Evaluating the association of osteoporosis with inhaled corticosteroid use in chronic obstructive pulmonary disease in Taiwan.

Chronic obstructive pulmonary disease (COPD) is characterized by airflow limitation and osteoporosis is the major comorbidity associated with poor prognosis in COPD. However, the effect of inhaled corticosteroids (ICS) on bone mineral density among COPD remains uncertain. There is the urgent need to examine whether the long-term ICS use may increase the risk of osteoporosis. In this nested case-control study retrieved from the Taiwan National Health Insurance Research Database from 2002 to 2017, the study aimed to investigate risk of osteoporosis associated with ICS, focusing on the dosage and duration of ICS therapy. Cases with osteoporosis or osteoporotic fractures claims were defined and matched to 3 randomly selected controls. Conditional logistic regressions were used to estimate odds ratios of osteoporosis from ICS treatment measured in 3 years before the index date. This population-based study included 891,395 patients with COPD, where after matching had 58,048 case groups and 174,144 matched control groups. After adjusting for potential confounders, ICS use in COPD was associated with a 1.053-fold (95% confidence interval 1.020-1.087) increased osteoporosis risk, where 7892 (13.59%) ICS use in case and 22,580 (12.97%) in control. New ICS use in COPD patients is associated with increased osteoporosis risk, regardless of exposure period.

Rapid HPLC Quantification Approach for Detection of Active Constituents in Modern Combinatorial Formula, San-Huang-Xie-Xin-Tang (SHXXT).

San-Huang-Xie-Xin-Tang (SHXXT), one of the most important traditional Chinese medicinal formulas, is comprised by three herbal medicines, the rhizome of Rheum officinale [or Rheum tanguticum (Polygonaceae) (Dahuang in Chinese)], the root of Scutellaria baicalensis (Labiatae) (Huangqin in Chinese), and the rhizome of Coptis chinensis (Ranunculaceae) (Huanglian in Chinese) in the ratios of 2:1:1 or 1:1:1. This study is aimed to quantitate and qualify of SHXXT, by a rapid, convenient, and effective HPLC-PDA approach associated with LC-MS technique. Of which method, nine chosen major bioactive components in SHXXT, including aloe-emodin (Ale), baicalin (Ba), berberine (Be), coptisine (Co), palmatine (Pa), resveratroloside (Res), rhein (Rh), sennoside A (Se-A), and wogonin (Wo), were evaluated within 30 min. The nine chemical markers were monitored in a high sensitivity with a low detection limit of 0.01-0.55 µg/mL and the correlation coefficient of the regression curve revealed a good linearity with R2 > 0.99. Moreover, the extraction solution system and the HPLC elution conditions were also optimized in the present study. This present developed protocol was then successfully applied to quantify nine chemical markers of 10 SHXXT products from eight Taiwanese TCM pharmaceutical companies. In quantitative results, Res was found as the major compound in SHXXT-1~5 and 8 with significantly higher amounts than those in other products, indicating the products SHXXT-1~5 and 8 may use R. tanguticum as the raw material, which possessed a higher concentration of the bioactive composition Res, instead of R. officinale. Simultaneously, Ale, Rh, and Wo were < 2% in these 10 products. Different chemical profiles of commercial products indicated that, probably, each product with the same named formula might be regarded as a sole medicine and need to be investigated individually. Importantly, it is never too much to emphasize the importance of quality control in TCM development.