Objective. The aim of this study is to evaluate the efficacy and safety of pulmonary rehabilitation (PR) in patients with idiopathic pulmonary fibrosis (IPF).Methods. Embase, PubMed, Cochrane Library, China National Knowledge Infrastructure (CNKI), Chongqing VIP (CQVIP), Wanfang Data, and Chinese Biomedical Literature Database (SinoMed) were comprehensively searched. Randomized controlled trials (RCTs) that investigated the effects of PR for IPF patients were included. Literature selection and data extraction were conducted by two review authors independently. The Cochrane Collaboration’s Risk of Bias tool and RevMan software (version 5.3) were used to evaluate the quality of studies and conduct statistical analysis, respectively.Results. Seven studies (190 participants) were included. PR had a significant effect on six-minute walk distance (6MWD) (MD:48.60; 95%CI: 29.03 to 68.18;Z=4.87,P<0.00001), and 6MWD was improved more in subgroup analysis including studies conducted in Asia (MD: 53.62; 95%CI: 30.48 to 76.66;Z=4.54,P<0.00001) and Europe (MD:54.10; 95% CI: 26.65 to 101.56;Z=2.23,P=0.03). Forced vital capacity (FVC%) was higher (MD: 3.69; 95%CI: 0.16 to 7.23;Z=2.05,P=0.04). St. George’s Respiratory Questionnaire (SGRQ)/IPF-specific SGRQ (SGRQ-I) total score was lower (MD: -7.87; 95% CI: -11.44 to -4.30;Z=4.32,P<0.0001). No significant effects were found for lung diffusing capacity determined by the single-breath technique (DLCO%) (MD: 3.02; 95%CI: -0.38 to 6.42;Z=1.74,P=0.08).Conclusions. This study suggests that PR may enhance exercise capacity and improve quality of life in IPF patients. Besides, PR may also delay the decline of lung function of patients with IPF. However, further research should more fully assess the efficacy and safety of PR for IPF.

Objective. The role of telemonitoring interventions (TIs) for chronic obstructive pulmonary disease (COPD) has been studied in many systematic reviews (SRs) and meta‐analyses (MAs), but robust conclusions have not been reached due to wide variations in scopes, qualities, and outcomes. The aim of this overview was to determine the effectiveness of TIs on COPD patients. Methods. PubMed, EMBASE, Web of Science, and Cochrane Library were searched for all reviews on the topic of TI in treating COPD from inception to July 8, 2019, without restrictions on language. According to the inclusion and exclusion criteria, the retrieved literature studies were screened to select SRs and MAs of randomized control trials (RCTs) that evaluated the effects of TIs in COPD patients. The methodological quality of SRs and MAs was assessed with the AMSTAR‐2 tool, and the strength of evidence was assessed with the grades of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes in terms of mortality, quality of life (SGRQ total scores), exercise capacity (6MWD), and exacerbation‐related outcomes (hospitalizations, exacerbation rate, and emergency room visits). Results. Our overview included eight SRs and MAs published in 2011 to 2019, from 95 RCTs involving 10632 participants. After strict evaluation by the AMSTAR‐2 tool, 75% of the SRs and MAs in this overview had either low or critically low methodological quality. The effects of TIs for COPD on mortality, quality of life, exercise capacity, and exacerbation‐related outcomes are limited, and all of these outcomes scored either low or very low quality of evidence on the GRADE system. Conclusions. There might be insufficient evidence to support the effectiveness of TIs for COPD currently, but the results of this overview should be interpreted dialectically and prudently, and the role of TIs in COPD needs further exploration.

Chronic obstructive pulmonary disease (COPD), with high prevalence rate, mortality, disability rate, and heavy disease burden, has become a critical chronic disease seriously threatening public health worldwide. Traditional Chinese medicine and Western medicine both have shown advantages in diagnosing and treating COPD, which has been widely applied in the clinics. In order to improve the diagnostic and treatment level for COPD with integrated traditional Chinese and Western medicine, the Guidelines of Integrated Chinese and Western Medicine for Diagnosis and Treatment of COPD were developed by the Internal Medicine Committee of the World Federation of Chinese Medicine Societies. First, a multidisciplinary working group was established. Development methods and processes of international clinical practice guidelines were adopted in the whole research. In final, a total of 13 recommendations for the diagnosis and treatment of COPD were established based on available evidence with the best quality. Meanwhile, characteristics of integrated traditional Chinese and Western medicine in treating COPD were taken into account with pros and cons of each intervention. The guidelines could be used as a reference for physicians in respiratory medicine departments (traditional Chinese medicine, integrated traditional Chinese and Western medicine, and Western medicine) at various levels of medical institutions in their diagnosis and treatment.

Background: Procalcitonin (PCT)‐guided antibiotic therapy has emerged as mainstream treatment for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and has been studied in many systematic reviews (SRs), but robust conclusion has not been drawn. Thus, this overview aims to summarize and critically evaluate the methodological and evidence quality of SRs on this topic.Methods: PubMed, EMBASE, Cochrane library, and Web of science were searched for SRs regarding on PCT‐guided antibiotic therapy on AECOPD. Two reviewers assessed the quality of SRs in line with AMSTAR‐2 tool and evaluated the strength of evidence quality with the grading of recommendations, assessment, development, and evaluation (GRADE) system for concerned outcomes independently.Results: Six SRs were published from Jun 2011 to Aug 2019, with from 4 (556 patients) to 15 (2571 patients) randomized controlled trials (RCTs) and retrospective studies. All the included SRs were classified as critical low methodology quality according to A MeaSurement Tool to Assess Systematic Reviews 2 (AMSTAR‐2) tool. Most of SRs were absented a list of excluded studies (item 7), and adequate investigation of publication bias and discuss its likely impact on the results (item 15). The PCT‐guided antibiotic therapy may reduce antibiotic exposure days and antibiotic prescription rate in patients with AECOPD without affecting treatment success rate or causing adverse events (all‐cause mortality, re‐admission, re‐exacerbation), but the results should be study deeper for the low or moderate evidence quality.Conclusion: Current SRs show that PCT‐guided antibiotic therapy could be employed by clinicians in treatment of AECOPD. However, the high‐quality evidence of outcomes is lacking, further intensive exploration should be carried out on the precise role of PCT‐guided antibiotic therapy on AECOPD.

Chronic obstructive pulmonary disease (COPD) affects millions worldwide. Although many therapies exist and are being developed to relieve symptoms and reduce mortality, few data are available to understand which of the therapeutic alternatives is the most cost-effective for COPD patients in everyday clinical practice, especially for traditional Chinese medicine (TCM). Comparative effectiveness research can help patients, clinicians, and decision-makers make best informed treatment decisions where such evidence was previously lacking. This study aims to compare the effectiveness and economic evaluation of three treatments: (1) conventional Western medicine; (2) TCM treatments, which have been evaluated and have certain effect; and (3) a combination of both conventional Western medicine and TCM treatments, and then determine which treatment is the most suitable for COPD patients. A multicenter, pragmatic, randomized, controlled trial is adopted. A total of 360 patients will be recruited and randomly assigned to one of the three treatments group, with 120 in each group. Patients in the conventional Western medicine group will be given Salbutamol, Formoterol, Salmeterol/fluticasone, respectively, according to the guidelines. For the TCM group, patients will be given Bufei granule, Bu-Fei Jian-Pi granule, Bu-Fei Yi-Shen granule, and Yi-Qi Zi-Shen granule based on their corresponding TCM syndrome patterns, respectively. For the combination of conventional medicine and TCM treatments group, patients will be given a combination of conventional Western medicine and TCM granules. Treatments in each group are recognized as a whole comprehensive intervention. After the 26-week treatment, another 26 weeks will be followed up. The outcome measures including the frequency and duration of acute exacerbations, lung function, dyspnea, exercise capacity, quality of life, and economic evaluation will be assessed. It is hypothesized that each of the three treatments will have beneficial effects in reducing the frequency and duration of acute exacerbations, improving exercise capacity and psychosocial function of COPD patients. In addition, the combination of conventional medicine and TCM treatments may be most suitable for COPD patients with better effectiveness and economic evaluation. ClinicalTrials.gov NCT01836016 .

Chronic obstructive pulmonary disease (COPD) is a common and frequently occurring disease that seriously endangers health, causing a heavy economic burden on patients and society. Acupuncture has been reported to have a therapeutic effect on patients with chronic obstructive pulmonary disease (COPD). However, compared with medications, it is difficult to identify a superior therapy. Therefore, the aim of this study was to evaluate the efficacy and safety of acupuncture, conventional drug and acupuncture plus conventional drug in the treatment of COPD. This was a multicenter, open-label randomized controlled trial (RCT) through a central randomization system. A total of 150 COPD patients were randomly assigned at a 1:1:1 ratio to the acupuncture group, conventional drug group or acupuncture plus conventional drug group for 12 weeks of treatment, followed by 12 weeks of untreated follow-up. The primary outcomes included the six-minute walk distance (6MWD) and St. George's Respiratory Questionnaire (SGRQ), and the secondary outcomes included the modified Medical Research Council dyspnea scale (mMRC), acute exacerbation, lung function, and quality of life (COPD assessment test). Statistical analysis was conducted via SPSS software (version 26.0). A total of 150 patients were included in the study, and 143 patients completed the trial. There were time effects, group effects and interaction effects in the three groups (P < 0.05). Compared with that in the conventional drug group, the 6MWD in the acupuncture plus conventional drug group increased significantly at 4, 8, and 12 weeks of treatment and at 12 weeks of follow-up. The difference was statistically significant (P < 0.05). The symptom scores, motor scores, impact scores and total SGRQ scores at different time points in the three groups tended to change with time, with a time effect (P < 0.05), and there was no group or interaction effect (P > 0.05). Among the secondary outcomes, there were time effects on the number of acute exacerbations, forced expiratory volume in one second (FEV1) and forced expiratory volume in one second/forced vital capacity (FEV1/FVC) at different time points in the three groups (P < 0.05). mMRC had time and group effects (P < 0.05). CAT had time effects, group effects and interaction effects (P < 0.05). Compared with the acupuncture group and the conventional drug group, the acupuncture plus conventional drug group was better at improving exercise ability, improving quality of life, and reducing dyspnea. It is safe and effective for the treatment of chronic obstructive pulmonary disease in the stable period, which can provide a reference for further related research. ClinicalTrials.gov, NCT03169504. Registered on 30 May 2017.