Efficacy of Acupuncture in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis.

ABSTRACT

Purpose: The effect of acupuncture as adjunctive therapy for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) was controversial. Thus, we aimed to evaluate the effects of acupuncture for treating AECOPD. Methods: Eight databases were searched from database inception to July 30, 2023. All RCTs compared acupuncture plus conventional western medicine with conventional western medicine alone were included. Outcomes were quality of life, lung function, blood oxygen condition, exercise capacity, daily symptoms, duration of hospitalization, and adverse events. The statistical analyses were conducted using Stata 17.0, and methodological quality was measured by the Cochrane bias risk assessment tool. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of evidence. Results: Twelve studies including 915 patients were included. Compared with conventional western medicine alone, acupuncture combined with conventional western therapy significantly improved quality of life (CAT MD -3.25; 95% CI -3.73 to -2.78, P<0.001) and arterial blood gas (PaCO2 MD -1.85; 95% CI -2.74 to -0.95, P<0.001; PaO2 MD 5.15; 95% CI 1.22 to 9.07, P = 0.01). And for lung function, statistical benefits were found in FEV1/FVC (MD 4.66; 95% CI 2.21 to 7.12, P<0.001), but no difference was seen for FEV1% (MD 1.83; 95% CI -0.17 to 3.83, P = 0.073). There was no significant improvement in exercise capacity (6MWD MD 96.69; 95% CI -0.60 to 193.98, P = 0.051), hospitalization duration (MD -5.70; 95% CI -11.97 to 0.58, P = 0.075), and dyspnea (mMRC MD -0.19; 95% CI -0.61 to 0.63, P = 0.376) between two groups. Overall bias for CAT and mMRC was in "high" risk, FEV1%, FEV1/FVC, PaCO2, and PaO2 was in "some concern" and 1 RCT assessing hospitalization duration was in "low" risk. And the overall assessments were either moderate, low or very low certainty. Seven trials performed safety assessment of acupuncture, and no serious adverse events were reported. Conclusion: Acupuncture might have auxiliary effects on AECOPD. However, the quality of the evidence is limited, and more high-quality RCTs are needed to be performed in the future.