Name: Auricular Acupuncture for Chronic Obstructive Pulmonary Disease
Uploaded: 2023-08-18T12:50:00
Description: Watch this Scientific Journal Video about Auricular Acupuncture for Chronic Obstructive Pulmonary Disease at JoVE.com

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.

Watch this Scientific Journal Video about Auricular Acupuncture for Chronic Obstructive Pulmonary Disease at JoVE.com

Auricular Acupuncture for Chronic Obstructive Pulmonary Disease  

Begin by explaining the method of completing the pre-treatment scale to the patient, and ask the patient to fill in the PSQI and cat scales independently under the doctor's guidance. For pre-operation preparation, provide sleep hygiene education to patients, and verify the patient's identification information. Check the medical devices used in the treatment, ensuring that all materials are within the validity period.Begin by positioning the patient. Hold the oracle with one hand, and use a cotton swab with the other hand to probe the auricular acupoints with appropriate strength. Choose sensitive points as specific acupuncture points, and mark the points with a sterile marker.Then, wipe the operator's fingers with 75%alcohol cotton ball. Also, disinfect the acupuncture site using an iodophor cotton ball held with tweezers. Next, use tweezers to hold the edge of the tape of the press needle, and aim the needle tip at the acupoint.Then, pierce the needle vertically and slowly. Make sure that the round handle on top of the needle, fits flat against the skin surface, and is firmly fixed with tape. Then, press gently with fingertips for about one to two minutes.Simultaneously, ask the patient if there is a comprehensive feeling of soreness, numbness, bloating, and heaviness. If yes, it indicates that a state of deci is achieved, indicating the success of the operation. Next, instruct the patient to use the correct manipulation to press the acupuncture site.Use thumb and index finger to press from the back and front of the oracle with light to heavy strength. Carefully observe the patient's feelings, whether there is a state of deci, or dizziness, pain, and other discomforts. After the needle is inserted, ask the patients to rest on their backs for at least 30 minutes, to avoid accidents and adverse reactions.Post-treatment, keep the puncture sites dry and clean to prevent infection. When removing the needle, use tweezers to hold the tape and pull it out. After removing the needle, disinfect the acupoints again on the puncture site to prevent infection.In case of needle syncope, remove the press needle immediately, and check the integrity of the removed needle. Ask the patient to lie down to increase blood flow to the brain and reduce dizziness. Then, loosen the patient's collar and waistband.Keep warm, and ensure air circulation, and administer intravenous glucose to the patient if necessary. Perform the treatment for two weeks, three times a day, during the course of treatment. Instruct the patients to follow the steps shown on the screen for the follow-up treatment.After two weeks of treatment, ask the patients to fill the scales again. In this study, a total of eight patients were evaluated for PSQI scores, including the sleep quality, sleep latency, sleep duration, sleep efficiency, hypnotic drugs, and daytime dysfunction scores. It was found that the scores were lower than before, indicating that auricular acupuncture can effectively improve the patient's sleep quality.A comparison of total CAT scores showed a statistical difference before and after treatment, indicating improvement in the quality of life for the patients.