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Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials

¹ Dept of Statistics, Salamanca University, Salamanca, Spain. ² Institute of Psychiatry, King's College London, London, ³ Cancer Division, Medical Research Council, Clinical Trials Unit, London, ⁴ Dept of Complementary Medicine, School of Postgraduate Medicine and Health Sciences, University of Exeter, Exeter, and ⁵ Dept of Palliative Care & Policy, King's College London, London, UK

CORRESPONDENCE: A.N.A. Donaldson, GKT School of Medicine, Weston Education Centre, Office 247, Denmark Hill, London, SE5 9RJ. Fax: 44 2078485517. E-mail: nora.donaldson@kcl.ac.uk

Keywords: acupuncture, alternative medicine, complementary medicine, hetereogeneity, meta-analysis, systematic review

Received: September 8, 2000
Accepted May 28, 2002

Contradictory results from randomised controlled trials of acupuncture in asthma suggest both a beneficial and detrimental effect. The authors conducted a formal systematic review and meta-analysis of all randomised clinical trials in the published literature that have compared acupuncture at real and placebo points in asthma patients.

The authors searched for trials published in the period 1970–2000. Trials had to measure at least one of the following objective outcomes: peak expiratory flow rate, forced expiratory volume in one second (FEV₁) and forced vital capacity. Estimates of the standarised mean difference, between acupuncture and placebo were computed for each trial and combined to estimate the overall effect. Hetereogeneity was investigated in terms of the characteristics of the individual studies.

Twelve trials met the inclusion criteria but data from one could not be obtained. Individual patient data were available in only three. Standardised differences between means ranging from 0.071 to 0.133, in favour of acupuncture, were obtained. The overall effect was not conventionally significant and it corresponds to an approximate difference in FEV₁ means of 1.7. After exploring hetereogenenity, it was found that studies where bronchoconstriction was induced during the experiment showed a conventionally significant effect.

This meta-analysis did not find evidence of an effect of acupuncture in reducing asthma. However, the meta-analysis was limited by shortcomings of the individual trials, in terms of sample size, missing information, adjustment of baseline characteristics and a possible bias against acupuncture introduced by the use of placebo points that may not be completely inactive. There was a suggestion of preferential publication of trials in favour of acupuncture. There is an obvious need to conduct a full-scale randomised clinical trial addressing these limitations and the prognostic value of the aetiology of the disease.

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				A. Hansell Efficacy of acupuncture in asthma Eur. Respir. J., May 1, 2003; 21(5): 909 - 909. [Full Text] [PDF]