| Objective:To evaluate the the clinical effectiveness and safety of acupuncture and moxibustion in the treatment of bronchial asthma by using the method of systems review and Meta-analysis.Methods:According to the inclusion and exclusion criteria which were developed.Randomized controlled studies of clinical trials related to acupuncture and moxibustion for bronchial asthma(including cough variant asthma)which were published in CNKI,Wanfang,VIP,CBM,Pub Med,Cochrane,and Embase databases from 2010 to 2020 were searched by computer and combined with manual searches as well as supplementary searches.Two researchers extracted data and assessed the quality of the included studies.The primary outcome indicators were efficiency,incidence of adverse events,PEF,FEV1/FVC,FEV1.On the other hand,the secondary outcome indicators were IgE,IL-3,IL-4,CD4~+,AQLQ score,and ACT score of patitents.The data were statistically analyzed by Revman 5.3 software.The dichotomous variables were recorded by risk ratio(RR),meanwhile the continuous variables were recorded by the mean difference(MD).And the standardized mean difference(SMD)was used when the units are different.The 95%as confidence interval for each effect size.The statistical results were finally graded for quality of evidence using the GRADE profiler 3.6.Result:Finally,39 articles were included,including 27 articles using acupuncture as intervention measures,with a total of 2321 patients,and 12 articles using moxibustion as intervention measures,with a total of 1365 patients.The clinical studies which were involved in this study,there are some risks in the implementation of randomization and blinding.Most trials have not clearly claimed randomization methods and hidden methods of allocation methods.1.Acupuncture and moxibustion treatment of acute bronchial asthma(1)Compared with the modern medical therapy,acupuncture therapy combined with basic therapy was able to improve clinical efficiency[RR=1.15,95%CI(1.08,1.24)],FEV1,PEF levels,FEV1/FVC levels[WMD=9.25,95%CI(6.02,12.47);WMD=9.02,95%CI(5.61,12.43);WMD=4.97,95%CI(0.71,9.23)],while there was no statistical difference in efficiency rate when compared with theophylline drugs[RR=1.00,95%CI for(0.98,1.02)].(2)Compared with modern medicine,moxibustion combined with Western basic therapy can achieve clinical efficacy comparable to the modern medicine therapy[RR=1.03,95%CI(0.98,1.08)],with some advantage in improving IgE levels in patients[WMD=-0.14,95%CI(-0.21,-0.07)].(3)All of the above evidence was rated as low and very low by GRADE.2.Acupuncture and moxibustion treatment of chronic persistent bronchial asthma(1)Compared with the modern medicine,acupuncture therapy can achieve the clinical efficiency that was not inferior to modern medical therapy[RR=1.07,95%CI(1.00,1.16)]and improved patients’PEF and FEV1 levels,reduced serum IgE and improved patients’CD4~+level[WMD=8.32,95%CI(5.33,13.31);WMD=13.71,95%CI(9.63,17.78);WMD=-112.86,95%CI(-126.35,-99.37);WMD=2.96,95%CI(1.02,4.90)].Besides there was no statistical difference in the incidence of adverse effects and improvement in patients’ACT and AQLQ scores between two groups[RR=0.17,95%CI(0.02,1.37);WMD=-0.64,95%CI for(-1.56,0.28);WMD=0.78,95%CI(-7.74,9.30)].And there was no statistical difference between acupuncture alone and western drug control alone in terms of patient FEV1 improvement[WMD=3.20,95%CI(-0.63,7.03)];there was no statistical difference between acupuncture alone and sham acupuncture or conventional training in terms of patient FEV1/FVC improvement,while there was an advantage when combining with western drugs compared to western drugs[WMD=-0.52,95%CI(-2.98,1.95);WMD=8.96,95%CI(5.12,12.80)];laser therapy combined with modern medicine was less effective than modern medicine therapy in improving patients’PEF[WMD=-4.40,95%CI(-7.38,-1.42)].(2)Compared with modern medical therapy,moxibustion or combined modern medicine was able to achieve comparable clinical efficacy with a lower incidence of adverse effects than modern medicine[RR=1.09,95%CI(0.98,1.21);RR=0.05,95%CI(0.00,0.90)],and was not as effective as modern medicine in improving patients’FEV1,PEF,FEV1/FVC levels and ACT scores against modern medicine were not statistically different[WMD=1.38,95%CI(-1.66,4.42);WMD=-1.76,95%CI(-6.73,3.21);WMD=-1.09,95%CI(-5.13,2.95);WMD=-0.70,95%CI(-1.51,0.10)].(3)All of the above evidence was rated as low and very low by GRADE.3.Acupuncture treatment of cough variant asthma(1)Compared with the modern medicine,acupuncture therapy was able to improve clinical efficiency and reduce the incidence of adverse effects[RR=1.16,95%CI(1.09,1.24);RR=0.12,95%CI(0.04,0.33)];And improve patients’PEF levels[WMD=10.56,95%CI(9.07,12.05)].(2)Compared with modern medicine or pulmonary rehabilitation therapy,moxibustion combined with basic treatment could achieve better clinical outcomes[RR=1.16,95%CI(1.05,1.28);RR=1.95,95%CI(1.42,2.67)]and improve patients’FEV1,IgE,CD4~+,IL-4 levels[WMD=8.08,95%CI(6.57,9.59);WMD=-32.03,95%CI(-46.94,-17.12);WMD=7.34,95%CI(5.80,8.88);WMD=-5.50,95%CI(-5.90,-5.10)].(3)All of the above evidence was rated as low and very low by GRADE.Conclusion:1.Acupuncture and moxibustion treatment of acute bronchial asthmaAcupuncture therapy intervention in acute bronchial asthma:Acupuncture combined with modern medicine had definite efficacy and improvement of patients’lung function indexes(PEF,FEV1/FVC,FEV1)and was superior to modern medicine;Moxibustion combined with modern medicine was superior to modern medicine in terms of clinical efficiency and improvement of patients’IgE indexes.2.Acupuncture and moxibustion treatment of chronic persistent bronchial asthmaAcupuncture therapy for chronic persistent bronchial asthma:The efficacy of acupuncture combined with modern medicine was confirmed,and it improved patients’lung function indexes(FEV1,PEF,FEV1/FVC)and serum inflammation indexes(IgE,CD4~+),and was better than modern medicine.But there was no sufficient evidence to confirm its advantages in reducing patients’symptoms and safety;Moxibustion combined with modern medicine was superior in clinical.The efficacy of moxibustion combined with modern medicine is clear and better than the modern medicine group in terms of clinical efficacy,safety and improvement of lung function level.But there was no sufficient evidence to confirm its advantage in improving symptoms and FEV1/FVC levels.3.Acupuncture treatment of cough variant asthmaAcupuncture and moxibustion therapy for cough variant asthma:Acupuncture in combination with modern medicine has definite efficacy and is superior to modern medicine in terms of clinical efficacy,improvement of patients’lung function(PEF)and clinical safety;Moxibustion in combination with modern medicine is superior to modern medicine in terms of clinical efficacy and improvement of patients’IgE,IL-4 and CD4~+levels.The results obtained in this study were evaluated by GRADE as low and very low levels.In the future,studies are likely to have a significant impact on the existing results.And the possibility of changing the credibility of the assessment results is high.So the conclusion should be treated with caution. |
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