*4.2. Clinical Implications*

Although the main therapeutic approaches for COPD are pharmacological approaches and lifestyle management [4], manual therapy is considered a promising adjuvant therapy [5]. In this review, various types of manual therapies were categorized as therapies derived from the East or West according to their origins, and the most effective manual therapy for individual outcomes related to COPD was explored through the NMA methodology. Although with limited certainty, some clinical evidence indicated that massage was the most effective treatment for FEV1 and FEV1/FVC, acupressure for FVC, and tuina for 6MWD. Since manual therapies are generally used as a complement to conventional treatment for COPD in clinical settings, the findings of this review suggest that it may be helpful to select a specific manual therapy method according to the individual patient's characteristics and target symptoms.

COPD is a long-standing problem, and the development of non-pharmacological therapies to improve the quality of life of COPD patients is important [48]. In this review, manual therapies that showed significant improvement in some outcomes of the quality of life in COPD patients were acupressure and tuina belonging to Eastern manual therapy. These therapies may not only affect lung function or exercise capacity in COPD patients but may also help improve other disturbing symptoms, including pain [49], insomnia [50,51], and fatigue [50], as seen in previously published studies, thereby contributing to the improvement in the quality of life of COPD patients.
