Acupuncture improved COPD in a "real" randomized trial - PulmCCM
Jun 232012

Acupuncture has danced on the fringes of mainstream Western medical therapy for decades. Acupuncture has been shown to improve numerous conditions --for example, reducing dyspnea in patients with cancer, asthma and chronic obstructive pulmonary disease (COPD) in a few randomized trials. But -- unsurprisingly, given complementary medicine's lack of funding and acceptance among traditional academics -- it's been easy to discount these intriguing results as biologically implausible or false positives ("alpha-errors") due to publication bias. Acupuncture studies' generally second-rate methodology and publishing journals have probably contributed to the skepticism, rightly or wrongly.

So you can expect acupuncture advocates to cheer for Masao Suzuki et al's small but well-conducted randomized trial in the June 11, 2012 Archives of Internal Medicine, showing that acupuncture for people with COPD improved dyspnea scores, six-minute walk distance, and oxygen desaturation as compared to placebo. FEV1 even improved in patients receiving acupuncture, albeit only by 4% over placebo.

What They Did

Authors randomized 68 Japanese patients with COPD (moderate-to-severe, with significant dyspnea at baseline) to receive either traditional Chinese acupuncture or "placebo needling" (sticking needles into one's body at points not specified by Chinese medicine) once a week for 12 weeks. Patients were all taking standard prescribed COPD medications. All patients and investigators were blinded to treatment allocation -- however, the acupuncturists were not. When questioned, patients could clearly not tell which treatment (real or fake acupuncture) they were receiving.

At baseline and at 12 weeks, dyspnea scores (the 0-10 modified Borg scale) after six-minute walk testing, as well as pulmonary function testing, were recorded. The Borg scale is validated as a test for dyspnea during exercise (the SGRQ and MRC scales are for activities of daily living).

What They Found

Dyspnea scores improved in the group receiving traditional acupuncture: from an average of 5.8 to 1.5 on the 10 point modified Borg scale. The sham acupuncture group, by comparison, had no improvement in its dyspnea scores: from 4.2 to 4.6. This amounted to a relative 4 point improvement in dyspnea (out of 10 possible) in the traditional acupuncture group. SGRQ and MRC scores (measuring dyspnea during normal activity) were also significantly improved. (ATS published a comparison of dyspnea scales, here.)

Patients receiving real acupuncture also had a relative improvement in their six-minute walk distance -- an average of 78 meters better than the placebo acupuncture group. No one knows the test parameters of 6MWD, but 40-50 meters has been proposed as the minimally clinically significant difference.

Other secondary outcomes improved with acupuncture for COPD, as well:

  • Oxygen saturation during exercise improved from 86 to 89.5% (mean) in the real acupuncture group, while it declined from 88 to 87% in placebo patients -- a relative 4% increase.
  • Pulmonary function saw tiny improvements (but statistically significant) in the real acupuncture group for FEV1 (4% predicted), FVC, DLCO, and expiratory strength.
  • Body mass index (BMI) improved by a relative 1 point in the real acupuncture group.

There were no significant adverse events in either group; there was no apparent difference between groups in medical therapy, the use of inhalers, etc.

What It Means

Like any randomized trial that produces a benefit from acupuncture or another so-called complementary therapy, these results are fascinating to the pharmacology-obsessed Western medical mind. How might it have worked? It's purely speculative, but needles were placed in the back alongside respiratory muscles, and authors posit that the needles somehow reduce accessory muscle fatigue.

It's impossible not to be intrigued by such positive findings, and based on this trial and the few that preceded it, I would happily support a trial of acupuncture to a COPD patient if she suggested it or asked about it.

Of course, before recommending it, it would be great to find out how these patients performed on the same scores and outcomes, 12 weeks after the trial (and their acupuncture therapy) concluded -- and then to see the same trial done in 300 patients at 10 centers, rather than 68 at three. After all, pulmonary rehabilitation also improves outcomes in the short term ... but unfortunately, not for longer, if the exercise is not sustained.

Who wouldn't be pleased if we had a new, effective, non-drug therapy like acupuncture for COPD (and who cares how it works, as long as it really does)? Maybe the U.S.'s taxpayer-funded National Center for Complementary and Alternative Medicine, a division of the NIH created by Sen. Tom Harkin after having his allergies cured by bee pollen (but which to my knowledge has so far produced no consistent evidence of benefit for any complementary therapy), could allocate a couple million bucks to help answer the question?

Suzuki M et al. A Randomized, Placebo-Controlled Trial of Acupuncture in Patients With Chronic Obstructive Pulmonary Disease (COPD)The COPD-Acupuncture Trial (CAT). Arch Intern Med 2012;172:878-886.

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