Inspired by Li et al and He et al 2025.[1,2]
COPD – chronic obstructive pulmonary disease
EA – electroacupuncture
API – allergic pulmonary inflammation
IF – impact factor
GOLD – Global initiative for chronic Obstructive Lung Disease
6MWD – 6-minute walk distance
SGRQ – St. George’s Respiratory Questionnaire
HRQoL – health-related quality of life
MCID – minimal clinically important difference– key to acronyms
A couple of weeks ago I worried us all with mechanistic data suggesting that an otherwise quite reasonable dorsal segmental EA approach could exacerbate asthma (a rodent model involving API) – see BL13 EA in asthma. So, when I noticed two recent RCTs on COPD, I thought they might reset the balance. Both papers are from China, but they appear to be entirely independent of each other.
One paper comes from Henan province and is published in Complementary Therapies in Medicine (IF 3.3) and the other comes from a single centre in Guangzhou (Guandong province) and is published in Integrative Medicine Research (IF 2.8). The former is a multicentre open pragmatic 3-arm trial (n=150) comparing acupuncture with drugs and with the combination of both. The latter is a single centre blinded explanatory (sham controlled) 2-arm trial (n=85) of EA plus exercise training versus a non-penetrating sham EA plus the same exercise training.
Both studies selected patients with COPD according to the GOLD diagnostic criteria; however, to challenge me, they quoted reports from different years: 2017 vs 2022. I checked both, as well as the current version from 2025. All three quote the same essential criterion for diagnosis of COPD – spirometry showing the presence of a post-bronchodilator FEV1/FVC <0.7 is mandatory to establish the diagnosis… The larger pragmatic trial also limited inclusion to the presence of 1 of 4 relevant TCM syndromes. This informed the selection of points in this trial, which were customised to the relevant syndrome, although there was a lot of overlap, and BL13, GV14, and BL12 were used in all cases.
By contrast, the smaller efficacy study used points on the ventral surface ‘…for comfort and compliance’ and apparently get close to the diaphragm (reference 17 of the paper).[3] The points used were CV4, CV12, CV17, ST16, ST18, ST25, and ST40. The latter point was used on one side only and alternated, presumably at each subsequent treatment session. EA pairs were as follows: CV4 to CV12; CV17 to ST25 (contralateral to ST40 I assume – described as unilateral); ST40 to ST25 (again described as unilateral in the text); ST16 to ST18 (described as ipsilateral, so I guess that is relative to ST40).
Both studies performed treatment 3 times a week, with the pragmatic study using a 12-week course and a further 12 weeks of follow-up, and the smaller efficacy study using an 8-week course with outcomes at the end of treatment only.
The primary outcome in both studies was the 6MWD. The larger pragmatic study also used the SGRQ as a primary outcome, which measures HRQoL. I will focus on the 6MWD, since this gives us the best comparison between the trials.
The baseline figures were quite different indicating a more severely affected group in the pragmatic trial. The mean was 385-388m compared with 423-425m, but SDs were quite large – 55-106m and 102-135m respectively. It was interesting that the SD in one group was half that in another in the 3-arm pragmatic trial. This may simply reflect low numbers in each of the groups, which varied from the upper 40’s in the larger 3-arm trial to the low 30’s in the smaller trial. Dropouts were under 10% in the larger trial and nearly 20% in the smaller one.
The figures for the change from baseline in each group was also quite different. In the 3-arm pragmatic trial (acupuncture vs drugs vs combination) the change figures were 26, 3, and 57 respectively. In the 2-arm efficacy trial (acupuncture plus exercise vs sham plus exercise) the change figures were 55 and 5. The MCID for the 6MWD is 25-30m,[4,5] so it seems that drugs alone or exercise plus sham don’t really cut the mustard, at least not in these trials.
References
1 Li J, Xie Y, Wang Y, et al. Effect of Acupuncture on Patients with Chronic Obstructive Pulmonary Disease: A Multicenter Randomized Controlled Trial. Complement Ther Med. 2025;103146. doi: 10.1016/j.ctim.2025.103146
2 He Y, Li G-Y, Tang C-Z, et al. Comparing penetrating needles and non-penetrating needles with electrical stimulation combined with exercise training for relief of dyspnea and improving exercise tolerance in chronic obstructive pulmonary disease patients: A single-blind randomized controlled trial. Integr Med Res. 2025;14:101117. doi: 10.1016/j.imr.2024.101117
3 Liu Q, Duan H, Lian A, et al. Rehabilitation Effects of Acupuncture on the Diaphragm Dysfunction in Chronic Obstructive Pulmonary Disease: A Systematic Review. Int J Chron Obstruct Pulmon Dis. 2021;16:2023–37. doi: 10.2147/COPD.S313439
4 Holland AE, Hill CJ, Rasekaba T, et al. Updating the minimal important difference for six-minute walk distance in patients with chronic obstructive pulmonary disease. Arch Phys Med Rehabil. 2010;91:221–5. doi: 10.1016/j.apmr.2009.10.017
5 Polkey MI, Spruit MA, Edwards LD, et al. Six-minute-walk test in chronic obstructive pulmonary disease: minimal clinically important difference for death or hospitalization. Am J Respir Crit Care Med. 2013;187:382–6. doi: 10.1164/rccm.201209-1596OC
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