O6.11 Complementary therapies

A systematic review by Guo (Guo 2006) concluded there was no clear evidence supporting the effectiveness of herbal medicines for treating COPD.

Tai Chi is a systematic callisthenic exercise that involves a series of slow and rhythmic circular motions moving from one form to another. The styles of Tai Chi are differentiated by the varying forms or postures, order of movement sequences, focus on muscle work, pace of movement and angle of knee flexion during practice. Tai Chi is most commonly performed in a semi-squat position and is recognised as an exercise of moderate intensity.

A Cochrane Review (Ngai 2016) in people with mild to very severe stable COPD included eight RCTs that compared Tai Chi to usual care. One trial was undertaken in Australia (Leung 2013). The findings provided very low to moderate quality evidence that when compared to usual care, Tai Chi improved functional exercise capacity (6MWD) (6 trials, n=318,) mean difference 29.64m (95% CI 10.52 to 48.77m) and lung function (FEV1) (4 trials, n=258), mean difference 0.11L (0.02 to 0.20L) [evidence level I]. There were no significant differences between Tai Chi and usual care in dyspnoea or quality of life.  No adverse events were reported. Tai Chi has also been shown to result in a significant improvement in body sway and functional balance in patients with COPD (see O7.5 Falls in COPD). Tai Chi did not show superiority when carried out in addition to breathing exercises (3 trials) or pulmonary rehabilitation (1 trial) when compared with these interventions alone.

Tai Chi can be carried out in a wide range of settings and does not require equipment or a large space. For these reasons, Tai Chi may be a potential treatment option when a pulmonary rehabilitation program is not available or if a patient declines referral.

There is some evidence that acupuncture may reduce exertional dyspnoea and improve exercise tolerance in people with moderate to severe COPD [evidence level II]. One placebo-controlled double blinded randomised trial (n=68), carried out in Japan (Suzuki 2012), compared acupuncture applied once a week for 12 weeks and sham acupuncture. Eleven standardised acupuncture points, including those close to the respiratory accessory muscles, were used with treatment lasting 50 minutes each session. Compared to sham acupuncture, real acupuncture reduced dyspnoea at the end of a 6-minute walk test (6MWT) by -3.58 points (95% CI -4.27 to -2.90) on the Borg 0-10 dyspnoea scale and improved 6-minute walk distance (6MWD) by 46metres in the treatment group when compared to the sham acupuncture group. A possible mechanism proposed for the benefits was an improvement in rib cage mobility and accessory muscle function due to suppressed electromyogram activity of the accessory muscles by the acupuncture. A well designed randomised controlled trial, including sham acupuncture, with blinding of all involved apart from the acupuncturists themselves, demonstrated an 80 metre improvement in 6-minute walk distance as well as improvements in quality of life (Feng 2016). The effect of the lack of blinding of the acupuncturist is uncertain.  Further studies are required to evaluate the effects of acupuncture and to determine whether any longer-term benefits of treatment occur.