Yes, the Archives of Internal Medicine just published a study from Japan that adds some evidence that acupuncture is an effective treatment for dyspnea. Now for all you skeptics out there: I realize I live in San Francisco but I swear I’m generally a skeptic as well. Complimentary and Alternative Medicine (CAM) studies are often fraught with methodological issues. This study done by a group of Japanese researchers unfroze my heart towards CAM, in part due to their interesting methods to blind participants and thoroughness in study design.
So, what did they do?
The authors performed a prospective, single-blind randomized controlled trial of clinically stable outpatients with stage II, III, or IV COPD who had stage II or higher dyspnea according to the Medical Research Council (MRC) criteria (Stage II is short of breath when walking up a short hill). These were reasonably functional patients who were able to walk unassisted and apparently had no evidence of cardiovascular disease, collagen disease, renal failure, thyroid dysfunction, hepatic function disorder, cancer, and severe mental disorders (this list rules out most of my patients).
What were the outcomes?
After 12 weeks of treatment the primary outcome, changes in dyspnea on exertion after a 6-minute walk test (6MWT) using a modified Borg scale (0 to 10 points), improved on average by 3.6 points in the real acupuncture group but not at all in the sham group. They also found significant improvements in the 6 minute walk distance, oxygen saturation during the 6MWT, quality of life scores, and dyspnea scores using the MRC after the 12 weeks of acupuncture.
Changes in the FEV1 did not reach statistical significance, although after 12 weeks of acupuncture, there were significant improvements in the real acupuncture group in regards to respiratory function (forced vital capacity, percentage of FEV1, DLCO, and percentage of DLCO) and respiratory muscle strength (maximum expiratory mouth pressure and maximum inspiratory mouth pressure).
What to do with this study?
This is the first study of it’s kind to show that acupuncture improves dyspnea on exertion and exercise tolerance in patients with COPD. It is a small study of only 68 patients in a relatively homogenous Japanese population, so generalizability is an issue. It is difficult to know whether the results of this type of acupuncture can be generalized to other types of acupuncture that a patient would get if he/she were sent to a therapist. Lastly, it is also plausible that the unblended therapist in this trial may still have influenced the results of the study, even though all the evaluators were blinded.
In the end though, the harms of acupuncture are small and the potential benefits are significant considering the morbidity that is associated with dyspnea. There still needs to be a bigger trial using similar rigorous research methods to confirm these findings, but I think I'm going to stick this in my bag of goodies next time I'm searching for a way to treat dyspnea in COPD.
by: Eric Widera (@ewidera)