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, wheezing, shortness of breath, and chest tightness. Conventional treatment includes bronchodilator and anti-inflammatory inhaled medications, which although effective, have led many patients to seek complementary therapies. Among these alternatives, acupuncture has gained prominence as a promising option for controlling asthma symptoms, being a millennia-old technique of traditional Chinese medicine that uses needles at specific body points to promote energetic balance and treat various health conditions.

In light of the need for more robust scientific evidence on the efficacy of acupuncture in asthma treatment, researchers from the University of São Paulo conducted a randomized controlled study at the Hospital das Clínicas. The main objective was to evaluate whether traditional Chinese acupuncture, when used as a complementary treatment to conventional medications, could effectively improve asthma control in patients with mild to moderate symptoms. For this, they used a methodological design known as a crossover study, in which all participants received both verum acupuncture and sham acupuncture at different times, allowing each person to serve as their own control. The study was conducted in a double-blind manner — neither the patients nor the professionals who assessed the results knew which type of acupuncture was being applied at each moment.

The research followed 74 nonsmoking adult patients with mild to moderate persistent asthma for a period of more than four years. Participants were divided into two groups: one group first received ten weekly sessions of verum acupuncture followed by a three-week period without treatment and then ten sessions of sham acupuncture; the other group followed the reverse sequence. Throughout the study, patients continued using their usual asthma medications when needed. Researchers measured several parameters to assess treatment efficacy, including pulmonary function through spirometry, analysis of inflammatory cells in induced sputum, measurement of exhaled nitric oxide as an inflammation marker, daily records of symptoms and peak flow meter use, and detailed quality of life questionnaires.

The results revealed interesting and complex findings about the effects of acupuncture on asthma control. When patients received verum acupuncture, significant improvement in peak expiratory flow was observed, which is an important indicator of respiratory function. Even more impressive was the demonstration of anti-inflammatory effects of verum acupuncture: there was a significant decrease in eosinophils and neutrophils in sputum, which are cells related to asthmatic inflammation, accompanied by an increase in macrophages, important cells in the regulation of allergic response. Regarding daily symptoms, both verum and sham acupuncture produced significant reductions in cough, wheezing, and shortness of breath, as well as decreasing the need for rescue medications.

In quality of life questionnaires, both types of acupuncture showed improvements in various aspects, including functional capacity, physical aspects, general health status, and vitality.

For asthma patients considering acupuncture as complementary treatment, these results suggest that the technique may offer real benefits, especially in controlling airway inflammation and improving respiratory function. The demonstration of anti-inflammatory effects is particularly relevant, since chronic inflammation is a central component of asthma. For healthcare professionals, the study provides evidence that acupuncture can be a useful tool as part of an integrated treatment plan, potentially helping to reduce dependence on medications and improving patients' quality of life. However, it is important that both patients and professionals understand that acupuncture should be viewed as a complementary treatment, not a substitute, for conventional medical therapy.

The study presented important limitations that should be considered in interpreting the results. Participant loss was considerable over the four years of research, with 111 volunteers dropping out for various reasons, including workload, change of address, and symptom improvement during the trial. Furthermore, the long duration prevented adequate control of seasonality, which can influence asthmatic symptoms, and the three-week period between treatments may not have been sufficient to completely eliminate the effects of acupuncture. Surprisingly, both verum and sham acupuncture produced similar improvements in many aspects, suggesting that it is difficult to establish a true placebo for acupuncture, since even points considered "sham" may have some therapeutic effect.

This finding questions the validity of the crossover study design for acupuncture research and indicates the need for different methodologies in future investigations of this promising complementary therapy for asthma treatment.