A network meta-analysis of different acupuncture modalities in the treatment of bronchial asthma

Background Glucocorticoids and Beta-2 receptor agonists are commonly used for the treatment of asthma in clinical practice, while these agents are accompanied by adverse reactions of different kinds. Studies have shown that acupuncture is effective in treating bronchial asthma. However, different acupuncture modalities have different costs and skill requirements, and there remains a lack of comparisons between different acupuncture modalities. This study aims to assess the efficacy of various acupuncture modalities in the treatment of asthma.Methods The following databases were searched for randomized controlled trials (RCTs) on acupuncture for the treatment of bronchial asthma from database inception to August 26, 2022: PubMed, Embase, The Cochrane Library, Web of Science, Chinese Journal Full-text Database (CNKI), Wanfang Database (Wanfang Date), VIP Database (VIP), China Biology Medicine disc (CBM). Stata 15.1 software was used to conduct network meta-analysis. The risk of bias in the included studies was evaluated using the Cochrane Risk of Bias Assessment Tool 2 (RoB2).Results A total of 8,693 relevant studies were found, and 30 RCTs were included, involving 2,722 patients with bronchial asthma and eight acupuncture modalities: manual acupuncture, moxibustion, electroacupuncture, ignipuncture, flying needle acupuncture, acupoint catgut embedding, acupoint application, and warm-needle moxibustion. The other 29 studies had certain risks, with the quality graded as "moderate". Among the pair-wise comparisons of statistical significance (p < 0.05), acupoint application was the most effective in improving pulmonary function (FEV1: Traditional medicine therapy-acupoint application [-7.29 (-12.11,-2.47)]; acupoint application-moxibustion [7.20 (0.28,14.11)]; FVC: acupoint application-Traditional medicine therapy [8.02 (2.54,13.50)]). Acupoint catgut embedding was the most effective in improving the ACT score of the patients (Traditional medicine therapy-acupoint catgut embedding [-4.29 (-7.94, -0.65)]; acupoint catgut embedding-moxibustion [5.52 (1.05,9.99)]).Conclusion Acupoint application has evident merits in improving the clinical response rate and pulmonary function, while acupoint catgut embedding can improve other secondary indicators. For the clinical treatment of asthma, acupoint application can be selected as a complementary and alternative therapy, while the other acupuncture therapies can also be considered according to the examination results of the patients.