Novel Approach to Respiratory Pharmacology—Pharmacological Basis of Cough, Sputum and Airway Clearance

Classic mechanisms and experimental models for the anti‐inflammatory effect of traditional Chinese medicine

Inflammation is a common disease involved in the pathogenesis, complications, and sequelae of a large number of related diseases, and therefore considerable research has been directed toward developing anti‐inflammatory drugs for the prevention and treatment of these diseases. Traditional Chinese medicine (TCM) has been used to treat inflammatory and related diseases since ancient times. According to the review of abundant modern scientific researches, it is suggested that TCM exhibit anti‐inflammatory effects at different levels, and via multiple pathways with various targets, and recently a series of in vitro and in vivo anti‐inflammatory models have been developed for anti‐inflammation research in TCM. Currently, the reported classic mechanisms of TCM and experimental models of its anti‐inflammatory effects provide reference points and guidance for further research and development of TCM. Importantly, the research clearly confirms that TCM is now and will continue to be an effective form of treatment for many types of inflammation and inflammation‐related diseases.

Efficacy and safety of Maekmoondong-tang for chronic dry cough: a study protocol for a randomized controlled trial

Background

Chronic cough, defined it lasts more than 8 weeks. The symptom is common, but highly troublesome, and it reduces quality of life. Despite much effort to develop a protocol for diagnosis and treatment of chronic cough, it remains problematic to determine its cause. As a result, treatment is often unsuccessful. Thus, there is much interest regarding the use of symptomatic drugs to control chronic cough.

Maekmoondong-tang is widely used in East Asian countries to treat chronic dry cough. Several experimental studies have reported that the herbal medicine has immunomodulatory and antitussive effects. Clinical studies involving Maekmoondong-tang have also been carried out; however, these studies have involved treating various diseases as a whole rather than chronic cough itself. Thus, we aim to evaluate the efficacy and safety of Maekmoondong-tang in chronic dry cough patients with a randomized controlled trial.

Methods/Design

This study is designed as an exploratory, single-center, placebo-controlled, double-blind, randomized, parallel group clinical trial. Patients with dry cough that has lasted more than 8 weeks will be recruited, after a 1-week run-in period, and randomly allocated to either the Maekmoondong-tang treatment group or the placebo group. The patients will receive Maekmoondong-tang or placebo granules 3 times daily for 4 weeks, with a 2-week follow-up. The primary outcome is a 10-point cough diary that will be recorded on a daily basis. The secondary outcomes comprise a cough visual analog scale, the Leicester Cough Questionnaire (Korean version), the Pattern Identification for Chronic Cough Questionnaire, biomarkers, safety testing, etc. Adverse events will also be reported.

Discussion

This trial will assess the efficacy and safety of Maekmoondong-tang in chronic dry cough.

Trial registration

Korean Clinical Trial Registry (http://cris.nih.go.kr; registration number: KCT0001646). Date of registration: October 5 2015

A pilot study of the multiherb Kampo medicine bakumondoto for cough in patients with chronic obstructive pulmonary disease

OBJECTIVES

To evaluate the effect of bakumondoto, Kampo medicine, on cough in patients with chronic obstructive pulmonary disease (COPD).

DESIGN

A 16-week, randomized, open-labeled, cross-over design.

SETTING

Outpatient clinics at one university hospital and two general hospitals in Japan from May 2007 to March 2009.

PARTICIPANTS

Twenty-four elderly patients (14 men and 9 women aged over 65) with COPD.

INTERVENTION

Treatment with or without bakumondoto for 8 weeks in a cross-over design.

MEASUREMENTS

The primary outcome measurements were the frequency and intensity of cough assessed by a visual analogue scale (VAS) and a daily cough diary. Secondary outcome measurements were quality of life (QOL) assessed using St. George's Respiratory Questionnaire (SGRQ) and lung functions measured using spirometry.

RESULTS

Treatment with bakumondoto significantly improved cough severity during the first treatment period (week 0 vs. week 8, p=0.004) and showed a trend to decrease during the second treatment period (week 8 vs. week 16, p=0.129) assessed by the VAS. Neither QOL nor lung function was affected by the treatment with bakumondoto.

CONCLUSION

Bakumondoto may be effective in suppressing cough in elderly patients with COPD. To further confirm the efficacy, a larger and placebo-controlled study with objective cough assessment is necessary.