auricular acupuncture for chronic obstructive pulmonary disease

Acupuncture Stimulation of Ears to Alleviate Sleeping Disorders in COPD Patients

Chronic obstructive pulmonary disease (COPD) is a heterogeneous lung condition characterized by chronic respiratory symptoms (dyspnea, cough, sputum production, exacerbations) due to abnormalities of the airways (bronchitis, bronchiolitis) and/or alveoli (emphysema) that cause persistent, often progressive, airflow obstruction1. Its rate of incidence is closely related to individual factors like age, gender, genetics, and environmental factors such as smoking, air pollution, occupational dust, etc2. In recent years, COPD has represented a significant public health challenge and has gradually become one of the three causes of death worldwide, which threatens human health and affects the quality of life of patients. According to the 2019 global burden of disease survey, 212.3 million COPD epidemics were reported globally, resulting in approximately 3.3 million deaths3. It is worth noting that COPD, as the third leading cause of death globally in 2019, has brought a substantial economic burden to patients and their families, as well as medical and social resources4.
The clinical symptoms of COPD are complex, with a broad spectrum of comorbidities, and sleep disorders (including insomnia, sleep apnea syndrome, etc.), which mainly occur in severe cases, especially in elderly patients, but are often underestimated or ignored. It is estimated that about 40% of COPD patients suffer from sleep disorders5, and often experience nocturnal awakenings due to symptoms such as coughing, dyspnea, mucus production, and nocturnal oxygen desaturation. Chronic sleep deprivation not only reduces a patient&#39;s quality of life, but it also significantly increases the risk of COPD exacerbations and respiratory-related emergencies. Studies have shown that sleep disorders are closely related to the progression of COPD and have become an independent risk factor for COPD exacerbation and increased mortality6.
The reasons for this are mainly related to the following mechanisms: 
Firstly, sleep brings physiological stress to the respiratory system, which is amplified in respiratory diseases, leading to decompensation7. Secondly, low-quality sleep may lead to cognitive impairment, triggering negative emotions such as anxiety and depression, thereby affecting the self-management behavior of COPD patients8,9. More importantly, poor sleep may impair immune function, resulting in a significantly increased risk of patients exacerbated because of infectious diseases10,11.
Currently, symptomatic treatment measures such as nocturnal oxygen therapy, continuous positive airway pressure (CPAP) and benzodiazepines are mainly adopted for COPD complicated with sleep disorders12,13. Nocturnal oxygen therapy and CPAP can effectively increase blood oxygen levels14. However, critically ill patients usually need to be treated in specialist sleep centers, and the vast overheads can add to the patient&#39;s burden. Benzodiazepines have the side effect of central respiratory depression, which may aggravate the exacerbate hypoxia of COPD patients and even increase the risk of respiratory failure15,16. Therefore, improving the therapeutic effect, reducing the side effects and cost of the treatment, and finding an effective measure to improve the sleep quality of patients with COPD combined with sleep disorders remain important issues for current research.
As an essential part of traditional Chinese medicine, the effectiveness of acupuncture has been tested in its long history, but still needs to be thoroughly recognized worldwide17. Existing acupuncture treatments are still dominated by electro-acupuncture or traditional acupuncture. However, since COPD combined with sleep disorder is a chronic disease that requires long-term and stable treatment, the limitations of these two acupuncture stimulation methods, including the risk of unexpected events such as broken needles and bent needles18, immobilization treatment, and fixed treatment time, inconvenience of other medical operations during needle retention and so on, which make it difficult for patients to adhere to long-term acupuncture treatment and lead to unstable curative effect19,20.
Auricular acupuncture, as a particular type of acupuncture, is a treatment method that stimulates specific points in the ear to diagnose and treat physical and psychosomatic disorders21. This treatment can be subdivided into acupuncture therapy, plaster therapy, needle-embedding therapy, auricular massage therapy, electro-acupuncture therapy, etc., among which auricular needle-embedding therapy and auricular plaster therapy method are most commonly used in clinical practice. Press needles (as shown in Figure 1) are an improved method of intradermal acupuncture. It has a short body and a circular handle buried in a piece of medical adhesive tape. With the advantages of long-lasting effect and high safety, it has been widely used in treating chronic pain, insomnia, paralysis, and other diseases in recent years22,23,24,25. Up to now, with more and more clinical reports proving the efficacy of auricular acupuncture, it is gradually becoming an important non-drug alternative therapy26,27.
This article explains in detail the specific methods of auricular acupuncture for the treatment of COPD combined with sleep disorders, including patient qualification assessment, medical devices used, acupoints, courses of treatment, post-treatment care, adverse reactions, emergency response measures, etc. The Pittsburgh sleep quality index (PSQI) and the chronic obstructive pulmonary disease assessment scale (CAT) were used as primary outcome measures for this method.
The effectiveness of this measure can be concluded by comparing the PSQI and CAT scores of patients before and after treatment. The advantages of auricular acupuncture, such as a simple operation, few adverse reactions, and low price, are worthy of further research and promotion and provide a reference for clinical treatment.

Author Spotlight: Utilizing Traditional Chinese Acupuncture of the Ear to Improve Sleep Disorders 

Auricular Acupuncture as a Traditional Chinese Medicine Therapy for Chronic Obstructive Pulmonary Disease Combined with Sleep Disorders

The auricular acupuncture protocol demonstrated here is a Traditional Chinese Medicine treatment method. We hope to investigate the efficacy of auricular acupuncture in improving the sleep and life quality of COPD patients combined with sleep disorders by comparing the PSQI and CAT scores before and after the treatment. According to Traditional Chinese Medicine, the ear is connected to the brain and various viscera through the meridians.In recent years, some scholars have combined Traditional Chinese Medicine theory with modern neuroanatomical knowledge to systematically organize the connection between the ear, brain, and the viscera, and have proposed the theory of ear, brain, viscera axis, providing new ideas for the principles and mechanisms of auricular acupuncture treatment. Compared with traditional acupuncture, auricular acupuncture is widely accepted by the patients with its advantages of easy operation, few side effects, and the low price, and it places a unique role in the treatment of chronic disease. With the advantage of long-lasting effect and the high safety, auricular acupuncture is a further promotion and the clinical application as an effective non-drug alternative treatment.

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Auricular Acupuncture for Chronic Obstructive Pulmonary Disease  

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