COPD

The Global Initiative for Chronic Obstructive Lung Disease (GOLD) defines chronic obstructive pulmonary disease (COPD) in its 2026 report as a varied lung condition with long-standing breathlessness, cough, sputum or flare-ups, caused by damage to the airways or the air sacs that leaves airflow out of the lungs persistently and often progressively obstructed. The trials below measure breathlessness on exertion, on the modified Borg scale, a 0 to 10 rating taken straight after a 6-minute walk test; the distance walked in those 6 minutes, a measure of exercise capacity; and quality of life on the St George’s Respiratory Questionnaire (SGRQ) or the COPD Assessment Test (CAT).

No Cochrane review

The nearest Cochrane work is a 2008 review by Bausewein, Booth, Gysels and Higginson of non-drug treatments for breathlessness in advanced cancer, COPD, interstitial lung disease, heart failure and motor neurone disease. It included 47 studies with 2,532 participants, most of them in COPD, and rated the evidence that acupuncture or acupressure helps, from 5 studies, as low in strength. Cochrane withdrew the review in 2013 as out of date. Its planned replacement was split in 2016 into four reviews of separate kinds of treatment, and by September 2020 those had been deregistered or their protocols withdrawn for not meeting Cochrane’s standards. No Cochrane review of acupuncture for breathlessness or for COPD has been published since.

Later reviews

The reviews below mix three comparisons that answer different questions: acupuncture against sham acupuncture, a control procedure made to look like the real one (Sham acupuncture covers the kinds in use); acupuncture added to drugs or rehabilitation against the same care alone; and acupuncture against drugs. A standardised mean difference (SMD) states an effect in units of the spread between patients, so that trials using different scales can be pooled; I² is the share of the variation between trials that chance does not explain.

Von Trott’s review, by researchers in London and Berlin, is the one GOLD cites. In a subgroup of 6 studies with 302 people that used a sham control and treated for at least 3 weeks, breathlessness was lower again (SMD −2.53, I² 91%), and in 6 studies with 287 people exercise tolerance on the walk test improved (SMD 0.93). Quality of life improved in 4 of the 6 studies that measured it. The authors named methodological heterogeneity and low power as problems for future trials to fix. Wang’s review, from the Beijing and Henan universities of Chinese medicine, found better SGRQ scores for symptoms, activity and impact taken separately, and no overall change in FEV1, the volume of air a person can blow out in 1 second, except where acupuncture was added to other treatment. Li’s review, from the Centre for Complementary Medicine at Freiburg University Hospital, rated 8 of its 25 trials high quality against the CONSORT reporting standard, and could pool only trials in stable COPD, because too few studied acute exacerbations.

An overview of 22 systematic reviews by Zeng and colleagues at Chengdu University of Traditional Chinese Medicine, searched to the end of 2023, rated the methods of 19 of them critically low on AMSTAR 2, a checklist for appraising reviews, and judged only 3 of the outcome measures it assessed high certainty on GRADE, the scale reviewers use from high to very low. The primary trials most often used BL13 (Feishu), BL23 (Shenshu) and Dingchuan (XB01B, which the overview writes EX-B1).

Trials against sham

Suzuki and colleagues in Japan tested the question in a 2008 pilot: 30 people in matched pairs, half given weekly acupuncture for 10 weeks on top of their medication and half medication alone. After the walk test the acupuncture group scored 2.2 on the Borg scale against 6.4, but the control group had no sham.

The COPD-acupuncture trial that followed, published in Archives of Internal Medicine in 2012 and run from Kyoto University’s department of respiratory medicine between 2006 and 2009, randomised 68 people already on standard medication to traditional acupuncture or placebo needling at the same points, once a week for 12 weeks. Patients, assessors and the statistician did not know who had which. The Borg score after the walk test fell 3.6 points with acupuncture and rose 0.4 with placebo needling, a difference of 3.58 points (95% CI 2.90 to 4.27), and the acupuncture group walked further in the 6 minutes. The authors concluded that acupuncture was a useful add-on for breathlessness on exertion.

A 2016 trial in China by Feng and colleagues repeated the design at several centres in 72 people, three sessions a week for 8 weeks. The sham was the Park device, a blunt needle that retracts into its handle instead of entering the skin. Both groups had the same points: LU01 (Zhongfu), LU09 (Taiyuan), LI18 (Futu), ST36 (Zusanli), GB12 (Wangu), BL13, BL20 (Pishu) and BL23. Walk distance and SGRQ scores were better with real acupuncture. LU01 lies over the chest wall; Needling over the chest reports what the case series record about needles reaching the lung.

Two trials looked past breathlessness on exertion. In a two-centre trial led from Chengdu University of Traditional Chinese Medicine, Xu and colleagues randomised 74 people aged 40 to 80 to 36 sessions of acupuncture or sham, three a week, alongside their medication. FEV1 as a share of the predicted value rose 1.35 points with acupuncture and fell 2.44 with sham, an adjusted difference of 3.46 points; adverse events, all mild, numbered 11 with acupuncture and 2 with sham. In Israel, a three-arm trial by Levy and colleagues treated 72 people in hospital for an acute flare-up of COPD with acupuncture, a sham procedure or standard care alone. Breathlessness on the Borg scale differed between the arms from the first day after treatment until the third, with no difference in physiological measures and no adverse events from acupuncture.

Added to drugs, without a sham

The largest trial with a walk-distance outcome is an open-label trial by Li and colleagues, led from Henan University of Chinese Medicine and published in 2025. It randomised 150 people with stable COPD to acupuncture, conventional drugs, or both, for 12 weeks with 12 weeks of follow-up. Acupuncture with drugs raised walk distance more than drugs alone at 4, 8 and 12 weeks and at follow-up, while SGRQ scores improved over time in all three groups with no difference between them. With no sham and patients aware of their treatment, the trial cannot separate the needling from the attention that comes with it.

What guidelines say

The GOLD 2026 report, version 1.3 dated 8 December 2025, is current and adds research published between January 2024 and July 2025. Acupuncture appears once in its text, in the section on palliative treatment of breathlessness, which lists acupuncture and acupressure among non-drug approaches in advanced COPD that may improve breathlessness and quality of life and cites von Trott’s review.

The NICE guideline NG115 for England and Wales was published on 5 December 2018 and last changed in July 2026, when NICE added a section on biological therapy; it will be reviewed again only if new evidence is likely to change it. Its recommendations do not mention acupuncture. They offer pulmonary rehabilitation to people who see themselves as functionally disabled by COPD, usually grade 3 or above on the Medical Research Council breathlessness scale, and recommend opioids to relieve breathlessness in end-stage COPD that has not responded to other medical treatment. Clinical guidelines lists what other guideline bodies say about acupuncture, and Asthma reports the trials in the other common airway disease.

What the reviews could not settle

The reviews could not say how large any benefit is. Von Trott’s pooled estimates carry I² values of 85% to 91%, so the trials disagree far more than chance allows, and the estimates of extra walking distance from Wang’s and Chen’s reviews, 48 m and 12 m, differ fourfold depending on which trials go in. They could not separate the needling from the attention around it, because they pool sham-controlled trials with trials that add acupuncture to usual care and have no sham, and the four sham-controlled trials above enrolled 68 to 74 people each. The change in lung function reported by the 2024 trial rests on that single trial of 74 people.

AcuiQ’s COPD and dyspnoea pages list the protocols individual studies prescribed, each with its citation.