Evaluation of efficacy of traditional Chinese medicines in the treatment of childhood bronchial asthma: clinical trial, immunological tests and animal study. Taiwan Asthma Study Group.
Traditional Chinese medicines (TCM) have been used to treat bronchial asthma for several centuries and a certain degree of clinical benefit has been observed; however, scientific substantiation is lacking. A multicenter, double-blind and placebo-controlled study was therefore conducted to evaluate the clinical efficacy in terms of symptom score, medication score, morning and evening PEFRs, and changes of immunoregulatory function, such as distribution of lymphocyte subsets and in vivo and in vitro production of lymphokines (IFN-gamma and IL-4) and inflammatory mediators (histamine, PGE2 and LTC4). Furthermore, the protective effect of TCM on the late asthmatic reaction (LAR) was evaluated by using asthmatic guinea pigs. Three hundred and three asthmatic children were classified by Chinese doctors, according to a standardized questionnaire designed on the basis of basic logic of Chinese medicine, into three groups of specific constitution (group A, B and C). Group A consisted of 32 herb A-treated patients and 34 placebo-treated; group B, 74 herb B-treated and 64 placebo-treated; and group C, 55 herb C-treated and 44 placebo-treated. The study period was six months. The results were: 1) Both treatment group and placebo group showed an improvement in all clinical parameters, thus demonstrating a placebo effect. However, the improvement was usually greater in the former than the latter, although only the difference in PEFR was significant; 2) Herb A could increase total T cell and decrease B cell; 3) Herb A and B enhanced production of PGE2 but not LTC4, IFN-gamma and IL-4; 4) There was a general tendency for in vivo and in vitro production of histamine to decrease at the end of study in both treatment group and placebo group; however, the decrease was significantly greater in the former than the latter; 5) In asthmatic guinea pigs, 10-day's pretreatment with Chinese herbs could reverse the decrease of sGaw, suppress eosinophilia in bronchoalveolar lavage fluid (BALF), prevent the eosinophil infiltration of airways, increase PGE2 production and decrease LTC4 production in serum and BALF. Thus, traditional Chinese medicines did show a certain degree of clinical efficacy. The decreased production of histamine and LTC4, increased production of PGE2 that were found in both asthmatic children and asthmatic guinea pigs, and prevention of occurrence of LAR by suppressing eosinophil infiltration of airways and preserving airway conductance that were observed in asthmatic guinea pigs after allergen challenge might be used to account partly for the effectiveness.
Hsieh
K H
KH
Chang Gung Children's Hospital, Chang Gung Medical College, Taiwan, Republic of China.
D000293:Adolescent; D000818:Animals; D001249:Asthma / Q000188:drug therapy*; D001980:Bronchi / Q000473:pathology; D001992:Bronchoalveolar Lavage Fluid / Q000737:chemistry / Q000166:cytology; D002648:Child; D015232:Dinoprostone / Q000096:biosynthesis / Q000097:blood; D004311:Double-Blind Method; D016903:Drug Monitoring; D004365:Drugs, Chinese Herbal / Q000627:therapeutic use*; D004802:Eosinophilia; D004804:Eosinophils / Q000276:immunology; D005260:Female; D006168:Guinea Pigs; D006632:Histamine / Q000096:biosynthesis / Q000097:blood; D006801:Humans; D007371:Interferon-gamma / Q000096:biosynthesis; D015847:Interleukin-4 / Q000096:biosynthesis; D007668:Kidney / Q000502:physiology; D017997:Leukotriene C4 / Q000096:biosynthesis / Q000097:blood; D016131:Lymphocyte Subsets / Q000276:immunology; D008297:Male; D010047:Ovalbumin / Q000276:immunology; D010366:Peak Expiratory Flow Rate; D012720:Severity of Illness Index; D013154:Spleen / Q000502:physiology; D011795:Surveys and Questionnaires; D014611:Vaccination
D004365:Drugs, Chinese Herbal; D015847:Interleukin-4; D017997:Leukotriene C4; D006632:Histamine; D007371:Interferon-gamma; D010047:Ovalbumin; D015232:Dinoprostone