Background: Breathlessness is a commonly encountered symptom in many chronic diseases, particularly those of the heart and lung. It is often multifactorial, difficult to treat, and may best respond to a multi-modal treatment approach which could include complementary medical approaches.
Design and Participants: A systematic review and meta-analysis was conducted according to the Cochrane17 and Preferred Reporting of Items for Systematic Reviews and Meta-Analyses18 guidelines. The review included 12 studies with a total of 597 participants. In nine studies (470 patients) the intervention was acupuncture and in three studies (127 patients) the intervention was acupressure. Ten studies included patients with advanced COPD (Stage III and IV) and 2 included advanced cancer patients.
Results: Breathlessness severity was the primary outcome; results of a six-minute walk test (6MWT) was a secondary outcome. Ten of the 12 studies provided numerical measurements for breathlessness severity (480 patients) and were included in a meta-analysis. The analysis showed a significant effect on breathlessness severity favoring the acupuncture group. The SMD was 1.77 (95% CI 3.05, 0.49; P ¼ 0.007) but heterogeneity (I2 ¼ 90%) was high. In six studies, a 6MWT was measured to assess exercise tolerance. 143 patients treated with acupuncture, compared to 144 control patients. The SMD was 0.93 (95% CI 0.27 to 1.59), showing a significant difference favoring the acupuncture group (P ¼ 0.006), however, again heterogeneity was high (I2 ¼ 85%). Acceptability could be assessed for six studies. The odds ratio was 0.61(95% CI 0.31 to 1.20; P ¼ 0.15) and heterogeneity was low (I2 ¼ 2%). However, six studies were excluded due to failure to report the number of dropouts and withdrawals.
Commentary: There appeared to be a significant effect for acupuncture reducing breathlessness severity in patients with advanced disease, There also appeared to be a significant treatment effect of acupuncture on 6MWT results. Acceptability seemed similar in acupuncture and control groups. Unfortunately, there was a limited number of studies and participants, and only English language articles were included in the review. The considerable amount of heterogeneity across the studies makes this data difficult to interpret. Heterogeneity may be related to the variability of the acupuncture interventions, the different treatment durations, and the disparate scales used to measure breathlessness amongst the studies. Due to these limitations, evidence is insufficient to determine if acupuncture is effective at improving breathlessness in advanced disease. Further research is needed.
Bottom Line: In advanced diseases, acupuncture may help reduce breathlessness and appears to likely be well-tolerated. While acupuncture can be considered as an adjunct treatment for select patients, providers should continue offering standard-of-care therapies.
Source: von Trott P, Oei SL, Ramsenthaler C. Acupuncture for Breathlessness in Advanced Diseases: A Systematic Review and Meta-analysis. J Pain Symptom Manage. 2020;59(2):327-338.e3. doi:10.1016/j.jpainsymman.2019.09.007
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