] overall). A previously unreported confounding variable was identified and concerned the designation of sham points. Most sham points were believed to be inactive but, according to traditional Chinese principles, many are active in pulmonary disease. Reappraised accordingly, the unequivocally positive studies were summed with those in which "real" and "sham" acupuncture were not significantly different but in which the combined effect of all acupuncture (i.e., real + sham) on breathlessness was significantly different from baseline. This yielded 13 of 16 (81%) [corrected] studies in which acupuncture led to significant improvement. In most studies, current pharmacologic treatment had a greater effect than acupuncture alone. However, in the 11 studies in which it was evaluated, medication could be significantly reduced by acupuncture in 10 (91%). Twenty-three of the 320 patients in the 16 studies (7%) reported minimal side effects, none requiring intervention. Current published evidence reveals no reason to withhold acupuncture as a safe and potentially effective treatment in patients with bronchial asthma and chronic obstructive lung disease. Further, more appropriately designed studies are urgently required. This would be facilitated in the United States by licensing the acupuncture needle as a therapeutic agent and might lead to important new insights and therapeutic opportunities.

Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials

“…Acupuncture is one of the most popular of the alternative therapies. Some of the attractions stem from its long standing use in Chinese medicine and the avoidance of the side-effects of more conventional treatments for asthma such as corticosteroids and b 2 -agonist sympathomimetics [8]. Overall effect sizes (standardised differences between means) of magnitudes between 0.07 and 0.13 (95% CI -0.07-0.31) were obtained.…”

“…An aim of meta-analysis is to increase the number of patients in order to detect such moderate effects with clinical significance [11] but the integrated number of patients in the present meta-analysis was still below the size given by a conventional power requirement. Secondly, placebo points used in asthma trials seem to be active in pulmonary disease [8]. Thirdly, missing information was a considerable limitation.…”

“…Initially, references from published papers [1,6] and narrative reviews about the topic [3,8] were searched. A computer-assisted search examining the following literature databases was also performed: Medline, Biological Abstracts and Dissertation Abstracts.…”

“…This may be due to differences in trial design and mode of treatment or to the small size of the trials. In terms of design, the insertion of a needle prevents the use of blindness to remove the placebo effect and therefore needles are sometimes inserted in "placebo points" [8]. The wide range of outcomes measured using objective tests (peak flow rates) to perceived breathlessness or anxiety introduces another source of variation.…”

Combined Standard Medication and Acupuncture for Copd: A Case Series

“…3 4 A review of 16 randomised controlled trials involving 2937 participants concluded that acupuncture is a safe and potentially effective intervention for patients with asthma and COPD. 5 We have previously demonstrated that respiratory function evaluated with Borg scale scores and the 6 min walking distance (6MWD) could be markedly improved with acupuncture in a prospective matched-pair trial that included patients treated with acupuncture and those receiving standard medication. 6 However, differences in the effect of acupuncture between subgroups classifi ed according to disease severity are unclear.…”