Chronic Cough

Toux : évaluation de l'acupuncture

1. Systematic Reviews and Meta-Analysis

☆☆☆	Evidence for effectiveness and a specific effect of acupuncture
☆☆	Evidence for effectiveness of acupuncture
☆	Limited evidence for effectiveness of acupuncture
Ø	No evidence or insufficient evidence

1.1. Generic Acupuncture

1.1.1. Xiong 2021 (Cough-Variant Asthma)

Xiong J, Qi W, Yang H, Zou S, Kong J, Wang C, Zhou Y, Liang F. Acupuncture Treatment for Cough-Variant Asthma: A Meta-Analysis. Evid Based Complement Alternat Med. 2021. [218248]. doi

Background	In recent years, there have been many clinical reports on acupuncture treatment of cough-variant asthma, but no researcher has objectively analysed and evaluated the efficacy and safety of acupuncture treatment of cough-variant asthma from the perspective of evidence-based medicine.
Objective	To systematically evaluate the clinical efficacy and safety of acupuncture in treating cough-variant asthma and to provide reference values for clinical decision-making.
Methods	The comprehensive computer retrieval Chinese journal full-text database (CNKI), Chinese science and technology periodical database (VIP), ten thousand data knowledge service platform (WanFang Data), PubMed, Embase, and the Cochrane Library were used to collect literature for relevant randomized controlled trials (RCT) of acupuncture treatment of cough-variant asthma, as well as to retrieve papers and add reference retrieval after literature review, in accordance with the standard of literature filtering, data extraction, and quality evaluation. The data were meta-analysed using ReviewManager5.3 software recommended by Cochrane.
Results	A total of 11 randomized controlled clinical studies were screened and included, comprising 929 patients. The results of the meta-analysis showed that, compared with the control group, acupuncture intervention on CVA could enhance the total clinical effectiveness rate, reduce the relapse rate of drug withdrawal, relieve symptoms of cough, phlegm, and diaphragmatic congestion, and improve lung function-related indicators and immune inflammation indicators. There were statistically significant differences in all efficacy evaluation criteria.
Conclusion	The clinical curative effect of acupuncture treatment for cough-variant asthma is precise and has certain advantages in relieving symptoms and reducing the recurrence rate. However, the low quality of the evaluation in the RCT research literature is a problem, and more high-quality clinical randomized controlled trials are needed to further verify the comprehensive clinical efficacy and safety of this treatment.

1.2. Special Acupuncture Techniques

1.2.1. Acupoint sticking therapy

1.2.1.1. Tu 2022

Tu H, Zhang Q. Assessment of Acupoint Therapy of Traditional Chinese Medicine on Cough Variant Asthma: A Meta-analysis. Biomed Res Int. 2022 Jul 30;2022:4168308. https://doi.org/10.1155/2022/4168308

Background	Acupoint application has been used in China to treat various illnesses for ages. In cough variant asthma (CVA), the main clinical sign is episodic night cough. Acupoint application therapy of traditional Chinese medicine is an effective procedure to treat cough variant asthma.
Methods	The current study is designed to systematically assess the effectiveness of acupoint application therapy in traditional medicine for patients with cough variant asthma. The comprehensive computer retrieval related to comparison between acupoint application and nonacupoint application therapy for cough variant asthma was carried out in various databases (n = 8) from database establishment until July 4, 2021. Both English and Chinese articles about original investigations in humans were searched. Two independent authors extracted the data, and disagreements were resolved by discussion. ReviewManager 5.3 software provided by Cochrane did a meta-analysis of selected randomized controlled trials (RCTs). Quality of experimentation and risk bias were analyzed by the Cochrane Handbook tool.
Results	A total of thirteen randomized controlled clinical articles along with 1237 patients were included in the study. Findings of meta-analysis showed that compared with nonacupoint application treatment, the total effective rate of acupoint application treatment is more effective (RD = 0.13, 95% CI (0.09, 0.17), Z = 6.70, P < 0.00001). Besides, acupoint application can improve patients' lung function, the lung function index FVC (mean difference = 0.55, 95% confidence interval (0.42, 0.68), Z = 8.40, P < 0.00001), FEV1 (MD = 0.35, 95% CI (0.23, 0.47), Z = 5.86, P < 0.00001), FEV1/FVC (%) (MD = 12.68, 95% CI (4.32, 21.03), Z = 2.97, P = 0.003), FEV1 (%) (MD = 8.63, 95% CI (8.01, 9.25), Z = 27.44, P < 0.00001), and PEF (day) (MD = 0.62, 95% CI (0.52, 0.71), Z = 12.40, P < 0.00001) of patients treated by acupoint application therapy were increased. Moreover, acupoint application might lower the level of immunoglobulin E (MD = -54.58, 95% CI (-63.54, -45.61), Z = 11.93, P < 0.00001) and EOS (MD = -0.21, 95% CI (-0.35, -0.06), Z = 2.77, P = 0.006). The LCQ (Leicester cough questionnaire) total score of CVA patients was also increased (MD = 2.30, 95% CI (1.55, 3.06), Z = 5.98, P < 0.00001).
Conclusions	Acupoint application therapy is effective in controlling symptoms of CVA. It also has a positive effect in improving lung function and life quality of patients. It can reduce the eosinophil levels and peripheral blood IgE levels of patients as well.

2. Clinical Practice Guidelines

⊕ positive recommendation (regardless of the level of evidence reported)
Ø negative recommendation (or lack of evidence)

2.1. Agency for Healthcare Research and Quality (ARQ, USA) 2013 Ø

X. Assessment and Management of Chronic Cough Agency for Healthcare Research and Quality (ARQ, USA). 2013. 256p. [192678].

Still, our systematic review of the literature identified only two studies of nonpharmacological interventions for chronic cough; one was published in 1988 and one in 2006, and neither involved complementary or alternative medical approaches that have recently garnered attention by patients, clinicians, researchers. Only one study included in our review involved such an approach.

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