A Perspective on Acupuncture Techniques for Relief of Dyspnea in Chronic Obstructive Pulmonary Disease

Abstract

Abstract

Effective treatment of dyspnea, or breathing difficulty, for patients with chronic obstructive pulmonary disease is a major unmet need. Five of six published randomized controlled trials show that acupuncture and/or applying transcutaneous electrical nerve stimulation over acupuncture points improves breathing difficulty in patients with chronic obstructive pulmonary disease. Acupuncture techniques may relieve the perception of dyspnea by three possible mechanisms: (1) activation of areas in the central nervous system where afferent signals are processed and integrated; (2) relaxation of bronchial smooth muscle; and (3) the release of neurotransmitters, such as endorphins, that modulate breathlessness. Adverse events of acupuncture reported in a national database in the United Kingdom include retained needles, dizziness, loss of consciousness/unresponsiveness, falls, bruising at the needle site, and pneumothorax. Caution is advised before needles are placed into the chest of an individual who has chronic obstructive pulmonary disease because lung hyperinflation and low chest wall fat may increase the risk of a pneumothorax. Transcutaneous electrical nerve stimulation at acupuncture points is an alternative noninvasive approach to insertion of needles into the chest. Clinical uncertainties need to be addressed in prospective clinical trials to further understand the potential role of acupuncture techniques in relieving the distressing symptom of dyspnea.