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.

What’s New About Breathlessness

Dr. Denis O’Donnell (Kingston, Ontario, Canada) and I wrote a review called Recent Advances in Dyspnea (medical word for breathlessness) in the January 2015 issue of the journal CHEST (pages 232-241). The review covered new research information about breathing difficulty over the past 4 years.

Here is information about how breathlessness affects daily life.

Dr. Denis O'Donnell, Professor of Medicine at Queen's University, in Kingston, Ontario, Canada

Dr. Denis O’Donnell, Professor of Medicine at Queen’s University, in Kingston, Ontario,

  1. Of 2,258 individuals with severe COPD, breathlessness was worse upon awakening in the morning.
  2. Most individuals reported that their breathing varied from day to day and from week to week.
  3. Treatment with a long-acting bronchodilator reduced the variability in breathing difficulty.
  4. Women generally report more breathlessness than men.
  5. In the United Kingdom, 20% of menopausal women reported breathing difficulty. This may be related to low levels of estrogen and progesterone which could affect mood.
  6. Obesity is associated with an increase in breathlessness.
  7. Anxiety and depression are more common in those with heart and lung diseases.

Here are some of the key findings about treatment.

  1. Most long-acting bronchodilators inhaled once or twice daily improve breathing difficulty in those with COPD.
  2. In general. the improvement in breathlessness is greater with two different bronchodilators in a single inhaler compared with one bronchodilator in an inhaler.
  3. Individuals with COPD reported less breathlessness related to anxiety after 8 weeks in a pulmonary rehabilitation program compared with “usual care.”

Here is information on new therapies not yet approved to relieve breathing difficulty. These therapies require more testing before use.

  1. Those with COPD had less breathlessness after acupuncture compared with a sham, or pretend, treatment.
  2. Placement of valves or coils into breathing tubes through a scope can deflate the lung and improve breathing difficulty.
  3. Using a breathing machine connected to plastic tubes in the nose (nasal cannula) to assist breathing during walking improves breathing by allowing the breathing muscles to work less.

Acupuncture for Relief of Breathlessness

Can Acupuncture Help my Breathing?

Dear Dr. Mahler:

I want to know your thoughts on using acupuncture to help my breathing.   I was told 6 years ago that I had COPD, and my breathing continues to slowly get worse. I was taking Spiriva and Advair for years, and use ProAir several times a day. My doctor recently had me stop both Spiriva and Advair, and tried me on Anoro.  It may have helped a little, but I really can’t do the things that I want because I get winded easily. On some days, I am short of breath just getting out of bed or getting dressed. I did pulmonary rehabilitation in the past, but can’t exercise because of back pain due to spinal stenosis. I tried acupuncture a few years ago for my back pain, and it helped a lot. Do you think that it can help my breathing problem?

Betty from Red Bank, NJ

Dear Betty:

According to traditional Chinese medicine, qi is the life force that flows through pathways in our body. If there is an  imbalance between complementary forces – yin (means shady side) and yang (means sunny side) – qi is disrupted and illness develops. Acupuncture involves the placement of thin needles into the skin to correct imbalances in qi.  There are at least 350 different acupuncture points in the body where energy flow can be accessed. Generally, at each treatment, 5 – 20 needles are inserted at various acupuncture sites and left in place for 10 – 20 min. Usually, there are 6 – 12 treatments over a few months.

Multiple needles placed into skin of individual.

Multiple needles placed into skin of individual.

Acupuncture is most commonly used for pain relief, and is generally safe when done by an appropriately trained practitioner using clean technique and single-use needles.

Effects of Acupuncture in COPD

Different studies have examined the effects of acupuncture for those who have COPD. In November 2014, Coyle and colleagues from Australia reviewed the results of 16 studies which compared acupuncture with no treatment in patients with COPD (medical journal: Alternative Therapies in Health and Medicine)(http://www.ncbi.nlm.nih.gov/pubmed/25478799). Overall, patients had less breathlessness and had better quality of life after acupuncture compared with placebo (sham or pretend treatment). In a few studies, investigators measured levels of endorphins (naturally occurring narcotic substances made in our bodies), and found that they increased after acupuncture, while there was no change in these levels after placebo. It is possible that the release of endorphins (just like taking morphine) with acupuncture may have contributed to a feeling that breathing was easier and quality of life was improved.

Should You Try Acupuncture?

I suggest that you share this information  with your doctor and ask about any possible risks. Also, you will need to find out if there is a licensed acupuncturist in your area. If there is, you may wish to call her/his office and ask specifically about that person’s experience in treating those with COPD. Acupressure points for relieving breathing problems are shown below (sites A – E).

Acupressure points for relieving breathing problems.

Acupressure points for relieving breathing problems

Acupressure points for relieving breathing problems.

Acupressure points for relieving breathing problems.

Acupressure points for relieving breathing problems.

Acupressure points for relieving breathing problemPlease let me know if you try acupuncture and whether it is helpful for you.

Please let me know if you try acupuncture and if it helps you.  Best wishes,

Donald A. Mahler, M.D.