|
Acupuncture In The Treatment Of Patients
With Chronic Obstructive Bronchitis: A Randomized Controlled Trial
Vadim Buevich, MD
Iraida G. Menshikova, MD
Irina V. Skliar, MD
Elena E. Kalashnikova, MD
Elena A. Shevchenko, MD
Marina Loevets, MD
ABSTRACT
Background Despite the fact that acupuncture is used with patients with a range of chronic obstructive pulmonary diseases, the vast majority of research concentrates only on its use with bronchial asthma. A limited number of reports exist on the efficacy of acupuncture with chronic obstructive bronchitis.
Objective To examine both the efficacy and safety of acupuncture with chronic obstructive bronchitis, complicated by pulmonary hypertension and chronic cor pulmonale.
Design, Setting, and Patients A randomized controlled trial of the use of acupuncture in 70 adults (average age, 46.4 years); inpatients admitted to the pulmonology department of the First Municipal Hospital of Blagoveshensk City (Russia). All patients received pre- and post-treatment Ryodoraku diagnostics, respiratory tests, partial-pressure blood gas analysis, diaphragm ultrasound, and measurement of systolic pulmonary artery pressure.
Intervention Corporal and auricular acupuncture points were stimulated with steel, gold, and silver needles, moxa warming and the use of the Electronic Marker of Acupuncture Points (EMAT-Express01).
Main Outcome Measures Change from baseline in bronchitis symptoms, respiratory tests (vital capacity, FEV1 [forced expiratory volume in 1 second], and FEF25, 50, 75 [forced expiratory flow]), and blood gases.
Results A statistically significant improvement from baseline, and in comparison with the control group, was attained in patients without pulmonary hypertension and for those with compensated chronic cor pulmonale. The degree of improvement in acupuncture patients with decompensated cor pulmonale, however, was no higher than in the control group.
Conclusions This study suggests that acupuncture is a safe and effective method in the complex therapy of patients with chronic obstructive bronchitis. It improves airway permeability, pulmonary hemodynamics, and the functional state of respiratory muscles. Acupuncture allows for a decrease in the drug load on patients and increases the efficacy of treatment in general.
KEY WORDS
Chronic Obstructive Pulmonary Disease, Chronic Obstructive Bronchitis, Acupuncture, Randomized Controlled Trial
INTRODUCTION
Chronic obstructive pulmonary disease (COPD) includes conditions such as chronic obstructive bronchitis (COB), bronchial asthma (BA), emphysema, small airway disease, cystic fibrosis, and multiple bronchiectasis. COPD is one of the most widespread diseases in the world.1 Its debilitating effects rank 6th, while mortality rates from COPD rank 7th among diseases in developed countries.2 The major factor that accounts for the prevalence of COPD is an increase in smoking.3
Chronic obstructive bronchitis plays a principal part in COPD in Russia, where 5%-20% of adults have the disease.4 In the United States, the number of individuals with COB was estimated at 12.5 million in 1995.5 A higher rate of mortality among COB patients is caused by disturbed pulmonary ventilation, which leads to severe respiratory failure, following chronic cor pulmonale (CCP) and congestive heart failure.6
Acupuncture is used in the treatment of patients with COPD, but the vast majority of research in this field is carried out with respect to BA patients.7,8 There are few works cited in the literature regarding the use of acupuncture with chronic obstructive bronchitis. We found no articles that described the degree of effectiveness of acupuncture dependent upon CCP stages of development.
It is not clearly understood how the various acupuncture methods influence pulmonary ventilation and hemodynamics, respiratory muscle tone, and their contractile ability. These questions are complex and have not yet been adequately explored. Elaborating on this field of acu-puncture will allow us to optimize the treatment process of COB patients and decrease their drug load.
The purpose of this study was to examine the efficacy and safety of acupuncture in the complex treatment of COB patients at different stages of CCP development. We also wanted to determine the relationship between the clinical signs and functional test results of such patients and the data from electroacupuncture diagnostics.
METHODS
Subjects
This research was carried out at the pulmonology department of the 1st Municipal Hospital in Blagoveschensk City, Russia. Seventy inpatients (53 men, 17 women; average age, 46.4 years) were enrolled in the trial. Of the 70 patients, 51 (72.9%) were smokers. Patients were divided into 3 groups depending on their level of systolic pulmonary artery pressure (SPAP). The 1st group included 23 patients (32.9%) who showed no pulmonary hypertension at rest (SPAP <30 mm Hg). The 2nd group consisted of 33 patients (47.1%) who showed pulmonary hypertension at rest (SPAP$30 mm Hg) but who had no clinical signs of cardiac insufficiency. The 3rd group included 14 patients (20%) having symptoms of decompensated cor pulmonale. A control group for each of the 3 trial groups consisted of 15 people each comparable in age and disease severity, but receiving only treatment according to common medical standards.
All patients from both the control groups and the study participants took a medical examination before and after treatment. This examination consisted of the following:
- Electropuncture diagnostics; Ryodoraku (Y. Nacatani), a measurement of electrical conduction of the skin at Source Points (Yuan Xue) on the meridians, with computer analysis (Automatic Reflex Diagnostics Complex; ARDC, Russia) of the results.
- The respiratory function was valued using the Spiroset-3000 spirograph (Germany). We calculated such indices of the spirogram as vital capacity (VC), forced expiratory volume during 1 second (FEV1), and forced expiratory flow at 25%, 50%, and 75% (FEF25, 50, 75) of forced vital capacity.
- The partial pressure of blood gases (PaO2 , PaCO2) was measured by means of the gasanalyzer AVL 9000 (Austria).
- An ultrasound scan was taken with Aloka-650SSD scanner (Japan) for measuring SPAP and diaphragm excursion at rest (DEr) and forced diaphragm excursion (DEf).
Treatment
All patients received common pharmacotherapy in accordance with medical insurance standards and in addition, physical rehabilitation and physiotherapy. The study participants also took acupuncture treatment. We deployed such acupuncture styles as corporal needling using gold-silver-plated steel needles (30 mm length, 0.3 mm diameter; Asia-Med, Munich, Germany), stainless steel needles (50.3 mm, Hwa To Factory, Su Zhou, China), and auricular acupuncture (Stainless steel, 10.0.15 mm, Hwa To Factory).
The number of acupuncture treatments performed was 7-10. Those sessions were performed daily except on weekends. Treatment methods for each patient were based on data from the physical examination, pulse palpation, Ryodoraku diagnostics, and consideration of the stage of disease. The individual acupuncture protocols were made using an ancient Five-Phase conception (the selection of points was based on mother-son, grandfather-grandson, husband-wife, day-night rules); Back Shu, Front Mu, Influential, and Extraordinary points were also used. In some cases, points on the Extra Meridians were also used.
During the treatment session, 5 to 8 needles were inserted into bilateral points. Auricular points were needled unilaterally. Depths of needle insertion varied with point locations. The achievement of De Qi was utilized as the main sign of exact point needling. This achievement was expected on average depth 0.5 cun. Needles were maintained for 5-20 minutes (depending on stimulation or disperse method) with intermittent manual rotation and thrusting for 5 seconds every 5 minutes. We applied moxa warming and the noninvasive influence of points with a low-energy fractal electromagnetic field using the Electronic Marker of Acupuncture Points (EMAT-Express01), Novosibirsk, Russia. EMAT-acupuncture protocols were identical to the needling, but different in time by 2-3 minutes on each point. (The acupuncturist was a Board-certified physician, trained in acupuncture and moxabustion in China with 12 years clinical experience and a Master's degree in acupuncture.)
To appreciate the effectiveness of acupuncture in COB patients, we compared data of tests before and after treatment period inside groups, and between both control and research groups. The data handling (mean [SE] by t test) was performed with Statistica 6.0 program.
RESULTS
The main aim of electroacupuncture Ryodoraku (the Japanese meaning is "line of high electrical conductivity") diagnostics is to determine the normal interval of conductivity, which is individual for each patient. The meridians whose electrical conduction is higher than the upper norm limit are defined as "excess meridians." Those meridians with conduction less than the lower edge of the norm are "in insufficient state."
The following diagrams show the results of Ryodoraku diagnostics in 3 acupuncture groups. The percentage frequency of meridians displacing toward surplus is given in Figure 1; Figure 2 demonstrates the percentage of insufficient meridians in the same persons.
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Figure 1. Percentage of "excess" meridians in enrolled patients
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Figure 2. Percentage of "insufficient" meridians in enrolled patients
|
|
|
|
|
Contrary to widespread opinion, we observed that the lung meridian stays in a deficit state even during the exacerbation period of disease, especially in patients from the 1st group. In the early stage of disease, the pathology of the cardiovascular (PC), immune, and endocrine (TE, SP) systems has already taken place. Liver excess shows up in an overwhelming majority of cases. In accordance with classical Chinese theory, the endopathogenic factors of cough are Spleen failure in its transformation and transportation, causing obstruction of the Lung by phlegm, and dampness and Liver fire attacking the lungs9 (illustrated in the figures where there are peaks in the Liver and Spleen zones). In addition, the Bladder peak may be linked to muscular tension and fatigue, especially of the respiratory muscles. The functioning of these muscles in these conditions of prolonged stress leads to a formation of myofascial trigger points which restrict the muscular force, mobility, and contractility.
There was no evident repeatability of these results among patients in the 3rd group. Such a decrease in the reactivity of the meridians was probably caused by total exhaustion of vital forces.
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Table 1. Yin/Yang ratio and average electric conductivity at Source (Yuan) points by Ryodoraku test
|
|
|
Mean (SD)
|
|
|
1st group
(n = 23)
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2nd group
(n = 33)
|
3rd group
(n=14)
|
|
SYin/SYang
|
1.104 (0.032)
|
1.278 (0.044)
|
1.083 (0.051)
|
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Conductivity, mKA
|
40.3 (3.30)
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31.8 (2.08)
|
17.5 (3.56)
|
|
Additionally, we analyzed such integral indexes of Ryodoraku as the ratio of the sum of Yin meridians to Yang (S Yin/S Yang) and average electrical conductivity in Yuan-points.
The vast majority of patients in the 1st and 2nd groups noticed a subjective improvement of their general condition when being treated with acupuncture. Usually, this happened within 60-120 minutes after an acupuncture session, with patients reporting improvement in breathing function and relief of phlegm secretion together with a reduction in cough and shortness of breath. A small number of patients in the 2nd group reported a temporary change for the worse in their general condition, usually between the 3rd and 5th acupuncture session. However, it was not considered reason enough to stop the acupuncture, confirmed afterward by progressive improvement. Notably, only 5 people (36%) in the 3rd group subjectively reported an improvement clearly tied to acupuncture. In the case of a further 4 patients (28.5%), it was necessary to stop needling because of patient weakness, dizziness, and shortness of breath arising during or right after the acupuncture session. Their treatment was continued using the noninvasive EMAT Express01 machine which did not provoke the above named adverse effects, but had no less powerful an influence than the needles.
Table 2 shows the results of respiratory function tests and blood gases and their dynamics in both control and research groups. Data are given in percentages of the individual norm. We estimated the most important characteristics of the spirogram for COB patients, which are VC, FEV1, and FEF25, 50, 75.
The dynamics of SPAP decreasing, produced by the common and complex therapy with acupuncture, in both control and research patients is given in Figure 3 and in Table 3. At the same time and in the course of our research, we took an ultrasound scan of the diaphragm with measurement of its excursion between the lowest and highest positions during spontaneous and forced breathing. Data from these measurements are also given in Table 3.
Ryodoraku diagnostics helps us to examine a patient's condition as well as to plan a therapeutic approach. Contrary to widespread opinion, we saw that the Lung meridian (Figures1, 2) stays in deficit state even during the exacerbation period of disease, especially in patients from the 1st group. In the early stage of disease, the pathology of the cardiovascular (PC), immune, and endocrine (TE, SP) systems has already taken place. In particular, a Liver excess shows up in an overwhelming majority of cases. In accordance with classical Chinese theory, the endopathogenic factors of cough are spleen failure in its transformation and transportation, causing obstruction of the lung by phlegm, dampness, and Liver fire attacking the lungs.9 This is illustrated in Figures 1 and 2, where there are peaks in the Liver and Spleen
zones. In addition, we believe that the bladder peak was linked to muscular tension and fatigue, especially of the respiratory muscles.
The functioning of these muscles in these conditions of prolonged stress leads to a formation of myofascial trigger points, which restrict the muscular force, mobility, and contractility. The same signs of Ryodoraku test are inherent in patients from the 2nd group. But there was no evident repeatability of these results among patients in the 3rd group. Such a fall in the reactivity of the meridians was probably caused by total exhaustion of vital forces.
The Yin/Yang ratio calculated during the Ryodoraku test is important to assess a patient's condition (Table 1). Under normal circumstances, this ratio would be approximately 0.900-1.100. It is generally accepted that the tone of the Yin meridians reflects the activity of the parasympathetic nervous system, while the Yang meridians show the opposite, the sympathetic part of the vegetative nervous system. It is therefore evident how this index gradually moves from the upper edge of the norm in the 1st group to the obvious prevalence of the Yin in the 2nd group. In physiological terms, this means an increasing tone of parasympathicus; from the ancient Chinese perspective, this is a "penetration of disease deep down, with destruction," i.e., a chronic process with inconvertible changes. The normalization of the Yin/Yang ratio in the 3rd group was apparent. The average conductivity of the Yuan-points in the norm would be 25-50 mkA. The upper value of 50 mkA is estimated as the functional hyperergic state of the body and if lower, 25 mkA; this is a hypoergic state accompanying the general exhaustion of vital force. In the 1st group, Iav was displaced towards the upper norm edge 40.3 ± 3.30 mkA, which reflects a functional pathology and exertion of compensatory systems. In the 2nd group, Iav decreased to 31.8 ± 2.08 mkA, and in the 3rd group, it fell to 17.5± 3.56 mkA. This is much lower than the norm. Indeed, the normalization of the SYin/SYang ratio in the 3rd group was "equilibrium of Yin-exhaustion," indicating the expansion of inconvertible pathologic changes and an extremely unfavorable prognosis.
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Table 2. Changes in respiratory tests and partial pressure of gases in peripheral blood in control and acupuncture groups*
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|
|
Group 1
(Control n = 15;
Acupuncture n = 23)
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Group 2
(Control n = 15;
Acupuncture n = 33)
|
Group 3
(Control n = 15;
Acupuncture n = 14)
|
|
Before
|
After
|
Within-
group
P value
|
Before
|
After
|
Within-
group
P value
|
Before
|
After
|
Within-
group
P value
|
|
Vital capacity,
% predicted
|
Control
|
86.1 ± 5.39
|
90.7 ± 5.01
|
>.05
|
69.5 ± 3.07
|
79.9 ± 3.31
|
<.05
|
57.3 ± 2.56
|
66.4 ± 3.17
|
<.05
|
|
Acupuncture
|
79.9 ± 2.01
|
102.4 ± 1.69†
|
<.001
|
74.2 ± 1.52
|
95.6 ± 2.43
|
<.001
|
52.4 ± 2.54
|
64.9 ± 2.52§
|
<.01
|
|
FEV1,
% predicted
|
Control
|
64.2 ± 2.38
|
70.2 ± 3.16
|
>.05
|
54.3 ± 3.34
|
60.9 ± 3.56
|
>.05
|
34.7 ± 3.18
|
40.9 ± 4.74
|
>.05
|
|
Acupuncture
|
70.9 ± 2.39
|
93.4 ± 2.48‡
|
<.001
|
58.3 ± 1.29
|
82.6 ± 2.65‡
|
<.001
|
35.8 ± 2.95
|
46.1 ± 2.70§
|
<.02
|
|
FEF25,
% predicted
|
Control
|
53.7 ± 5.98
|
69.8 ± 4.35
|
<.05
|
44.4 ± 3.96
|
52.0 ± 3.34
|
>.05
|
29.9 ± 3.48
|
39.7 ± 2.13
|
<.05
|
|
Acupuncture
|
57.2 ± 1.81
|
78.7 ± 2.21§
|
<.001
|
45.9 ± 1.49
|
71.8 ± 2.95‡
|
<.001
|
27.7 ± 2.50
|
36.6 ± 2.85§
|
<.05
|
|
FEF50,
% predicted
|
Control
|
61.7 ± 4.14
|
64.5 ± 4.91
|
>.05
|
42.1 ± 5.74
|
47.6 ± 2.13
|
>.05
|
26.9 ± 3.71
|
36.4 ± 4.12
|
>.05
|
|
Acupuncture
|
59.2 ± 2.37
|
86.7 ± 2.80¶
|
<.01
|
45.7 ± 1.54
|
70.5 ± 2.74‡
|
<.001
|
25.5 ± 2.15
|
35.6± 2.33§
|
<.01
|
|
FEF75,
% predicted
|
Control
|
55.7 ± 5.01
|
57.5 ± 5.96
|
>.05
|
40.3 ± 3.37
|
46.5 ± 3.12
|
>.05
|
22.9 ± 3.32
|
29.8 ± 3.71
|
>.05
|
|
Acupuncture
|
56.4 ± 2.29
|
85.8 ± 2.39‡
|
<.001
|
46.7 ± 2.19
|
69.1 ± 2.91‡
|
<.001
|
28.8 ± 2.19
|
37.6 ± 2.15§
|
<.02
|
|
PaO2,
mm Hg
|
Control
|
84.0 ± 2.72
|
86.1 ± 2.21
|
>.05
|
69.2 ± 2.34
|
76.6 ± 1.47
|
<.05
|
62.9 ± 3.24
|
71.8 ± 2.27
|
<.05
|
|
Acupuncture
|
81.2 ± 1.67
|
85.1 ± 1.39§
|
>.05
|
68.4 ± 1.69
|
80.7 ± 1.21†
|
<.001
|
58.1 ± 2.39
|
65.7 ± 2.99§
|
>.05
|
|
PaCO2,
mm Hg
|
Control
|
38.1 ± 1.12
|
38.0 ± 1.41
|
>.05
|
40 ± 2.17
|
39.2 ± 1.26
|
>.05
|
44.4 ± 2.67
|
43.6 ± 2.13§
|
>.05
|
|
Acupuncture
|
37.3 ± 0.89
|
35.7 ± 0.43§
|
>.05
|
39.4 ± 0.45
|
36.4 ± 0.29†
|
<.001
|
42.99 ± 2.66
|
40.3 ± 1.61§
|
>.05
|
|
*Data are presented as mean (SD). Control vs acupuncture difference (P values) after treatment: †<.05; ‡<.001; §>.05; ¶<.01.
|
The respiratory function and blood gases serve as the main criteria for condition of patients with COB. In Table 2, the increase in vital capacity among patients without pulmonary hypertension was more significant in the acupuncture group than in the control group. A difference between the control and acupuncture groups in treatment efficacy became more demonstrative when we measured FEV1 and FEF25, 50, 75.
The acupuncture patients in the 1st group showed a significant improvement in FEV1 (+22.5% from the baseline), and notably, in FEF50 and FEF75 (+27.5% and +29.4%), which reflect a permeability of middle and small airways. The same factors in the control groups were FEV1 +6%, FEF50 +2.8%, and FEF75 +1.8%. In the control group, the most progress was achieved in the permeability of large bronchi: FEF25 +16.5%; in acupuncture patients, it was +21.5%. The blood gases in both control and acupuncture patients normalized at treatment end. A difference of partial gas pressure (PaO2 and PaCO2) between the groups was not significant.
In those patients with compensated cor pulmonale, a complex reatment using acupuncture was significantly more effective than standard treatment alone. This was true for vital capacity, and forced expiratory volume and flow (Table 2). All respiratory tests in the acupuncture group were significantly better than in control patients. (At this stage of COB, the ventilation/ perfusion disturbances lead to arterial hypoxemia and hypercapnia.) An improvement of blood gases was attained because of treatment. However, in the acupuncture group, the PaO2, having increased 12.3 mm Hg, reached 80.7 mm Hg, which is the lower edge of the norm; in the control group, these figures were 7.4 and 76.6 mm Hg.
Following treatment in those patients with decompensated corpulmonale, no statistically significant differences between control and research groups in respiratory and blood gas tests was found. In 3 patients, the ventilation function became worse.
DISCUSSION
The level of SPAP is very important in COB patients. An increase in response to risen pulmonary resistance leads to right heart hypertrophy and then to congestive right heart failure, which is a main cause of invalidity and mortality in such people.6 In those patients without pulmonary hypertension by the end of treatment, SPAP did not differ between the groups. The most significant decrease in SPAP from 41.1 ± 0.89 to 33.9 ± 0.68 mm Hg occurred in COB patients with compensated cor pulmonale who were receiving acupuncture. Despite the fact that the level of SPAP after treatment in the acupuncture group did not differ significantly from the control group, the rate of SPAP reduction within groups was significantly different: 7.2 ± 0.44 mm Hg and 4.7 ± 0.83 mm Hg (P = .02).
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Figure 3. Change of systolic pulmonary artery pressure in control and acupuncture patients during treatment
|
|
|
|
Interesting results were obtained from the 3rd group. The rate of SPAP decreasing in acupuncture patients was greater than in the controls, although not significantly: 7.8 ± 0.90 and –5.5 ± 0.87 mm Hg (P = .05). But in the course of a single acupuncture session, we observed a fall of SPAP by 5-7 mm Hg without any improvement on respiratory tests. The most distinguishable hypotensive effect was observed after Nei Guan (PC 6) needling. This phenomenon shows the direct influence of acupuncture on pulmonary hemodynamics avoiding the Von Euler–Liliestrand reflex (1946).
Presently, in COPD patients, many specialists pay attention to the state of the respiratory muscles, especially the principal one, the diaphragm.10,11 The muscles, being overloaded in the condition of hypoxemia, gradually undergo morphological changes. Myofascial trigger points forming in the muscles limit their mobility and contractility. There occurs a substitution of normal muscle fibers for connective tissue. These changes in COPD patients correlate directly in FEV1.12 In the 1st group, we observed the normalization of DEr (Table 3) in those patients receiving standard therapy and in acupuncture patients alike. With regard to Def, in the research group, we could obtain a limit below the norm, but there was no significant difference between groups (P = .05). Differences became more obvious in patients with compensated cor pulmonale. In cases where patients received acupuncture, DEr almost attained the norm, being significantly better than in the control group (P = .05). The difference in Def was also distinguishable between groups (P = .01). The patients with decompensated cor pumonale also showed a statistically significant increase in diaphragm mobility, but the difference between groups was only with DEr (P = .01). We believe this situation arose because of fibrosis and remodeling of the diaphragm leading to less force and elasticity at this stage of the disease.12
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Table 3. Systolic pulmonary artery pressure and diaphragm excursion in control and acupuncture patients before and after treatment*
|
|
|
SPAP, mm Hg
|
Diaphragm Excursion at rest, mm
|
Diaphragm Excursion forced, mm
|
|
Group
|
|
Before
|
After
|
Within-
group
P value
|
Before
|
After
|
Within-
group
P value
|
Before
|
After
|
Within-
group
P value
|
|
1
|
Control (n = 15)
|
27.7 ± 1.19
|
26.5 ± 1.17
|
>.05
|
18.7 ± 0.93
|
19.9 ± 0.84
|
>.05
|
66.5 ± 2.38
|
74.3 ± 2.11
|
<.05
|
|
|
Acupuncture (n = 23)
|
28.0 ± 0.93
|
24.4 ± 0.87§
|
<.02
|
17.6 ± 0.39
|
20.2 ± 0.52§
|
<.001
|
66.5 ± 2.51
|
79.3 ± 1.28‡
|
<.001
|
|
2
|
Control (n = 15)
|
40.8 ± 1.27
|
36.1 ± 1.34
|
<.05
|
15.7 ± 0.97
|
16.4 ± 1.23
|
>.05
|
46.8 ± 3.18
|
56.2 ± 2.74
|
<.05
|
|
|
Acupuncture (n =33)
|
41.1 ± 0.89
|
33.9 ± 0.68§
|
<.001
|
14.7 ± 0.42
|
19.4 ± 0.40‡
|
<.001
|
48.5 ± 1.98
|
69.2 ± 1.67¶
|
<.001
|
|
3
|
Control (n =15)
|
48.2 ± 2.06
|
42.7 ± 2.34
|
>.05
|
12.0 ± 1.21
|
13.7 ± 0.51
|
>.05
|
36.9 ± 2.49
|
45.7 ± 3.04
|
<.05
|
|
|
Acupuncture (n = 14)
|
56.7 ± 2.25
|
48.9 ± 2.17§
|
<.05
|
12.2 ± 0.50
|
15.9 ± 0.42‡
|
<.001
|
31.6 ± 1.00
|
45.4 ± 2.1§
|
<.001
|
|
Healthy
|
No treatment (n = 20)
|
24.6 ± 1.15
|
|
|
20.3 ± 1.38
|
|
|
81.3 ± 2.41
|
|
|
|
*Data are presented as mean (SD). Control vs acupuncture difference (P values) after treatment: †<.05; ‡<.001; §>.05; ¶<.01.
|
CONCLUSION
Administration of acupuncture is reasonable in the complex treatment of patients with chronic obstructive bronchitis. It has a greater effect in cases that lack pulmonary hypertension at rest, and in those patients with compensated chronic cor pulmonale. For patients with decompensated cor pulmonale, the possibilities of acupuncture treatment must be assessed individually.
Acupuncture has statistically significant positive effects on airway permeability and on pulmonary hemodynamics in COB patients. Acupuncture improves contractility and mobility of the diaphragm in COB patients at all stages of the disease. Before starting acupuncture treatment, it is reasonable to complete Ryodoraku diagnostics for individualization of acupuncture protocol and right point selection.
ACKNOWLEDGEMENTS
We express our gratitude to all our colleagues working at the pulmonology department of 1st Municipal Hospital of Blagoveshensk City, Russia, for their help and support of our research. We are also thanful to Sue Marriott for helping us with the redaction of English translation.
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AUTHORS' INFORMATION
Dr Vadim Buevich is a Medical Doctor, Licensed Acupuncturist, and Head of Private Clinic of Traditional Oriental Medicine in Russia.
Vadim Buevich, MD, MAc*
Artilleryiskaya St. 64/2-3
Blagoveschensk, 675007
Russia
Phone: +7 4162 356745 • Fax: +7 9145 386643
E-mail: moxa@amur.ru
Dr Iraida Menshikova is a Medical Doctor, Head of Faculty of Inner Diseases, and Head of Regional Cardiology Society in Russia.
Iraida G. Menshikova, MD, PhD
Amur State Medical Academy
Gorky St. 95
Blagoveschensk, 675000
Russia
Phone: +7 4162 538273
Dr Irina Skliar is an Internist, and Assistant Professor of Faculty of Inner Diseases in Russia.
Irina V. Skliar, MD, PhD
Amur State Medical Academy
Gorky St. 95
Blagoveschensk, 675000
Russia
Phone: +7 4162 538273
Dr Elena Kalashnikova is a Cardiologist with subspecialty training in ultrasound diagnostics of the cardiovascular system, and Department Head of Functional Diagnostics at 1st Municipal Hospital in Russia.
Elena E. Kalashnikova, MD, PhD
1st Municipal Hospital of Blagoveschensk City
Bolnichnaya St. 32
Blagoveschensk, 675007
Russia
Phone: +7 4162 521786
Dr Elena Shevchenko is an Internist with subspecialty training in ultrasound diagnostics in Russia.
Elena A. Shevchenko, MD
1st Municipal Hospital of Blagoveschensk City
Bolnichnaya St. 32,
Blagoveschensk, 675007
Russia
Phone: +7 4162 521786
Dr Marina Loevets is an Internist with subspecialty training in respiratory tests in Russia.
Marina A. Loevets, MD
1st Municipal Hospital of Blagoveschensk city
Bolnichnaya St. 32,
Blagoveschensk, 675007
Russia
Phone: +7 4162 521786
*Correspondence and reprint requests
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