A critical analysis of acupuncture in pulmonary disease: efficacy and safety of the acupuncture needle.

Criteria for therapeutic efficacy and safety include significant amelioration of symptoms and, ideally, cure (i.e., patients' belief in effective improvement of symptoms and quality of life, durable impact on symptoms, verifiable subjective and objective changes); improved patient management (e.g., diminishing, or ceasing medication, physiotherapy, and other interventions); safety for patient and practitioner and an acceptable side effect profile; cost-effectiveness of the therapy in practice and to teach to others. There is evidence that in bronchial asthma, chronic bronchitis, and chronic disabling breathlessness the use of acupuncture fulfills these to varying degrees. It can facilitate reducing pharmacologic medication and is safe, suggesting that acupuncture as an adjuvant in the treatment of respiratory disease might be safer than prolonged pharmaceutical maintenance therapy alone. Its cost-effectiveness has yet to be adequately researched. Twenty-one papers in English were obtained and 16 were further evaluated; eight were double-blind, five single-blind, and three unblinded. The remaining five, and most of the Chinese literature, were excluded on account of their poor quality. Acupuncture was effective in four of eight of the double-blind, three of five single-blind, and three of three unblinded studies (i.e., 10 of 16 [62.5%] overall). A previously unreported confounding variable was identified and concerned the designation of sham points. Most sham points were believed to be inactive but, according to traditional Chinese principles, many are active in pulmonary disease. Reappraised accordingly, the unequivocally positive studies were summed with those in which "real" and "sham" acupuncture were not significantly different but in which the combined effect of all acupuncture (i.e., real + sham) on breathlessness was significantly different from baseline. This yielded 13 of 16 (81%) [corrected] studies in which acupuncture led to significant improvement. In most studies, current pharmacologic treatment had a greater effect than acupuncture alone. However, in the 11 studies in which it was evaluated, medication could be significantly reduced by acupuncture in 10 (91%). Twenty-three of the 320 patients in the 16 studies (7%) reported minimal side effects, none requiring intervention. Current published evidence reveals no reason to withhold acupuncture as a safe and potentially effective treatment in patients with bronchial asthma and chronic obstructive lung disease. Further, more appropriately designed studies are urgently required. This would be facilitated in the United States by licensing the acupuncture needle as a therapeutic agent and might lead to important new insights and therapeutic opportunities.