Clinical Outcomes of High-Flow Nasal Cannula Combined with Standardized Acupoint Application in Acute Exacerbations of COPD: A Retrospective Study.

PURPOSE: To evaluate the clinical outcomes associated with adding standardized acupoint application (AA) to high-flow nasal cannula (HFNC) in hospitalized patients with acute exacerbation of COPD (AECOPD). PATIENTS AND METHODS: This retrospective comparative effectiveness study included 178 consecutive AECOPD patients treated between February 2024 and April 2025 who received either HFNC alone (n=89) or HFNC plus AA (n=89). All patients received guideline-based conventional care. Propensity score matching was used to adjust for baseline differences. Clinical outcomes were assessed at day 10, including a validated Traditional Chinese Medicine (TCM) syndrome-scoring scale (primary outcome), selected to holistically capture the multi-symptom response targeted by the integrative intervention, pulmonary function (FEV1, FVC), arterial blood gases (PaO2, PaCO2, SaO2), inflammatory biomarkers (IL-8, IL-17, TNF-α, hs-CRP, PCT), immune subsets (CD4⁺, CD8⁺, CD4⁺/CD8⁺ ratio), and patient-centered outcomes (CAT, mMRC, 6MWD, SGRQ). RESULTS: The HFNC plus AA group showed a higher clinical response rate (88.76% vs 70.79%; adjusted risk difference, 17.98%; relative risk, 1.25; 95% CI, 1.08-1.46; P=0.003). The combination group demonstrated greater improvements in FEV1 (mean difference [MD] 0.07 L), FVC (MD 0.20 L), PaO2 (MD 5.03 mmHg), and PaCO2 (MD -1.93 mmHg) (all P<0.05). Reductions in inflammatory markers (IL-8, IL-17, TNF-α, hs-CRP, PCT) and favorable immune modulation (increased CD4⁺/CD8⁺ ratio) were more pronounced in the HFNC plus AA group (all P<0.01). Patient-centered outcomes also favored the combination: CAT (MD -2.59), 6MWD (MD 28.53 m), and SGRQ (MD -5.76) (all P≤0.01). Adverse events were higher in the combination group (47.67% vs 32.18%; RR 1.48; 95% CI 1.02-2.16), driven primarily by local skin reactions. CONCLUSION: In this observational study, adding standardized AA to HFNC was associated with improved clinical outcomes and a generally manageable safety profile. However, these findings are exploratory and require prospective validation.