Evidence behind this recommendation.
Selected studies from our library that inform the recommendations on this page. Evidence grade shown when available.
A randomized, controlled, crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture
“Asthma is a chronic respiratory condition that affects approximately 300 million people globally, characterized by constant airway inflammation that causes bronchial narrowing, increased mucus production, and symptoms such as cough...”
Research on the Mechanism and Application of Acupuncture Therapy for Asthma: A Review
“This comprehensive review examines the mechanisms by which acupuncture treats asthma, a condition that affects approximately 300 million people worldwide. The authors analyzed clinical and experimental evidence from the last 15 years, focusing...”
What Is Bronchial Asthma
Asthma is a chronic inflammatory airway disease characterized by bronchial hyperreactivity and variable, reversible airflow obstruction. Its pathophysiology involves eosinophilic and mast cell infiltration of the bronchial mucosa, airway remodeling (subepithelial fibrosis), and IgE-mediated hypersensitization to aeroallergens.
In Brazil, it affects approximately 10% of the adult population and 12% to 15% of children, with a high burden of hospitalization and school/work absenteeism. Diagnosis is confirmed by spirometry showing reversible obstruction (FEV1/FVC <0.70 and reversibility ≥12% or 200 mL with bronchodilator). Classic clinical manifestations include expiratory wheezing, dyspnea, chest tightness, and cough, typically worse at night and early morning.
Precipitating factors include inhaled allergens (pollen, mites, fungi, animal dander), viral infections (rhinovirus, RSV), physical exercise, pollution, NSAIDs (intolerance in 10% of asthmatics), GERD, and emotional stress — the latter directly modulated by the HPA axis and the autonomic nervous system, opening an interface for neurovegetative intervention.
Conventional Treatments
Stepwise asthma treatment (GINA) aims for symptomatic control with the lowest possible medication dose. Inhaled corticosteroids (ICS) are the basis of maintenance treatment for all persistent forms.
STEPWISE ASTHMA TREATMENT (GINA)
| GINA STEP | MEDICATIONS | CONSIDERATIONS |
|---|---|---|
| Step 1 (intermittent) | SABA (albuterol/salbutamol) as needed | Rescue only; no ICS |
| Step 2 (mild persistent) | Low-dose ICS (budesonide 200 mcg) + SABA | ICS is cornerstone — do not skip |
| Step 3 (moderate persistent) | Medium-dose ICS or ICS + LABA | Inhaled formoterol/budesonide |
| Step 4 (severe persistent) | High-dose ICS + LABA + antimuscarinic | Tiotropium add-on |
| Step 5 (severe uncontrolled) | Biologic (omalizumab, mepolizumab) | Anti-IgE or anti-IL-5; high cost |
| Rescue in attack | SABA or budesonide-formoterol (MART) | Never use LABA without ICS in attack |
How Acupuncture Works in Bronchial Asthma
Acupuncture acts on asthma through neuroimmunological mechanisms that address central components of the pathophysiology: modulation of the Th2/IgE response, regulation of bronchial autonomic tone, and activation of the HPA axis with elevation of endogenous cortisol.
Mechanism of Action in Bronchial Asthma
BL-13 (Feishu) — Posterior Lung Point
Lung back-shu point (T3); segmental stimulation activates somatic afferents T3–T4 → spinal signaling → modulation of the bronchial vagal reflex → reduction of reflex bronchospasm.
ST-36 — Hypothesis of HPA Axis Activation
Experimental studies suggest that ST-36 may modulate the HPA axis, with potential effect on endogenous cortisol and anti-inflammatory cytokines. This is a hypothesized complementary mechanism — it does not replace inhaled corticosteroid nor reach the same magnitude of local anti-inflammatory effect.
LU-7 — Airway Regulation
Luo point of the lung meridian; some studies suggest modulation of bronchial mucosal permeability and mucus production; reduction of histamine and bradykinin observed in animal models and in specific human studies — preliminary evidence.
CV-17 (Shanzhong) — Respiratory Center
Point on the sternum, over the lungs; influence on the midbrain respiratory center; relieves the sensation of chest tightness and psychofunctional dyspnea associated with asthma.
Hypothesis of IgE / Th2 Profile Modulation
Studies included in the Cochrane 2018 review suggest reduction of IL-4 and IL-13 (Th2 → IgE cytokines) and relative modulation of IFN-γ, with reduction of serum IgE observed in subgroups. This is a hypothesized mechanism, supported by low to moderate quality evidence (GRADE) — needs confirmation.
Scientific Evidence
Acupuncture for asthma has one of the largest bodies of evidence among respiratory conditions — including a high-quality Cochrane review with 29 clinical trials.
Cochrane Review 2018 — 29 RCTs (n=1,925)
J Asthma 2019 — Electroacupuncture RCT (n=128)
Modern Approach: Integrative Medical Acupuncture
CLINICAL PROTOCOL IN BRONCHIAL ASTHMA
| PARAMETER | SPECIFICATION | RATIONALE |
|---|---|---|
| Main points | BL-13 + ST-36 + LU-7 | Posterior lung + vagal + lung meridian |
| Auxiliary points | CV-17 + KI-3 | Chest tightness + renal basis of respiration |
| Electroacupuncture | 2 Hz at BL-13+ST-36 | Modulates endogenous cortisol and reduces IgE |
| Frequency | 2 sessions/week for 8–12 weeks | Active phase; assess with spirometry |
| Maintenance | 1 session/month in controlled asthma | Prevention of seasonal exacerbations |
| Maintain ICS | ALWAYS in persistent asthma | Do not reduce without pulmonology supervision |
When to See a Medical Acupuncturist
Ideal Candidates
- Partially controlled asthma despite adherence to ICS
- Asthma with anxiety/stress trigger component
- Exercise-induced asthma
- Goal of reducing rescue SABA use
- Desire to reduce ICS dose (under pulmonology supervision)
Situations Requiring Medical Attention
- Severe acute attack: medical emergency first
- Asthma GINA step 4–5: pulmonologist coordinates
- SpO2 <94%: immediate oxygen + bronchodilator
- Uncontrolled asthma: do not start acupuncture without stabilization
Frequently Asked Questions
Frequently Asked Questions
No. Discontinuing ICS without pulmonology supervision is dangerous and can precipitate a severe attack. Acupuncture is an adjuvant — it can help reduce the ICS dose over time, but always under medical follow-up and with spirometric monitoring.
Asthma is a chronic disease without known cure. Acupuncture can reduce the frequency and severity of attacks, improve pulmonary function (FEV1, PEF) and quality of life — but does not definitively eliminate bronchial hyperreactivity. The realistic goal is better control with less medication.
Studies used 2 weekly sessions for 8 to 12 weeks in the active phase, with spirometric assessment at the end. In controlled asthma, monthly maintenance sessions — especially in seasons of greater allergen exposure — can prevent exacerbations.
Studies in allergic asthma suggest a favorable symptomatic response. Allergic asthma has a Th2/IgE component, and some studies indicate modulation of these markers by acupuncture (reduction of IL-4, IL-13, IgE in subgroups). Patients with united airway syndrome (asthma + allergic rhinitis) frequently report relief of both conditions; the response is individual and does not eliminate the need for ICS when indicated.
Pediatric studies show results similar to those in adults, with good tolerability. Adapted technique (smaller needles, shorter sessions) is used in children. Combination with ICS is maintained — acupuncture aims to reduce attacks and SABA use, not to replace pharmacological control.