TCM and Non-acute bronchial Asthma complicated with gastroesophageal reflux

A review of effectiveness and safety of TCM treatments for bronchial asthma and gastroesophageal reflux (GERD)


Study: Zhao Yu-Hao, LIU Zhao-hua, JIANG Sheng-hua, SHI Cheng-he: Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux. Journal of Traditional Chinese Medicine: 32(1):12-18

Location of trials: All trials in this review were conducted in China

Treatment

This review looked at  randomized, controlled trials that compared TCM treatments to western medical treatments such as anti-inflammatory drugs, bronchodialators for asthma and drugs to inhibit gastric acid production and promote gastric peristalsis. TCM trials selected included those using various herbal formulas and one trial involving a  combined treatment of acupoint injections , cupping and ginger-separated moxibustion.

Medical Condition

Gastroesophageal reflux and bronchial asthmas are often found together in patients. The theory is that regurgitated contents of the gut during reflux can irritate or damage tissues outside the esophagus such as the bronchial tissue of the lungs. It is believed this type of irritation of bronchial may cause asthma. One study revealed that 59.2 % of asthma patients had symptoms of gastroesophageal reflux.

What is gastroesophageal reflux? Also referred to as Gastrophageal reflux disease (GERD) or acid reflux is where stomach acid breaches the barrier (a sphincter type lid)  between the stomach and the esophagus. The acid damages the esophagus wall and causes that painful feeling we call heart burn. Nausea, belching, regurgitation are other symptoms associated withGERD.

Participants

Six studies were analysed – totalling 304 patients.

Outcomes Measured

  1. Asthma Scores: Reid method was reported in two studies
  2. Gastroesophageal reflux scores: used Harper method in three studies the symptoms relieved and the bulk of signs disappeared within 5 days
  3. Pulmonary function: was reported in two studies
  4. Adverse reactions: no adverse reactions were reported in any of the selected studies.

Results

Methodological quality was low in all six RCTs. Two RCTs showed that clinical efficacy was higher in the treatment group than in the control group (RR: 1.43, 95% CI: 1.10 to 1.87 vs RR: 1.51, 95% CI: 1.09 to 2.08). One RCT showed that the asthma score was lowered more effectively in the treatment group than in the control group (MD: -1.10, 95% CI: -2.04 to -0.16). Two RCTs showed that the gastroesophageal reflux score was reduced more effectively in the treatment group than in the control group (RR: -3.70, 95% CI: -4.30 to 3.10 vs RR: -5.30, 95% CI: -6.32 to -4.28). One RCT showed that some pulmonary function values were improved more effectively in the treatment group than in the control group (P<0.05). No differences were seen in the various indexes between groups in the other RCTs. No adverse reactions, dropout rates, or follow-up rates were reported in any of the RCT

More About one Treatment

One study used these herbs to treat asthma (dosage not available in review paper)

Sha Shen (Radix Glehniae seu Adenophorae),Ban Xia (Rhizoma Pinelliae), Bai Zhu (Rhizoma Atractylodi Macrocephalae), Wu Zhu Yu (Fructus Evodiae), Huang Lian (Rhizoma Polygonati) , Zhi Shi (Fructus Aurantii Immaturus), Zhi Gan Cao (Radix Glycyrrhizae Preparata).

Commanality of herbs across the six studies were:

Ban Xia – 5/6 studies

Gan Cao – 4/6 studies

Zhi Shi – 3/6

Huang Lian/Whu Zhu Yu/Xuan fu hua/Wu Zei Gu – 2/6

Cochrane Quality 

Methodological quality was rated low in all studies selected for this review.

The quality of the selected trials was criticised for being of low quality due, what seems to be a set of common characteristics of TCM trials conducted in CHINA including inconsistent interventions (different formulas), difficulties extracted bigger numbers of trials , lack of detail around the trial methodologies  and measures that would only lead the reviewers to conclude the trials may be subject to bias.  In this case there were no details of drop-outs and follow-ups. In thew review  the authors make many more specific comments regarding trial quality.

 

Comments

This review demonstrates that at a collective level of the selected studies, and based on the information available to the reviewers, that TCM treatments for bronchial asthma and gastroesophageal reflux could be just as effective as common western medication and in one study a TCM combined with western medicine was significantly better that  using western medicine alone to treat asthma.

However in the limitations section of this paper , the authors  caution readers to jump to conclusions that TCM is definitely equally curative or better than pharma treatments. This is a small review and not a meta-analysis.

 

References

Zhao Yu-Hao, LIU Zhao-hua, JIANG Sheng-hua, SHI Cheng-he: Systematic review of randomized controlled trials of traditional Chinese medicine treatment of non-acute bronchial asthma complicated by gastroesophageal reflux. Journal of Traditional Chinese Medicine: 32(1):12-18

 

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