Acupuncture for Breathing Difficulty in COPD

Review of Results from Six Acupuncture Studies

In the February 2016 issue of the journal Medical Acupuncture, I wrote a perspective on acupuncture for relief of breathlessness in those with COPD. Why Consider Acupuncture? Many of those with COPD have shortness of breath with daily activities or even at rest despite best available therapies. I consider acupuncture to be an “alternative” for relief of breathing difficulty after all standard treatments have been tried. Here is brief information on how acupuncture works.  According to traditional Chinese medicine, the bodily functions are regulated by an energy called Qi that flows through the body. Breathing difficulty is due to a deficiency in the flow of Qi in the lungs.
Lung Meridian Route

Lung Meridian Route – begins in the solar plexus, moves down to meet the large intestine, moves up and crosses the diaphragm, divides, and enters the lungs. It then passes up the windpipe and over the shoulder and down the front of the arm to the wrist and hand.

Acupuncture is a family of procedures that aim to correct imbalances in the flow of Qi by stimulating points on or under the skin. Acupuncture is thought to allow Qi to flow from inside of the body to the skin and muscles along channels called meridians. The lung meridian (see above) controls breath and energy. There are 11 acupuncture sites of the lung meridian that include the front of chest just below the clavicle (collar bone), the arm, forearm, and hand.
L1 and L2 acupuncture sites for breathing

Lung Acupoints 1 and 2

Lung Acupoints 3 - 5

Lung Acupoints 3 – 5

Lung Acupoints 6 - 11

Lung Acupoints 6 – 11

In my review, I found six published studies that examined acupuncture for relief of dyspnea in a total of 256 individuals with COPD. Treatments ranged from a single 45-minute session to 14 sessions over 4 weeks. In all 6 studies, there a sham (placebo) or control group for comparison with the treatment group. Ratings of breathing difficulty decreased significantly in 5 of 6 studies. Some studies used needles placed in the skin, while other studies applied electrical stimulation to pads placed on the skin (see below).
Placement of needle in the forearm

Placement of needle in the forearm

How might these acupuncture techniques relieve breathing difficulty? There are 3 main possibilities.
  1. Areas of the brain – where breathing difficulty is experiended – are altered.
  2. Lung function improves – studies show increases of 20 – 128 milliliters in air exhaled in one second
  3. Endorphins – naturally occurring narcotic substances – are released that reduce pain as well as breathlessness
Are there Risks? There are reports of dizziness, loss on consciousness, bruising at the needle insertion site, and pneumothorax with acupuncture. For pneumothorax to occur, the needle most likely penetrated through the lining around the lung, allowing air to enter into this space, and compress the lung. In 3 of the 6 studies,  transcutaneous electrical nerve stimulation (TENS) was applied to pads instead of placing needles in the skin.
Photo of TENS machine that delivers electrical stimulaion and pads that can be placed at specific sites.

Photo of TENS machine that delivers electrical stimulation via pads that can be placed at specific sites on the skin. In three studies using this approach, those with COPD reported less breathing difficulty.

My Comment: The results are encouraging as 5 of 6 studies showed relief of breathlessness compared with sham treatment. You may wish to consider either acupuncture or electroacupuncture with pads placed on the skin if your experience of breathlessness is disabling and distressing. If you try one of these techniques, you should find an experienced practioner who is willing to discuss the pros and cons with you.

Donald A. Mahler, M.D. is Emeritus Professor of Medicine at Geisel School of Medicine at Dartmouth in Hanover, New Hampshire. He works as a pulmonary physician at Valley Regional Hospital in Claremont, NH, where he is Director of Respiratory Services.