Acupuncture techniques for COPD: a systematic review

Efficacy and Safety of Acupuncture in Managing COPD: An Overview of Systematic Reviews

Background

Acupuncture has been used as an adjuvant therapy for Chronic obstructive pulmonary disease (COPD). However, systematic reviews (SRs) and meta-analyses (MAs) have reported inconsistent results and unknown quality. This overview aimed to summarize the current SRs/MAs to provide evidence for the effectiveness and safety of acupuncture in the treatment of COPD.

Methods

SRs/MAs were searched via eight databases from their establishment to December 31, 2023. The methodological quality was assessed by A Measurement Tool to Assess Systematic Reviews 2 (AMSTAR 2). The risk of bias was assessed using the Risk of Bias in Systematic Review (ROBIS) tool. The Preferred Reporting Items for Systematic Reviews and Meta-analyses for Acupuncture (PRISMA-A) to evaluate the reporting quality. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) was used to determine the strength of evidence. In addition, we also conducted an analysis of the acupuncture points used in the primary RCTs.

Results

Twenty-two SRs/MAs were included in this overview. Based on the assessment using AMSTAR 2, nineteen SRs/MAs were "critically low". Eight SRs/MAs had a low risk of bias. Based on PRISMA-A, the reporting completeness of eighteen SRs/MAs were more than 70%. As for GRADE assessment, only three outcome measures were of high quality. COPD patients can benefit from moxibustion, acupoint application, acupoint catgut embedding, manual acupuncture, and electroacupuncture, as indicated by effectiveness in measures including lung function, 6MWD, mMRC, CAT, and acute exacerbation. In addition, the efficacy of TENS needed to be further demonstrated. The commonly used acupuncture points in the RCTs include BL13, BL23, and EX-B1.

Conclusion

Evidence from SRs showed that acupuncture is beneficial to lung function, acute exacerbation, 6MWD, mMRC and CAT. For SGRQ and brog scale, acupuncture should be used selectively, but this finding should still be taken with caution.

Transcriptomic Insights into Different Stimulation Intensity of Electroacupuncture in Treating COPD in Rat Models

Background

Electroacupuncture (EA), with varying stimulation intensities, has demonstrated therapeutic potentials in both animal and clinical studies for the treatment of chronic obstructive pulmonary disease (COPD). However, a comprehensive investigation of the intensity-related effects, particularly 1mA and 3mA of EA, and the underlying mechanisms remains lacking.

Methods

A COPD rat model was established by prolonged exposure to cigarette smoke and intermittent intratracheal instillation of lipopolysaccharide. EA treatment was administered at acupoints BL13 (Feishu) and ST36 (Zusanli), 20 minutes daily for 2 weeks, with intensities of 1mA and 3mA. EA effectiveness was evaluated by pulmonary function, histopathological change, serum level of inflammatory cytokines, and level of oxidative stress markers in serum and lung tissues. Transcriptome profiling and weighted gene co-expression network analysis (WGCNA) were performed to reveal gene expression patterns and identify hub genes. Real-time quantitative PCR (RT-qPCR) and Western blot (WB) were performed to detect the mRNA and protein expression levels, respectively.

Results

EA at both 1mA and 3mA exerted differing therapeutic effects by improving lung function and reducing inflammation and oxidative stress in COPD rats. Transcriptome analysis revealed distinct expression patterns between the two groups, functionally corresponding to shared and intensity-specific (1mA and 3mA) enriched pathways. Eight candidate genes were identified, including Aqp9, Trem1, Mrc1, and Gpnmb that were downregulated by EA and upregulated in COPD. Notably, Msr1 and Slc26a4 exclusively downregulated in EA-1mA, while Pde3a and Bmp6 upregulated solely in EA-3mA. WGCNA constructed 5 key modules and elucidated the module-trait relationship, with the aforementioned 8 genes being highlighted. Additionally, their mRNA and protein levels were validated by RT-qPCR and WB.

Conclusion

Our results demonstrated that 1mA and 3mA intensities induce distinct gene expression patterns at the transcriptional level, associated with shared and 1mA vs 3mA-specific enriched pathways. Genes Mrc1, Gpnmb, Trem1, and Aqp9 emerge as promising targets, and further studies are needed to elucidate their functional consequences in COPD.

Anti-inflammatory effects of acupuncture in the treatment of chronic obstructive pulmonary disease

Numerous randomised controlled trials have suggested the positive effects of acupuncture on chronic obstructive pulmonary disease (COPD). However, the underlying therapeutic mechanisms of acupuncture for COPD have not been clearly summarized yet. Inflammation is central to the development of COPD. In this review, we elucidate the effects and underlying mechanisms of acupuncture from an anti-inflammatory perspective based on animal studies. Cigarette smoke combined with lipopolysaccharide is often used to establish animal models of COPD. Electroacupuncture can be an effective intervention to improve inflammation in COPD, and Feishu (BL13) and Zusanli (ST36) can be used as basic acupoints in COPD animal models. Different acupuncture types can regulate different types of inflammatory cytokines; meanwhile, different acupuncture types and acupoint options have similar effects on modulating the level of inflammatory cytokines. In particular, acupuncture exerts anti-inflammatory effects by inhibiting the release of inflammatory cells, inflammasomes and inflammatory cytokines. The main underlying mechanism through which acupuncture improves inflammation in COPD is the modulation of relevant signalling pathways: nuclear factor-κB (NF-κB) (e.g., myeloid differentiation primary response 88/NF-κB, toll-like receptor-4/NF-κB, silent information regulator transcript-1/NF-κB), mitogen-activated protein kinase signalling pathways (extracellular signal-regulated kinase 1/2, p38 and c-Jun NH2-terminal kinase), cholinergic anti-inflammatory pathway, and dopamine D2 receptor pathway. The current synthesis will be beneficial for further research on the effect of acupuncture on COPD inflammation. Please cite this article as: Jiang LH, Li PJ, Wang YQ, Jiang ML, Han XY, Bao YD, Deng XL, Wu WB, Liu XD. Anti-inflammatory effects of acupuncture in the treatment of chronic obstructive pulmonary disease. J Integr Med. 2023; 21(6): 518-527.

Efficacy of acupuncture therapy for stable chronic obstructive pulmonary disease: A systematic review and meta-analysis

BACKGROUND

Acupuncture therapy (AT) is a widely used, alternative medicine in China. AT is an effective treatment for many diseases, but its efficacy in stable chronic obstructive pulmonary disease (COPD) remains controversial. Therefore, we performed the present meta-analysis to evaluate the efficacy of AT in stable COPD patients.

METHODS

Randomized controlled trials (RCTs) for AT efficacy in stable COPD patients were searched in literature databases from the inception to December 31, 2021. Pooled effect sizes of outcome measurements with respect to lung function (forced vital capacity [FVC], forced expiratory volume in 1 second [FEV1], FEV1 in predicted value [FEV1%], FEV1/FVC), quality of life (St. George respiratory questionnaire [SGRQ]), exercise capacity (6-minute walking distance [6MWD]) and effective rate were estimated by calculating weighted mean difference (WMD) or odds ratio (OR) with corresponding 95% confidence interval (95% CI), respectively, by a random-effect model.

RESULTS

A total of 28 RCTs with 2130 COPD patients were included. AT group had significant improvement in FVC (WMD = 0.29 L, 95% CI: 0.22-0.36, P < .001), FEV1 (WMD = 0.33 L, 95% CI: 0.23-0.43, P < .001), FEV1% (WMD = 3.30%, 95% CI: 3.30-4.64, P < .001), FEV1/FVC (WMD = 5.45%, 95% CI: 4.41-6.49, P < .001), 6MWD (WMD = 45.48 m, 95% CI: 28.21-62.16, P < .001), SGRQ (WMD = -7.79, 95% CI: -12.34 to -3.24, P < .001), and a higher effective rate (OR = 3.71, 95% CI: 2.50-5.52, P < .001) compared to the control group. Subgroup analysis stratified by comparison model (AT combined with other treatments vs other treatments, AT alone vs sham AT) and treatment duration (≥8 weeks, <8 weeks) also showed more improvement in AT arm than control arm without significant between-subgroup difference. Adverse events were reported in a few studies and only mild reactions were observed.

CONCLUSION

AT is effective in improving lung function, quality of life and exercise capacity, and can be used as an adjunctive treatment in patients with stable COPD.

Acupoint Transcutaneous Electrical Nerve Stimulation in Hospitalized COPD Patients with Severe Dyspnoea: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effect of acupuncture transcutaneous electrical nerve stimulation (acuTENS) on the reduction of dyspnoea during acute exacerbation of chronic obstructive pulmonary disease (AECOPD).

METHODS

A multicentric randomized control trial with masked patients and evaluators was carried out. During hospitalization, AECOPD patients received 45 min of acuTENS (experimental group) or sham acuTENS (controls) daily on 5 consecutive days. The trial was conducted at the Hospital del Mar, Barcelona, and Hospital Sant Joan de Déu, Manresa (both in Spain). Dyspnoea and peak expiratory flow were measured daily from the first to fifth days. Length of stay, readmissions at 3 months and adverse events were also analysed.

RESULTS

Finally, 19 patients with moderately to severely exacerbated COPD were included. Although some tendencies in dyspnoea during day 1 and length of hospital stay were found favouring acupuncture, no significant differences were shown between groups.

CONCLUSIONS

The acuTENS intervention was feasible#well tolerated in AECOPD patients and no important side effects were reported.

Acupuncture for breathlessness in advanced cancer: a protocol for systematic review and meta-analysis with trial sequential analysis

INTRODUCTION

Breathlessness in advanced cancer, a frequent multicomponent and debilitating disorder, severely reduces function and quality of patients' life. Multiple studies have shown that non-pharmacological therapies can effectively palliate breathlessness in advanced cancer. However, no systematic review has investigated the application of acupuncture, as a non-pharmacological treatment, for breathlessness in advanced cancer. A systematic review will be conducted to summarise evidence supporting the efficacy and safety of acupuncture as a therapeutic option for breathlessness in advanced cancer based on existing randomised controlled trials (RCTs).

METHODS

RCTs will be retrieved from nine scientific databases, including the MEDLINE via PubMed, Web of Science via the Web of Knowledge, Embase via Ovid, the Cochrane Central Register of Controlled Trials via the Cochrane Library, and Allied and Complementary Medicine Database via EBSCO, China National Knowledge Infrastructure, Wanfang Database, VIP Database, Chinese Biomedical Literature Database; three clinical registry platforms, including the WHO International Clinical Trials Registry Platform, NIH Clinical trials.gov and Chinese Clinical Trial Registry, as well as from other sources. Studies published since inception of these databases to 1 August 2021 will be retrieved. Search terms will include breathlessness, cancer, acupuncture and RCT. Two investigators will independently select and extract data from RCTs and assess the risk of bias. The primary outcome, which is alleviation of breathlessness, will be assessed. Meta-analysis will be performed using RevMan V.5.4 and STATA V.15.0. The TSA 0.9.5.10 β software will be used to conduct trial sequential analysis. Finally, the quality of evidence from RCTs will be assessed using the Grading of Recommendations Assessment, Development and Evaluation System tool.

ETHICS AND DISSEMINATION

Results will be disseminated through peer-reviewed journals or conference reports. Since this study involves acquisition of secondary data, ethical approval requirements will be waived.

PROSPERO REGISTRATION NUMBER

CRD42021240085.

Acupuncture Point Stimulation Treatments Combined With Conventional Treatment in Chronic Obstructive Pulmonary Disease: A Systematic Review and Network Meta-Analysis

Background: Chronic obstructive pulmonary disease (COPD), which is a disease characterized by dyspnea, cough, and respiratory symptoms, leading to impaired health-related quality of life (HRQL) and exercise capacity, is highly prevalent worldwide. Some studies demonstrated that acupuncture point stimulation treatments (APSTs) are effective and safe in treating patients with COPD. The aim of this systematic review and network meta-analysis is to analyze the effects on HRQL and FEV1% predicted of diverse APSTs in treating patients with COPD.

Materials and Methods: We searched seven electronic databases. Randomized controlled trials (RCTs) with stable COPD patients comparing APSTs and conventional treatment (Tx) were included. The primary outcome was HRQL measured by COPD Assessment Test or St. George's Respiratory Questionnaire. The secondary outcome was FEV1% predicted. We performed random effect network meta-analysis using a consistency model.

Results: This network meta-analysis analyzed 21 RCTs with 1,577 stable COPD participants. In comparison with Tx, acupressure massage (AM) + Tx [−5.11; 95% confidence interval (CI), −6.65 to −3.57] was the most effective intervention in improving HRQL, followed by moxibustion (Mx) + Tx (−2.86; 95% CI, −3.86 to −1.86). Moreover, in comparison with Tx, Mx + Tx (7.79; 95% CI, 2.16 to 13.42) was the most effective intervention in improving FEV1% predicted, followed by acupuncture (A) + Tx (5.79; 95% CI, 2.90 to 8.68).

Conclusions: Combined interventions (APSTs + Tx) are more effective than single intervention in improving both HRQL and FEV1% predicted. AM, Mx, and A can be considered effective non-pharmacological complementary interventions in treating patients with COPD under Tx.

Moxibustion for stable chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis

BACKGROUND

There is no optimal treatment to alleviate the decline of lung function in the stable phase of chronic obstructive pulmonary disease (COPD). The effectiveness of moxibustion as an adjunctive treatment for COPD in the stable phase has been reported clinically, but the conclusions on efficacy and safety have not been unified. This study will systematically evaluate the efficacy and safety of moxibustion on the treatment of COPD in the stable phase, providing clinical-based evidence.

METHODS

We will systematically search 7 literature databases and 2 clinical trial registration platforms. The searching time will be conducted from the establishment of databases to March 31, 2021, regardless of language. We will include the randomized controlled trial (RCT) evaluation of moxibustion combined with basic therapy vs basic therapy alone for the treatment of stable COPD. We will assess the risk of bias for individual RCTs using the Cochrane Handbook 5.1.0 evaluation tool. The primary outcome is forced expiratory volume in 1 second/forced vital capacity. The secondary outcomes include forced expiratory volume in 1 second, forced vital capacity, six-minute walking distance, COPD assessment test score, maximum ventilation, response to treatment, and incidence of adverse events. We will collect the effective data of individual RCT through systematic analysis of the random effect model. Heterogeneity will be tested by Cochran Q test and I-squared statistics. Two subgroup analyses will be performed to explore the sources of heterogeneity based on clinical experience. Excluding RCTs with a high risk of bias, fixed-effect model will be used for sensitivity analysis to test the robustness of the meta-analysis results. The publication bias will be assessed by funnel plot and Egger test.

RESULTS

This study will provide systematic evidence on the efficacy and safety of moxibustion on the treatment of patients with stable COPD through strict quality assessment and reasonable data synthesis. We hope that the results will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This systematic review will provide the best current evidence for the adjuvant treatment of stable COPD with moxibustion.

INPLASY REGISTRATION NUMBER

INPLASY202140047.

Acupuncture for COVID-19 patient after ventilator weaning: A protocol for systematic review and meta-analysis

BACKGROUND

COVID-19 has spread globally since its outbreak in late 2019. It mainly attacks people's respiratory system. Many patients with severe COVID-19 require a ventilator to support breathing, and their lung function is often impaired to varying degrees after ventilator weaning. Acupuncture has been reported to improve respiratory function, but there is no evidence that it can improve respiratory function in ventilator users with COVID-19 after they are removed from the machine. The protocol of the systematic review and meta-analysis will clarify safety and effectiveness of acupuncture on respiratory rehabilitation after weaning from the ventilator during the treatment of COVID-19.

METHODS

We will search PubMed, EMBASE, MEDLINE, the Cochrane Library, Chinese National Knowledge Infrastructure, Chinese Biomedical Literature Database, Chinese Science and Technology Periodical Database, Wanfang Database, Clinical Trials and Chinese Clinical Trial Registry. Relevant English language and Chinese language literature will be included. A combination of subject words and free text words will be applied in the searches. The complete process will include study selection, data extraction, risk of bias assessment, and meta-analyses. We will use subgroup analysis and sensitivity analysis to explore the sources of heterogeneity if there is heterogeneity. We will use funnel charts to assess the risk of bias. Endnote X9.3 will be used to manage data screening. The statistical analysis will be completed by RevMan5.2 or Stata/SE 15.1 software.

RESULTS

This study will assess safety and effectiveness of acupuncture for rehabilitation on respiratory function after weaning from the ventilator during the treatment of COVID-19.

CONCLUSIONS

The conclusion of this study will give evidence to prove safety and effectiveness of acupuncture for rehabilitation on respiratory after weaning from the ventilator during the treatment of COVID-19.

REGISTRATION

PROSPERO CRD42020206889.