Efficacy and safety of electroacupuncture in chronic obstructive pulmonary disease: a systematic review and meta-analysis.

Background: Electroacupuncture (EA) has gained increased attention for chronic obstructive pulmonary disease (COPD) management, but the evidence-based research is limited. While some randomized controlled trials (RCTs) reported improvements in pulmonary function and quality of life (QoL), others showed no significant benefits compared to conventional therapies. This study aims to evaluate the clinical efficacy of EA in the treatment of COPD through a systematic review and meta-analysis. Methods: Following PRISMA guidelines, relevant RCTs were searched in six databases [PubMed, Embase, Cochrane, Web of Science, Wanfang, and China National Knowledge Infrastructure (CNKI)] from inception to October 8, 2023. Eligible articles were identified based on the PICOS principles: participants (COPD patients aged ≥18 years), interventions (EA monotherapy or combination therapy), comparisons (sham acupuncture, medications, rehabilitation), outcomes (pulmonary function, symptom scores), and study design (RCTs). Forest plots and funnel plots of meta-analyses of different outcomes were generated using RevMan 5.4. One-way sensitivity analyses were performed using Stata 15.0. The quality of the included RCTs was evaluated using the Cochrane Collaboration's tool for assessing risk of bias. The primary outcomes included body mass index (BMI), modified Medical Research Council (mMRC) score, COPD Assessment Test (CAT) score, clinical effective rate, 6-minute walk distance (6MWD), forced expiratory volume in 1 second (FEV1), forced vital capacity (FVC), FVC%, FEV1%, and FEV1/FVC%. Results: A total of 15 RCTs involving 1,076 patients were included. Our data demonstrated significantly higher FVC [weighted mean difference (WMD): 0.28; 95% confidence interval (CI): 0.14, 0.43; P<0.001], FEV1% (WMD: 3.99; 95% CI: 2.30, 5.67; P<0.001), FEV1/FVC% (WMD: 3.77; 95% CI: 2.38, 5.17; P<0.001), 6MWD (WMD: 11.74; 95% CI: 7.48, 16.01; P<0.001) and clinical effective rate (risk ratio: 1.11; 95% CI: 1.03, 1.20; P=0.006), as well as lower CAT scores (WMD: -2.39; 95% CI: -3.63, -1.15; P<0.001), in the EA group compared to the control group. Subgroup analyses revealed enhanced therapeutic outcomes (e.g., pulmonary rehabilitation) in patients who received ≥8 weeks of EA monotherapy or combination therapies. However, risk of bias was unclear in three RCTs due to inadequate randomization, and heterogeneity arose from variability in control interventions. Conclusions: EA is a promising therapy for improving COPD outcomes, particularly when combined with rehabilitation and extended treatment duration. Future studies should prioritize homogeneous designs, larger multiethnic cohorts, and mechanistic investigations to validate these findings and optimize protocols.