Abstract
This systematic review evaluated the effects of Chinese herbal medicine (CHM) plus routine pharmacotherapy (RP) on the objective outcome measures BODE index, 6-minute walk test (6MWT), and 6-minute walk distance (6MWD) in individuals with stable chronic obstructive pulmonary disease (COPD). Searches were conducted of six English and Chinese databases (PubMed, EMBASE, CENTRAL, CINAHL, CNKI and CQVIP) from their inceptions until 18th November 2013 for randomized controlled trials involving oral administration of CHM plus RP compared to the same RP, with BODE Index and/or 6MWT/D as outcomes. Twenty-five studies were identified. BODE Index was used in nine studies and 6MWT/D was used in 22 studies. Methodological quality was assessed using the Cochrane Risk of Bias tool. Weaknesses were identified in most studies. Six studies were judged as ‘low’ risk of bias for randomisation sequence generation. Twenty-two studies involving 1,834 participants were included in the meta-analyses. The main meta-analysis results showed relative benefits for BODE Index in nine studies (mean difference [MD] −0.71, 95% confidence interval [CI] −0.94, −0.47) and 6MWT/D in 17 studies (MD 54.61 meters, 95%CI 33.30, 75.92) in favour of the CHM plus RP groups. The principal plants used were Astragalus membranaceus, Panax ginseng and Cordyceps sinensis. A. membranaceus was used in combination with other herbs in 18 formulae in 16 studies. Detailed sub-group and sensitivity analyses were conducted. Clinically meaningful benefits for BODE Index and 6MWT were found in multiple studies. These therapeutic effects were promising but need to be interpreted with caution due to variations in the CHMs and RPs used and methodological weakness in the studies. These issues should be addressed in future trials.
Highlights
Chronic obstructive pulmonary disease (COPD) is a disorder characterized by progressive development of airflow limitation and an enhanced chronic inflammatory response in the airways [1]
This study found positive results for BODE Index and 6-minute walk test (6MWT) in the combined Chinese herbal medicine (CHM) plus routine pharmacotherapy (RP) group, but the descriptions of randomisation and allocation concealment methods were not adequate and there was no assessment of the effectiveness of blinding, so the results may have been influenced by these methodological shortcomings [54]
CHM appears to be a well-tolerated addition to routine pharmacotherapy for stable COPD
Summary
Chronic obstructive pulmonary disease (COPD) is a disorder characterized by progressive development of airflow limitation and an enhanced chronic inflammatory response in the airways [1]. The aim of current routine pharmacotherapy (RP) for stable COPD is to control disease progression by using bronchodilators and anti-inflammatory drugs [1]. The use of the complementary and alternative medicine (CAM) is relatively common among stable COPD sufferers. Studies have indicated that some plants have anti-inflammatory effects [6,7,8,9], can improve immune functions [10,11,12,13,14] and can assist in expelling phlegm [15,16]. CHMs can be administered as oral decoctions or prepared into pills, powders or capsules. They are commonly combined with routine pharmacotherapy in an attempt to improve outcomes [17]
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