Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
BMC Complementary Medicine and Therapies
Published in: BMC Complementary Medicine and Therapies 1/2019

Open Access 01-12-2019 | Research article

Comparative effectiveness of six Chinese herb formulas for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and network meta-analysis

Authors: Shaonan Liu, Jing Chen, Jinhong Zuo, Jiaqi Lai, Lei Wu, Xinfeng Guo

Published in: BMC Complementary Medicine and Therapies | Issue 1/2019

Login to get access

Abstract

Background

Six Chinese herb formulas, namely, the Weijing decoction (WJ), the Maxingshigan decoction (MXSG), the Yuebijiabanxia decoction (YBBX), the Qingqihuatan decoction (QQHT), the Dingchuan decoction (DC) and the Sangbaipi decoction (SBP), are commonly used, along with routine pharmacotherapy, to manage the acute exacerbation of chronic obstructive pulmonary disease (AECOPD). In this study, we conducted a systematic review to summarize the efficacy of these six formulas, and we also conducted a network meta-analysis (NMA) to rank these formulas.

Methods

We searched five English databases and four Chinese databases, with dates ranging from the starting dates of these databases to December 2016. Randomized controlled trials that evaluated any of the six Chinese herb formulas combined with the use of pharmacotherapy for AECOPD were identified.

Results

Fifty-five studies involving 4560 participants were included. The pairwise meta-analyses showed that WJ and QQHT had superior effects on the improvement of lung function (forced expiratory volume in 1 seconds; FEV1) (mean difference (MD): 0.25, 95% confidence interval (CI): 0.19–0.30 and 0.34, 95%CI: 0.10–0.58). MXSG, WJ and QQHT were found to be more effective for improving arterial blood gases (PaO2 and PaCO2). In terms of effective rates, all of these formulas had additional favourable effects compared to routine pharmacotherapy. The results of the NMA analyses indicated that only MXSG showed superior add-on effects for the improvement of FEV1 (MD: 0.37, 95% credible interval (CrI): 0.03–0.72). Most of the formulas combined with routine pharmacotherapy were superior to pharmacotherapy alone for the improvement of arterial blood gases and effective rates. The ranking tests suggested that QQHT and MXSG combined with routine pharmacotherapy might be optimal options for the treatment of AECOPD.

Conclusions

This NMA indicated that QQHT and MXSG might be more effective treatment regimens for AECOPD. Further well-designed studies that specifically examine the direct comparisons of these formulas are needed to support our conclusions.
Appendix
Available only for authorised users
Literature
1.
2.
Soler-Cataluna JJ, Martinez-Garcia MA, Roman Sanchez P, Salcedo E, Navarro M, Ochando R. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005;60:925–31.PubMedPubMedCentralCrossRef
3.
Suissa S, Dell'Aniello S, Ernst P. Long-term natural history of chronic obstructive pulmonary disease: severe exacerbations and mortality. Thorax. 2012;67:957–63.PubMedPubMedCentralCrossRef
4.
Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, et al. Acute exacerbation of COPD. Respirology. 2016;21:1152–65.PubMedCrossRef
5.
Chinese Academy of Chinese Medical Sciences. Evidence-Based Guidelines of Clinical Practice in Chinese Medicine. Beijing: Chinese Academy of Chinese Medical Sciences Publishing House; 2011.
6.
China Association of Chinese Medicine. Guideline for diagnosis and treatment of common internal disease in Chinese medicine: Symptoms in Chinese medicine. Beijing: China Press of Tradit Chinese Medicine; 2008.
7.
China Association of Chinese Medicine. Guideline for diagnosis and treatment of common internal disease in Chinese medicine: Diseases of modern medicine. Beijing: China Press of Tradit Chinese Medicine; 2018.
8.
Liu S, Shergis J, Chen X, Yu X, Guo X, Zhang AL, et al. Chinese herbal medicine (weijing decoction) combined with pharmacotherapy for the treatment of acute exacerbations of chronic obstructive pulmonary disease. Evid Based Complement Alternat Med. 2014;2014:257012.PubMedPubMedCentral
9.
Yang X, Yang Z, Huang F, Zhang Y, Jiang J. Therapeutic effect and symptom changes of phlegm-clearing decoction combined with western medicine for COPD with acute exacerbation: a systematic review and meta-analysis. Chin Archives of Tradit Chin Med. 2016;34:860–3.
10.
Jiang L, Gao M, Qu F, Li HL, Yu LB, Rao Y, et al. Pharmacokinetics of maxing Shigan decoction in normal rats and RSV pneumonia model rats by HPLC-MS/MS. Zhongguo Zhong Yao Za Zhi. 2015;40:2649–55.PubMed
11.
Li L, Yu CH, Ying HZ, Yu JM. Antiviral effects of modified dingchuan decoction against respiratory syncytial virus infection in vitro and in an immunosuppressive mouse model. J Ethnopharmacol. 2013;147:238–44.PubMedCrossRef
12.
Li L, Bao H, Wu J, Duan X, Liu B, Sun J, et al. Baicalin is anti-inflammatory in cigarette smoke-induced inflammatory models in vivo and in vitro: a possible role for HDAC2 activity. Int Immunopharmacol. 2012;13:15–22.PubMedCrossRef
13.
Cipriani A, Higgins JP, Geddes JR, Salanti G. Conceptual and technical challenges in network meta-analysis. Ann Intern Med. 2013;159:130–7.PubMedCrossRef
14.
Jansen JP, Crawford B, Bergman G, Stam W. Bayesian meta-analysis of multiple treatment comparisons: an introduction to mixed treatment comparisons. Value Health. 2008;11:956–64.PubMedCrossRef
15.
Salanti G, Ades AE, Ioannidis JP. Graphical methods and numerical summaries for presenting results from multiple-treatment meta-analysis: an overview and tutorial. J Clin Epidemiol. 2011;64:163–71.PubMedCrossRef
16.
Liu S, Chen J, He Y, Wu L, Lai J, Zuo J, et al. Comparative effectiveness of six Chinese herb formulas for acute exacerbation of chronic obstructive pulmonary disease: protocol for systematic review and network meta-analysis. BMJ Open. 2017;7:e017099.PubMedPubMedCentralCrossRef
17.
Hutton B, Salanti G, Caldwell DM, Chaimani A, Schmid CH, Cameron C, et al. The PRISMA extension statement for reporting of systematic reviews incorporating network meta-analyses of health care interventions: checklist and explanations. Ann Intern Med. 2015;162:777–84.PubMedCrossRef
18.
19.
Zheng X. Guidance for clinical research on new drugs of TCM. Beijing: China Medical Science Press; 2002.
20.
Zou H. To observe the clinical effect of integrated traditional and western medicine on chronic obstructive pulmonary disease at acute exacerbation stage. Shanxi J Tradit Chin Med. 2015;31:17–20.
21.
Zhou Z, Wei Y. Efficacy of Maxingshigan decoction in treatment of chronic obstructive pulmonary disease with acute exacerbation and effects on inflammatory factor. Eval Anal Drug Hosp China. 2016;16:1628–30.
22.
Zhou Y. The academic ideas and clinical experiences of Prof. He and the clinical research of He Jia Wei Dingchuan decoction in the treatment of AECOPD. Nanjing: Nanjing university of Chinese medicine; 2015.
23.
Zhou K. Effect of Maxingshigan decoction combined with western medicine for the treatment of chronic obstructive pulmonary disease. Health. 2016;10:31–2.
24.
Zheng X. Clinical efficacy on Jiawei Sangbaipi decoction in treating AECOPD with phlegm heat and blood stasis type and its influence on HMGB1 and FIB. Fuzhou: Fujian University of TCM; 2014.
25.
Zhao W. Effect of SOD and LPO in the peripheral blood and clinical research on efficacy of acute exacerbations of chronic obstructive pulmonary disease (AECOPD) with the management of clearing away heat-evil and resolving phlegm. Guangzhou: Guangzhou University of Chinese medicine; 2007.
26.
Zhang L. Effect of modified Weijing decoction for the treatment of acute exacerbations of chronic obstructive pulmonary disease. J Shandong Univ TCM. 2011;35:148–9.
27.
Zhang J. Effect of Qingqihuatan decoction combined with routine pharmacotherapy for 30 cases of acute exacerbations of chronic obstructive pulmonary disease. Tradit Chin Med Res. 2012;25:36–8.
28.
Zhang J. Clinical research of Maxingshigan decoction for the treatment of chronic obstructive pulmonary disease. Shenyang: Liaoning university of Chinese Medicine; 2011.
29.
Zhang J. The clinical effect research and influence and meanings to IL-8 of the Weijing decoction of AECOPD. Guangzhou: Guangzhou university of Chinese Medicine; 2006.
30.
Zhang C, Mao J, Yang Q, Chen Y. Clinical effect of integrative medicine for the treatment of syndrome of phlegm-heat obstructing lung for acute exacerbation of chronic obstructive pulmonary disease. Medical J Chin Peoples Health. 2012;24:2725,76.
31.
Zhang C, Li D, Chen Z. Clinical observation of Yuebijiabanxia decoction for the acute exacerbations of chronic obstructive pulmonary disease. Guangxi J Tradit Chin Med. 2016;39:24–6.
32.
Ye L, Hong X. Effective observation of treating acute exacerbation of chronic obstructive pulmonary disease with Sangbaipi decoction. J Practical Tradit Chin Intern Med. 2011;25:44–6.
33.
Yang H. Clinical effect of Maxingshigan decoction for the treatment of syndrome of phlegm-heat obstructing lung of acute exacerbation of chronic obstructive pulmonary disease. Psychol Doct. 2012;306.
34.
Xie W. Effect of modified Maxingshigan decoction for the treatment of acute exacerbation of chronic obstructive pulmonary disease. Chin Med Mod Distance Educ China. 2009;7:101–2.
35.
Xie J, Zeng X, Lin G. Combine traditional Chinese and western medicine treatment of acute exacerbation of chronic obstructive pulmonary disease clinical observation period. J Liaoning Univ Tradit Chin Med. 2011;13:155–6.
36.
Wang X. Maxingshigan decoction for treating AECOPD in 39 cases and nursing measures. China Pharm. 2015;24:93–5.
37.
Wang P, Lin X. Clinical effect of Yuebijiabanxia decoction for the treatment of syndrome of phlegm-heat obstructing lung of acute exacerbation of chronic obstructive pulmonary disease. J Front of Med. 2012;02:138–9.
38.
Wang C, Guo W, Zhang F, Liu Y. Clinical observation of Maxingshigan decoction for the treatment of acute exacerbation of chronic obstructive pulmonary disease and influence on inflammatory markers. World Latest Med Inf. 2015;15:163–4.
39.
Wang B. Observation of traditional Chinese and western medicine treatment of acute exacerbation of chronic obstructive pulmonary disease. World Latest Med Inf. 2016;16:14–5.
40.
Sun X, Xu G. Clinical observation on modified Maxingshigan decoction on treating acute exacerbations of chronic obstructive pulmonary disease. World Chin Med. 2015;10:199–201,5.
41.
Sun J. The effect of Dilong Dingchuan decoction combined with western medicine for 31 cases of acute exacerbations of chronic obstructive pulmonary disease. Shandong J Tradit Chin Med. 2012;31:891–2.
42.
Shi Y. Clinical research of Weijingxuanbi decoction for the treatment of acute exacerbations of chronic obstructive pulmonary disease. Chengdu: Chengdu university of Tradit Chinese Medicine; 2005.
43.
Ma D, Cai W. Sangbaipi decoction on acute exacerbation of chronic obstructive pulmonary disease (phlegm-heat obstructing lung) clinical efficacy and prognosis. J Zhejiang Univ Tradit Chin Med. 2013;37:691–4.
44.
Lv T. Clinical observation of Qingqihuatan decoction combined with western medicine for the treatment of acute exacerbations of chronic obstructive pulmonary disease. J Emerg in Tradit Chin Med. 2014;23:972–3.
45.
Liu X. The clinical observation of acute onset of chronic obstructive pulmonary disease by Dingchuantang add-subtract atomization therapy. Haerbin: Helongjiang University of Chinese Medicine; 2011.
46.
Liu J, Jing X, Liu X. Influence of modified Qianjin Weijing decoction on airway clearance in patients with acutely exacerbated chronic obstructive pulmonary disease. J Guangzhou University of Tradit Chin Med. 2006;23:21–4.
47.
Lin Y, Ke J. Effect of integrative medicine for 102 case of acute exacerbations of chronic obstructive pulmonary disease. Fujian J Tradit Chin Med. 2014;45:41–2.
48.
Lin J. Clinical observation of modified Dingchuan decoction for acute exacerbation of chronic obstructive pulmonary disease. J New Chin Med. 2011;43:22–4.
49.
Li Z, Liu X, Li L, Ye Y, Zheng X. Clinical observation of Sangbaipi decoction for syndrome of phlegm-heat obstructing lung of acute exacerbation of chronic obstructive pulmonary disease. J New Chin Med. 2016;48:57–8.
50.
Li Y. Clinical research of modified Sangbaipi decoction for syndrome of phlegm-heat obstructing lung of acute exacerbations of chronic obstructive pulmonary disease. Luzhou: Southwest medical university; 2012.
51.
Li Y, Huang Z. Clinical observation of treatment of 30 cases for acute exacerbations of chronic obstructive pulmonary disease by clearing heat and resolving phlegm. Hunan J Tradit Chin Med. 2013;29:40–2.
52.
Li X. Clinical effect of medium frequency iontophoresis with Sangbaipi decoction for syndrome of phlegm-heat obstructing lung of acute exacerbations of chronic obstructive pulmonary disease. Hangzhou: Zhejiang Chinese Medical University; 2014.
53.
Li S, He Q, Cai Y. Study on mechanism of Qingqihuatan decoction in treatment of acute exacerbation of chronic obstructive pulmonary disease by inflammatory cytokines. Chinese J Inf Tradit Chin Med. 2013;20:16–8.
54.
Li L. Clinical effect of Maxingshigan decoction combined with western medicine for the treatment of acute exacerbations of chronic obstructive pulmonary disease. Chin J Clin Ration Drug Use. 2016;9:60–1.
55.
Li H. The clinical observation of Qingqihuatan decoction treating phlegm-heat obstructing lung type of AECOPD. Haerbin: Heilongjiang university of Chinese Medicine; 2012.
56.
Ju P. Clinical observation of modified Qingqihuatan decoction for the treatment of syndrome of phlegm-heat obstructing lung of acute exacerbations of chronic obstructive pulmonary disease. Asia-pacific Tradit Med. 2015;11:103–5.
57.
Jing X. Clinical research of modified Maxingshigan decoction for the treatment of acute exacerbations of chronic obstructive pulmonary disease. Shijiazhuang: Hebei Medical University; 2011.
58.
Jing X, Wang D, Li H, Cui X, Gao J. Effects of inflammatory response and oxidative stress for Qingrehuatan prescription on acute exacerbations of chronic obstructive pulmonary disease. Chinese J Clinicians. 2009;13:582–8.
59.
Jing X, Li X, Liu J, Cui X. Effect of modified Qianjin Weijing decoction on nuclear factor-kB of chronic obstructive pulmonary disease in acute deteriorated stage. Chin J TCM WM Crit care. 2007;14:271–4.
60.
Jiang H. Effect analysis on integrated traditional Chinese and western medicine in the treatment of chronic obstructive pulmonary disease. China Modern Med. 2015;22:133 4,7.
61.
Jia J, Zhao H. Clinical observation of Qingqihuatan decoction for syndrome of phlegm-heat obstructing lung of acute exacerbations of chronic obstructive pulmonary disease. J Emerg in Tradit Chin Med. 2016;25:2153–5.
62.
Huang X. White mulberry soup combined western medicine therapy with thermal yu lung phlegm random parallel control study of chronic obstructive pulmonary disease. J Practical Tradit Chin Intern Med. 2013;27:61–2.
63.
Hua W. Clinical observation of integrative medicine for the treatment of acute exacerbations of chronic obstructive pulmonary disease. J Pract Tradit Chin Med. 2017;33:41.
64.
Hu J, Shi S, Yang J, Liu G. Effect on inflammatory response for TLRs of Maxingshigan decoction for chronic obstructive pulmonary disease. J Sichuan Tradit Chin Med. 2015;33:58–60.
65.
Guo Y. Clinical research of Weijing decoction combined western medicine for the treatment of acute exacerbations of chronic obstructive pulmonary disease. Hebei J Tradit Chin Med. 2010;32:1680–1.
66.
Guo F, Fu L, Zhao B, Jiao C, Fu Y, Shi Y. Clinical observation of modified Sangbaipi decoction combined routine care for syndrome of phlegm-heat obstructing lung for acute exacerbations of chronic obstructive pulmonary disease. Clinical J TCM. 2012;24:839–40.
67.
Gao X, Shen Y, Gong X. Clinical research of modified Dingchuan decoction for 40 cases of phlegm-heat obstructing lung type of chronic obstructive pulmonary disease. Asia Pac Tradit Med. 2017;13:148–9.
68.
Fan H. Effect of modified Qingqihuatan decoction for 57 cases of acute exacerbations of chronic obstructive pulmonary disease. J Sichuan of Tradit Chin Med. 2003;21:30–1.
69.
Chen X, Wang R. Clinical observation of treatment of 31 cases of severe chronic obstructive pulmonary disease by clearing away heat, resolving phlegm and activating blood circulation combined with western drugs. Jiangsu J Tradit Chin Med. 2009;41:25–7.
70.
Chen X. Effect of Sangbaipi decoction combined moxifloxacin for 65 cases of phlegm-heat obstructing lung type chronic obstructive pulmonary disease. Fujian J Tradit Chin Med. 2016;47:40–1.
71.
Chen H, Qiu L. Clinical effect of Qianjin modified Weijing decoction for 60 cases of acute exacerbations of chronic obstructive pulmonary disease. J Front Med. 2012;122.
72.
Bi W, Xu J, Zhang H, Zhang P. Effect of modified Dingchuan decoction combined triple atomization inhalation for acute exacerbations of chronic obstructive pulmonary disease. Mod J Integr Tradit Chin West Med. 2016;25:3622–,33.
73.
Jing X, Wang D, Li X, Liu J, Xiong Y. Research of Qingfeihuatan quyu prescription on the treatment of chronic obstructive pulmonary disease in acute deteriorated stage. Chin J TCM WM Crit Care. 2006;13:270–2.
74.
Wang X. The clinical observation on ingredients-adding Qingqihuatan liquid in treating acute exacerbation of chronic obstructive pulmonary disease with heat-phlegm obstructing lung and impact of airway mucus hypersecretion. Chengdu: Chengdu university of Tradit Chinese Medicine; 2010.
75.
Wang G, Mohammadtursun N, Lv Y, Zhang H, Sun J, Dong J. Baicalin exerts anti-airway inflammation and anti-Remodelling effects in severe stage rat model of chronic obstructive pulmonary disease. Evid Based Complement Alternat Med. 2018;2018:7591348.PubMedPubMedCentral
76.
Liczbinski P, Bukowska B. Molecular mechanism of amygdalin action in vitro: review of the latest research. Immunopharmacol Immunotoxicol. 2018;40:212–8.PubMedCrossRef
77.
Du W, Su J, Ye D, Wang Y, Huang Q, Gong X. Pinellia ternata attenuates mucus secretion and airway inflammation after inhaled corticosteroid withdrawal in COPD rats. Am J Chin Med. 2016;44:1027–41.PubMedCrossRef
78.
Lee MY, Shin IS, Jeon WY, Lim HS, Kim JH, Ha H. Pinellia ternata Breitenbach attenuates ovalbumin-induced allergic airway inflammation and mucus secretion in a murine model of asthma. Immunopharmacol Immunotoxicol. 2013;35:410–8.PubMedCrossRef
79.
Mills EJ, Druyts E, Ghement I, Puhan MA. Pharmacotherapies for chronic obstructive pulmonary disease: a multiple treatment comparison meta-analysis. Clin Epidemiol. 2011;3:107–29.PubMedPubMedCentralCrossRef
80.
Cope S, Donohue JF, Jansen JP, Kraemer M, Capkun-Niggli G, Baldwin M, et al. Comparative efficacy of long-acting bronchodilators for COPD: a network meta-analysis. Respir Res. 2013;14:100.PubMedPubMedCentralCrossRef
81.
Tricco AC, Strifler L, Veroniki AA, Yazdi F, Khan PA, Scott A, et al. Comparative safety and effectiveness of long-acting inhaled agents for treating chronic obstructive pulmonary disease: a systematic review and network meta-analysis. BMJ Open. 2015;5:e009183.PubMedPubMedCentralCrossRef
82.
83.
Chinese Pharmacopoeia Commission. Pharmacopoeia of the People’s Republic of China. Beijing: China Medical Science Press; 2015.
84.
Cheng CW, Wu TX, Shang HC, Li YP, Altman DG, Moher D, et al. CONSORT Extension for Chinese Herbal Medicine Formulas 2017: Recommendations, explanation, and elaboration. Ann Intern Med. 2017;167:112–21.PubMedCrossRef
85.
Ioannidis JP, Evans SJ, Gotzsche PC, O'Neill RT, Altman DG, Schulz K, et al. Better reporting of harms in randomized trials: an extension of the CONSORT statement. Ann Intern Med. 2004;141:781–8.CrossRef
Metadata
Title
Comparative effectiveness of six Chinese herb formulas for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and network meta-analysis
Authors
Shaonan Liu
Jing Chen
Jinhong Zuo
Jiaqi Lai
Lei Wu
Xinfeng Guo
Publication date
01-12-2019
Publisher
BioMed Central
Published in
BMC Complementary Medicine and Therapies / Issue 1/2019
Electronic ISSN: 2662-7671
DOI
https://doi.org/10.1186/s12906-019-2633-2

Other articles of this Issue 1/2019

BMC Complementary Medicine and Therapies 1/2019 Go to the issue

Research article

Experimental validation and computational modeling of anti-influenza effects of quercetin-3-O-α-L-rhamnopyranoside from indigenous south African medicinal plant Rapanea melanophloeos

Research article

Preclinical evaluation of safety and potential of black hellebore extracts for cancer treatment

Research article

Bioassay-guided isolation of active anti-adipogenic compound from royal jelly and the study of possible mechanisms

Research article

Hepato-protective effects of Glossogyne tenuifolia in Streptozotocin-nicotinamide-induced diabetic rats on high fat diet

Research article

Inhibitory effects of berberine on proinflammatory M1 macrophage polarization through interfering with the interaction between TLR4 and MyD88

Research article

Inhibitory effects of ChondroT and its constituent herbs on RANKL-induced osteoclastogenesis