A Critical Appraisal of Acupuncture for Respiratory Diseases
The Royal Marsden NHS Trust, Downs Road, Sutton, Surrey SM2 5PT, United Kingdom
Acupuncture has been used for asthma, chronic obstructive pulmonary disease and advanced cancer related dyspnoea.
Acupuncture was only sought by 7% of patients in one large survey of patients seeking complementary medicine for moderate to severe asthma. Conventional drug regimens can usefully control symptoms in most patients, but an effective, low risk, non drug treatment that reduces medication consumption and side effects would be of great value to the overall management of asthma. It is essential to measure both subjective and objective parameters in acupuncture trials.
This is because there is often a discrepancy between the subjective and objective signs of respiratory obstruction as illustrated by 15% of patients who could not identify marked airways obstruction when breathlessness was induced by methacholine. Acupuncture must be compared with an effective control group, as the placebo response may be marked in asthmatics; Butler and Steptoe (1986) induced asthma with a sham bronchoconstrictor and then demonstrated that the bronchoconstriction could be prevented by pre-treatment with a placebo that had been described as a powerful new drug! In addition to subjective and objective parameters, medication use, quality of life and global assessment are necessary.
It is important to note that asthma can be fatal if orthodox treatment is abandoned altogether as it controls asthma and chronic bronchitis very effectively. Three separate reviews of acupuncture trials for asthma treatment reached different conclusions and these will be compared and discussed. It is noteworthy that conventional treatment for asthma also has its controversies and marked variation in methodological quality.
Acupuncture has been used for chronic obstructive pulmonary disease and advanced cancer related breathlessness. Findings will be discussed and further prospective controlled studies will be recommended for these conditions which exhibit a limited response to conventional treatments. Perhaps treatment should concentrate on these "Cinderella" areas, which so far have attracted the least research.