Dr Lam Man Sze - Acupuncture for asthma patientsA small observational study involving patients presenting to the emergency department (ED) with an acute asthma attack has noted therapeutic benefits with adjunct acupuncture, resulting in fewer inpatient admissions and rapid improvement in peak expiratory flow rate (PEFR).
“Although limited by small sample size and nonrandomized design, these findings provide preliminary real-world evidence supporting further investigation of acupuncture in acute asthma care,” said lead study author Dr Man Sze Lam, Department of Acupuncture Service, Changi General Hospital, Singapore.
Lam and colleagues conducted this study in the Short Stay Unit (SSU) of the ED at Changi General Hospital between May 2019 and February 2020. They classified patients presenting with moderate asthma exacerbations (n=13) into two exposure groups based on whether they received acupuncture during their SSU stay.
The acupuncture group (n=7) received acupuncture in addition to standard care when licensed Traditional Chinese Medicine (TCM) physicians were available on-site, while the control group (n=6) received standard management only. SSU-to-inpatient admission rate was the primary outcome, while secondary outcomes included PEFR before and after acupuncture treatment.
The acupuncture group exhibited a lower SSU-to-inpatient admission rate than the control group (42.9 percent vs 83.3 percent). However, the difference between groups was not statistically significant (odds ratio, 0.15, 95 percent confidence interval, 0.00‒2.97; p=0.135). [Proc Singap Healthc 2026;doi:10.1177/20101058261485611]
Patients who received acupuncture also showed significant improvement in PEFR following treatment. The median PEFR increased from 190 L/min before acupuncture to 240 L/min after acupuncture (p=0.021). The mean PEFR also increased from 188.6 to 221.4 L/min (p=0.023). Results were consistent in both tests.
"I would be cautious about attributing all reported benefits to placebo, but equally cautious about claiming that acupuncture has conclusively demonstrated benefits beyond placebo in asthma," Lam said.
“[T]he findings suggest a potential association between acupuncture exposure and improved clinical disposition outcomes,” wrote Lam and colleagues. “As this study reflects real-world clinical practice without controlled allocation, the observed findings should be interpreted as associations rather than causal effects.”
Mechanism
From a TCM perspective, the therapeutic effect of acupuncture may be explained by the regulation of obstructed Qi, as well as the reduction in phlegm production in the airways. From a biological angle, acupuncture could deter the infiltration of inflammatory cells around the airways and lower mucus secretion. [Eur J Integr Med 2015;7:485-491; Evid Based Complement Alternat Med 2015;2015:340126]
Qi is generally translated as "vital energy" and is deemed "a highly active, subtle substance that is constantly moving, forming part of the body and sustaining its vital activities," said Lam. "It is also described as the driving force that supports and regulates the functions of the organs."
“However, because of the limited sample size and lack of follow-up data, our study could not determine whether the PEFR improvement was sustained over time,” according to Lam and colleagues.
TCM clinical studies have been using PEFR as an indicator of pulmonary function in asthma, but previous research suggests its limitations. [Alternative Ther Health Med 2013;19:13-18; J Alternative Compl Med 2014;20:169-177; J Alternative Compl Med 2002;8:737-750]
A study by Karras and colleagues stated that PEFR changes may not capture subtle symptomatic improvements and suggested that the dyspnoea Visual Analogue Scale is a better measure for evaluating symptom changes in asthma patients. [Acad Emerg Med 2000;7:327-334]
“Our findings support this observation: two subjects demonstrated PEFR improvement yet still required inpatient admission, while others reported symptomatic relief despite little or no change in PEFR,” according to Lam and colleagues.
"Larger randomized studies, including a sham acupuncture group and accounting for concurrent asthma treatment, would help clarify whether any benefits are specific to acupuncture, clinically meaningful, and sustained," Lam said. "In the meantime, acupuncture should be considered only as an adjunct to standard asthma treatment."