Important to know: Chronic health conditions should be addressed under direct medical supervision of your GP or consultant, acupuncture would be an adjunct or complement to usual care – we advise that you let you doctor know when you use this approach.

Cough may have many different causes and usually represents a symptom, whereby there are other aspects of the system involved, concerning infection, post-viral, allergy, neurological and other causes. Below are some studies regarding different types of chronic cough, and acupuncture’s effect on these. Some of the underpinning mechanisms of action of acupuncture may help a symptom when caused by different underlying factors, mechanisms of action are discussed below.

Interpreting the research:

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.

Post infectious cough

Li et al (2015, n=90) looked at the clinical efficacy of acupuncture using points from the Lung and Stomach Meridians in treating post-infectious cough.  Two treatment groups abd a control were used, whereby 2 groups received acupuncture, while the control group received oral medication.  They found the total effective rate was highest in the group treated with points from both the Lung and Stomach Meridians, showing significant improvement in both daytime and nighttime cough.

Lee’s (2024) presentation regarding a large systematic review and meta-analysis to be presented at ISPOR (2024 – to be followed by the paper) looked at 30 RCT’s (n=2835) and concluded “Acupuncture, when combined with conventional treatment (medication and lifestyle guidance), significantly improved cough severity and cough-related quality of life compared to conventional treatment alone” and with a low side effect profile.

Xiong et al (2021, n=929) carried out a meta-analysis and systematic review of 11 RCT’s to evaluate the clinical efficacy and safety of acupuncture in treating cough-variant asthma.  In spite of issues with quality of some studies (they call for further, high quality RCTs), they were able to conclude that acupuncture may relieve symptoms of cough, phlegm, and diaphragmatic congestion, and demonstrated improvement in both lung function-related indicators, and immune inflammation indicators.

For Suppressing Cough in a Medical Scoping Setting

Zhang et al (2019, n=100) investigated transcutaneous electric acupoint stimulation (LI4; PC6; LU7) to supress coughing during flexible bronchoscopy (FB).  They compared TEAS+midazolam to midazolam alone, finding lower cough scores, and the need for less lidocaine and fentanyl in the TEAS+midazolam (acupoint plus drug) group. This meant that adding transcutaneous electric acupoint stimulation was more effective for cough suppression than was midazolam alone.  They’d found increased β-endorphin levels in the TEAS group, and theorised that, as one of the body’s natural painkillers, which works on μ-opioid receptors, this was the mechanism of both a painkilling and an anti-tussive (anti-cough) effect.

Post Viral Respiratory Issues

Researchers have started to look at the place of acupuncture alongside conventional medicine, as an adjuvant (add-on) alongside medical care – to support patients post-COVID.  There may be a place for this in their ongoing management, and Williams et al (2022) reference previous research is post-viral conditions and conclude that “acupuncture is a viable adjunctive health care modality as part of a multidisciplinary approach” to approaching disease management and improving quality of life in Long COVID patients.  Trager et al (2022); Hollifield et al (2022); Yin et al, (2021) have also presented case studies, showing promise in this arena and now well-designed RCTs should be designed to investigate further.

Cough Symptom after Surgery

May & May’s (2022) case study stated that “when the underlying etiology of the cough is not well understood, a nonconventional approach can sometimes be promising. In this article, a cough of unknown etiology resistant to conventional treatments seems to be suppressed with the use of acupuncture techniques” [sic].  They reference the need for larger studies, but the pragmatic fact that this as a low-risk approach based on clinical judgement, where improved quality of life was seen, acupuncture may be beneficial for such chronic coughs that are unresponsive to usual therapies.

Cough Symptom in Lung Cancer Patients

Note: acupuncture is an adjunct that should be used with the knowledge of your medical team alongside your mainstream hospital care.

An RCT (Zhang et al, 2024; n=130) used acupuncture alongside routine nursing care (as an add-on) for cough symptoms in lung cancer patients.  The intervention group received both routine nursing and acupuncture, while the control group received only routine nursing. The symptoms of cough in the intervention group were significantly improved, although the expectoration and shortness of breath had no significant change.  A promising start, with more research is needed to see how this might complement medical-led care.

Other Studies

Chronic Spastic Bronchitis:  Promise was found in an older study in helping patients lower their doses of corticosteroid over a period of three years, although this was an observational study, rather than an RCT (Sliwinski et al, 1984).

Xie et al (2019, n=171) found promise for acupuncture alongside routine care for the treatment of postoperative chronic cough in patients with non-small cell lung cancer.   This was a retrospective (not RCT) study, to address the symptom of cough after their lung operation but nonetheless indicative of a trend that should inform future research.

Animal Models

Wang et al (2023), looked at a chronic cough model, finding that electroacupuncture significantly reduced cough frequency, lung tissue damage, and inflammation.  It worked by downregulating a specific pathway in the nervous system (TRPV1) involved in cough reflexes. 

References:

Hollifield, M., Cocozza, K., Calloway, T., Lai, J., Caicedo, B., Carrick, K., Alpert, R. and Hsiao, A.F., 2022. Improvement in long-COVID symptoms using acupuncture: a case study. Medical Acupuncture, 34(3), pp.172-176.

Lee, B (2024). Acupuncture for the Treatment of Chronic Cough: A Systematic Review. Presented at ISPOR Europe 2024, Copenhagen, Denmark, 3-6 November 2024. Available at: https://www.ispor.org/conferences-education/conferences/upcoming-conferences/ispor-europe-2024/program/plenary-sessions/session/euro2024-4016/141909 [Accessed 1 October 2024].

LI, X. and Shi, Z., 2015. Acupuncture Treatment Based on Lung-stomach Theory in Treating Post-infectious Cough. Shanghai Journal of Acupuncture and Moxibustion, pp.211-213.

May G, May M M (May 30, 2022) A Possible Treatment for Persistent Cough Status Post-pulmonary Carcinoid Tumor Resection. Cureus 14(5): e25499. DOI 10.7759/cureus.2549

Sliwinski, J. and Matusiewicz, R., 1984. The effect of acupuncture on the clinical state of patients suffering from chronic spastic bronchitis and undergoing long-term treatment with corticosteroids. Acupuncture & electro-therapeutics research, 9(4), pp.203-215.

Trager, R.J., Brewka, E.C., Kaiser, C.M., Patterson, A.J. and Dusek, J.A., 2022. Acupuncture in multidisciplinary treatment for post-COVID-19 syndrome. Medical Acupuncture, 34(3), pp.177-183.

Wang, G.X., Zhou, J., Chen, Y.M., Xu, L.D., Tao, S.M., Ma, J., Sun, Y.H., Wu, M.S., Chen, Z.W., Zhu, Y.F. and Xie, M.R., 2023. Mechanism of electroacupuncture at acupoints of the lung meridian through PKA/PKC regulation of TRPV1 in chronic cough after lung surgery in guinea pigs. Journal of Thoracic Disease, 15(4), p.1848.

Williams, J.E. and Moramarco, J., 2022. The role of acupuncture for long COVID: mechanisms and models. Medical Acupuncture, 34(3), pp.159-166.

Xie, M.R., Zhu, Y.F., Zhou, M.Q., Wu, S.B., Xu, G.W., Xu, S.B. and Xu, M.Q., 2019. Analysis of factors related to chronic cough after lung cancer surgery. Thoracic cancer, 10(4), pp.898-903.

Xiong, J., Qi, W., Yang, H., Zou, S., Kong, J., Wang, C., Zhou, Y. and Liang, F., 2021. Acupuncture Treatment for Cough‐Variant Asthma: A Meta‐Analysis. Evidence‐Based Complementary and Alternative Medicine, 2021(1), p.6694936.

Yin, X., Cai, S.B., Tao, L.T., Chen, L.M., Xiao, S.H., Fan, A.Y. and Zou, X., 2021. Recovery of a patient with severe COVID-19 by acupuncture and Chinese herbal medicine adjuvant to standard care. Journal of Integrative Medicine, 19(5), pp.460-466.

Zhang, W., Yang, Y.X., Yu, W. and Qi, S.H., 2019. Cough Suppression during flexible bronchoscopy using transcutaneous electric acupoint stimulation: A randomized controlled study. Evidence‐Based Complementary and Alternative Medicine, 2019(1), p.5650413.

Zhang, C.X., Bu, M.R., Wu, X.M., Liao, R.R., Wei, J.H., Zhou, J. and Ye, Z.J., 2024. Efficacy of acupuncture for a cough-related symptom cluster in patients with lung cancer: A randomized controlled trial. European Journal of Oncology Nursing, 70, p.102598.