Medical Acupuncture
A Journal For Physicians By Physicians

Published by
The American Academy of
Medical Acupuncture

Fall / Winter 1998 / 1999 - Volume 10 / Number 2
"Aurum Nostrum Non Est Aurum Vulgi"

MONITORING THE SUCCESS OF ACUPUNCTURE IN TREATMENT OF REACTIVE AIRWAY DISEASE BY USE OF THE PEAK FLOW METER
By Capri-Mara Fillmore, M.D., Bethesda, Maryland

INTRODUCTION
     One of the repeated criticisms of acupuncture is the lack of objective measurable results. Sophisticated measurements of results such as the PET scan are currently being studied. A simple peak flow meter (cost: $15) is an inexpensive and easy way to monitor the success of acupuncture treatment in treating asthma or reactive airway disease. This meter measures the volume of exhaled air at the point of maximum speed and forcefulness of exhalation. This measuring device has boon recommended for several years in the home management of asthma ( 1 ).
     A review by Jobst (2) of acupuncture in the treatment of pulmonary disease showed 10 of 16 studies (double-blind, single-blind, and unblinded) had significant improvement of "breathlessness" with acupuncture: 10 of 11 studies indicated that medication could be reduced with acupuncture treatment.
     A review by Helms discussed 16 controlled studies (3); 9 studies concluded that acupuncture is more effective than "sham" needling (4). Success was measured by reduction of medicine, general well-being, and decrease in perception of dyspnea or breathlessness. Pulmonary function tests were used to measure succcss in one study: no measurable change over a period of several months was found (4).

KEY WORDS
     Acupuncture, Asthma, Reactive Airway Disease, Peak Flow Meter CASE STUDY A 45-year-old Yang Ming earth male presented for treatment with a five-day history of severe cough and whitish-gray sputum. He stated that his symptoms were worse than a usual cold. Coughing had made his diaphragm painful. The patient's exam indicated bilateral pulmonary wheezes and ronchi in all fields, oral temperature 101.8~F, chest X-ray normal. His respiratory history was significant for occasional prolonged cough with mild wheezing for a few weeks following common colds; no smoking history. The patient's diagnosis was acute bronchitis and infection-related reactive airway disease (or, infection-induced asthma).
     He was treated bilaterally on his first visit (April 13) with BL 10 (for acute cold symptoms): Kidney Shu points (BL 23- -) connected with Ding Chuan points (++) for 20 minutes, at 8 hertz; and simultaneous cupping of BL 13 (Lung Shu points) and the Hua Tuo points, with a single cup on each side of the spine. This treatment was the patient's first experience with acupuncture.
     Auscultation immediately after the treatment had only rare wheezes. The patient improved immediately. He was given a prescription of clarithromycin, an albuterol inhaler, and was told to return to thc clinic in two days.
     Returning to the clinic, the man reported that he felt well for 36 hours. However, he then reported feeling fatigued, his cough returned (no longer productive), and his temperature was 100.3"F. Auscultation of his lungs revealed bilateral wheezing. KI 3 (- -) was connected to KI 7 (++) to strengthen the kidney meridian. BL23 (- -) was connected to BL 13 (++); Dingchaun and BL 10 were piqured. Cupping of BL 13 and Hua Tuo was done as a second step. This time, a before-and-after peak flow measurement was taken; they were 320dl and 420dl, respectively, with no wheezing after treatment.
     The patient returned to the clinic five days later. He reported feeling well for 24 hours, but again displayed increasing fatigue, though normal temperature. Bilateral wheezes were evident on auscultation: peak flow had dropped to 410dl. Both patient and physician became curious whether an albuterol treatment did as well. Thus, two puffs of albuterol using a spacing device was administrated. The patient reclined on his stomach in a dimly lit room for 20 minutes (as was done during the acupuncture treatment). A second peak flow reading showed 450dl with a mild wheeze. He was then given another acupuncture treatment. LU I was piqured instead of BL 10, since the dis- case was no longer acute. Thc peak flow improved to 500dl. Lung sounds were clear. The patient felt "well."
     This individual was seen again seven days later. He reported improvement. He had rare wheezes; peak flow 500dl. Acupuncture treatment pictured LU 5 (- -) connected to LU 7 (++), and LI 4 bilaterally (instead of KI 3,7, and LU 1 ). The physician chose a treatment reflecting the patient's Yang Ming earth character. The illness was no longer acute. All other points previously used were needled. After treatment, the man no longer displayed wheezes or prolonged expiratory phase: his peak flow was 600dl.

DISCUSSION
     Several different methods are used for the treatment of asthma or reactive airway disease with acupuncture. However, many of the schools of acupuncture use the Dingchuan point in the treatment of these diseases. This treatment is a variation of the treatment taught by two sources, Helms (5) and Xinnong (6).
     This case history appears to be one of the few using an objective measuring instrument to compare the acute effect of acupuncture treatment versus medication. Peak flow was used for objective measurement of the success of treatment; auscultation changes were also reported. The findings before and after the treatments are listed in Table 1. The results were reproduced at the time of each acupuncture treatment during this illness. Peak flow measurements after treatment improved up to 25% higher than before treatment. This improvement was greater than the improvement expected or found with albuterol aerosol. However, since neither patient nor physician was blinded, the placebo effect could be argued. One might also argue that peak flow measurements could be biased by greater effort after acupuncture treatment. The patient appeared to be making his best effort with each peak flow test. (Best of three measurements were used for each volume recorded in Table 1.)
     This study of acute changes in peak expiratory flow does not give insight to the use of acupuncture in long term treatment of reactive airway disease or asthma. Nonetheless, peak flow measurement helped to confirm to both patient and physician the immediate effectiveness of treatment of reactive airway disease by acupuncture. Similar treatment was tried on several other patients with similar success, but are not presented in this paper. The peak flow meter is an inexpensive way to measure acupuncture effectiveness, which may also be useful for clinical trials.

REFERENCES

1. National Institutes of Health 1995, Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention. National Heart, Lung, and Blood Institute/World Health Organization Worshop Report. N1H/NHLBI, Publ No. 95-3659.
2. Jobst KA. Acritical analysis of acupuncture in pulmonary disease: efficacy and safety of the acupuncture needle. J Altern Comple Med 1995; 1 ( 1 ):57-85.
3. Hehns JM. Acupuncture energetics: a clinical approach for physicians. Medical Acupuncture Publishers, Berkeley, California 1995: 49.
4. Jobst KA., et al. Controlled trial of acupuncture for disabling breathlessness, The Lancet 1986; 2:1416-1419.
5. Helms JM. 1995 course syllabus. Clinical pearls, acupuncture for physicians, 1994-5.
6. Xinnong, C. Ed. Chinese acupuncture and moxibustion. Foreign Languages Press, Beijing 1997.

Table 1 · Type of treatment before and after auscultation and peak flow results

AUTHOR INFORMATION
Dr. Capri-Mara Fillmore is currently an Epidemiology and Biostatistics Research Fellow at the National Cancer Institute, National Institutes of Health, Bethesda, Maryland. She is doing a rotational year at Johns Hopkins University Medical Center and School of Public Health in Preventive Medicine. Dr. Fillmore has a Masters Degree in Human Nutrition, and is board-certified in Family Medicine.

Capri-Mara Fillmore, M.D. M.P.H., M.S.
Pendleton Community Care
Main St., Franklin, W. VA
Phone: 304-358-2355
and
10902 Kenilworth Ave. Garrett Park, MD
Phone: 301-962-0943 · Home: 301-402-3204 · Fax: 301-496-6829
Email: FillmorC@epndce.nci.nih.gov

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