Effects of the Clearing the Lung and Dissipating Phlegm Method in the Treatment of Acute Exacerbation of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

摘要

Objective:The objective of this study is to evaluate the efficacy and Safety of the clearing the lung and dissipating phlegm method in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) and to provide evidence for the treatment of the disease.Materials and Methods:Literature was searched from the United States National Library of Medicine (PubMed),Embase,Cochrane Library,China National Knowledge Infrastructure,Wanfang Database (Wanfang),and the Full-Text Database of Chinese Scientific and Technical Periodicals (VIP).A comprehensive collection was made of randomized controlled trials (RCTs) before June 2018,in which the treatment groups used either the clearing the lung and dissipating phlegm formulas only or combined it with routine Western medicine therapy,and the control group adopted routine Western medicine therapy only for the acute exacerbation of COPD.The Cochrane risk of bias method was used to evaluate the quality of the literature.The data were analyzed and retrieved independently by two reviewers before meta-analysis was carried out with RevMan 5.3 software to evaluate the primary outcome measures,including the total clinical effective rate,and the secondary outcome measures such as the pulmonary function (forced vital capacity [FVC],forced expiratory volume in the 1 s [FEV 1],percentage of FEV 1 [FEV 1％],and FEV 1/FVC)and blood gases (PaO2 and PaCo2).Results:A total of 13 RCTs involving 990 patients (496 in the treatment group and 494 in the control group)were included in this study.Meta-analysis revealed significant difference in the efficacy of the group that adopted solely the routine Western medicine method and the group that combined the Western medicine with the clearing the lung and dissipating phlegm method.Outcome measures including the pulmonary function (FVC,FEV 1,FEV 1％,and FEV1/FVC) and the blood gases (PaO2 and PaCo2) were significantly improved as compared to the control group (P ＜ 0.00001).However,adverse effects in the treatment group using combined traditional Chinese medicine were not reported due to the short observation time of the study.Conclusion:The clearing the lung and dissipating phlegm method can improve the efficacy in the treatment of acute exacerbation of COPD,the outcome measures of the pulmonary function and the blood gases,as well as the life quality of the patients.However,due to the fact that the existing studies are generally of poor quality in which randomization and its implementation were not properly carried out,more high-quality RCTs are necessary to confirm the findings of this study.