Clinical Effects Of Acupuncture On The Pathophysiological Mechanism Of Chronic Obstructive Pulmonary Disease During Exercise

Abstract

Purpose

Pharmacological therapy and pulmonary rehabilitation are useful for exertional dyspnoea in patients with chronic obstructive pulmonary disease (COPD); however, several patients have no meaningful improvements. Although acupuncture significantly improves exercise intolerance and dyspnoea, the pathophysiological mechanism of these effects is unknown; therefore, we evaluated this mechanism using cardiopulmonary exercise testing in a single-arm, open experimental study.

Patients and methods

Sixteen patients with COPD underwent acupuncture once a week for 12 weeks. Primary outcomes were exercise performance parameters, including peak oxygen uptake in the incremental exercise tests (IETs) and the time to the limit of tolerance measured in constant work rate exercise tests (CWRETs) at 70% peak work-rate of the IET. IETs and CWRETs were performed at baseline and at weeks 12, 16, and 24.

Results

During the time course, there were significant increases in peak oxygen uptake (p = 0.018) and minute ventilation (V̇_E, p = 0.04) in the IETs. At 12 weeks, the endurance time significantly increased (810 ± 470 vs 1125 ± 657 s, p < 0.001) and oxygen uptakes at terminated exercise were significantly lower (771 ± 149 mL/min, p < 0.05) than those at baseline (822 ± 176 mL/min) in CWRETs. The significant decreases in oxygen uptake and minute ventilation and improvements in Borg scale scores were also observed during CWRETs after acupuncture. The decreases at isotime in the Borg scale (r = −0.789, p = 0.0007) and V̇_E (r = −0.6736, p = 0.0042) were significantly correlated with the improvement of endurance time.

Conclusion

The positive effects of acupuncture on exertional dyspnoea were associated with increased endurance time influenced by improved oxygen utilisation and reduced ventilation during exercise. Acupuncture may be a new intervention for COPD in addition to conventional maintenance therapies.

Keywords:

• chronic obstructive pulmonary disease
• COPD
• acupuncture
• exercise intolerance and dyspnoea
• cardiopulmonary exercise test
• CPET

Acknowledgments

We thank Professor Kenji Namura (Meiji University of Integrative Medicine) and Mr. Teranishi T. (CMIC Holdings Co., Ltd. Tokyo, Japan) for their assistance in statistical analysis. This study received Grant-in-Aid for Clinical Research from National Hospital Organization in Japan.

Ethics Approval And Informed Consent And Consent For Publication

This study was performed in accordance with the Declaration of Helsinki and its amendments, the Guidelines for Good Clinical Practice for Epidemiological Studies, the Standards for Reporting Interventions in Clinical Trials of Acupuncture (STRICTA), and the Guidelines for Clinical Research issued by the Japanese Ministry of Health. The institutional review board of the National Hospital Organization Osaka Toneyama Medical Center approved this study (number: 1580), and each patient provided written informed consent. The study protocol is registered at the University Hospital Medical Information Network in Japan (UMIN000017609).

Data Availability

The authors confirm that the data supporting the findings of this study are available within the article.

Author Contributions

All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.