Cordyceps sinensis (CS) is a complementary medicine used for Chronic Obstructive Pulmonary Disease (COPD) of Global Initiative for Chronic Obstructive Lung Disease (GOLD) stages 2-3. Many randomized controlled trials have been conducted to evaluate the effect of CS alone or in combination with other herbs on stable COPD. To provide a synthesis of the evidence, we searched nine major electronic databases for randomized controlled trials on CS published before 21st December 2016. Fifteen interventional studies, including 1,238 participants, met the inclusion criteria. Meta-analysis showed that both CS preparations and CS formulae showed the potential benefits in lung function, exercise endurance, life quality, and improvement of symptoms. No serious adverse events were reported. So CS may be a promising treatment for patients with stable COPD of GOLD stages 2-3. No studies were placebo-controlled or of high methodological quality, which limits the conclusions.

Jianpiyifei II granule (JPYF II) is an oriental herbal formula used clinically in China to treat chronic obstructive pulmonary disease (COPD). The aim of the present study was to investigate the anti‐inflammatory and antioxidative activities of JPYF II in a mouse model of COPD induced by lipopolysaccharide (LPS) and cigarette smoke (CS) and in RAW264.7 cells stimulated with cigarette smoke extract (CSE). Mice were given LPS via intratracheal instillation on days 1 and 15 and exposed to CS generated from 4 cigarettes/day for 28 days. The mice were treated with 0.75, 1.5, or 3 g/kg/d JPYF II by intragastric administration in low, middle, and high dose groups, respectively, for two weeks. RAW264.7 cells were stimulated by CSE and treated with JPYF II at doses of 12.5, 25, or 50 μg/mL. In the mouse model of LPS and CS‐induced COPD, JPYF II decreased inflammatory cell counts in broncho alveolar lavage fluid (BALF), in addition to mRNA expression of proinflammatory cytokines and metalloproteinases (MMPs) in lung tissues. In addition, JPYF II elevated catalase (CAT) and glutathione peroxidase (GSH‐Px) activities and reduced the levels of malondialdehyde (MDA) and IκBα and p65 phosphorylation and inflammatory cell infiltration in the lung tissues. In RAW264.7 cells stimulated with CSE, JPYF II inhibited the mRNA levels of inflammatory mediators and the phosphorylation of IκBα and p65. Our results suggest that JPYF II enhanced anti‐inflammatory and antioxidative activities in a mouse model of COPD induced by LPS and CS and in RAW264.7 cells stimulated with CSE via inhibition of the NF‐κB pathway.

Introduction. Herbal medicine is commonly used by patients with chronic cough, but the role of herbal medicine for cough variant asthma (CVA) has not yet been clearly defined. For the first time, we performed a meta-analysis to integrate the current evidence of randomized controlled trials (RCTs) on this topic and assess the efficacy of herbal medicine in adults with CVA. Methods. A comprehensive search was conducted in electronic databases to identify RCTs of herbal medicine for adult CVA. Cochrane systematic review methods were followed, and the Grading of Recommendations Assessment, Development, and Evaluation was performed to evaluate the quality of evidence. Results. Twenty-eight RCTs were included. Compared with placebo, moderate-quality evidence from two studies showed that herbal medicine was associated with reduced cough symptom score (CSS) (MD 1.15 points; 95 CI, 1.67 to 0.63) and visual analogue scale (VAS) (MD 1.76 points; 95 CI, 2.66 to 0.86). Compared with montelukast, low- to moderate-quality evidence from 11 studies indicated that herbal medicine was associated with improved Leicester Cough Questionnaire (LCQ) (MD 2.38 points; 95 CI, 1.32 to 3.44), reduced CSS (SMD 0.81 points; 95 CI, 1.09 to 0.53), and VAS (MD 1.34 points; 95 CI, 1.82 to 0.86). There were no significant differences between herbal medicine and ICS plus bronchodilator. Conclusions. In adults with CVA, herbal medicine may result in improved quality of life and reduced cough frequency and severity scores compared with placebo or montelukast. Herbal medicine was not better than ICS plus a bronchodilator but the evidence is very uncertain.

Background. Acupoint application of herbal medicine (AAHM) has been widely used in China. At present, there is no systematic review of AAHM versus placebo in the treatment of asthma. This systematic review aims to assess the efficacy of AAHM for asthma. Methods. Searches were conducted in five English databases and four Chinese databases from their inceptions until December 2020. Randomized double-blind placebo-controlled trials were screened, and included studies evaluated routine pharmacotherapy (RP) plus AAHM versus RP plus placebo or AAHM versus placebo. The Cochrane risk of bias tool and Grading of Recommendations Assessment, Development and Evaluation (GRADE) were performed to evaluate the methodological quality and quality of evidence separately. Results. Sixteen studies involving 1,730 participants were included in this review. Compared with placebo plus RP, participants receiving long-term AAHM plus RP showed improvement in asthma quality of life questionnaire (AQLQ) with moderate-quality evidence (MD 6.53 points, 95 CI 2.70 to 10.36). Low-quality evidence indicated that AAHM plus RP was associated with improved FEV₁ () compared with placebo plus RP, whether long- or short-term use (MD 11.80, 95 CI 2.84 to 20.76; MD 10.57, 95 CI 8.40 to 12.74; respectively). Moderate-quality evidence showed that participants receiving short-term AAHM were associated with a higher AQLQ score (MD 6.57 points, 95 CI 3.76 to 9.38) and a lower frequency of acute exacerbations (MD 1.84, 95 CI 2.32 to 1.36) compared with placebo. Low-quality evidence also indicated that AAHM was associated with improved FEV₁ (L) compared with placebo, whether long- or short-term use (MD 0.35litres, 95 CI 0.03 to 0.67; MD 0.66litres, 95 CI 0.59 to 0.73; respectively). Conclusions. Moderate-quality evidence is promising that AAHM can improve the quality of life and reduce acute exacerbations in patients with asthma. AAHM also shows a positive role in improving lung function, but the evidence is so indefinite due to low quality.

Purpose: Increasing evidence suggests that mechanical power (MP) is associated with mortality among patients undergoing invasive mechanical ventilation. However, the relationship between MP and mortality in chronic obstructive pulmonary disease (COPD) patients undergoing invasive ventilation remains uncertain. The aim of this study was to investigate the association between MP and 28-day all-cause mortality among COPD patients undergoing invasive ventilation. Patients and Methods: Data were obtained from the Medical Information Mart for Intensive Care (MIMIC-IV) database. COPD patients undergoing invasive ventilation were categorized into three categories based on MP tertiles to further assess the robustness of our results. The primary outcome was 28-day all-cause mortality. The relationship between MP and 28-day all-cause mortality in COPD patients undergoing invasive ventilation was performed to evaluate restricted cubic splines and Cox proportional hazards regression analysis. Receiver operating characteristic (ROC) curves and Kaplan-Meier survival analysis were employed to evaluate and visualize the predictive value of MP for 28-day all-cause mortality. Additionally, the optimal cut-off value of MP was determined. Finally, subgroup analysis was conducted to assess the robustness of the findings. Results: 1704 COPD patients undergoing invasive ventilation (56.92% male) were included in the study. Based on the Cox regression analysis, MP was significantly associated with 28-day all-cause mortality risk in the unadjusted model (Model 1) [HR (95% CI) 1.04 (1.03– 1.05), p< 0.001]. However, as this is an observational study, causality cannot be inferred. Restricted cubic spline regression models revealed a linear rise in the risk of 28-day mortality as MP increased (P for non-linearity = 0.967). The area under the curve (AUC) for MP was 0.602. This study also identified an optimal cut-off value of 17.38 J/min for MP. Kaplan-Meier survival analysis demonstrated statistically significant differences in survival among invasive ventilation patients stratified by MP tertiles. Subgroup analysis of potential confounding factors indicated no significant interaction between MP and any subgroup (P for interaction: 0.114– 0.967). Conclusion: MP is associated with 28-day all-cause mortality in COPD patients undergoing invasive ventilation. The cut-off value of 17.38 J/min may serve as a reference point for clinicians in assessing disease severity. However, further research is needed to investigate the causal relationship between MP and mortality.

Background: Chronic obstructive pulmonary disease (COPD) is the most common chronic lung disease creating an immense burden on social health care systems. Pulmonary rehabilitation (PR) has proven to be effective in patients with COPD. However, exercise training as the basis of PR becomes extremely tedious, occasionally causing a loss of perseverance in patients. Therefore, we considered an approach that makes this technique interesting and easier to persist. The aim of this project was to explore an exercise training approach based on PR-integrated coached exercise training to promote the new exercise training approach as a form of group rehabilitation activity in the future. Methods: Participants will be randomly divided into the trial and control groups. The trial group will be treated with PR-integrated coached exercise training (plus usual care). All exercise programs will be guided by sports coaches with a physical education background. Meanwhile, the control group will receive traditional PR and home exercises, including walking and swimming. The study will last for 12 weeks. The primary outcome measure is exercise tolerance using the 6-min walking test and secondary outcomes are the peak oxygen uptake of cardiopulmonary exercise tests, the COPD Assessment Test, and the St. Georges Respiratory Questionnaire. Other evaluated outcomes include changes in postbronchodilator forced expiratory volume at 1^st second, forced vital capacity, body fat and muscle composition, and mental status measured using the Hamilton Anxiety and Depression Scales. Discussion: This study provides a simple, feasible, repeatable, and fun exercise training approach. To the best of our knowledge, there are no randomized controlled trials in the existing literature on PR-integrated coached exercise. The protocol shared in our study can be used as a reference for exercise training in patients with COPD. Trial registration: Ethical approval (BF2020-236–02) was obtained from the Guangdong Provincial Hospital of Chinese Medicine Human Research Ethics Committee. All participants signed an informed consent form. ChiCTR-2100043543. The registration date is 2021/02/21 and it is the third version.