Abstract
BackgroundChinese herbal medicine is widely used in combination with usual care for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China. Chinese patent medicine Shufeng Jiedu (SFJD) capsules is widely used for respiratory infectious diseases. This review aims to evaluate effectiveness and safety of SFJD for AECOPD.MethodsA systematic review of randomised controlled trials (RCTs) in patients with AECOPD, who received SFJD as a single intervention or as add-on treatment to usual care. PubMed, the Cochrane Library, EMBASE, Scopus, Web of Science and four Chinese databases were searched from inception to April 2019. Two authors screened trials, extracted data, and assessed risk of bias, independently. Meta-analysis was performed using RevMan 5.3 software. We performed subgroup analyses and sensitivity analyses according to the predefined protocol. Quality of evidence was assessed using GRADE.ResultsThirteen RCTs (1036 patients, with 936 inpatients) were included, all compared SFJD in combination with usual care (including antibiotics) to usual care alone. The mean age of participants ranged from 52 to 67 years, with approximately 60% male. Due to lack of blinding and other factors, all trials were of high risk of bias. SFJD was associated with a significant reduction in treatment failure, from 20.1 to 8.3% (11 trials; 815 patients; relative risk 0.43, 95% confidence interval [CI] 0.30 to 0.62), and duration of hospital stay (2 trials; 79 patients; mean difference − 4.32 days, 95% CI − 5.89 to − 2.75 days). No significant difference in adverse events was found between SFJD and control groups.ConclusionLow certainty evidence suggests SFJD may bring additional benefit in reducing treatment failure, shorten hospital stay, and improving symptoms. Further large, high quality RCTs are needed to confirm its benefit and safety.Trial registrationPROSPERO CRD42019133682.
Highlights
Chinese herbal medicine is widely used in combination with usual care for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China
Acute exacerbations lead to a decline in lung function and quality of life, increased need for hospitalisation, and are associated with increased risk of death [11, 12], account for the greatest proportion of the total Chronic obstructive pulmonary disease (COPD) burden on healthcare system [13, 14]
In light of the recently published randomised controlled trials (RCTs) on Shufeng Jiedu (SFJD), we aimed to evaluate the effectiveness and safety of SFJD for AECOPD by conducting a systematic review and meta-analysis where appropriate
Summary
Chinese herbal medicine is widely used in combination with usual care for acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in China. Chinese patent medicine Shufeng Jiedu (SFJD) capsules is widely used for respiratory infectious diseases. Chronic obstructive pulmonary disease (COPD) is one of most common causes of impaired health [1]. In the UK there is an estimation of 3 million COPD patients, among whom 1.2 million have been diagnosed, costing the National Health Service over 800 million pounds per year [3, 4]. Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are defined as an acute worsening of respiratory symptoms that require additional therapy [5,6,7,8,9]. Patients with COPD on average experience 0.5–3.5 acute exacerbations per year [10]. Acute exacerbations lead to a decline in lung function and quality of life, increased need for hospitalisation, and are associated with increased risk of death [11, 12], account for the greatest proportion of the total COPD burden on healthcare system [13, 14]
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