Efficacy and Safety of Re Du Ning Injection for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis

Abstract

Background. Re Du Ning, a traditional Chinese medicine injection, has been widely used for the treatment of chronic obstructive pulmonary disease, although without established systematic review evidence. This systematic review aimed to assess the efficacy and safety of Re Du Ning in the treatment of acute exacerbations of chronic obstructive pulmonary disease (AECOPD). Methods. We searched seven databases (PubMed, Embase, the Cochrane Library, SinoMed, CNKI, WanFang, and the Chinese Clinical Trial Registry) up to November 1, 2021, to identify randomized controlled trials of Re Du Ning for AECOPD. Two researchers independently carried out literature screening and data extraction. Effects were measured by risk ratios (RRs) or mean differences (MDs) with 95% confidence intervals (CIs). The meta-analysis was completed by RevMan 5.4 software. Results. Twenty-six studies met the eligibility criteria, with a total of 2284 patients. The findings of the meta-analysis indicated that the response rate of the experimental group was higher than that of the control group: RR = 1.14% and 95% CI: (1.09, 1.19). Significantly greater improvements in pulmonary function: FEV1: MD = 0.28 L, 95% CI: (0.20, 0.36); FEV1/FVC: MD = 8.63%, 95% CI: (4.68, 12.59); T-lymphocyte counts: CD4: MD = 6%, 95% CI: (2.44, 9.56); CD3: MD = 10.42%, 95% CI: (8.6, 12.24); CD4/CD8: MD = 0.38%, 95% CI: (0.32, 0.43); acid/base imbalance: PH: MD = 0.05, 95% CI: (0.01, 0.10); PaO2: MD = 9.02 mmHg, 95% CI: (11.11, 0.10), p = 0.005 ; C-reactive protein: MD = −6.65 mg/L, 95% CI: (−10.97, −2.34); and PCT: MD = −0.28 μg/L, 95% (CI: −0.41, −0.15) were observed in patients receiving Re Du Ning compared with those receiving the control treatment. Re Du Ning did not significantly change the carbon dioxide partial pressure. All reported adverse reactions were mild. Conclusion. Re Du Ning injection, as a complementary therapy to routine treatment, has better efficacy than Western medicine alone in relieving clinical symptoms, delaying pulmonary function decline, and improving inflammation indicators for AECOPD, with good safety. The evidence was limited by a lack of high-quality RCTs.

Effects of acetylcysteine on micro-inflammation and pulmonary ventilation in chronic obstructive pulmonary disease exacerbation

“…IL-6 is a cytokine that mediates the inflammatory response, which is increased in AECOPD and is correlated with exacerbation frequency and lung function decline[ 21 ]; (2) The change in the level of tumor necrosis factor-alpha (TNF-α) in serum from baseline to the end of treatment, as measured by the ELISA method (R&D Systems, Inc., United States). TNF-α is a pro-inflammatory cytokine that induces the production of other inflammatory mediators, which is elevated in AECOPD and linked with the airway inflammation and the oxidative stress[ 22 ]; (3) Change in the level of CRP in the sputum from baseline to the end of treatment, as measured using the immunoturbidimetric method (model: AU5800, Beckman Coulter, Inc., United States). CRP in sputum reflects local inflammation in the airways, which is increased in AECOPD and is associated with bacterial infection and sputum characteristics[ 23 ]; (4) The change in the IL-6 and TNF-α levels in sputum from baseline to the end of treatment, as measured using the ELISA method (R&D Systems, Inc., United States); and (5) The change in lung ventilation function parameters from baseline to the end of treatment, including FEV1, FVC, and peak expiratory flow (PEF), were measured using a spirometer (model: SP-10, Contec Medical Systems Co., Ltd., China), according to the American Thoracic Society/European Respiratory Society guidelines[ 24 ].…”