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.