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Efficacy of Acupuncture in Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis
International Journal of Chronic Obstructive Pulmonary Disease ( IF 2.8 ) Pub Date : 2024-03-11 , DOI: 10.2147/copd.s450257 Chunyan Yang , Hao Tian , Guixing Xu , Qin Luo , Mingsheng Sun , Fanrong Liang
International Journal of Chronic Obstructive Pulmonary Disease ( IF 2.8 ) Pub Date : 2024-03-11 , DOI: 10.2147/copd.s450257 Chunyan Yang , Hao Tian , Guixing Xu , Qin Luo , Mingsheng Sun , Fanrong Liang
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.
Keywords: acute exacerbation of chronic obstructive pulmonary disease, acupuncture, systematic review, meta-analysis
中文翻译：
针灸治疗慢性阻塞性肺疾病急性加重的疗效：系统评价和荟萃分析
目的：针灸辅助治疗慢性阻塞性肺疾病急性加重（AECOPD）的效果存在争议。因此，我们的目的是评估针灸治疗 AECOPD 的效果。
方法：检索了8个数据库，从数据库建库到2023年7月30日。所有比较针灸加常规西药与单独常规西药的随机对照试验均被纳入。结果包括生活质量、肺功能、血氧状况、运动能力、日常症状、住院时间和不良事件。使用Stata 17.0进行统计分析，并通过Cochrane偏倚风险评估工具测量方法学质量。使用建议评估、制定和评价分级（GRADE）方法来评估证据的质量。
结果：纳入 12 项研究，共 915 名患者。与单纯常规西医治疗相比，针灸联合常规西医治疗显着改善生活质量（CAT：MD：− 3.25；95% CI：− 3.73至− 2.78，P < 0.001）和动脉血气分析（PaCO 2：MD： − 1.85；95% CI：− 2.74 至 − 0.95，P < 0.001；PaO 2：MD：5.15；95% CI：1.22 至 9.07，P = 0.01）。对于肺功能，FEV 1 /FVC具有统计学意义（MD：4.66；95% CI：2.21 至 7.12，P < 0.001），但 FEV 1 %没有差异（MD：1.83；95% CI： − 0.17 至 3.83，P = 0.073）。运动能力（6MWD：MD：96.69；95% CI：− 0.60至193.98， P = 0.051）、住院时间（MD：− 5.70；95% CI：− 11.97至0.58，P = 0.075）没有显着改善和呼吸困难（mMRC：MD：− 0.19；95% CI：− 0.61 至 0.63，P = 0.376）。CAT 和 mMRC 的总体偏倚属于“高”风险，FEV1%、FEV 1 /FVC、PaCO 2和 PaO 2属于“有些担忧”，1 项评估住院时间的 RCT 属于“低”风险。总体评估为中等、低或极低确定性。七项试验对针灸进行了安全性评估，没有报告严重不良事件。
结论：针刺对AECOPD可能有辅助作用。然而，证据质量有限，未来需要进行更多高质量的随机对照试验。
关键词:慢性阻塞性肺疾病急性加重, 针灸, 系统评价, Meta 分析
更新日期：2024-03-11
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.
Keywords: acute exacerbation of chronic obstructive pulmonary disease, acupuncture, systematic review, meta-analysis
中文翻译：
针灸治疗慢性阻塞性肺疾病急性加重的疗效：系统评价和荟萃分析
目的：针灸辅助治疗慢性阻塞性肺疾病急性加重（AECOPD）的效果存在争议。因此，我们的目的是评估针灸治疗 AECOPD 的效果。
方法：检索了8个数据库，从数据库建库到2023年7月30日。所有比较针灸加常规西药与单独常规西药的随机对照试验均被纳入。结果包括生活质量、肺功能、血氧状况、运动能力、日常症状、住院时间和不良事件。使用Stata 17.0进行统计分析，并通过Cochrane偏倚风险评估工具测量方法学质量。使用建议评估、制定和评价分级（GRADE）方法来评估证据的质量。
结果：纳入 12 项研究，共 915 名患者。与单纯常规西医治疗相比，针灸联合常规西医治疗显着改善生活质量（CAT：MD：− 3.25；95% CI：− 3.73至− 2.78，P < 0.001）和动脉血气分析（PaCO 2：MD： − 1.85；95% CI：− 2.74 至 − 0.95，P < 0.001；PaO 2：MD：5.15；95% CI：1.22 至 9.07，P = 0.01）。对于肺功能，FEV 1 /FVC具有统计学意义（MD：4.66；95% CI：2.21 至 7.12，P < 0.001），但 FEV 1 %没有差异（MD：1.83；95% CI： − 0.17 至 3.83，P = 0.073）。运动能力（6MWD：MD：96.69；95% CI：− 0.60至193.98， P = 0.051）、住院时间（MD：− 5.70；95% CI：− 11.97至0.58，P = 0.075）没有显着改善和呼吸困难（mMRC：MD：− 0.19；95% CI：− 0.61 至 0.63，P = 0.376）。CAT 和 mMRC 的总体偏倚属于“高”风险，FEV1%、FEV 1 /FVC、PaCO 2和 PaO 2属于“有些担忧”，1 项评估住院时间的 RCT 属于“低”风险。总体评估为中等、低或极低确定性。七项试验对针灸进行了安全性评估，没有报告严重不良事件。
结论：针刺对AECOPD可能有辅助作用。然而，证据质量有限，未来需要进行更多高质量的随机对照试验。
关键词:慢性阻塞性肺疾病急性加重, 针灸, 系统评价, Meta 分析
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