Research - Chronic Obstructive Pulmonary Disease
Qigong Yi Jinjing Promotes Pulmonary Function, Physical Activity, Quality of Life and Emotion Regulation Self-Efficacy in Patients with Chronic Obstructive Pulmonary Disease: A Pilot Study
Zhang Min, Xv Guihua, Luo Caifeng, Meng DiJuan, and Ji Yan.
Purpose: The purpose of this pilot study was to examine the effect of a Chinese traditional exercise program,Qigong Yi Jinjing (QYJJ), on patients with chronic obstructive pulmonary disease (COPD).
Methods: One hundred and thirty eligible COPD patients were randomly divided into three groups: the QYJJ group (n = 42), the self-management exercise group (n = 43), and the control group (n = 45). Data were collected and analyzed at baseline and again at one, three, and six months. A pulmonary rehabilitation index, consisting of pulmonary function, six-minute walk test, Regulatory Emotion Self-Efficacy questionnaire, and exercise of the COPD Assessment Test widely used to evaluate health-related quality of life (HRQL) in participants with COPD, was measured.
Results: Compared with the other groups, participants in QYJJ group had significantly better lung function (forced expiratory volume in one second: F = 8.96, p = 0.000; forced expiratory volume in one second/forced vital capacity: F = 11.55, p = 0.000; the percentage of forced expiratory volume in one second in prediction: F = 24.27,p = 0.000); walked a longer distance (F = 152.52, p = 0.000), and had more satisfactory HRQL (F = 14.08, p = 0.000). QYJJ training also contributed to improving the ability of emotion regulation (F = 36.56, p = 0.000). There were significant positive changes in expressing positive affect (F = 56.25, p = 0.000) and managing despondency/distress (F = 21.58, p = 0.000), apart from the ability to regulate anger/irritation (F = 1.20, p = 0.305). The longer QYJJ is practiced, the more effective the influence is on the pulmonary rehabilitation-related index measures.
Conclusions: These results indicate that QYJJ exercise produced positive effects on pulmonary function, physical activity, emotion regulation self-efficiency (modulating the expression of despondency or distress and experiencing and expressing positive affect), and HRQL in patients with COPD.
Source : Journal Alternative and Complementary Medicine
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Sequential Treatments with Tongsai and Bufei Yishen Granules Reduce Inflammation and Improve Pulmonary Function in Acute Exacerbation-Risk Window of Chronic Obstructive Pulmonary Disease in Rats
Xiaofan Lu,1,2 Ya Li,3,4,5 Jiansheng Li,2,3,6 Haifeng Wang,3,6 Zhaohuan Wu,2,3 Hangjie Li,2,3 and Yang Wang2,3
Background. Sequential treatments of Chinese medicines for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) risk window (RW) have benefits for preventing reoccurrences of AEs; however, the effects on pulmonary function, pulmonary, and systemic inflammatory biomarkers remain unclear.
Methods. Cigarette-smoke/bacterial infections induced rats were randomized into Control, COPD, AECOPD, Tongsai Granule/normal saline (TSG/NS), moxifloxacin + salbutamol/NS (MXF+STL/NS), TSG/Bufei Yishen Granule (BYG), MXF+STL/STL, and TSG+MXF+STL/BYG+STL groups and given corresponding medicine(s) in AE- and/or RW phase. Body temperature, pulmonary function, blood cytology, serum amyloid A (SAA) and C-reactive protein (CRP), pulmonary histomorphology and myeloperoxidase (MPO), polymorphonuclear (PMN) elastase, interleukins IL-1β, IL-6, and IL-10, and tumor necrosis factor- (TNF-) α expressions were determined.
Results. Body temperature, inflammatory cells and cytokines, SAA, CRP, and pulmonary impairment were higher in AECOPD rats than stable COPD, while pulmonary function declined and recovered to COPD level in 14–18 days. All biomarkers were improved in treated groups with shorter recovery times of 4–10 days, especially in TSG+MXF+STL/BYG+STL group.
Conclusion. Sequential treatments with Tongsai and Bufei Yishen Granules, during AECOPD-RW periods, can reduce inflammatory response and improve pulmonary function and shorten the recovery courses of AEs, especially the integrated Chinese and Western medicines.
Source : Evidence Based Complementary and Alternative Medicine Journal
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The Use of Spinal Manipulative Therapy in the Management of Chronic Obstructive Pulmonary Disease: A Systematic Review
Objectives: To evaluate the methodologic quality of the evidence for the use of spinal manipulative therapy (SMT) with and without other therapies in the management of chronic obstructive pulmonary disease (COPD).
Design: A systematic review of the literature.
Participants: Any participant of a primary research study that investigated the effect of SMT on COPD. Only studies with participants older than age 18 years with an existing diagnosis of COPD were included.
Interventions: Interventions included any form of high-velocity, low-amplitude spinal manipulation with or without other forms of manual therapy, exercise, and/or pharmacologic intervention.
Outcome measures: Six-minute walking test, forced expiratory volume in 1 second, forced vital capacity, residual volume, total lung capacity, Chronic Respiratory Questionnaire, St George's Respiratory Questionnaire, and the Hospital Anxiety and Depression Scale.
Results: Six articles met all of the inclusion criteria and were included in the review: three randomized controlled trials (RCTs), one pre–post observational study, one case series, and one single case study. Sample sizes varied from 1 to 33 participants ranging in age from 55 to 85 years. Risk of bias was low for the three RCTs and high for the other studies. All three RCTs used SMT in conjunction with exercise from a pulmonary rehabilitation program. Five of the six studies reported improvements in lung function and exercise performance following SMT intervention.
Conclusions: This review provides a methodologic evaluation of the evidence for using SMT with and without other therapies in the management of COPD. While the quality of the evidence provided by three RCTs was high, they were all conducted on small sample sizes. These results highlight the need for further research into the use of SMT in conjunction with exercise on people with COPD.
Source : Journal Alternative and Complementary Medicine
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Effect of Liuweibuqi capsule, a Chinese patent medicine, on the JAK1/STAT3 pathway and MMP9/TIMP1 in a chronic obstructive pulmonary disease rat model
Wang Chengyang, Li Zegen, Liu Xiangguo, Peng Qinghe, Li Fang, Li Da, Wang Chuanbo
To observe effect of Liuweibuqi Capsule, a Traditional Chinese Medicine (TCM), on the janus kinase (JAK)/signal transducer and activator of transcription (STAT) pathway and matrix metalloproteinases (MMPs) in a chronic obstructive pulmonary disease (COPD) rat model with lung deficiency in terms of TCM's pattern differentiation.
Rats were randomly divided into a normal group, model group, Liuweibuqi group, Jinshuibao group, and spleen aminopeptidase group (n= 10). Aside from the normal group, all rats were exposed to smoke plus lipopolysaccharide tracheal instillation to establish the COPD model with lung deficiency. Models were established after 28 days and then the normal and model groups were given normal saline (0.09 g/kg), Liuweibuqi group was given Liuweibuqi capsule (0.35 g/kg), Jinshuibao group was given Jinshuibao capsules (0.495 g/kg), and the spleen group was given spleen aminopeptidase (0.33 mg/kg), once a day for 30 days. Changes in symptoms, signs, and lung histology were observed. Lung function was measured with a spirometer. Serum cytokines were detected using enzyme-linked immunosorbent assay, and changes in the JAK/STAT pathway, MMP-9, and MMPs inhibitor 1 (TIMP1) were detected by immunohistochemistry, RT-PCR, and western blotting, respectively.
Compared with the normal group, lung tissue was damaged, and lung function was reduced in the model control group. Additionally, the levels of interleukin (IL)-1β, γ interferon (IFN-γ), and IL-6 were higher, while IL-4 and IL-10 were lower in the model control group than those in the normal group. The expressions of JAK1, STAT3, p-STAT3, and MMP-9 mRNA and protein in lung tissue were higher, and TIMP1 mRNA and protein was lower in the model group compared with the normal group. After treatment, compared with the model group, the expression of inflammatory cytokines was lower in each treatment group, and expressions of JAK/STAT pathway, MMPs were lower. Compared with the positive control groups, the Jinshuibao and spleen aminopeptidase groups, lung function was better, and JAK1, STAT3, and p-STAT3 protein were lower and TIMP1 was higher in the Liuweibuqi group.
Liuweibuqi capsules can improve the symptoms of COPD possibly by regulating the expression of the JAK1/STAT3 pathway and MMP9/TIMP1.
Source : Journal Traditional Chinese Medicine
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Pelargonium Extract Effective and Safe as Adjunct in Managing Chronic Obstructive Pulmonary Disease (COPD)
Matthys H, Pliskevich DA, Bondarchuk OM, Malek FA, Tribanek M, Kieser M. Randomised, double-blind, placebo-controlled trial of EPs 7630 in adults with COPD. Respir Med. 2013;107(5):691-701.
Chronic obstructive pulmonary disease (COPD) is a disease of chronic and usually progressive airflow blockage. It is not fully reversible, and it is associated with an abnormal inflammatory response of the lung to noxious particles or gases. Acute exacerbations can lead to death. EPs 7630 (Umckaloabo®; ISO Arzneimittel; Ettlingen, Germany) is an herbal preparation from Pelargonium sidoides roots that has been shown to have anti-infective and immunomodulatory activity in vitro. In addition, a systematic review and meta-analysis revealed that EPs 7630 is more effective than placebo in treating acute bronchitis.1 The purpose of this multicenter, randomized, placebo-controlled, double-blind study was to evaluate whether EPs 7630, as an add-on therapy, prolongs time to first exacerbation and reduces exacerbation frequency compared to placebo in patients being treated for moderate-to-severe COPD.
The study was conducted in 18 centers in Kiev and Lugansk, Ukraine. The study included patients (n = 200; ≥ 18 years) with a history of chronic bronchitis (characterized by cough and sputum production on most days for ≥ 3 months/year for at least 2 consecutive years), stable disease, ≥ 3 exacerbations in the prior 12 months, and a forced expiratory volume during 1 second (FEV1) < 80% and ≥ 30% of predicted normal value (COPD-II/III). The spirometry for grading and reversibility testing of patients with COPD was performed ≥ 6 hours after the last ipratropium bromide/fenoterol inhalation. Only patients with an improvement of FEV1 ≤ 0.3 liter after 2 puffs of ipratropium bromide/fenoterol were included in the study. Major exclusion criteria were relevant cardiac diseases, pneumonia, active pulmonary tuberculosis, cystic fibrosis, bronchiectasis, lung cancer, asthma, infiltrates or other abnormalities of the lungs; COPD-IV; acute exacerbation within 4 weeks; known concomitant bacterial infection or respiratory tract infections; AIDS; concomitant medication with beta blockers, angiotensin-converting enzyme (ACE) inhibitors, regular inhalative glucocorticoids (except COPD-III) or oral glucocorticosteroids (except during exacerbation), anticholinergics (except ipratropium bromide), β2-agonists other than salmeterol or fenoterol, analgesics except acetaminophen, mucolytics and antitussives other than dextromethorphan/bromhexine/ammonium chloride, immune modulators (e.g., bacterial vaccines), or coumarin derivatives; known alcohol or drug abuse; tendency to bleed; gastrointestinal disorders; severe heart, renal, or liver diseases; and immunosuppression.
Patients received standard treatment for COPD. Specifically, inhalation baseline treatment for COPD-II included salmeterol regularly and ipratropium bromide/fenoterol as needed, and for COPD-III, salmeterol and budesonide regularly and ipratropium bromide/fenoterol as needed. In the event of exacerbations, additional oral prednisolone and the antibiotics amoxicillin/clavulanic acid or ofloxacin were prescribed. As add-on therapy, patients received 3 × 30 drops/day of placebo or EPs 7630 for 24 weeks. The primary efficacy variable was time to first exacerbation of COPD. Exacerbations were defined as a subjective increase in ≥ 1 chronic symptom over baseline (such as increased sputum production, sputum purulence [yellow pus], and/or dyspnea [shortness of breath]) that required an extra visit to the doctor (moderate exacerbations) or an increased use of ≥ 2-fold mean dose of ipratropium bromide/fenoterol for 5 consecutive days due to increased respiratory symptoms, self-managed by the patient (mild exacerbations). Secondary efficacy variables were number and duration of exacerbations during treatment, health status, patient satisfaction with treatment, and duration of inability to work.
Compliance was nearly 100% in both groups. The median time to first exacerbation occurrence was 57 days in the EPs 7630 group and 43 days in the placebo group (P = 0.005). When evaluating mild and moderate exacerbations separately, the time to moderate exacerbation was significantly greater with EPs 7630 than with placebo (P < 0.0001); whereas, the time to mild exacerbation was not significantly different between groups. The probability of remaining free of exacerbations was significantly greater for the EPs 7630 group than the placebo group (P = 0.005). The median duration of moderate exacerbations was about one day shorter in the EPs 7630 group. Significantly fewer patients in the EPs 7630 group needed antibiotic treatment during exacerbations compared to the patients in the placebo group (P < 0.0001, 37.8% and 73.3%, respectively), and antibiotic treatment had a shorter mean duration of treatment (P = 0.0466, 8 days and 9.8 days, respectively). After 24 weeks, patient satisfaction with treatment was significantly higher with EPs 7630 compared to placebo (P < 0.0001). The EPs 7630 group had a significantly lower average amount of days off work during a mild or moderate exacerbation compared with the placebo group (P = 0.004, 1.97 and 4.08 days, respectively). Also, the mean total number of days off work due to exacerbations during the study was significantly less in the EPs 7630 group than placebo (P < 0.001, 2.96 vs. 7.17 days, respectively).
A total of 51.5% of patients taking EPs 7630 suffered from adverse events (AEs) compared with 40.0% of patients taking placebo. A causal relationship between AEs and EPs 7630 could not be excluded for 18 patients but was assessed as unlikely. Gastrointestinal disorders were the most frequently reported system organ class for which a causal relationship could not be excluded.
The authors conclude that EPs 7630 add-on therapy was superior to placebo, particularly for moderate exacerbations, less consumption of antibiotics, improved quality of life, and less days of work lost. Health economic studies are needed to determine whether using EPs 7630 as an add-on therapy provides a benefit in terms of both patient outcomes and financial concerns (i.e., cost of treatment vs. health care utilization vs. loss of productivity vs. mortality rate).
—Heather S. Oliff, PhD
Source : American Botanical Council
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Effects of comprehensive therapy based on traditional Chinese medicine patterns in stable chronic obstructive pulmonary disease: a four-center, open-label, randomized, controlled study
Su-yun Li,1 Jian-sheng Li,1,2 Ming-hang Wang,1 Yang Xie,2 Xue-qing Yu,1 Zi-kai Sun,3 Li-jun Ma,4 Wei Zhang,5 Hai-long Zhang,2 Fan Cao,2 and Ying-chao Pan2
Traditional Chinese medicine (TCM) has been used to treat chronic obstructive pulmonary disease (COPD) for many years. This study aimed to evaluate the efficacy and safety of the comprehensive therapy based on the three common TCM patterns in stable COPD patients.
A four-center, open-label randomized controlled method was conducted. A total of 352 patients were divided into the trial group (n = 176, treated with conventional Western medicine and Bu-Fei Jian-Pi granules, Bu-Fei Yi-Shen granules, and Yi-Qi Zi-Shen granules based on the TCM patterns respectively) and the control group (n = 176, treated with conventional Western medicine). The frequency and duration of acute exacerbation, lung function, clinical symptoms, 6-minute walking distance (6MWD), dyspnea scale and quality of life were observed during a 6-month treatment period and at a further 12-month follow-up.
A total of 306 patients completed the study fully. The full analysis set (FAS) population was 350 and the per-protocol analysis set (PPS) population was 306. After the 6-month treatment and 12-month follow-up, there were significant differences between the trial and control group in the following: frequency of acute exacerbation (FAS: P = 0.000; PPS: P = 0.000); duration of acute exacerbation (FAS: P = 0.000; PPS: P = 0.001); FEV1 (FAS: P = 0.007; PPS: P = 0.008); symptoms (FAS: P = 0.001; PPS: P = 0.001); 6MWD (FAS: P = 0.045; PPS: P = 0.042); dyspnea scale (FAS: P = 0.002; PPS: P = 0.004); and physical domain (FAS: P = 0.000; PPS: P = 0.000), psychological domain (FAS: P = 0.008; PPS: P = 0.011), social domain (FAS: P = 0.001; PPS: P = 0.000) and environment domain (FAS: P = 0.015; PPS: P = 0.009) of the WHOQOL-BREF questionnaire. There were no differences between the trial and control group in FVC, FEV1% and adverse events.
Based on the TCM patterns, Bu-Fei Jian-Pi granules, Bu-Fei Yi-Shen granules and Yi-Qi Zi-Shen granules have beneficial effects on measured outcomes in stable COPD patients over the 6-month treatment and 12-month follow-up, with no relevant between-group differences in adverse events.
Source : BMC Complement Altern Med. 2012
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Broccoli-Based Compound Beats Drug Resistance in Lung Disease
Chronic obstructive pulmonary disease (COPD) is a common lung disease that gets progressively worse over time, making it harder and harder to breathe. It is caused primarily by cigarette smoking, which leads to persistent inflammation in the airways and the subsequent destruction of the lung tissue.
Given the central role of inflammation in COPD, it is surprising that patients derive little benefit from treatment with potent anti-inflammatory drugs known as corticosteroids.
Working with cells from individuals with COPD, a team of researchers led by Shyam Biswal and Rajesh Thimmulappa, at Johns Hopkins University, Baltimore, has identified a candidate therapeutic that could potentially be used to augment the anti-inflammatory effects of corticosteroids in individuals with COPD -- sulforaphane, a compound obtained from cruciferous vegetables such as broccoli, Brussels sprouts, and cabbages.
Source : Science Daily via "
Denitrosylation of HDAC2 by targeting Nrf2 restores glucocorticosteroid sensitivity in macrophages from COPD patients"
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Tai Chi Shown to Improve COPD Exercise Capacity
Tai Chi can be used as an effective form of exercise therapy for people with chronic obstructive pulmonary disease (COPD), according to new findings.
The research, which was published online August 9, 2012 ahead of print in the European Respiratory Journal, suggests that this form of exercise can improve exercise capacity and quality of life in people with COPD and may be as beneficial as pulmonary rehabilitation.
It is well known that moderate forms of exercise can help COPD patients to improve their exercise tolerance, symptoms of breathlessness and their overall quality of life. This new study aimed to investigate whether Sun-style Tai chi could be used as an effective form of exercise therapy.
This form of Tai Chi (Sun-style) has been shown to help people with chronic conditions such as arthritis and involves less difficult movements enabling people of all ages to perform this martial art.
Researchers from the Concord Repatriation General Hospital and the University of Sydney, Sydney, Australia, worked with 42 people with COPD. Half the group attended Tai Chi lessons twice a week, as well as performing Tai Chi at home, whereas the other half followed their usual medical management which did not include exercise.
Researchers tested the exercise capacity of all participants via a walking test and also asked all participants to complete the Chronic Respiratory Disease Questionnaire, which gives an indication of how the disease affects their quality of life. The exercise intensity of Tai Chi was measured in those participants who completed the Tai Chi training to assess whether it met the training requirements suggested for COPD patients.
Compared to the group completing the usual medical management, participants completing the Tai Chi exercise training could walk significantly longer in the walking test. They also had an increased score on the questionnaire, indicating a better quality of life.
The results also showed that the intensity of the Tai Chi was moderate, which met the recommendations for exercise training for people with COPD.
Lead author, Regina Wai Man Leung from the Concord Repatriation General Hospital, said: "With increasing numbers of people being diagnosed with COPD, it is important to provide different options for exercise that can be tailored to suit each individual. The results from this small sample provide compelling evidence that Tai Chi is an effective training programme for patients with COPD, and could be considered as an alternative to the usual exercise training programmes that are available in pulmonary rehabilitation."
Title: Short-form Sun-style Tai Chi as an exercise training modality in people with COPD Authors: Regina Leung, Zoe McKeough, Matthew Peters and Jennifer Alison DOI: 10.1183/09031936.00036912
Source : Science Daily
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Acupuncture Appears Linked With Improvement in Patients With Chronic Obstructive Pulmonary Disease
According to a small clinical trial reported by investigators from Japan, acupuncture appears to be associated with improvement of dyspnea (labored breathing) on exertion, in patients with chronic obstructive pulmonary disease (COPD), according to a study published Online First by Archives of Internal Medicine, a JAMA Network publication.
he management of dyspnea is an important target in the treatment of COPD, a common respiratory disease characterized by irreversible airflow limitation. COPD is predicted to be the third leading cause of death worldwide by 2020, according to the study background. Masao Suzuki, L.Ac., Ph.D., of Kyoto University and Meiji University of Integrative Medicine, Kyoto, Japan, and colleagues conducted a randomized controlled trial from July 2006 through March 2009. A total of 68 patients diagnosed with COPD participated, and 34 were assigned to a real acupuncture group for 12 weeks, plus daily medication. The other 34 were assigned to a placebo acupuncture group in which the needles were blunt (and appeared to, but did not enter the skin). The primary measure was the evaluation of a six-minute walk test on a Borg scale where 0 meant "breathing very well, barely breathless" and 10 signified "severely breathless."
"We demonstrated clinically relevant improvements in DOE [dyspnea on exertion] (Borg scale), nutrition status (including BMI), airflow obstruction, exercise capacity and health-related quality of life after three months of acupuncture treatment," the authors note.
After 12 weeks of treatment, the Borg scale score after the six-minute walk test improved from 5.5 to 1.9 in the real acupuncture group. No improvement was seen in the Borg scale score in the placebo acupuncture group before and after treatment (4.2 and 4.6, respectively), according to the study results.
"Randomized trials with larger sample sizes and longer-term interventions with follow-up evaluations are necessary to confirm the usefulness of acupuncture in COPD treatment," the authors conclude.
Invited Commentary: Reevaluating Acupuncture Research Methods
In an invited commentary, George T. Lewith, M.A., M.D., F.R.C.P., M.R.C.G.P, and Mike Thomas, Ph.D., F.R.C.P., of the University of Southampton, Hampshire, England, write: "Where does this study lead us? The authors note that acupuncture must be used in addition to conventional care, and although this is undoubtedly correct, it may have significant economic implications."
They continue: "Evaluating traditional interventions, such as acupuncture, that are widely available has many implications, including the fact that best practice and dose response have rarely been evaluated scientifically as would be the case for a new pharmaceutical agent."
"This study points to an important potential role for acupuncture in COPD management. These findings demand larger but equally methodologically rigorous confirmatory studies if we are to consider integrating this approach into our management strategy," they conclude.
Source : Science Daily
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