Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, and acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.
Asthma affects around 5.4 million people in the UK. The British Acupuncture Council has produced a research based fact sheet for patients, as well as a review of the evidence for effectiveness in this area (see Resources, below).
Research and Resources on Asthma and Acupuncture:
A scholarly search of the available research studies on “acupuncture and asthma” reveals over 44,000 papers from journals, and narrowing this to “systematic review” leads to over 15,000 hits, of which 38% have been carried out since 2017. From this we can deduce that acupuncture is being used extensively, traditionally and currently in this area; widely scientifically researched in this area, and that the pace at which the research is being carried is increasing – leading us to understand this is an area worthy of scientific appraisal and consideration.
Interpreting the Evidence:
Any research articles referred to on this page (and on the BAcC helpsheets) are listed in full in the References section at the foot of the relevant page. Within the text, where studies are quoted as sources of the information being given, the first author’s name and the year of the paper is used (as authors usually have numerous publications), with the full title, journal, etc listed in the References section, in alphabetical order by Author surname to enable identifying and finding the original source paper.
When reading health research, it is important to know that Systematic Reviews or Meta Analyses of a large number of high-quality research studies are the very best way to be able to say to what extent a given treatment can address a condition, symptom, or set of symptoms. The next best level of evidence is the individual Randomised Controlled Study (RCT) which uses a systematic technique to compare two or more groups of patients receiving different treatments (or a treatment against a “control”, or no treatment). In acupuncture trials, the nature of the control group is of particular interest as it is hard to blind a patient to whether they are having a needle inserted or not, and even more challenging to blind the researcher/team to this.
The means and quality of how research is carried out varies considerably from country to country, and in terms of how an intervention is compared to another intervention (or a control). Of note is the fact that “sham” acupuncture (where needles are placed in apparently inert locations rather than traditional acupuncture points) is not really an inert process as it has physiological effects, so that comparing sham and “true acupuncture” may therefore not give a clear picture alone; but and form a part of a research body where acupuncture versus no treatment, vs conventional treatment or vs a different approach/modality also form part of the evidence base.
The n= figure (where quoted in research) tells you how many people were participants in the study, and usually the larger a study (when it is of good quality and design), the more likely it is to be reliable and applicable to larger populations. When (statistical) “significance” is discussed in view of studies it has a very particular meaning – it is the confidence in the data (using statistical tests) that tells us how likely a result could have just come about by chance. The lower the possibility of a chance result, the more likely it is due to the intervention in the experiment. When you are reading a trial/study, the “p” is the number telling us of significance, and this must be under 5% (or p less than 0.05) to mean we can say it is a (statistically) “significant” result.
There is some evidence from trials to suggest acupuncture may be a useful adjunct to usual care, be beneficial over placebo and can improve quality of life and be cost effective in asthma (Karlson & Bennicke, 2013; Chu et al 2007; Rheinhold et al, 2014).
Some systematic reviews have been carried out into acupuncture in this area, with the most recent looking at 11 trials, found that many were only small trials and that more research would be needed (Martin et al, 2002) and a Cochrane meta-analysis a year later (McCarney et al, 2003) looked at 12 studies (n=350) drew a similar conclusion. More recently Chen et al, (2020) proposed a protocol for a new systematic review and meta analysis of the research, as they noted that an increasing amount of research trials have been done in this area in recent years, warranting a further, large and structured review.
Pang et al (2023) carried out a systematic review and meta-analysis of 16 RCTs to evaluate the effectiveness of acupuncture for treatment of asthma in adults. Acupuncture was well-tolerated and could improve FEV1% (lung function), Cai’s AQLQ (quality of life in Asthma score)), symptom score, ACT score, and exacerbation frequency compared with sham/placebo acupuncture. However, other lung function and medication use parameters were not statistically significant. The researchers also noted that further studies with appropriate controls, more participants, and high-quality evidence are needed.
Brinkahus et al, (2017) carried out a large randomised pragmatic trial in Germany (n=1445) giving acupunctrure in addition to usual care for allergic asthma, and comparing to a usual care alone group. They found symptomatic improvement, as well as improvement in quality of life (asthma quality of life questionnaire – AQLQ) measures for the acupuncture group.
Mechanisms of action:
In the condition of allergic asthma, inflammatory considerations may play a key part in the process. Acupuncture has been shown to have anti-inflammatory effects, and a review article (Kavoussi & Ross, 2007) suggests this may be due to activation of the vagus nerve, alongside deactivation of inflammatory macrophages and other proinflammatory cytokines which have been seen in studies.
Other studies (Zijlstra et al, 2003) suggest some of the anti-inflammatory effects exhibited in acupuncture may be due to stimulation of vasodilators, neurotransmitters and painkillers (beta-endorphins, CGRP and substance P) within the body when acupuncture is applied, and these further stimulate cytokines and nitric oxide, all of which play roles in inflammatory states.
Zijlstra et al (2003) reviewed the effects and mechanisms of acupuncture in treating various inflammatory diseases and conditions. They proposed the mechanisms of action:
- Acupuncture may release neuropeptides from nerve endings that have vasodilative and anti-inflammatory effects through CGRP.
- Acupuncture may also interact with substance P, which is involved in pain transmission and inflammation.
- Acupuncture may influence the balance between cell-specific pro-inflammatory and anti-inflammatory cytokines such as TNF-α and IL-10.
Wang et al (2023) reviewed evidence from animal and human studies regarding the immunomodulatory mechanism of acupuncture, regarding its effects on different components of the immune system, such as mast cells, macrophages, neutrophils, natural killer cells, astrocytes, microglia, CD4+ and CD8+ T cells, and cytokines. They detailed the neuroanatomical mechanisms of acupuncture in immunomodulation, such as the vagal-adrenal pathway, the cholinergic anti-inflammatory pathway, the spinal sympathetic pathway, the brain-gut axis, and the hypothalamus-pituitary-adrenal axis. They concluded that studies to support the role of acupuncture in regulating inflammation, infection, allergy, pain, and tissue repair.
Per MacDonald et al (2015), acupuncture may: reduce inflammation by downregulating proinflammatory neuropeptides, cytokines, and neurotrophins; modulate immune function by altering the balance of Th1 and Th2 cells and suppressing mast cell degranulation; influence various receptors and signalling pathways that are involved in inflammatory response, such as TRPV1, opioid, chemokine, dopamine, and cannabinoid receptors; activate a novel cholinergic anti-inflammatory pathway that involves vagal and sciatic nerves and is mediated by dopamine.
Animal Studies in Asthma Models
Wei et al, 2015 investigated the effect of acupuncture on airway inflammation and immune responses in mice with experimental asthma. Acupuncture was effective in reducing airway hyperresponsiveness (AHR); lung inflammation; mucus secretion; and inflammatory markers including Th17 cytokines and NF-κB pathway, in the asthma model. Additionally, acupuncture increased the number and function of Treg cells – a type of white blood cell that can suppress inflammation and prevent autoimmunity. The article suggests that acupuncture may be a useful complementary therapy for asthma patients due to anti-inflammatory and immune modulation effects.
Electroacupuncture (EA) has been shown in a rat model (Li et al, 2008) to have anti-inflammatory benefits by modulating the hypothalamic-pituitary-adrenal (HPA) axis, (HPA axis regulates the stress response and immune function). Specifically, Li et al outlined that EA sets off a cascade in the brain (via corticotropin-releasing hormone, and adrenocorticotropic hormone) to produce cortisol, which reduces inflammation and oedema.
Regarding Your Individual Condition and Symptoms:
Whilst the scientific studies are of great interest to researchers and acupuncturists in terms of comparing protocols, for the patient not versed in research they are less accessible, which is why when we asked “can acupuncture work for my (condition or symptom) we are not able to give a simple yes or no response. We are able to tell you what experience we have had in our decades of experience in practise, of the types of outcomes we have seen in similar cases, and give you an idea of our level of experience and knowledge in that area, and how this could relate to your own individual situation. For this, we recommend booking a free telephone consultation where we can answer any questions you have and give a realistic appraisal of what acupuncture may be able to provide.
British Acupuncture Council evidence based factsheet about asthma including specific research, trials and mechanisms of action for acupuncture in this condition.
British Acupuncture Council Review Paper: Bronchial asthma and acupuncture: the evidence for effectiveness
Brinkhaus, B., Roll, S., Jena, S., Icke, K., Adam, D., Binting, S., Lotz, F., Willich, S.N. and Witt, C.M., 2017. Acupuncture in patients with allergic asthma: a randomized pragmatic trial. The Journal of Alternative and Complementary Medicine, 23(4), pp.268-277.
Chen, Y.M., Xie, X.L., Xiao, P.Y., Wang, Q.H., Wang, J.S., Yu, X.D. and Deng, S., 2020. Acupuncture on treating asthma: A protocol for systematic review and meta analysis. Medicine, 99(1).
Chu, K.A., Wu, Y.C., Ting, Y.M., Wang, H.C. and Lu, J.Y., 2007. Acupuncture therapy results in immediate bronchodilating effect in asthma patients. Journal of the Chinese Medical Association, 70(7), pp.265-268.
Karlson, G. and Bennicke, P., 2013. Acupuncture in asthmatic children: a prospective, randomized, controlled clinical trial of efficacy. Alternative therapies in health and medicine, 19(4), p.13.
Li, A., Lao, L., Wang, Y., Xin, J., Ren, K., Berman, B.M., Tan, M. and Zhang, R., 2008. Electroacupuncture activates corticotrophin-releasing hormone-containing neurons in the paraventricular nucleus of the hypothalammus to alleviate edema in a rat model of inflammation. BMC Complementary and Alternative Medicine, 8(1), pp.1-8
Martin, J., Donaldson, A.N.A., Villarroel, R., Parmar, M.K.B., Ernst, E. and Higginson, I.J., 2002. Efficacy of acupuncture in asthma: systematic review and meta-analysis of published data from 11 randomised controlled trials. European Respiratory Journal, 20(4), pp.846-852.
McDonald, J.L., Cripps, A.W. and Smith, P.K., 2015. Mediators, receptors, and signalling pathways in the anti-inflammatory and antihyperalgesic effects of acupuncture. Evidence-Based Complementary and Alternative Medicine, 2015.
McCarney RW et al. Acupuncture for chronic asthma. Cochrane Database of Systematic Reviews 2003, Issue 3. Art. No.: CD000008. DOI: 10.1002/14651858.CD000008.pub2
Pang, J., Shergis, J.L., Zheng, L., Liu, S., Guo, X., Zhang, A.L., Lin, L., Xue, C.C. and Wu, L., 2023. Clinical Evidence for Acupuncture for Adult Asthma: Systematic Review and Meta-Analysis of Randomised Sham/Placebo-Controlled Trials. Complementary Therapies in Medicine, p.102956.
Reinhold, T., Brinkhaus, B., Willich, S.N. and Witt, C., 2014. Acupuncture in patients suffering from allergic asthma: is it worth additional costs?. The Journal of Alternative and Complementary Medicine, 20(3), pp.169-177.
Wang, M., Liu, W., Ge, J. and Liu, S., 2023. The immunomodulatory mechanisms for acupuncture practice. Frontiers in Immunology, 14.
Wei, Y., Dong, M., Zhang, H., Lv, Y., Liu, J., Wei, K., Luo, Q., Sun, J., Liu, F., Xu, F. and Dong, J., 2015. Acupuncture attenuated inflammation and inhibited Th17 and Treg activity in experimental asthma. Evidence-based complementary and alternative medicine, 2015.