OBJECTIVE: To assess the effectiveness of Jiuwei Zhuhuang Powder (JWZH), a Tibetan patent medicine in treating upper respiratory tract infection (URTI) associated cough in children. METHODS: The study was a multicenter, randomized, open-label, controlled trial. A total of 142 children aged 2 to 14 years old, with URTI-associated cough within 48 h of onset, were randomly assigned to two groups at a 1:1 ratio by computer-generated randomization sequence. Children were treated with JWZH (1 to 1.5 g, twice to thrice daily) in the treatment group or conventional treatment (Pediatric Paracetamol, Artificial Cow-bezoar and Chlorphenamine Maleate Granules, 0.25 to 1 g, thrice daily) in the control group for 5 days. The primary endpoints were the time to cough resolution and 4-day cough resolution rate. The secondary endpoints were the daily improvement in symptom scores and cough resolution rate during the study period. RESULTS: A total of 138 children were included in the intention-to-treat analysis, with 71 cases in the treatment group and 67 cases in the control group. Compared with the conventional treatment, the children receiving JWZH had a shorter time to cough resolution [hazard ratio, 2.10; 95% confidence interval (CI), 1.29-3.40; P=0.003]. The median time to cough resolution for children receiving JWZH was shorter than that of the conventional treatment (2 days vs. 3 days; P<0.001). The 4-day cough resolution rate in the JWZH group was higher than that of the control group (94.4% vs. 74.6%; risk difference: 19.8%, 95% CI: 8.1%-31.5%; relative risk: 1.265, 95% CI: 1.088-1.470; P=0.001). There were no statistically significant differences in the improvement of other symptoms caused by URTI (P>0.05). Adverse events was reported in 5.6% (4/71) and 4.5% (3/67) in participants of JWZH and PPACCM groups (P>0.05), respectively, which were all mild and resolved without treatment. CONCLUSION JWZH seemed to be a safe and effective therapy for URTI-associated cough in children. (Trial registration No. ChiCTR2000039421).
Child ; Cough/drug therapy* ; Drugs, Chinese Herbal ; Humans ; Nonprescription Drugs ; Powders ; Respiratory Tract Infections/drug therapy*

OBJECTIVEThis review focuses on current knowledge of traditional Chinese herbs on prevention and treatment of viral respiratory infections, especially caused by Severe Acute Respiratory Syndromes (SARS) virus, respiratory syncytial virus (RSV) and influenza viruses.

DATA SOURCESThe data used in this review were obtained from PubMed and CNKI up to May 2013. Terms of Chinese herbs and infections of respiratory tract were used in the search.

STUDY SELECTIONArticles related that Chinese herbs preventing and treating infections in respiratory tract were retrieved and reviewed. The risk of bias of included studies was assessed by the method in the "Cochrane Handbook of Systematic Reveiws of Interventionsand studies" with high risk of bias were excluded. Four criteria for selections were set as following: randomized controlled trial, particular effective compound or derivative, reproducible result and animal test.

RESULTSInfectious respiratory tract diseases cause most mortality among infectious illnesses around the world. As traditional medicines, Chinese herbs have been widely used to deal with diseases for centuries and have been proved effective in practice. The administration of some Chinese herbs stimulates, suppresses or regulates the activity of immune system, thus protecting the respiratory tract or relieving infections of pathogens. Many herbs have remarkable antiviral effects, therefore they are used as substitutes of antimicrobial drugs. Based on the theory of traditional Chinese medicine, mix-using herbs provide a synergistic benefit on preventing and healing respiratory tract infections. Many commercial herbal medicines containing one or more compounds have been successfully applied to prevent and treat viral infections of respiratory tract clinically.

CONCLUSIONSTraditional Chinese herbs could directly inhibit pathogens infecting respiratory tract, or coordinate the activity of immune system to avoid or relieve infections. With the emergence of antidrug pathogens or new variants, Chinese herbs give strong evidence to protect human health.

This study systematically sorted out the evidence data of the safety, effectiveness, economy, innovation, suitability, accessibility, and characteristics of traditional Chinese medicine(TCM) of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) with the qualitative and quantitative evaluation methods adopted. Based on evidence-based medicine, epidemiology, clinical medicine, evidence-based pharmacy, pharmacoeconomics, and health technology evalua-tion(HTA), the clinical value of Reyanning Mixture was evaluated using multi-criteria decision analysis(MCDA) model, Chinese patent medicine clinical evidence, and value evaluation software(CSC v2.0). The SRS monitoring data, Meta-analysis, and other safety evidence showed that the main adverse reactions of Reyanning Mixture were nausea, diarrhea, and rash, and no serious adverse reactions were found. The pharmacovigilance system was sound, and the system was perfect. There was no recall, notification, or interview for unqualified products. Based on the existing research, the evidence was sufficient, and the risk was controllable. Hence, its safety was grade A. Meta-analysis showed that in the treatment of acute upper respiratory tract infection, Reyanning Mixture combined with Amoxicillin Capsules was better than Amoxicillin Capsules alone in shortening the complete fever relief time and improving the cure rate. Besides, it was superior to Shuanghuanglian Granules in shortening the complete fever relief time, cough relief time, nasal congestion relief time, and pharyngeal congestion relief time. The Meta-analysis was conducted based on AMSTAR standard, and its ove-rall quality was proved good. The evidence quality in GRADE system evaluation was medium and low. The quality of evidence was medium, and the clinical value was obvious. Hence, its effectiveness was grade A. The results of pharmacoeconomic research showed that compared with Amoxicillin Capsules, Reyanning Mixture alone or in combination with Amoxicillin Capsules had cost-effectiveness advantages in the treatment of acute upper respiratory tract infection, and the results were stable in sensitivity analysis. According to the CASP economic evaluation checklist, the research problems were clear and the results were reliable. As revealed by the comprehensive evaluation, the evidence quality was sufficient and the result was clear. Its economy was grade B. Reyanning Mixture had multiple therapeutic targets like anti-virus, anti-bacteria, antipyresis, and anti-cough, with good clinical innovation. There were many innovative initiatives in ensuring drug supply, especially at the grass roots, drug safety, and effectiveness, and also multiple innovative contributions to production technology, quality control, scientific and technological research and development, and enterprise management and marketing. Therefore, its innovation was grade B. The dosage form of Reyanning was mixture, which made it convenient for storage and transportation. The usage was easy to be mastered and accepted by doctors and nurses, exhibiting good suitability for clinicians, nurses, pharmacists, and patients who received this drug and basically meeting the needs of clinical medication. The suitability was grade B. The average daily cost of this drug was 8.082 yuan, and the price was low. The treatment cost accounted for a small proportion of the annual disposable income of urban and rural residents, indicating that it was affordable. Reyanning Mixture was available in 31 provinces, cities and autonomous regions, covering 6 910 hospitals. The allocation of hospitals at all levels was more than 50%. There was no shortage or supply restriction of medicinal material resources. The annual production capacity was sufficient to meet the supply demand, so its accessibility was grade A. Reyanning Mixture, sourced from "pneumonia Ⅲ", has been subjected to a real-world study of its clinical application, with 4 367 cases involved, and the characteristic of TCM was grade B. The comprehensive evaluation results demonstrated that the clinical value score of Reyanning Mixture in the treatment of acute upper respiratory tract infection(heat-toxin attacking lung syndrome) was 0.80, making it rated class A. According to the Guidelines for Management of Comprehensive Clinical Evaluation of Drugs(trial version 2021), it is recommended to convert it into the relevant policy results of basic clinical medication management according to the procedures.
Hot Temperature ; Humans ; Lung ; Medicine, Chinese Traditional ; Respiratory Tract Infections/drug therapy* ; Syndrome

Anti-Bacterial Agents/therapeutic use* ; Child ; Humans ; Practice Patterns, Physicians' ; Respiratory Tract Infections/drug therapy*

To evaluate the effectiveness and safety of Yupingfeng Granules in the treatment of recurrent respiratory tract infection.Six Chinese and English databases were retrieved,namely CNKI,Wan Fang,VIP,CBM,PubMed and Cochrane Library. Randomized controlled trials of Yupingfeng Granules in the treatment of recurrent respiratory tract infection were collected and screened. According to the evaluation criteria and tools of Cochrane,the heterogeneity among the studies was analyzed,and the Meta-analysis was carried out by Rev Man 5.3 software. A total of 16 studies were included in this study,with a total sample size of 1 788 cases,including 901 cases in the experimental group and 887 cases in the control group. Among them,11 intervention measures were Yupingfeng Granules combined with Western medicine routine vs routine Western medicine,and 5 research interventions were Yupingfeng Granules combined with pidomod vs pidomod based on routine therapy. Meta-analysis showed that the total effective rate of Yupingfeng Granules combined with Western medicine in the treatment of recurrent respiratory tract infection was better than that of Western medicine( RR= 1. 27,95%CI[1. 21,1. 34],P<0. 000 01). Based on the routine therapy,the total effective rate of Yupingfeng Granules combined with pidomod in the treatment of recurrent respiratory tract infection was better than that of pidomod( RR = 1. 23,95% CI[1. 13,1. 35],P<0. 000 01). A total of 21 cases of adverse events were reported in this study,including 6 cases in the experimental groups combined with traditional Yupingfeng Granules therapy and conventional Western medicine therapy and 15 in the control group. The adverse events were mainly gastrointestinal reactions,such as fatigue,nausea and diarrhea,which can tolerate or disappear with no impact on treatment. The incidence of adverse events in the two groups was not statistically significant( RR = 0. 44,95% CI[0. 19,1. 03],P = 0. 06). The results showed no significant difference in the incidence of adverse events between the two groups during treatment. Based on the routine therapy,no adverse event was reported in Yupingfeng Granules pidomod vs pidomod,indicating that both groups were safe. The analysis showed that Yupingfeng Granules combined with routine Western medicine therapy or combined with pidomod could increase the level of immunoglobulin and T lymphocytes in children. Based on the existing data and methods,Yupingfeng Granules combined with routine Western medicine therapy for recurrent respiratory tract infection can improve the total effective rate,immune function and body immunity,with no serious adverse reaction. However,because of the low quality of the literatures included in this study,it is still necessary to adopt well-designed large-sample clinical trials in conformity to international standards to improve the quality of evidence.
Child ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Male ; Respiratory Tract Infections/drug therapy*

Xiyanping Injection is widely used in the treatment of respiratory infectious diseases. However,its package insert is still less instructive for physicians in understanding the specific clinical application of Xiyanping Injection. To discover potential clinical advantages of Xiyanping Injection,the team invited clinical experts of traditional Chinese medicine and western medicine from the field of respiratory diseases,pharmacists and methodologists of evidence-based medicine to compile the consensus. The consensus was based on a combination of clinical research evidence and expert experience,involving recommendations for clinical problems supported by clini-cal evidence as well as consensus suggestions for clinical problems with no clinical evidence. The consensus recommended the indication,timing of intervention,usage,dosage,course of treatment,combined medication of Xiyanping Injection used for adults,and introduced the safety and precautions of its clinical application. It is suitable for guiding clinical medical workers to rationally use Xiyanping Injection in the treatment of adult's respiratory infectious diseases.
Adult ; Consensus ; Drugs, Chinese Herbal/therapeutic use* ; Humans ; Medicine, Chinese Traditional ; Respiratory Tract Infections/drug therapy*

This study aims to evaluate the efficacy and safety of Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. Computer-based online searching of CNKI, VIP, SinoMed, Wanfang, ChiCTR, ClinicalTrials.gov, Cochrane Library, PubMed, EMbase, and Web of Science was performed to retrieve the randomized controlled trial(RCT) regarding Compound Qinlan Oral Liquid in the treatment of acute upper respiratory tract infection. In addition, manual searching of gray literature was conducted. After two evaluators independently selected articles, extracted data, and evaluated the quality of methodology included in the studies, Meta-analysis was carried out in RevMan 5.4 and trial sequential analysis(TSA) in TSA 0.9.5.10 Beta. GRADE profiler 3.6.1 was employed to evaluate the evidence quality. A total of 21 RCTs were included in this study, involving 2 651 patients(1 330 patients in the observation group and 1 321 patients in the control group). Meta-analysis showed that compared with conventional western medicine alone, Compound Qinlan Oral liquid improved the total response rate(RR=1.15, 95%CI[1.12, 1.19], P<0.000 01) without increasing the incidence of adverse reactions(RR=0.77, 95%CI[0.47, 1.25], P=0.16). The results of subgroup analysis are described as follows:(1) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid improved the total response rate(RR=1.10, 95%CI[1.05, 1.14], P<0.000 01) and shortened the time to symptom relief(SMD=-0.76, 95%CI[-1.02,-0.51], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=1.16, 95%CI[0.54, 2.47], P=0.71).(2) Compared with conventional western medicine alone, Compound Qinlan Oral Liquid + conventional western medicine improved the total response rate(RR=1.20, 95%CI[1.15, 1.25], P<0.000 01), decreased traditional Chinese medicine(TCM) syndrome scores(MD=-0.58, 95%CI[-0.75,-0.41], P<0.000 01), shortened the time to symptom relief(SMD=-2.44, 95%CI[-3.09,-1.80], P<0.000 01) and physical sign improvement(MD=-2.57, 95%CI[-4.11,-1.04], P=0.001), lowered the serum levels of inflammatory cytokines(SMD=-2.16, 95%CI[-2.61,-1.70], P<0.000 01), improved respiratory function indicators(SMD=1.48, 95%CI[1.00, 1.96], P<0.000 01), and enhanced the humoral immunity(MD=0.94, 95%CI[0.69, 1.18], P<0.000 01). There was no significant difference in the incidence of adverse reactions between the two groups(RR=0.57, 95%CI[0.29, 1.09], P=0.09). TSA showed that the cumulative Z curve of total response rate crossed the traditional threshold and TSA threshold, further confirming the clinical efficacy of Compound Qinlan Oral Liquid. The GRADE graded the evidence of the above outcome indicators as low or extremely low, and yielded weak recommendation. Compared with conventional western medicine alone, Compound Qinlan Oral Liquid can improve the total effective rate and reduce the time to symptom relief. The combination of Compound Qinlan Oral Liquid and conventional western medicine can improve the total response rate, mitigate the symptoms and improve the physical signs, reduce inflammation, and improve respiratory function and immunity of the patients with acute upper respiratory tract infection. In view of the limited number and quality of the included studies, the above conclusions still require high-quality RCT to provide evidence support.
Humans ; Drugs, Chinese Herbal/therapeutic use* ; Inflammation/drug therapy* ; Medicine, Chinese Traditional ; Respiratory Tract Infections/drug therapy* ; Treatment Outcome

Burn Units ; Cross Infection ; therapy ; Drug Resistance ; Humans ; Pneumonia ; etiology ; therapy ; Respiratory Tract Infections ; etiology ; therapy ; Ventilators, Mechanical ; adverse effects

To observe the outcomes of Traditional Chinese Medicine combined with CO_2 laser surgery on the clinical course and serum immunological indexes of Adult onset Recurrent Respiratory Papillomatosis.69 cases of adult recurrent respiratory papilloma patients who enrolled in Beijing Tongren Hospital from September 2014 to March 2016 were divided randomly into two groups.The Chinese medicine surgery group were treated with traditional Chinese medicine combined with CO_2 laser surgery and the surgery group were treated with CO_2 laser surgery alone.All patients were followed up for more than one year.Relapse time and Derkay score were examed and analyzed between two groups before and after treatment.The detection of aperipheral blood immunoglobulin,T cell subsets,percentage of B cell and NK cell and IgG subtype examed every six month.There was no significant difference between two group in Derkay score,lesion recurrence time and the index of immunology before the treatment(>0.05).However,the recurrence time after treatment [(14.11±1.57)months]prolonged than before treatment[(10.85±2.33)months]in the experimental group.The examination of IgG [(1 539.84±388.20)mg/dl],percentage of total T lymphocytes[(85.14±22.24)%],Th cells[(47.34±19.07)%],B lymphocytes[(12.55±5.26)%]in treatment of traditional Chinese medicine was higher than that before treatment of serum IgG [(1 225.14±260.27)mg/dl],T cells [(69.68±11.12)%],Th [(41.97±10.92)%],B lymphocytes[(10.30±5.45)%].The difference was statistically significant(<0.01).The curative effect of traditional Chinese medicine combined with laser surgery for the treatment of adult recurrent respiratory papillomatosis,can effectively prolong the recurrence time of patients,improve their immune cell antiviral ability and be worthy of clinical popularization and application.
Adult ; Humans ; Laser Therapy ; Medicine, Chinese Traditional ; Neoplasm Recurrence, Local ; Papillomavirus Infections ; drug therapy ; immunology ; surgery ; Respiratory Tract Infections ; drug therapy ; immunology ; surgery

A not pregnant 4-year-old Jersey cow was presented with the sudden appearance of respiratory noise, nasal discharge and moderate respiratory difficulty. Upon physical examination a snoring-like noise, extended head and neck position, exaggerated abdominal effort, bilateral nasal discharge and left prescapular lymph node enlargement were noted. Sub-occlusion of the initial portion of the respiratory tract was suspected. Radiographic and endoscopic examinations revealed a pedunculate mass on the dorsal aspect of the rhinopharynx, which was removed with endoscopically assisted electrosurgery. Histologic examination revealed a chronic pyogranulomatous inflammation with eosinophilic club-like bodies surrounding small colonies of rod-shaped bacteria. Results of histochemical staining were consistent with Actinobacillus-like bacteria and a diagnosis of respiratory actinobacillosis was reached. Surgery and antibiotic therapy were resolutive, as demonstated by an endoscopic check at the second month after surgery, even without the association of the traditional iodine cure, which is regarded as the treatment of choice for actinobacillosis.
Actinobacillosis/*diagnosis/drug therapy/microbiology/surgery ; Actinobacillus/physiology ; Animals ; Cattle ; Cattle Diseases/*diagnosis/drug therapy/pathology/surgery ; Female ; Respiratory Tract Infections/drug therapy/pathology/surgery/*veterinary ; Treatment Outcome