Efficacy of acupuncture in managing acute exacerbation of chronic obstructive pulmonary disease: a network meta-analysis

Background: This study aimed to evaluate the efficacy of acupuncture-related interventions for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) using a network meta-analysis. Methods: PubMed, Embase, Cochrane Library, Web of Science, CNKI, VIP, and Wan fang were searched from inception to September 20, 2025. Randomized controlled trials involving patients with AECOPD and evaluating acupuncture-related interventions, alone or in combination with usual treatment, were included. The primary outcome was symptom improvement. Secondary outcomes were forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), and FEV1/FVC. A Bayesian network meta-analysis was conducted to synthesize direct and indirect evidence across interventions. Results: A total of 45 randomized controlled trials involving 3,156 participants were included. Compared with usual treatment, several acupuncture-related interventions were associated with improvements in symptom-related outcomes and pulmonary function parameters. For symptom improvement, acupoint application (AA) and abdominal needle (AN) showed statistically significant associations compared with usual treatment (AA: OR = 4.97, 95% CrI 3.18-8.24; AN: OR = 6.84, 95% CrI 2.59-21.54). For pulmonary function outcomes, thunder-fire moxibustion (TFM) was associated with higher FEV1 values (MD = 0.71, 95% CrI 0.50-0.92), while conventional acupuncture (AC) and ear acupuncture (EAC) were associated with improvements in FVC and FEV1/FVC. Ranking analyses suggested that AN, TFM, AC, and AA/EAC tended to rank relatively higher for symptom improvement, FEV1, FVC, and FEV1/FVC, respectively; however, surface under the cumulative ranking curve (SUCRA) values reflect ranking probabilities rather than the magnitude of treatment effects. Conclusion: Acupuncture-related interventions may provide potential adjunctive benefits for patients with AECOPD when used in combination with conventional treatment. In this network meta-analysis, several interventions were associated with improvements in symptom-related outcomes and pulmonary function parameters. However, ranking results from SUCRA should be interpreted cautiously and considered together with effect estimates and the certainty of evidence. Given that most included trials evaluated acupuncture as an adjunct to usual care and the overall certainty of evidence ranged from moderate to low, further large-scale and well-designed randomized controlled trials are needed to confirm these findings. Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251080558, identifier CRD420251080558.