Are acupuncture and related therapies effective in improving chronic obstructive pulmonary disease as compared to placebo?
Date of publication of the systematic review: November 2014
Design
Systematic review of 16 randomized controlled trials (RCTs).
Participants
1016 patients (age range: 55 to 77 years, male % range: not reported) with chronic obstructive pulmonary disease (COPD). Studies with clear diagnosis of chronic bronchitis or emphysema were included (1) if spirometry was performed or (2) adhered to internationally recognized guidelines, such as those from the Global Initiative for Chronic Obstructive Lung Disease (GOLD), the British Thoracic Society, the American Thoracic Society, the European Respiratory Society, or the British Medical Research Council.
Intervention
Acupuncture and related therapies included manual acupuncture, acupressure, acupuncture plus massage, acu-TENS, acupuncture plus moxibustion, and point-application therapy, which refer to the application of an herbal paste to acupuncture points. The total number of treatment sessions ranged from 1 to 30 and duration of the therapies ranged from 1 day to 3 years.
Comparator
Comparison: Acupuncture and related therapies versus placebo.
Major Outcomes
Outcome 1: Level of disability caused by breathlessness measured by the Medical Research Council (MRC) Scale at the end of treatment;
Outcome 2: Level of breathlessness measured by Dyspnea Visual Analogue Scale (DVAS) at the end of treatment;
Outcome 3: Health-related quality of life measured by the St George’s Respiratory Questionnaire (SGRQ) at the end of treatment;
Outcome 4: Total distance walked in 6 minutes measured by the six-minute walk test (6MWT) at the end of treatment.
Settings
The reviewers included 13 trials conducting in inpatient, outpatient or community settings. Three trials did not report where they were conducted.
Comparison    Acupuncture and related therapies versus placebo
Main Results
Compared to placebo, acupuncture and related therapies significantly improved dyspnea among COPD patients as assessed by MRC scale (pooled mean difference (pooled MD): -0.34, 95% CI: -0.38 to -0.30) and DVAS (pooled MD: -8.85, 95% CI: -11.81 to -5.89). Acupuncture and related therapies also significantly improved patients’ quality of life as measured by SGRQ (pooled MD: -8.33, 95% CI: -13.13 to -3.53). It also increased the distance walked in the 6MWT (pooled MD: 28.14, 95% CI: 23.92 to 32.36).
Comparison: Acupuncture and related therapies versus placebo among COPD patients
Outcomes (units) No. of studies (Total no. of participants) Mean score (SD)/ No. of participants Heterogeneity test (I2) Pooled MD (95% CI) Overall quality of evidence*
Intervention Comparator
1 (NA) 2 (188) Not reported/93 Not reported/95 0% -0.34 (-0.38 to -0.30) High
2 (mm) 3 (110) Not reported/55 Not reported/55 48% -8.85 (-11.81 to -5.89) High
3 (NA) 3 (208) Not reported/103 Not reported/105 0% -8.33 (-13.13 to -3.53) High
4 (m) 3 (208) Not reported/103 Not reported/105 0% 28.14 (23.92 to 32.36) High
Keys: SD: standard deviation; MD: mean difference; RR: risk ratio; CI: confidence interval.
Comparison    Acupuncture and related therapies versus placebo
Main Results
Compared to placebo, acupuncture and related therapies significantly improved dyspnea among COPD patients as assessed by MRC scale (pooled mean difference (pooled MD): -0.34, 95% CI: -0.38 to -0.30) and DVAS (pooled MD: -8.85, 95% CI: -11.81 to -5.89). Acupuncture and related therapies also significantly improved patients’ quality of life as measured by SGRQ (pooled MD: -8.33, 95% CI: -13.13 to -3.53). It also increased the distance walked in the 6MWT (pooled MD: 28.14, 95% CI: 23.92 to 32.36).
Comparison: Acupuncture and related therapies versus placebo among COPD patients
Outcomes (units) 1 (NA) 2 (mm) 3 (NA) 4 (m)
No. of studies (Total no. of participants) 2 (188) 3 (110) 3 (208) 3 (208)
Mean score (SD)/ No. of participants Intervention Not reported/93 Not reported/55 Not reported/103 Not reported/103
Comparator Not reported/95 Not reported/55 Not reported/105 Not reported/105
Pooled MD (95% CI) -0.34 (-0.38 to -0.30) -8.85 (-11.81 to -5.89) -8.33 (-13.13 to -3.53) 28.14 (23.92 to 32.36)
Overall quality of evidence* High High High High
Keys: SD: standard deviation; MD: mean difference; RR: risk ratio; CI: confidence interval.
Conclusion
Benefits
This study showed that acupuncture and related therapies may significantly improve dyspnea and health-related quality of life in COPD patients when compared to placebo. The 6 minute walking distance also increases among patients receiving acupuncture and related therapies. For all outcomes, the overall quality of evidence is high. Further research is unlikely to have an important impact on our confidence in this estimate of effect.
Harms
No adverse events were reported in three studies and only one trial reported adverse events. In the treatment group, 4 out of 34 patients reported fatigue, 1 reported bruising and 5 reported needle-site pain; while in control group, 5 out of 34 patients reported fatigue and 2 made a complaint of bruising.
Link to Original Article
https://www.ncbi.nlm.nih.gov/pubmed/25478799
The synopsis is based on the following article:
Coyle M, Shergis J, Huang ET, Guo X, Di YM, Zhang A, et al. Acupuncture Therapies for Chronic Obstructive Pulmonary Disease: A Systematic Review of Randomized, Controlled Trials. Altern Ther Health Med, 2014 Nov;20(6):10-23.


* 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.