Role of Acupuncture in the Treatment of COPD: An Overview of Systematic Reviews

Figures & data

Figure 1 Flowchart of literature selection.

Table 1 Characteristics of the Included Systematic Reviews

First Author, Year	Country	Trials (Sample Size)	Intervention		Treatment Duration	Outcomes	Quality Assessment Tool	Overall Conclusion
			Treatment Group	Control Group
Coyle, 2014^Citation15	Australia	12 (841)	AT	MT	7 d-1 y	Effective rate; lung function (FEV1 and FVC); arterial blood gases (PaO2 and PaCO2); 6MWD; CAT; acute exacerbation	Cochrane risk of bias tool	AT might improve lung function and the effective rate in people with COPD; however, the evidence is not convincing.
Cao, 2017^Citation16	China	9 (326)	AT+PR; AT+MT; AT	SAT+PR; SAT+MT; SAT	10 d-12 w	6MWD; SGRQ; lung function (FEV1 and FVC)	Cochrane risk of bias tool	AT is a safe and effective treatment for COPD.
Li, 2017^Citation17	China	7 (398)	AT+MT; AT+PR	MT; SAT+PR	27 d-6 m	Effective rate; lung function (FEV1%pre and FEV1/FVC); 6MWD	Cochrane risk of bias tool	AT may increase the clinical efficiency, improve the lung function and the quality of life, but there was no significant difference in the 6MWD.
Wang, 2018^Citation18	China	19 (1298)	AT+PR; AT+MT; AT+PR+MT	MT; PR; SAT+MT; PR+MT; SAT+PR	3 w-6 m	Effective rate; dyspnoea (Borg, mMRC); QoL (SGRQ, CAT, and EQ-5D); 6MWD; arterial blood gas; lung function (FEV1, FVC, PEF, FEV1%pre, FEV1/FVC); acute exacerbation	Cochrane risk of bias tool	AT may be effective in improving functional effects, quality of life and pulmonary function in COPD patients.
Carles, 2019^Citation19	Spain	27 (-)	AT+PR; AT+MT; AT+PR+MT	PR; MT; PR+MT; SAT+MT; SAT+PR+MT	10 d-100 d	Dyspnoea (Borg, mMRC, and DVAS); QoL (SGRQ and CAT); lung function (FEV1%pre, FVC, FEV1/FVC, PEF, and TLC); 6MWD	Cochrane risk of bias tool	AT may improve QoL and exercise capacity in patients with stable COPD. Mixed results were obtained for lung function, but those statistically significant differences were not clinically relevant.
Hsieh, 2019^Citation20	China	12 (798)	AT+MT; AT+PR+MT; AT+PR	MT; PR+MT; PR	4 w-14 w	Effective rate; lung function (FEV1, FEV1/FVC, MVV, TLC, RV, and RV/TLC); ISWT; dyspnoea (Borg and mMRC); QoL (SGRQ, EQ-5D, and CAT); arterial blood gases (PaO2 and PaCO2)	Cochrane risk of bias tool	AT is an effective adjunct non-pharmacological treatment to improve HRQL in patients receiving medical treatment for COPD.
Xie, 2019^Citation21	China	8 (498)	AT+ MT	MT	14 d-20 d	Lung function (FEV1 and FEV1/FVC); CAT; mMRC	Cochrane risk of bias tool	AT may improve FEV1% and FEV1/FVC, and reduce the CAT scores and mMRC scores of patients with AECOPD.
Zheng, 2019^Citation22	China	10 (902)	AT + MT	MT	1 w-6 m	Effective rate; lung function (FEV1, FVC, FEV1%pre, and FEV1/FVC); CD4^+/CD8^+	Cochrane risk of bias tool	AT may improve the efficiency and the immune function of patients of COPD, but does not improve lung function.
Wang, 2020^Citation23	China	9 (682)	AT+PR; AT+MT; AT + MT	PR; MT; SAT+MT	1 w-6 m	6MWD; SGRQ; lung function (FEV1, FEV1%pre, FVC%, FEV1/FVC, PEF, TLC, and MVV); arterial blood gases (PaO2 and PaCO2);	Jadad scale	AT is a safe and effective treatment for COPD.

Note: Acupuncture therapy included needle acupuncture, acupuncture point injection therapy.

Abbreviations: AT, acupuncture therapy; SAT, sham acupuncture therapy; MT, medication therapy; PR, pulmonary rehabilitation; d, day; w, week; m, month; y, year; FEV₁, forced expiratory volume in 1 s; FVC, forced vital capacity; FEV₁%pre, forced expiration volume in 1 s/prediction; FEV₁/FVC, percentage of forced expiratory volume and forced vital capacity in 1 s; PEF, peak expiratory flow; MVV, maximal voluntary ventilation; TLC, total lung capacity; RV, residual volume; IVC, inspiratory vital capacity; 6MWD, six-minute walk distance; ISWT, incremental shuttle walk test; QoL, quality of life; SGRQ, St. George’s respiratory questionnaire; CAT, COPD assessment test; EQ-5D, EuroQol five dimensions questionnaire; mMRC, Modified Medical Research Council; DVAS, dyspnoea visual analogue scale; SSAI, Spielberger’s state anxiety inventory; GDS, geriatric depression scale; HAM-A, Hamilton anxiety rating scale; HAM-D, Hamilton depression rating scale.

Figure 2 Quality assessment according to the AMSTAR-2 items for included systematic reviews. Q1: Did the research questions and inclusion criteria for the review include the components of population, intervention, comparison, outcome (PICO)? Q2: Did the report of the review contain an explicit statement that the review methods were established prior to the conduct of the review and did the report justify any significant deviations from the protocol? Q3: Did the review authors explain their selection of the study designs for inclusion in the review? Q4: Did the review authors use a comprehensive literature search strategy? Q5: Did the review authors perform study selection in duplicate? Q6: Did the review authors perform data extraction in duplicate? Q7: Did the review authors provide a list of excluded studies and justify the exclusions? Q8: Did the review authors describe the included studies in adequate detail? Q9: Did the review authors use a satisfactory technique for assessing the risk of bias (RoB) in individual studies that were included in the review? Q10: Did the review authors report on the sources of funding for the studies included in the review? Q11: If meta-analysis was performed did the review authors use appropriate methods for statistical combination of results? Q12: If meta-analysis was performed, did the review authors assess the potential impact of RoB in individual studies on the results of the meta-analysis or other evidence synthesis? Q13: Did the review authors account for RoB in individual studies when interpreting/discussing the results of the review? Q14: Did the review authors provide a satisfactory explanation for, and discussion of, any heterogeneity observed in the results of the review? Q15: If they performed quantitative synthesis did the review authors carry out an adequate investigation of publication bias (small study bias) and discuss its likely impact on the results of the review? Q16: Did the review authors report any potential sources of conflict of interest, including any funding they received for conducting the review?.

Table 2 Quality of Evidence in Included Systematic Reviews with GRADE

Outcome Measures	Systematic Reviews	N/n	Effect Estimate (95% CI)	Quality Assessment					Quality of Evidence
				Risk of Bias	Inconsistency	Indirectness	Imprecision	Publication Bias
6 MWD	AT+MT vs MT
	Carles et al 2019^Citation19	4(306)*	MD 33.05(19.11, 46.99)	0	−1^b	0	−1^c	0	Low
		2(142)**	MD 0.65(−20.74, 22.04)	−1^a	0	0	−1^c	0	Low
	Wang et al 2020^Citation23	4(212)	MD 10.16(4.34, 15.99)	−1^a	0	0	−1^c	0	Low
	Li et al 2017^Citation17	3(155)	MD 14.71(−17.09, 6.50)	0	0	0	−1^c	0	Moderate
	Wang et al 2018^Citation18	4(263)	MD 35.15(2.37, 67.92)	0	−1^b	0	−1^c	0	Low
	AT vs SAT
	Wang et al 2018^Citation18	4(198)	MD 63.05(39.27, 86.83)	0	−1^b	0	−1^c	0	Low
	Cao et al 2017^Citation16	5(203)	MD 33.69(5.85, 61.52)	−1^a	0	0	−1^c	0	Low
	Carles et al 2019^Citation19	4(158)	MD 76.68(39.93, 113.43)	0	0	0	−1^c	0	Moderate
	AT+PR vs PR
	Hsieh et al 2019^Citation20	1(80)	MD 8.40(−5.88, 22.68)	0	−1^b	0	−1^c	0	Low
SGRQ	AT+MT vs MT
	Wang et al 2020^Citation23	2(130)	MD −2.76(−5.65, 0.14)	−1^a	0	0	−1^c	0	Low
	AT vs SAT
	Cao et al 2017^Citation16	2(98)	MD - 9.00(−14.44, −3.56)	0	0	0	−1^c	0	Moderate
	Wang et al 2018^Citation18	3(157)	MD −10.66(−22.24, 0.92)	0	0	0	−1^c	0	Moderate
	AT + PR vs PR
	Hsieh et al 2019^Citation20	1(40)	MD 0.3(−6.83, 7.43)	−1^a	−1^b	0	−1^c	−1^e	Very Low
FEV1%	AT +MT vs MT
	Zheng et al 2019^Citation22	4(321)	SMD 0.10(−0.62, 0.82)	0	−1^b	0	−1^c	0	Low
	Xie et al 2019^Citation21	6(313)	MD 4.94(1.75, 8.11)	−1^a	−1^b	0	−1^c	0	Very Low
	Wang et al 2020^Citation23	6(296)	MD 5.93(5.73, 6.14)	−1^a	0	0	−1^c	−1^d	Very Low
	Li et al 2017^Citation17	6 (354)	MD 1.98(0.14, 3.82)	0	0	0	−1^c	0	Moderate
	Hsieh et al 2019^Citation20	3(200)	MD 1.98(0.26, 3.70)	−1^a	0	0	−1^c	−1^e	Very Low
	Carles et al 2019^Citation19	9(462)*	MD 1.04(−0.21, 2.29)	−1^a	0	0	0	0	Moderate
		4(267)**	MD 3.09(1.00, 5.18)	−1^a	0	0	−1^c	0	Low
	Coyle et al 2014^Citation15	2(256) *	MD −5.06(−25.38, 15.26)	−1^a	0	0	−1^c	0	Low
		3(336) **	MD 1.46(−1.20, 4.11)	−1^a	0	0	−1^c	0	Low
	AT vs SAT
	Cao et al 2017^Citation16	5(219)	MD 4.93(1.87, 7.99)	0	0	0	−1^c	0	Moderate
	Carles et al 2019^Citation19	6(227)	MD 5.40(2.90, 7.91)	0	0	0	−1^c	0	Moderate
	AT + PR vs PR
	Hsieh et al 2019^Citation20	2(150)	MD 7.80(6.91, 8.68)	−1^a	0	0	−1^c	−1^e	Very Low
FEV1/FVC	AT +MT vs MT
	Zheng et al 2019^Citation22	3(251)	SMD −0.13(−0.37,0.12)	−1^a	0	0	−1^c	0	Low
	Xie et al 2019^Citation21	10(558)	MD 4.40(0.72, 8.08)	−1^a	0	0	0	0	Moderate
	Wang et al 2020^Citation23	6(438)	MD 10.16(4.34, 15.99)	−1^a	0	0	0	0	Moderate
	Li et al 2017^Citation17	7(398)	MD 0.47(0.27, 0.67)	−1^a	0	0	−1^c	−1^d	Very Low
	Hsieh et al 2019^Citation20	3(200)	MD 1.56(−0.18, 3.29)	−1^a	0	0	−1^c	−1^e	Very Low
	Carles et al 2019^Citation19	7(349) *	MD 1.33(−1.19, 3.85)	−1^a	−1^b	0	−1^c	0	Very Low
		4(330) **	MD 3.42(1.55, 5.29)	−1^a	−1^b	0	−1^c	0	Very Low
	AT vs SAT
	Cao et al 2017^Citation16	3(91)	MD 7.57(0.34, 14.80)	−1^a	0	0	−1^c	−1^d	Very Low
	Carles et al 2019^Citation19	4(145)	MD 6.64(3.44, 9.83)	0	0	0	−1^c	0	Moderate
	AT+PR vs PR+MT
	Hsieh et al 2019^Citation20	2(112)	MD −3.50(−10.11, 3.12)	−1^a	−1^b	0	−1^c	−1^e	Very Low

Notes: N: number of studies; n: number of participants; *stable COPD; **acute exacerbation of COPD; ^athe design of the experiment with a large bias in random, distributive hiding, or blind; ^bthe confidence interval overlaps less, the heterogeneity test P is very small, and I² is larger; ^cthe sample size is small, and the confidence interval is wide; ^dfunnel graph asymmetry; ^efewer studies are included, and there may be greater publication bias.

Figure 3 Evidence mapping of the interest outcomes. Bubbles: the studies included in this article (first author, publication year); Bubble size: sample size; X-axis: different intervention measures included; Y-axis: AMSTAR score; color: light blue represents the P-value<0.05, light purple represents the P-value>0.05; (A) evidence mapping of 6MWD; (B) evidence mapping of SGRQ; (C) evidence mapping of FEV1%pre; (D) evidence mapping of FEV1/FEV.

Notes: *Stable COPD, **acute exacerbation of COPD.

Abbreviations: CL, critically low; L, low; M, moderate; H, high; AT, acupuncture therapy; SAT, sham acupuncture therapy; MT, medication therapy; PR, pulmonary rehabilitation.

Coyle ME, Shergis JL, Huang ET-Y, et al. Acupuncture therapies for chronic obstructive pulmonary disease: a systematic review of randomized, controlled trials. Altern Ther Health Med. 2014;20(6):10–23.

 PubMed Web of Science ®Google Scholar

Cao IL, He HL, Zhou XM. Meta analysis of the therapeutic effect of acupuncture on chronic obstructive pulmonary disease. Global Tradit Chin Med. 2017;10(07):899–904. doi:10.3969/j.issn.1674-1749.2017.07.038

 Google Scholar

Tang J-F, Li,W-X, Zhang F. Discrimination of Radix Polygoni Multiflori from different geographical areas by UPLC-QTOF/MS combined with chemometrics. Henan Univ Chin Med. 2017;12. doi:10.1186/s13020-017-0155-8

 Google Scholar

Wang JJ, Li JS, Yu XQ, Xie Y. Acupuncture therapy for functional effects and quality of life in COPD patients: a systematic review and meta-analysis. Biomed Res Int. 2018;2018:3026726. doi:10.1155/2018/3026726

 PubMed Web of Science ®Google Scholar

Fernández-Jané C, Vilaró J, Fei Y, et al. Filiform needle acupuncture for copd: a systematic review and meta-analysis. Complement Ther Med. 2019;47:102182. doi:10.1016/j.ctim.2019.08.016

 PubMed Web of Science ®Google Scholar

Hsieh P-C, Yang M-C, Wu Y-K, et al. Acupuncture therapy improves health-related quality of life in patients with chronic obstructive pulmonary disease: a systematic review and meta-analysis. Complement Ther Clin Pract. 2019;35:208–218. doi:10.1016/j.ctcp.2019.02.016

 PubMed Web of Science ®Google Scholar

Xie HF. Effect of acupuncture therapy for acute exacerbation of chronic obstructive pulmonary disease, A systematic review and meta-analysis [Thesis of master’s degree]. Beijing Univ Chin Med. 2019.

 Google Scholar

Zheng WJ, Peng ZJ, Zhang TG, et al. A meta- analysis and trial sequential analysis of acupoint injection with chuankezhi injection for treating stable-stage patients with chronic obstructive lung disease. Traditl Chin Drug Res Clin Pharmacol. 2019;30(6):725–732. doi:10.19378/j.issn.1003-9783.2019.06.015

 Google Scholar

Wang YD, Li FS, Li Z, Yue JN, Ma CL. Systematic evaluation of acupuncture on pulmonary rehabilitation in patients with stable chronic obstructive pulmonary disease. Mod Tradit Chin Med Mater Medica World Sci Technol. 2020;22(01):196–204. doi:10.11842/wst.20190222003

 Google Scholar