Effects of the Chinese herb formula Yufeining on stable chronic obstructive pulmonary disease: A randomized, double-blind, placebo-controlled trial.

BACKGROUND: A Chinese herb formula Yufeining (YFN) has showed promise in the treatment of stable chronic obstructive pulmonary disease (COPD), less is known that the impact of YFN in combination with standard Western treatments on lung inflammation. This study evaluated the safety and efficacy of YFN as a treatment for stable COPD and as an anti-inflammatory agent. METHODS: Sixty patients with stable COPD were randomly assigned to two treatment groups (YFN treatment, N = 30; placebo treatment, N = 30). Both groups received inhaled steroids and bronchodilators during an 8-week intervention, and patient status was assessed at 8 weeks later and 4 months after treatment. The primary outcome included clinical efficacy. The secondary outcomes involved CAT score, mMRC grade, six-minute walking distance (6MWD). IL-8, TNF-α, IL-17A, LTB4, TGF-ß1 and CRP were also detection in peripheral serum, as well as adverse reaction conditions. RESULTS: The YFN group demonstrated a significant improvement in clinical efficacy (compare 89.3% to 63.3% in the placebo group; P < 0.05). CAT scores and mMRC grades significantly decreased (P < 0.05, P < 0.01), and 6MWD significantly increased (P<0.05), after YFN treatment. The levels of IL-8, TNF-α, LTB4 and CRP decreased significantly after 8 weeks of treatment compared to baseline levels in both groups. Only in the YFN treatment group, the levels of IL-17A decreased significantly after treatment compared to baseline levels (P < 0.05). No changes were observed inTGF-ß1 from pre-to post-treatment in either group (P > 0.05). Serum levels of IL-8, TNF-α, IL-17A, LTB4 and CRP decreased significantly after YFN treatment compared to the placebo group (P < 0.05). CONCLUSION: A combinatorial treatment approach with YFN, inhaled steroids and bronchodilators produced a clinically effective treatment for stable COPD, leading to a significant decrease in circulating inflammatory mediators. The study appeared YFN was safety. CLINICAL TRIAL REGISTRATION NUMBER: No. ChiCTR-IOR-17013577.

Diagnostic value of fractional exhaled nitric oxide for asthma-chronic obstructive pulmonary disease overlap syndrome.

To examine the difference in the fractional exhaled nitric oxide (FeNO) between chronic obstructive pulmonary disease (COPD) patients with asthma-COPD overlap syndrome (ACOS) and patients with Non-ACOS COPD (Non-ACOS) and to investigate the correlation between FeNO levels and the differential cell counts of eosinophils in induced sputum, in order to explore the diagnostic value of FeNO in ACOS.A prospective, case-control study was performed on 53 cases of ACOS group and 53 cases of Non-ACOS group in the Respiratory Medicine Outpatient of Zhangzhou Municipal TCM Hospital, Affiliated to Fujian University of Traditional Chinese Medicine. The FeNO levels and induced sputum cell counts were determined and the correlation between FeNO levels and eosinophile percentage was analyzed by Pearson linear correlation analysis.The FeNO levels in patients with ACOS (37[24.5-53.0]) ppb were significantly higher than those of patients with Non-ACOS (20 [15.5-24.5] ppb) (P < .01). Also, the percentage of eosinophils in induced sputum in the ACOS group (5.70 [1.50-17.62]%) were significantly higher than those of the Non-ACOS group (0.50 [0.00-1.00]%) (P < .01). FeNO in both groups correlated positively with the percentage of eosinophils in induced sputum (P < .01), with a correlation coefficient r of 0.521. The area under the receiver operating curve of FeNO for the diagnosis of ACOS phenotype was 0.815 (P < .01), the sensitivity and specificity reach highest when the cut off value was 25.50 ppb.The FeNO in patients from the ACOS group were significantly higher than those in Non-ACOS group and were moderately correlated with the percentage of eosinophils in induced sputum. The results indicated that FeNO may be used as a diagnostic index for ACOS, in addition to the induced sputum.

Efficacy of Chaihu Jisang decoction on post-infection cough and its effect on cough reflex sensitivity.

OBJECTIVE: To investigate the efficacy of Chaihu Ji Sang Decoction (CJSD), (a modification of Xiao Chaihu Tang (Minor Decoction of Bupleurum) was evaluated in patients with post-infection cough (PIC). Its effect on cough reflex sensitivity (CRS) was also described. METHODS: One hundred and eighteen patients with PIC were enrolled and randomly divided into an experimental group and control group (54 patients in each group). The experimental group was given CJSD orally, and the control group was given cetirizine hydrochloride for 7 d. Cough symptom scores and TCM symptom scores were compared before and after treatment. Efficacy, cough onset time, recurrence, and adverse drug reactions were additionally evaluated. Finally, CRS was evaluated before and after treatment of PIC patients in the experimental group. RESULTS: Fifty-two patients in the experimental group and fifty control patients completed the study. Cough symptom scores and the TCM symptom scores of the two groups were significantly improved after treatment, however cough symptoms in the experimental group 1 (0, 2) were significantly lower than the control group 2 (1, 2) after treatment (P < 0.05). Similarly, TCM symptom scores 4 (0, 7) in the experimental group were significantly lower than the control group 6 (3, 12) (P < 0.01). Overall, the effective rate of the experimental treatment (84.60%) was significantly higher than that of the control treatment (68.00%) (P < 0.01). The onset time of efficacy of the experimental treatment was one day faster than the control treatment [2 (2,3) d vs 3 (2,3) d, P < 0.01]. The relapse rate in the experimental group (9.09%) was lower than that of the control group (29.41%) (P < 0.05). 39 PIC patients in the experimental group completed a capsaicin cough challenge test before treatment. The lgC2 and lgC5 of the experimental group prior to treatment was 1.19 (0.59, 1.49) and 1.80 (1.49, 2.10), respectively. The lgC2, lgC5 of the healthy control group was 1.49 (0.89, 2.40) and 2.70 (2.40, 3.00), respectively. The differences in lgC2 and lgC5 between experimental group and healthy groups were significant at this time point (both P < 0.01). After treatment, 34 patients in the experimental group received re-examination. lgC5 increased from 1.80 (1.49, 2.10) to 2.10 (1.49, 3.00). CRS after treatment/re-examination was significantly lower than those of baseline in the experimental group (P < 0.05). CONCLUSION: CJSD could effectively improve the clinical symptoms of PIC patients, with demonstrable low recurrence and safety. CJSD also significantly decreased the CRS in patients with PIC.

Effects and mechanisms of actions of Chinese herbal medicines for asthma.

Asthma is a chronic inflammatory disorder of airways that affects approximately 300 million adults and children worldwide. Most therapy currently uses bronchodilators and corticosteroids. Systemic side effects from chronic use of these drugs are concern. Chinese medicine (CM) has a long history of human use in China and other Asian countries and well received by the patients. But as one component of Western integrative medicine (WIM), it is required that CM use is supported by scientific evidence. On the other hand, there are also suggestions that Western standardized medicine should consider personalized practice. In recent years there have been an increasing studies to narrow the gap between CM, the personalized medicine and Western medicine, evidence based medicine. This communication reviews several CM studies published in the English language in details by reviewing the effects and mechanisms of actions on asthma from clinic and experimental studies.Chinese herbal medicines exhibit broad actions on multiple asthma pathologic mechanisms. These mechanisms may involve antiinflammatory and immunomodulatory effects, inhibiting airway remodeling and normalization of hypothalamus, pituitary and adrenal (HPA)-axis disturbances. However, the mechanisms of actions of Chinese herbal medicines for asthma are not fully understood. More controlled clinical studies are warranted and some anti-asthma CM may be proved to be effective when used as monotherapy or complementary asthma therapies.

Transbronchoscopic selective bronchial occlusion for intractable pneumothorax.

BACKGROUND AND OBJECTIVE: The aim of this study was to evaluate the efficacy, complications and safety of the application of transbronchoscopic balloon detection (TBD) and selective bronchial occlusion (SBO) to intractable pneumothorax. METHODS: Forty patients with pneumothorax, who had experienced more than 7 days of chest tube drainage without closure of the pleural fistula, underwent TBD and SBO. In 10 patients, oxygenation and pulse rates were recorded. A thoracic CT scan was performed 10 days after SBO. RESULTS: The bronchi leading to the pleural fistula were located by TBD in 34 of 40 patients (85%). The air leakages ceased after the first occlusion in 30 patients, and five of these 30 patients underwent a second occlusion due to recurrence of pneumothorax 72 h after the first occlusion. In three of these patients, air leakages ceased after the second occlusion, while the remaining two patients underwent thoracoscopy. In total, 28 of 40 patients (70%) were cured using SBO. During TBD/SBO, the lowest SaO2 was 89.0 +/- 2.8%, the mean SaO2 was 93.4 +/- 2. 6% and the percentage of time during the procedure that SaO2 was <90% was 10.7 +/- 17.5%. Ten days after SBO, thoracic CT scans were performed on 10 patients and no obstructive atelectasis was detected in any patient. CONCLUSIONS: These results indicate that TBD and SBO are safe and effective procedures for treating patients with intractable pneumothorax.

[Transbronchoscopic balloon detection and selective bronchial occlusion for intractable pneumothorax].

OBJECTIVE: To evaluate the effect, complications and safety of transbronchoscopic balloon detection (TBD) and selective bronchus occlusion (SBO) for intractable pneumothorax. METHODS: Forty cases of pneumothorax from 5 teaching hospitals in Fujian province were included for this study. TBD was performed in all the 40 cases for whom chest tube drainage had lasted for more than 7days but failed to close the pleura fistulae. Bronchi leading to pleura fistulae (the target bronchus) were detected by balloon-catheter (Olympus B7-2C) through bronchoscope. After the target bronchus was located, SBO procedures were performed. Autologous blood (20 ml to 30 ml) was injected into the target bronchus and followed by thrombin solution (1000 U) through balloon-catheter. In 10 cases, oxygenation and pulse rate were recorded by pulse-oximeter (Healthdyne 920M) during TBD and SBO. Another 10 cases undergoing bronchoscope without performing TBD and SBO served as the controls. Thorax CT, white blood cell count, neutrophil count and body temperature were measured after SBO. RESULTS: Bronchi leading to pleura fistulae were located by TBD in 34 out of the 40 cases. Air leakage was stopped after the first occlusion in 30 cases, but 5 of which underwent a second occlusion because of recurrence in 72 h. Of the 5 cases, air leakage was stopped in 3, and surgery was required in 2. Taken together, 28 of the 34 cases were cured by SBO and 6 failed. There were no statistically differences between the treatment group and the control group in oxygenation changes during TBD and SBO procedures. In 10 cases thorax CT scan was followed up in 7 days after SBO, and no obstructive atelectasis was found. In 20 cases peripheral white blood cell count was followed up 72 hours after SBO. Leukocytosis (> 10.0 x 10(9)/L) was found in 3, in which pulmonary infection was diagnosed, and leukocytosis was present in 2 cases before the procedure. Five patients (5/34) experienced mild to moderate fever, which resolved quickly. CONCLUSION: TBD/SBO are safe and effective procedures for intractable pneumothorax.

[Effect of Yufeining on induced sputum interleukin-8 in patients with chronic obstructive pulmonary disease at the stable phase].

OBJECTIVE: To evaluate the effect of Yufeining, a traditional Chinese medicine, on induced sputum interleukin-8 (IL-8) in patients with chronic obstructive pulmonary disease (COPD) at the stable phase. METHODS: Thirty-six patients with COPD were divided into trial group (18 cases) and control group (18 cases) randomly. The trial group was treated with Yufeining pills taken orally for half a year; the control group was not given any medicine. Routine lung function was recorded before and after treatment. Total cell count (TCC), differential cell counts (DCCs) and IL-8 in induced sputum were determined at the baseline and 6 months later. RESULTS: The indices of lung function improved significantly after 6 months' treatment in trial group (P < 0.05); TCC and absolute neutrophil count decreased significantly compared with baseline in the trial group (P < 0.05); Sputum IL-8 concentration dropped significantly after 6 months' treatment, from a mean of 5.216 +/- 2.914 microg/L to 4.222 +/- 2.140 microg/L (P < 0.05). There were insignificant changes in the parameters in the control group between baseline and 6 months later. CONCLUSION: Yufeining could improve lung function, decrease sputum TCC, absolute neutrophil count and IL-8 concentration, and relieve airway inflammation in patients with COPD in the stable phase.