Clinical efficacy and safety of Chinese herbal medicine versus placebo for the treatment of chronic obstructive pulmonary disease: A systematic review and meta-analysis.

OBJECTIVE: Randomized clinical trials and published meta-analyses assessing the clinical effectiveness of Chinese herbal medicine (CHM) on the treatment of stable chronic obstructive pulmonary disease (COPD) yielded inconsistent results in terms of disease outcomes, in which the design of placebo-controlled studies can contribute to the heterogeneity. This study aimed to evaluate the efficacy and safety of CHM compared to placebo on the treatment of stable COPD, to provide robust evidence for the use of CHM in COPD. METHODS: Nine electronic databases were searched from inception to October 1, 2019 to identify placebo controlled randomized trials of CHM for the treatment of stable COPD and studies in English or Chinese were included. The primary outcomes were symptom score (CAT score), quality of life (SGRQ) and frequency of acute exacerbations. The secondary outcomes included lung function, clinical total effective rate and adverse events. The selection of studies, data extraction and coding and assessment of risk of bias of the included studies were conducted by two reviewers independently. Mean difference (MD) was used to analyze continuous variable and relative risk ratio (RR) for dichotomous data. RESULTS: A total of eleven studies involving 1223 patients were included. While maintaining routine western pharmacotherapies (WP), CHM had significant advantage over the treatment of placebo in improving CAT score (MD -3.93; 95 %CI -6.01 to -1.85) and SGRQ score (MD -6.20; 95 %CI -10.13 to -2.28), reducing the frequency of acute exacerbations (MD -0.78; 95 %CI -1.40 to -0.16) and improving clinical effective rate (RR 1.29; 95 %CI 1.14 to 1.45), but had no significant effect on improving FEV1%pred (MD 8.18; 95 %CI -4.22 to 20.58). High heterogeneity was found for the changes in exacerbation frequency and FEV1%pred. No serious adverse events related to CHM were reported. CONCLUSIONS: This meta-analysis of placebo-controlled RCTs demonstrated that the use of CHM in addition to WP could alleviate clinical symptoms, improve quality of life and clinical efficiency and reduce the frequency of exacerbations, which could be an alternative approach for treatment adjustment of COPD. CHM was a relatively safe treatment. These findings need to be verified in future with high-quality clinical trials.

The effect of acupoint application of traditional Chinese medicine for the treatment of chronic obstructive pulmonary disease: A protocol for systematic review and meta-analysis.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is a public threat, leading to progressive physical activity and poor quality of life. Although modern medicine has excellent achievement of COPD, the recurrence rate of stable COPD and the mortality of acute exacerbation COPD remain high. As one of the external therapy of traditional Chinese medicine, acupoint application has been treated COPD in China for a long time. Nevertheless, study evaluating the effect of acupoint application for COPD could not satisfy needs for clinic. METHOD: Randomized controlled trials meeting the inclusion criteria will be collected by the 2 reviewers. We choose the following electronic databases of Web of Science, Pub Med, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wan Fang, Chinese Scientific Journals Database, and Chinese Biomedical Database as our retrieval tool. The retrieval time was from inception to March 2020. The key to evaluation criteria is total clinical efficacy rate and lung function will be measured. Secondary outcomes include assessment scales and adverse reactions. The studies extracted will be assessed. The merging analysis will be carried out by Review Manager Software. RESULT: A scientific evidence of efficacy and safety of acupoint application for COPD will be found. CONCLUSION: The evaluation of the efficacy and safety of acupoint application for COPD will be presented. INPLASY REGISTRATION NUMBER: INPLASY202090023.

Chinese Herbal Medicine Versus Placebo for the Treatment Of Chronic Obstructive Pulmonary Disease: A Protocol of Systematic Review and Meta-analysis.

BACKGROUND: Chinese herbal medicine (CHM) has been shown to be effective in the treatment of stable chronic obstructive pulmonary disease (COPD) by published meta-analyses. However, disease outcomes were inconsistent and heterogeneity was observed attributed to placebo-controlled studies. We present a protocol for a systematic review aiming to evaluate the clinical efficacy and safety of CHM comparing to placebo in the treatment of stable COPD, to provide robust evidence for the use of CHM in COPD. METHODS: We will comprehensively search the following 9 databases from inception to March 2019: Web of Science, PubMed, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), Chinese National Knowledge Infrastructure (CNKI), WANFANG Database, Chinese Scientific and Technological Periodical Database (VIP) and Chinese Biomedical Database (CBM), and the Cochrane Library database. All clinical randomized controlled trials comparing CHM to placebo for the treatment of stable COPD in English or Chinese will be included. The primary outcome will be quality of life, symptom score and exacerbation frequency, and the secondary outcomes include traditional Chinese medicine syndrome score and effective rate, lung function, 6-minute walk distance, and adverse events. Data extraction and quality assessment will be performed independently by 2 reviewers. Data synthesis and risk of bias will be assessed using the Review Manager software. This protocol will be conducted according to the Preferred Reporting Item for Systematic Review and Meta-analysis Protocols (PRISMA-P) guidance. RESULTS: This systematic review and meta-analysis will provide a high-quality comprehensive evaluation of the efficacy and safety based on current literature evidence of CHM intervention for stable COPD. CONCLUSION: The conclusion of this study will present the evidence of whether CHM is an effective and safe intervention for stable COPD patients.

Acupuncture treatment of lung-spleen Qi deficiency in stable chronic obstructive pulmonary disease: a randomized, open-label, controlled trial.

OBJECTIVE: To evaluate the effectiveness and safety of acupuncture that reinforces the spleen to strengthen the lung in patients with stable chronic obstructive pulmonary disease (COPD). METHODS: This was a randomized, open-controlled trial in which the acupuncturist and the participants were not blinded, but the outcome evaluators and data analysts were blinded. One-hundred-and-two patients with stable COPD were randomly divided into two groups in a 1∶1 ratio. The acupuncture group received 30-minute sessions of acupuncture therapy at the same acupoints three times weekly for 6 weeks in addition to routine conventional Western Medicine treatment; the control group received routine conventional Western Medicine treatment alone. The primary outcome was the Borg scale score, which was assessed immediately after the 6-minute walk test. The secondary outcomes were the 6-minute walk distance, lung function, and oxygen saturation. Measurements were obtained at baseline and after 6 weeks of treatment. RESULTS: After 6 weeks of treatment, the Borg scale score in the acupuncture group was significantly better than that in the control group (2.02 ± 0.71 versus 5.01 ± 0.34, P < 0.05). Furthermore, the post-treatment improvements in the 6-minute walk distance, lung function, and oxygen saturation were significantly greater in the acupuncture group than in the control group, showing that the acupuncture group had better exercise tolerance. CONCLUSION: The findings suggest that acupuncture that aims to reinforce the spleen to strengthen the lung is a safe and effective adjuvant therapy that effectively improves the exercise capacity of patients with stable COPD.

Effectiveness of Traditional Chinese Medicine on chemo-radiotherapy induced leukaemia in patients with lung cancer: a Meta-analysis.

OBJECTIVE: To assess the curative effect of Traditional Chinese Medicine (TCM) on leukopenia induced by chemo-radiotherapy in patients with lung cancer. METHODS: A comprehensive electronic search in Medline, Embase, the Cochrane Libary database, China National Knowledge Infrastructure Database (CNKI) and Wanfang Database was conducted up to July 2017. Random-effects model was used to estimate the standardized mean differences (SMDs) with 95% confidence intervals (CIs). Eleven studies with a total of 957 patients were included in this meta-analysis. RESULTS: The effectiveness in TCM group was higher than control group [RR = 1.60, 95% CI (1.38, 1.85), P < 0.000 01]. Compare with Western Medicine group, the effectiveness has no significant difference [RR = 0.96, 95% CI (0.82, 1.12), P = 0.57]. The ineffective rate in test group was lower than the control group [RR = 0.30, 95% CI (0.21, 0.42), P < 0.000 01]. CONCLUSION: By meta-regression it was suggested that TCM has curative effect on leukopenia induced by chemo-radiotherapy in patients with lung cancer, but by the influence of number and quality of researches, publication bias, more evidence from high quality studies, and larger cohorts for observational trials are needed.