Clinical effect of adding acupuncture to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease

INTERVENTION: Acupuncture monotherapy (12 times in 3 months) followed by combined acupuncture‐PR (adding 12 sessions of acupuncture therapy to 20 sessions of pulmonary rehabilitation in 3 months) CONDITION: Chronic obstructive pulmonary disease (COPD) PRIMARY OUTCOME: As outcomes of acupuncture monotherapy: endurance time, peak oxygen uptake (peak VO2). SECONDARY OUTCOME: 1) As outcomes of acupuncture monotherapy: Borg scale, O2‐pulse, VD/VT,VE/VO2, VE/VCO2, delta Fo2, all of which will be measured using cardiopulmonary exercise testing (CPET).; ; 2) As outcomes of i) combined acupuncture‐PR alone, and of ii) adding combined acupuncture‐PR to acupuncture monotherapy (i.e., overall treatment), peak VO2, endurance time, Borg scale, O2‐pulse, VD/VT, VE/VO2, VE/VCO2, delta FO2, all of which will be measured using CPET.; ; 3) As outcomes of i) acupuncture monotherapy alone, ii) combined acupuncture‐PR alone, and iii) adding combined acupuncture‐PR to acupuncture monotherapy (i.e., overall treatment), a) respiratory muscle strength, b) body weight, c) CAT score, d) SGRQ, e) mMRC dyspnea scale, f) pulmonary function test (including MostGraph and expiratory fractional exhaled nitric oxide), g) daily physical activities measured using Activision markers, h) skeletal muscle mass, bone mass, and fat measured using dual‐energy X‐ray absorptiometry (DEXA), i) blood examination (norepinephrine, VEGF, ghrelin, hANP), and j) iliopsoas muscle (volume, CT number) INCLUSION CRITERIA: 1)COPD determined according to diagnostic criteria and classified as stage II or more using the GOLD criteria. Those rated as grade 1 or more according to modified Medical Research Council dyspnea scale (mMRC) were included. 2)Age 40 or more years 3)Stable patients able to tolerate cardiopulmonary exercise testing to ensure adequate evaluation 4)Signed agreement to participate in the study