Resumen de Efectivitat de l'acupuntura com a tècnica no farmacològica en el tractament de la malaltia pulmonar obstructiva crònica
Background: Chronic obstructive pulmonary disease (COPD) is a highly prevalent condition, affecting 12% of the global population; it is caused by chronic airway and lung inflammation. This disease has an important impact on patient quality of life by causing progressive dyspnoea, chronic cough and sputum production, wheezing, chest tightness and poor exercise capacity. Although several pharmacological and non-pharmacological treatment strategies are used for COPD patients, they only aim to reduce the progression of the disease and control symptoms as much as possible. However, symptom management is till unsatisfactory in many patients and therefore new strategies are needed. Acupuncture is a therapeutic technique that originated from traditional Chinese medicine. It uses several stimulation methods, most of them non-pharmacologic, and has been traditionally used to treat multiple diseases, including respiratory conditions such as COPD. In recent years, several studies have been published suggesting that acupuncture techniques could be beneficial to COPD patients; however, the evidence is still not clear. Moreover, limitations on the completeness of reporting of acupuncture interventions have been found in past trials in different clinical health conditions, such as knee osteoarthritis, neurological diseases or cancer. Therefore, it is important to assess the current completeness of reporting of acupuncture trials on COPD to ensure the proper assessment, replication and implementation of the results of clinical trials.
Methods: This work resulted in three publications on this topic, including two systematic reviews assessing the effectiveness of the most common used acupuncture techniques and an assessment on the completeness of reporting of acupuncture interventions in COPD trials.
Results: Our two systematic reviews revealed benefits for some acupuncture techniques in the management of COPD treatment. Evidence suggests benefits of filiform needle acupuncture for dyspnoea exercise capacity and quality of life and possibly for acupressure for dyspnoea, quality of life and anxiety. However, the current evidence is limited by the risk of bias, heterogeneity and low number of existing trials.
Regarding the completeness of reporting of acupuncture interventions, we observed suboptimal reporting in several items of the STRICTA checklist, including needling insertion depth, needle type, number of treatment sessions, setting and context of the treatment, description of the acupuncturist and control rationale.
Discussion: Although acupuncture techniques have been used for decades in China to treat lung diseases such as COPD, current evidence regarding its efficacy is still limited. Research into acupuncture techniques share some of the difficulties of other non-pharmacological interventions, including low number of participants, the heterogeneity of its practice and difficulties in the blinding process. Researchers must be aware of those limitations when designing future trials, and choose the most adequate intervention and control types according to their specific research question.
Deficiencies in acupuncture publications reporting is another issue that needs to be improved, both regarding the trials methodology and the intervention description. This lack of information does not only stifle the assessment of the trial’s risk of bias, but also hinders the adequate assessment and reproduction of acupuncture research. Reporting guidelines such as CONSORT and STRICTA must be used to guarantee proper reporting in the published papers.
Conclusions: There is some evidence that filiform needle acupuncture and acupressure could be helpful in the treatment of COPD. For other interventions, the evidence is unclear. Future large high-quality research with better reporting is needed to have more reliable estimates of acupuncture technique effects in COPD patients to allow solid recommendation regarding acupuncture use.
