Acupuncture as Adjunctive Therapy in COPD

Patients with chronic obstructive pulmonary disease (COPD) often experience dyspnea on exertion (DOE), a difficult-to-control symptom. COPD is characterized by irreversible airflow limitation and, by 2020, is expected to be the third leading cause of death worldwide. DOE is associated with significant disease burden and has a negative effect on varied aspects of daily life.

DOE is progressive, with the severity increasing over time, and is predictive of survival in COPD. Managing DOE is a crucial part of successful treatment of patients with COPD.

Previous studies have shown that acupuncture reduces breathlessness in patients with cancer. A review of 16 randomized, controlled trials, involving a total of 2937 patients, found that acupuncture is a safe and potentially effective intervention for patients with asthma and COPD. In this randomized, placebo-controlled trial, researchers sought to evaluate the efficacy of acupuncture in patients with COPD, with a focus on changes in DOE, evaluated with the 6-minute walk test (6MWT) and fully assessed respiratory functions. Results were reported online in Archives of Internal Medicine [doi:10.100/archinternmed.2012.1233].

The study was conducted from July 1, 2006, through March 31, 2009, at a university hospital in Japan. Patients were randomly assigned to 1 of 2 groups: (1) traditional acupuncture (real acupuncture group [RAG], n=34) or (2) placebo needling (placebo acupuncture group [PAG], n=34). The patients received real or placebo needling at the same acupoints once a week for 12 weeks.

The primary end point was the modified Borg scale evaluated immediately following the 6MWT. To rate breathlessness before and immediately after the 6MWT, the researchers used a modified 10-point Borg category ratio scale, where 0 signified “breathing very well, barely breathless,” and 10 signified “severely breathless.” Measurements were taken at baseline and following 12 weeks of treatment.

At the end of the 12-week intervention period, the Borg scale score after the 6MWT improved from 5.5 to 1.9 in the RAG; there was no significant improvement in the PAG. In the RAG, the difference in Borg scale was statistically significant compared with that in the PAG.

Secondary outcomes included improvement in oxygen saturation during the 6MWT and St. George Respiratory Questionnaire results after treatment. In the RAG, difference from baseline in both measures was significantly greater than in the PAG. Differences in change in forced expiratory volume in 1 second were not statistically significant between the 2 groups.

In other outcome measures, significant improvements in the Medical Research Council criteria score in the RAG, with a significantly greater reduction in scores compared with the PAG. Improvement in the nutritional status and range of motion in the rib cage was also evident in the RAG, with a statistically significant difference compared with that in the PAG.

There were some adverse reactions in the 2 groups. Four patients in the RAG and 5 in the PAG reported fatigue, 5 in the RAG reported subcutaneous hemorrhage, 1 in the RAG and 2 in the PAG reported dizziness, and 5 in the RAG reported needle site pain. All events were minor and recovery time was short. There were no serious adverse events.

In conclusion, the researchers said, “This study clearly demonstrates that acupuncture is a useful adjunctive therapy in reducing DOE in patients with COPD.”