Effectiveness of Chinese herbal medicine combined with conventional medicine on acute exacerbation of chronic obstructive pulmonary disease: a systematic review and Meta-analysis

doi:10.19852/j.cnki.jtcm.2023.02.003

Abstract

Abstract:

OBJECTIVE: To systematically evaluate the efficacy and safety of Chinese herbal medicine (CHM) combined with conventional Western Medicine (CWM) on acute exacerbation of chronic obstructive pulmonary disease (AECOPD) based on high-quality randomized placebo-controlled trials.

METHODS: We searched PubMed, Embase, Cochrane Library, China National Knowledge Infrastructure Database, Chinese Biomedical Literature Database, China Science and Technology Journal Database, and Wanfang databases for randomized placebo-controlled trials of CHM treatment for AECOPD from inception to June 4, 2021. The Cochrane Collaboration’s tool and the Grading of Recommendations, Assessment, Development and Evaluation were used to assess the risk of bias and the evidence quality of the included studies. Revman 5.3 software was used for Meta-analysis.

RESULTS: A total of 9 trials involving 1591 patients were included. The Meta-analysis showed that based on CWM treatment, CHM group had significant advantages over the placebo group in ameliorating clinical total effective rate [RR = 1.29, 95% CI (1.07, 1.56), P = 0.007, low quality] and TCM symptom scores [MD = -2.99, 95% CI (-4.46, -1.53), P < 0.0001, moderate quality], improving arterial blood gas results [PaO₂: MD = 4.51, 95% CI (1.97, 7.04), P = 0.0005, moderate quality; PaCO₂: MD = -2.87, 95% CI (-4.28, -1.46), P < 0.0001, moderate quality], reducing CAT scores [MD = -2.08, 95% CI (-2.85, -1.31), P < 0.000 01, moderate quality]，length of hospitalization [MD = -1.87, 95% CI (-3.33, -0.42), P = 0.01, moderate quality], and acute exacerbation rate [RR = 0.60, 95% CI (0.43, 0.83), P = 0.002, moderate quality]. No serious CHM-related adverse events were reported.

CONCLUSIONS: The current evidence indicates that CHM is an effective and well-tolerated adjunct therapy for AECOPD patients receiving CWM. However, considering the high heterogeneity, this conclusion requires confirmation.

Key words: drugs, Chinese herbal, pulmonary disease, chronic obstructive, acute exacerbation, systematic review, Meta-analysis, GRADE approach

GUO Wen, LI Xuanlin, ZHAO Hulei, LEI Siyuan, XIE Yang, LI Jiansheng. Effectiveness of Chinese herbal medicine combined with conventional medicine on acute exacerbation of chronic obstructive pulmonary disease: a systematic review and Meta-analysis[J]. Journal of Traditional Chinese Medicine, 2023, 43(2): 212-220.

Figures/Tables 7

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Study	Sample size		Sex (M/F)	Age	Intervention		Duration (days)		Follow- up	Outcome
Study	T	C	Sex (M/F)	Age	T	C	Duration (days)		Follow- up	Outcome
Huang MR et al 2019¹⁴	40	40	T: 26/14 C: 23/17	T: 65.6±4.2 C: 64.9±4.9	Mengshiguntan decoction+CWM	Placebo+CWM		14	NR
Li JS et al 2011¹⁵	34	31	T: 23/11 C: 19/12	T: 63.90±11.37 C: 65.70±12.31	Huoxuehuayu decoction+CWM	Placebo+CWM		14	NR	⑤
Li JS et al 2016¹⁶	173	180	T: 126/47 C: 126/54	T: 68.01±8.07 C: 67.87±8.36	3 CHM granules^△+CWM	Placebo+CWM		7-21	6 months	⑦⑧
Li JS et al 2020⁶	189	189	T: 155/34 C: 163/26	T: 65.73±8.47 C: 66.94±7.61	3 CHM granules^△+CWM	Placebo+CWM		14	3 months	⑦⑧⑨
Liu M et al 2014⁷	122	122	T: 88/34 C: 82/40	T: 70.1±9.8 C: 70.7±9.8	Xuanbaichengqi granules+CWM	Placebo+CWM		10	NR	⑤⑥⑨
Liu JY et al 2018¹⁷	30	30	T: 27/3 C: 28/2	T: 64.80±6.55 C: 65.67±5.36	Qingfei granules+CWM	Placebo+CWM		10	NR	②③⑦⑨
Zhang WJ et al 2018¹⁸	30	30	T: 19/11 C: 21/9	T: 63.45±9.67 C: 65.76±10.42	Gubenquyujiedu granules+CWM	Placebo+CWM		10	NR	②⑤⑥⑨
Zhe Z et al 2017¹⁹	51	56	T: 26/25 C: 28/28	T: 67.85±7.82 C: 66.87±8.65	Compound Fo’ercao decoction +CWM	Placebo+CWM		14	NR	⑨
Zheng FJ et al 2016²⁰	122	122	T: 84/38 C: 82/40	T: 69.9±10.3 C: 70.7±9.8	Rhubarb granules+CWM	Placebo+CWM		10	NR	②⑤⑥⑨

Study	Sample size		Sex (M/F)	Age	Intervention		Duration (days)		Follow- up	Outcome
Study	T	C	Sex (M/F)	Age	T	C	Duration (days)		Follow- up	Outcome
Huang MR et al 2019¹⁴	40	40	T: 26/14 C: 23/17	T: 65.6±4.2 C: 64.9±4.9	Mengshiguntan decoction+CWM	Placebo+CWM		14	NR
Li JS et al 2011¹⁵	34	31	T: 23/11 C: 19/12	T: 63.90±11.37 C: 65.70±12.31	Huoxuehuayu decoction+CWM	Placebo+CWM		14	NR	⑤
Li JS et al 2016¹⁶	173	180	T: 126/47 C: 126/54	T: 68.01±8.07 C: 67.87±8.36	3 CHM granules^△+CWM	Placebo+CWM		7-21	6 months	⑦⑧
Li JS et al 2020⁶	189	189	T: 155/34 C: 163/26	T: 65.73±8.47 C: 66.94±7.61	3 CHM granules^△+CWM	Placebo+CWM		14	3 months	⑦⑧⑨
Liu M et al 2014⁷	122	122	T: 88/34 C: 82/40	T: 70.1±9.8 C: 70.7±9.8	Xuanbaichengqi granules+CWM	Placebo+CWM		10	NR	⑤⑥⑨
Liu JY et al 2018¹⁷	30	30	T: 27/3 C: 28/2	T: 64.80±6.55 C: 65.67±5.36	Qingfei granules+CWM	Placebo+CWM		10	NR	②③⑦⑨
Zhang WJ et al 2018¹⁸	30	30	T: 19/11 C: 21/9	T: 63.45±9.67 C: 65.76±10.42	Gubenquyujiedu granules+CWM	Placebo+CWM		10	NR	②⑤⑥⑨
Zhe Z et al 2017¹⁹	51	56	T: 26/25 C: 28/28	T: 67.85±7.82 C: 66.87±8.65	Compound Fo’ercao decoction +CWM	Placebo+CWM		14	NR	⑨
Zheng FJ et al 2016²⁰	122	122	T: 84/38 C: 82/40	T: 69.9±10.3 C: 70.7±9.8	Rhubarb granules+CWM	Placebo+CWM		10	NR	②⑤⑥⑨

Outcome	Number of studies	Number of patients		RR/MD	95%CI	I² value (%)	P value
Outcome	Number of studies	T	C	RR/MD	95%CI	I² value (%)	P value
CAT scores	3	373	355	?2.08	?2.85, ?1.31	10	<0.000 01
PaO₂	4	279	281	4.51	1.97, 7.04	0	0.0005
PaCO₂	3	274	274	?2.87	?4.28, ?1.46	0	<0.0001
Length of hospitalization	3	392	399	?1.87	?3.33, ?0.42	86	0.01
Acute exacerbation rate	2	343	325	0.60	0.43, 0.83	0	0.002

Outcome	Number of studies	Number of patients		RR/MD	95%CI	I² value (%)	P value
Outcome	Number of studies	T	C	RR/MD	95%CI	I² value (%)	P value
CAT scores	3	373	355	?2.08	?2.85, ?1.31	10	<0.000 01
PaO₂	4	279	281	4.51	1.97, 7.04	0	0.0005
PaCO₂	3	274	274	?2.87	?4.28, ?1.46	0	<0.0001
Length of hospitalization	3	392	399	?1.87	?3.33, ?0.42	86	0.01
Acute exacerbation rate	2	343	325	0.60	0.43, 0.83	0	0.002

Certainty assessment							No. of patients			Effect		Certainty	Importance
No. of studies	Study design	Risk of bias	Inconsistency	Indirectness	Imprecision	publication bias		T	C	Relative (95% CI)	Absolute (95% CI)	Certainty	Importance
Clinical total effective rate
4	RCTs	serious^a	serious^b	not serious	not serious	none	123/134 (91.8%)		91/131 (69.5%)	RR 1.29 (1.07 to 1.56)	201 more per 1,000 (from 49 more to 389 more)	⊕⊕?? LOW	CRITICAL
TCM symptom scores
5	RCTs	not serious	serious^b	not serious	not serious	none	355		360	-	MD 2.99 lower (4.46 lower to 1.53 lower)	⊕⊕⊕? MODERATE	CRITICAL
CAT scores
3	RCTs	not serious	serious^b	not serious	not serious	none	373		355	-	MD 2.08 lower (2.85 lower to 1.31 lower)	⊕⊕⊕? MODERATE	CRITICAL
PaO2
4	RCTs	not serious	serious^b	not serious	not serious	none	279		281	-	MD 4.51 higher (1.97 higher to 7.04 higher)	⊕⊕⊕? MODERATE	IMPORTANT
PaCO2
3	RCTs	not serious	serious^b	not serious	not serious	none	274		274	-	MD 2.87 lower (4.28 lower to 1.46 lower)	⊕⊕⊕? MODERATE	IMPORTANT
Length of hospitalization
3	RCTs	not serious	serious^b	not serious	not serious	none	392		399	-	MD 1.87 lower (3.33 lower to 0.42 lower)	⊕⊕⊕? MODERATE	IMPORTANT
Acute exacerbation rate
2	RCTs	not serious	serious^b	not serious	not serious	none	48/343 (14.0%)		77/325 (23.7%)	RR 0.60 (0.43 to 0.83)	95 fewer per 1000 (from 135 fewer to 40 fewer)	⊕⊕⊕? MODERATE	IMPORTANT

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