만성호흡기 질환으로 어른 아이 모두에게 생기는 만성적 염증질환 a chronic inflammatory disease both in children & adults
Characteristics 특성 airway hyper-responsiveness, obstruction, mucus hyper-production, airway wall re-modelling
알레르기염으로 인해 기관지가 과도하게 반복적으로 좁아지는 기관지 질환
특정 유발 원인 물질에 노출시 갑작스런 기관지의 염증을 유발 기관지 점막이 붓고 그로 인해 주위 근육이 경련을 일으키며 점액을 분비해 좁아진 기관지로 인해 기침, 천명 (숨쉴 때 쌕쌕거리는 소리), 호흡곤란, 가슴 답답함이 반복적으로 발생
만성시, 섬유화 및 기도개형이 발생하며 영구적 폐기능 저하를 초래 최근 전 세계적으로 환자 수가 증가 airway hyper-responsiveness, obstruction, mucus hyper-production, airway wall re-modelling
1% - 37% of children (depending on country) 1-37% 유아 (국가에 따라)
* 원인 * 유전적 요인 + 환경적 요인
대기 알레르겐
[꽃가루] 봄에는 수목, 여름에는 목초, 가을에는 잡초 화분 화분은 바람에 의해 수 km씩 이동하므로 도시에서도 높은 분포를 보입니다.
[곰팡이] 실외의 곰팡이는 종류에 따라 포자 형성시기가 다르기는 하나 한국은 우기인 7, 8월에 분포가 절정에 달합니다. 집 안에서는 습도가 높은 지하실, 창고, 부엌에 많고, 부패된 음식물에도 곰팡이가 숨기 쉽습니다.
청결유지와 실내 습도를 낮추는 것이 예방책입니다.
[집먼지진드기] 카펫, 침대 메트리스, 천으로 만든 소파, 커튼, 봉제인형 등에 서식합니다.
[바퀴벌레] 바퀴는 체부가 중요한 알레르겐입니다. 약제로 박멸하고 실내 특히 부엌을 깨끗이 하고 음식물 찌꺼기를 없애야 합니다.
[동물 알레르겐] 고양이는 털뿐 아니라 침에도 알레르겐이 존재합니다. 애완견도 문제가 되며 개와 고양이의 털 사이에는 교차 항원성이 존재합니다.
실내의 비특이적 자극원
[담배연기] 담배연기는 증상을 악화시키므로 천식 환자는 금연해야 합니다. 부모가 흡연할 경우에 아동의 천식 발생 빈도가 증가합니다.
[냄새] 음식 조리 시 발생하는 냄새, 향수, 각종 스프레이, 방향제, 난방기구의 냄새 등 천식 증상을 악화시킬 수 있으므로 음식을 조리할 때는 후드를 사용하고, 환기를 잘 해야 합니다.
* 증상 * 천 명: 숨을 들이쉬고 내쉴 때 나는 휘파람 비슷한 소리(색색거리는 소리) 기 침: 발작적이고 밤에 더 심합니다. 흉부압박: 가슴을 조이는 듯한 답답한 느낌 호흡곤란: 마치 빨대를 입에 물고 숨을 쉬는 것처럼 숨이 찹니다. 가 래: 끈끈하고 덩어리가 진 가래
[천식 증상은 복합적이며 자주 변합니다.] 환자에 따라 기침만 하거나, 호흡 곤란만 느낄 수도 있지만 대부분 복합적 증상을 나타냅니다. 때로는 오래 지속되고 반복되기도 하는 등 천식의 증상은 자주 변화하는 것이 특징입니다.
[환자에 따라 같은 양상으로 발작이 반복됩니다.] 어떤 사람은 감기 증상이 있다가 서서히 악화되어 심한 천식 발작을 일으키기도 하지만, 또 어떤 사람은 전혀 증상이 없다가 갑자기 심한 천식 발작을 일으키기도 합니다. 증상의 발현과 악화 정도, 회복 기간 등에서 환자마다 특징적 양상으로 반복되는 수가 많습니다.
* 진단 * 기침, 천명, 호흡곤란 등의 증상이 있으며, 특히 야간이나 새벽에 악화 되고 증상의 악화와 호전이 반복됩니다. 가족 중 천식 환자가 있는 경우가 많습니다.
진단 검사 [폐기능 검사] 폐활량과 호기 속도 측정을 통해 기관지가 좁아진 정도를 알 수 있습니다. 기관지확장제를 흡입한 후 변화여부를 보기도 합니다.
[기관지유발시험] 기도과민증의 정도를 검사하여 천식을 진단합니다.
[피부단자시험] 공기 중의 원인물질을 확인할 수 있습니다.
* 치료 * 목적 to achieve the full control for reducing the risk of future exacerbations and progressive loss of lung function 재발 위험을 줄이고 폐기능 상실 위험을 줄이는 것이고 improved asthma control & quality of life 천식의 증상을 완화하고 삶의 질을 높이는 것이 목적입니다.
many wrong diagnosis, poor treatments 특히 유아인 경우, 잘못된 진단과 적절하지 못한 치료가 많습니다
* Risk 위험인자 * poor control = increased risk of severe LU function damages asthma = requires a prolonged treatments
환경관리 : 원인이 되는 대기알레르겐과 비특이적 자극원 차단 약물치료 : 천식 증상이 심할수록 환경관리 외에 약물치료가 중요합니다.
천식 치료약물
standard albuterol inhaler effective to control acute symptoms
but not enough lose effectiveness over time and overuse
combine with drug therapy = better results
일반적으로 Puffer에 쓰는 약물은 급성시 효과를 보이지만
장기간 사용시 효과가 경감됩니다.
일반적으로 약물과 같이 쓰는 것이 효과를 증가시킵니다.
* high-dose inhaled corticosterioids (ICS) * reduce mucus secretion by inhibiting the release of secretagogue from macrophages
* long-acting β2-agonist (LABA) * effects on smooth muscle causes dilation of bronchial passages, vasodilation in muscle & LV, relaxation of uterine muscle, release of insulin
* omalizumab * IgE Fc Region controlling medication
일반적으로 장기적 질병 조절제와 속효성 증상완화제로 나눌 수 있습니다.
질병조절제 장기적으로 기도의 염증 반응을 억제, 천식 발작을 예방. 매일 규칙적으로 사용. 증상이 없어도 사용 예) 세레타이드, 심비코트, 풀미코트, 후릭소타이드 등
증상완화제 증상을 즉시 완화시켜 주는 속효성 기관지 확장제 약물이 직접 폐에 전달되어 다른 부작용 없이 효과를 낼 수 있도록 만들어진 약제 증상이 심할 때에만 사용. 사용법이 정확하지 않으면 약물이 제대로 폐에 도달X. 정확한 사용법을 익히는 것이 중요 예) 벤톨린
면역치료 알레르기 원인물질에 대한 과민반응을 억제하는 치료법 효과가 오랫동안 지속되며, 원인 물질에 다시 노출되어도 발작을 예방가능 적어도 3년 이상의 장기 치료 필요, 반드시 알레르기 전문의사에 의해 시행
however, underlying health may not improve
단 이러한 치료들은 단순히 증상을 완화시켜줄 뿐 근본 건강을 증진시켜주지는 않습니다.
* 주의사항 * 기관지천식의 관리원칙 처방된 약물을 정기적으로 사용
천식 = 장기적으로 꾸준히 관리해야 하는 만성적 질환으로
특히 질병조절제를 매일 투여하는 것이 천식관리의 핵심이고, 평상시 천식 악화 인자(알레르기 항원, 찬공기, 감기 등)을 가능한 한 피해야 합니다. 증상이나 최고호기유속을 잘 기록하면 천식관리에 큰 도움이 됩니다. 매일 증상과 폐기능을 기록하면 응급 상황에 알맞게 대처할 수 있으며 병원 진료시 의사의 처방 계획에 큰 도움이 됩니다. 규칙적으로 의사를 방문해야 합니다. 천식을 성공적으로 관리하려면, 의사와 환자가 함께 지속적으로 관리계획을 세워야 합니다. 천식발작시 응급대처법을 익혀야 합니다. 증상이 악화되었을 때를 대비하여
응급약제 투여방법, 병원 상담실 연락, 응급실 이송 등 대처방법을 정확히 알고 있어야 합니다.
overused asthma medications
약물과용시 anxiety, depressive mood disorders, tremors, cognitive & behavioral changes impair immune function by overuse combining with
numerous factors like air pollution, diet, lifestyle, overuse of other medications or antibiotics
by overuse of synthetic corticosteroids & adrenergic inhibitors = adverse effects on adrenal system. insufficient adrenal
▶ decrease cortisol levels
▶ affect the body's ability to fight infection
& control inflammatory increase,
& affect the sleep quality & general energy.
Discussion 소아를 치료시, 다음과 같은 의문은 중요합니다
in acute asthma, does high dose of medications (the addition of a nebulized anticholingeric agent (ipratropium bromide) to a nebulized β2-agonist) decrease the risk of admission to hospital? In young children with persistent asthma, does inhaled corticosteroid therapy result in growth impairment? In 3 year old children with asthma, is an MDI with spacer an effective means of delivering inhaled medication?
한의학 천식 = 효천증 병증 중 하나 효천증 = 천식성 기관지염, 폐기종, 심장성 천식 등 폐와 관련 된 병증을 포괄 효(哮)는 숨쉴 때 기도에서 그르릉 거리는 소리가 나는 것, 천(喘)이란 호흡이 급하고 촉박하게 내쉬는 걸 의미 천식은 기도가 좁아지면서 호흡이 원활하게 이루어지지 않아 일컫는 말입니다.
발작적인 기침과 거친 호흡 등이 기도점막의 염증을 원인으로 보기 때문에 항염증 작용을 갖는 약제 위주로 치료 마황이 배합되어 있는 갈근탕이 발작적 경증의 만성천식에 사용 한의학적인 치료에서는 담을 제거하는데 가장 중점을 두게 되는데, 먼저 증상을 감별하여 그 허실을 가린 다음 실증에는 풍한, 담탁을 제거시켜 주며, 허증에는 폐와 신을 보해 주면 증상 완화에 도움이 됩니다
천식 증상은 재발이 잦고, 증상이 계속적으로 나타나면 폐에 영구적인 손상이 남을 수도 있으므로 전문의를 찾아 정확한 진단을 받는 것이 중요합니다.
한방치료의 효과를 확신시키기에는 아직도 많은 장애들이 남아있습니다. 저널을 통해 효과를 증명하고는 있지만 그와 반대되는 저널 또한 많이 있습니다.
some RCTs = efficacy over acupuncture treatments acupuncture + routine treatments = better quality of life ↔ several meta-analyses = no consistent evidence of a significant benefit
TCM theory 한방에서 보는 천식은 당연히 폐의 기능을 주 원인으로 보고 있습니다.
Qi Control LU Qi moves downwards, KD holds it down LU control inhalation, KD control exhalation
LV Qi ascends LV & LU coordinate up and down Qi
Wheezing = difficulty exhaling the air trapped in Lungs the Kidney Qi unable to grasp the LU Qi
asthma = KD & LU Qi deficiency weak KD Qi can't hold the LU Qi, eventually the energy circulate without being replenished then stagnating in the LU
Allegic Asthmatic Reaction = an imbalance in LV Qi
Asthma 치료에 있어서 중요한 점은
일반적으로 증상이 일어났을때, 환자의 정신적, 신체적 상태가 불안정한 경우가 많기 때문에
우선적으로 해야 할 것은 심신안정입니다.
Steps of TCM Treatment Asthma, COPD = inherent angiety
Initial = calm shen, increase ability to cope with physical and mental stress
Pathology obstruction in LU Qi direction either by LU Qi deficient, KD Qi Deficient, LV Yang Rising, Phlegm obstruction by SP deficiency, external Wind
Wind is persistently lodged in the air passes, affect in producing bronchospasms @ allegen, cold, stress and so on
풍 또한 천식에서는 빼놓을수 없는 중요한 요인입니다.
Wind = important in Asthma Wind penetrates the Wei (esp. neck & shoulder) = colds, chills, fevers, moving aches & pains, sinusitis Weak Wei Qi can't fight,
Wind goes deeper,
enter the LU,
causes wheeze, SOB, cough, fear, panic and so on. (Asthma symptoms)
과도한 감정상태 또한 Trigger 가 될 수 있죠
Emotion = important in disease complex interconnections btn emotion & body Metal Energy = LU = Grief, Water = KD = Fear, Wood = LV = anger
extreme emotions injure their organs
그 외에도 LU 과 관련된 주위 장부의 역활또한 중요합니다.
possible causes of LU disease external pathology = Wind, Cold, Damp, Heat, Dryness SP disorders (mother affect the child) HT disorder (Fire attack Metal) LV disorder (Wood is counterdominant over the Metal)
Treatment Principles @ Acute Attack : relieve symptoms @ Severe Attack : WM treatment is recommended
다음은 CASE STUDY로 나온 CLINIC 에서 사용했던 Acupuncture 입니다.
오행이론에 따라 신장과 폐의 관계를 따집니다. KD7 = tonification point in excess condition of LU, reinford KD7 will reinforce KD function weak KD function obstruct water passage with LU
LU = mother of KD stimulation cause excess LU sucked by the Son (Kidney) = reduced LU + strenthened KD
** some pts might feel tired with combination of acu, if so, omit BL13 ** ** same combination can be used for prevention for autumn & winter asthma
한방 치료의 효과를 journal에서 확인하려면 다음과 같은 인자들을 확인합니다. a variety of cells and cytokines play major roles pathogenesis of airway inflammation in asthma patients may be related to the imbalance of Th1/Th2 Increased number and activation status of Th2 cells ▼ cause elevated secretion of Th2-type cytokines (IL-4, IL-5, and IL-10) (critical factors in the initiation and maintenance of airway inflammation)
* Medication * 대부분 쓰고 있는 천직치료제에는 위에서 언급한 것들을 함유하고 있습니다. series empirical prescriptions have a regulatory effect on leukotriene receptor gene expression & the imbalance of Th1/Th2 immune cells in the process of asthmatic attacks
esp. TCM formula could effectively control asthma attacks improve multiple lung function indices
to know the immunologic mechanism of TCM need to exam the expression of cytokines related to asthma, incl. IL-10, IL-17, TGF-β1, and MMP-9
*Journal* Formula * She Gan Ma Huang Tang* (Belamcandae and Ephedrine Decoction) is known as improving the immune function (prevent hypersensitivity)
Result TCM group a reduced expression of TGF-β1, decreased thickness of bronchial wall and smooth muscle reduction in inflammatory cells infiltration. Decreased level of IL-10 after 12 weeks (possible reduced secretion of IL-10, suppress airway inflammation, control asthma attack)
checking TH17/Treg & MMP-9 imbalance of Th17/Treg = highly relate to asthma MMP-9 = relate to airway remodeling by degrading collagen and promoting epithelial cell migration an effectively control asthma attacks and reduce the levels of IL-10, IL-17, and MMP-9 in peripheral blood.
*Chronic Bronchitis* chronic non-specific inflammation of bronchial mucosa & surrounding tissues by infected or non-infected factors
WM diagnosis for chronic brochitis is from cough to expectoration for 3 months with a history over 2 years. Can be classified as “cough”, “dyspnea” and “asthma” in TCM
TCM more than 20 classic formula available to treat cough & asthma
천식과 기침을 치료하는데는 약 20개 정도의 주 한방이 알려져 있습니다.
* Phlegm-Fluid lying latent in LU * Xiao Qing Long Tang Xiao Qing Long Jia Shi Gao Tang Hou Pu Ma Huang Tang She Gan Ma Huang Tang Zhen Wu Tang Jia Gan Jiang Xi Xin Wu Wei Zi SI Ni San Jia Wu Wei Zi Gan Jiang Liu Wei Xiao Chai Hu Tang
* Internal Phlegm Retention * Zao Jia Wan Ting Li Da Zao Xie Fei Tang Gua Lou Xie Bai Bai Jiu Tang Wei Jiang Tang Jie Geng Tang Jie Geng Bai San
* Upper Jiao Yang Deficiency * Gan Cao Gan Jiang Tang
* Excessive Fluid * Shi Zao Tang Gui Ling Wu Wei Gan Cao Tang Qu Gui Jia Gan Jiang XI Xin
* External Syndrome * Xiao Xu Ming Tang Ma Huang Yue Bi Jia Ban Xia Tang Gui Zhi Jia Hou Pu Xing Zi Tang
* Cough & Asthma * Xing Su Er Chen Tang Ban Xia Hou Pu Tang Gui Zhi Fu Ling Wan Ma Huang Fu Zi Xi Xin Tang
* Asthma with Blood Stasis * Da Chai Hu Tang + Gui Zhi Fu Ling Wan /or/ Tao He Cheng Qi Tang
* Congested Fluid Retention * She Gan Ma Huang Tang Xiao Qing Long Jia Shi Gao Tang Ge Gen Tang Ling Gan Wu Wei Jiang Xin Xia Xing Tang
어떤 방제를 써야할지는 그 증상을 보고 패턴을 따라 해야겠지요
i.e. chest distress, dyspnea, feeling of expansion in the eyes = Yue Bi Jia Ban xia Tang sweating, aversion to wind, chronic bronchitis by exogenous evil = Gui Zhi Jia Hou Pu Xing Zi Tang
*Journal* Clinical Study:Effect of Traditional Chinese Medicine on Inflammatory Mediators in Pediatric Asthma
Objective To observe the effects of empirical prescriptions of TCM on inflammatory mediators in pediatric asthma and to explore the underlying molecular mechanism in the treatment of asthma
Groups QT= 182 children with asthma Groups= randomly selected (TCM group (n=97)+ SM Group (n=85)) ** TCM = Tranditional Chinese Medication ** SM = salbutamol and Montelukast
Procedure TCM group = treatment with a series of empirical prescriptions of TCM SM group = treatment with salbutamol and montelukast Length 12 weeks 35 TCM pts + 34 SM pts = provide venous blood
Methods Real-time PCR (the mRNA expression levels of interleukin- (IL-) 10, IL-17, matrix metalloproteinase-9 (MMP-9), and transforming growth factor β1 (TGF-β1) in peripheral blood mononuclear cells before and after treatment) Enzyme-linked immunosorbent assay ( IL-10, IL-17, MMP-9, and TGF-β1 in peripheral blood before and after treatment)
no significant difference between the two groups regarding the levels of IL-10, IL-17, TGF-β1, and MMP-9 = No significant differences btn two groups
** The difference of the level of IL-17 was negatively correlated with
the change of C-ACT score in TCM group and SM group.
Conclusion TCM has a regulatory effect on the balance of some inflammatory mediators in pediatric asthma.
CASE STUDY Experts' Experience: Clinical Application of the TCM Classic Formulae for Treating Chronic Bronchitis possible Formulas to relieve chronic bronchitits
Principle of Treatment reconciling Shao Yang warming the LU relieve Fluid retention
Shao Yang Disease is important in Asthma
Shao Yang Syndrome Differentiation #1 simple disease (Shao Yang syndrome only) = must reconcile Shao Yang
#2 Shao Yang & Yang Ming disease Shao Yang transfer to Yang Ming/Yang Ming transfer to ShaoYang) = thirst, desire for cold, high fever, reddish complexion,no aversion to cold, cough w. yellow phlegm
#3 Shao Yang + Tai Yin (Hyperfunctioned SP & ST + Shao Yang syndrome) = bitter taste @mouth, pharynx dryness, daze, altering btn cold and heat, full &discomfort @ chest / hypochondrium, poor appetite, headache,abdominal pain, wiry pulse Liu Wei Xiao Chai Hu Tang can be used (Modified Minor Decoction of Bupleurum)
* Liu Wei Xiao Chai Hu Tang * Chai Hu (Radix Bupleuri) = reconciling Shao Yang Huang Qin (Radix Scutellariae) = clear heat of Shao Yang Ban Xia (Rhizoma Pinelliae) = regulating ST, alleviate vomit Gan Cao (Radix Glycyrrhizae) = strengthen MJ, replenish Qi Gan Jiang (Rizoma Zingiberis) = warm LU, dissipate excessive fluid to relieve cough Wu Wei Zi (Fructus Schisandrae) = astringe LU to relieve cough
CASE female, age 33 chronic bronchitis for 32 years Cough started from 1 y.o. No obvious predisposing causes cough by common cold, cooking smoke, tired, spoke loudly @winter occasional dry cough with little white phlegm worsen @spring severe emotional stimulation worsen symptoms
WM diagnosis
chronic bronchitis taking WM medication – no obvious results
2 weeks prior that symptoms worsen = dry cough worsen with itchy & belching throat, depression, irritability, no sweat, facial acne, accelerated heart rate & blood pressure
Blood pressure: 145/90 mmHg
Heart rate: 105 beats/min
harsh breath sound @ LU
Thin tongue with less fur congenital short lingual frenum thready, weakened, rapid pulse
no sign in the phlegm retention, the exterior syndrome, the Yang deficiency,
Formula Chai Hu 12g Huang Qin 10g Ban Xia 12g Gan Jiang 6g Wu Wei Zi 6g Gan Cao 6g
Result after 3 doses = cough improved 2 more doses = itchy & belching disappeared another formula prescribed for facial acne after that no recurrence (follow-up survey for half a year)
* She Gan Ma Huang Tang * Belamcanda & Ephedra Decoction known formula for asthma, dyspnea, cough, anhelation,
Pathogenesis Exterior Cold, Interior Fluid Retention, Cold Phlegm-Fluid lying latent in the Lung
Principle of Treatment
Warm LU to eliminate Cold dissipate excessive fluid relieve cough
Formula She Gan (Rhizoma Belamcandae) = relieve sore throat, dissove phlegm Ban Xia (Rhizoma Pinelliae), Sheng Jiang (Rhizoma Zingiberis Recens) = dissipate excessive fluid Ma Huang (Herba Ephedrae) = ventilate LU to relieve asthma, relieve the exterior symptom, dispel cold. Zi Wan (Radix Asteris), Kuan Dong Hua (Flos Farfarae) = moisten LU, lower adverse Qi, dissolve phlegm, relieve cough Xi Xin (Herba Asari) = expel wind & cold, warm LU to reduce watery phlegm Wu Wei Zi (Fructus Schisandrae) = astring LU to relieve cough Hong Zao (Fructus Ziziphi Jujubae), Sheng Jiang (Rhizoma Zingiberis Recens) = strengthen Qi @ MJ
superficial wind cold
syndrome. Aversion to cold, nasal obstruction, watery nasal
discharge, headache, pain & rigidity of back
Ma Huang/ Gui Zhi / Bai Shao
CASE female: age 56 cough & asthma @ winter for 10 years white phlegm, dyspnea, phlegm sound in throat (worsen by cooking smoke)
WM diagnosis acute attack of chronic bronchitis
WM treatment anti=inflammation, spasmolysis, expelling phlegm and so on
Result of WM No obvious result
2 months prior to worsen symptoms by cold stimulation, chest distress, cough, SOB, cough up white phlegm, heavy cough sound, phlegm sound @ throat, headache (worsen by cooking smoke & breathing in cold iar) pink tongue, thin white fur, deep pulse
Diagnosis Cold Phlegm Fluid lying latent in the Lung, abnormal rising LU Qi
principle of treatment warm LU to eliminate cold dissipate excessive fluid relieve cough
Formula She Gan 10g Sheng Ma Huang 6g Ban Xia 12g Zi Wan 10g Kuan Dong Hua 10g
Xi Xin 6g Wu Wei Zi 6g Sheng Jiang 15g Hong Zao 5 pieces
Result after taking 1 dose = symptoms eased taking 2 more doses = all symptoms disappeared with no recurrence
Auricular Acupuncture
이침
to help energy imbalance Shen Men, Kidney (for Yin & Yang balance) LV, LU, SP for Blood deficiency LI, Hunger, Anxiety
by treat Yin & Yang balance, & Blood Deficiency = will automatically treat Qi deficiency twice a week 10 sessions then maintain once a week 10+ sessions
Diet avoid drink worsen KD Qi soft drinks, coffee, matte tea Yang Xu = avoid raw foods like vegetables & raw fruits (except apples, papaya, lemon)
recommended food smooth & even flow of energy in LU, KD & LV avoid all allegen foods: dairy products, eggs, wheat products, chocolates, citrus fruits, juice
Exercise breathing excercise, swimming, yoga, tai chi @ normal
REFERENCE from [Daum백과] 천식 – 질병백과, 서울아산병원
[네이버 지식백과] 천식 [asthma] (서울대학교병원 의학정보, 서울대학교병원)
[네이버 지식백과] 환절기 비상! 기온 차로 더욱 심해지는 기침과 천식에 좋은 생활요법 (자생한방병원 건강칼럼)
Du, H., Wang, Y., Shi, Y., Yu, J., Sun, W., & Zhang, Y. (2016) Clinical Study: Effect of Traditional Chinese Medicine on Inflammatory Mediators in Pediatric Asthma Mediators of Inflammation. Vol 2016 doi: 10.1155/2016/5143703
Mirra, V., Montella, S., & Santamaria, F. (2018) Pediatric severe asthma: a case series report and perspectives on anti-IgE treatment BMC Pediatr. 2018; 18:73 PMID:29466963 doi: 10.1186/s12887-018-1019-9
liebertpub.com/doi/abs/10.1089/acu.2018.29078.cpl?journalCode=acu ** Typical Syndrome Chai Hu syndrome = altering cold and heat (chill and fever) depression, poor appetite, interversion(tendency of shy) (= LV Qi stagnation) Gan Jiang syndrome = cough worsen by winter, better in spring Ban Xia syndrome = cough by belching
Integrated traditional Chinese medicine for childhood asthma in Taiwan: a Nationwide cohort study.
BMC complement Altern Med, 14, 389.
doi: 10.1186/1472-6882-14-389
DATA: Longitudinal Health Insurance Database 2000, the National Health Research Databases
Participants: age under 15, WM diagnosed QT: 12850 (12435 from non TCM group, 406 from TCM treatment, 9 in Outpatient Healthcare Quality Improment(OHQI) project with TCM treatment) 3 groups from 15 hospitals involved 35 TCM physicians Prescribed Xiao Qing Long Tang + Ding Chuan Tang for Cold or Phlegm Heat pattern Acupuncture: LU10. ST36 Herbal Paste: BL12, BL13, Du14
Limitation ONLY 9 were under OHQI treatment (number too small) Children age: no one under age 6 Diagnostic methods: possible common symptoms for infants or toddlers. no proper data for the exact diagnosis of astham missing details of treatment: size of acu needle, duration of insertion, depths on each points. dosage & frequency of herbal medicine according to the age,
STUDY2
(Du et al., 2017)
Du, H., Hu, H., Li, S., Shi, Y., Sun, W., Wang, Y., … Zhang, Y. (2017).
Prescriptions from Traditional Chinese Medicine compared with salbutamol and montelukast for the treatment of pediatric asthma: a randomized controlled trial.
Journal of Traditional Chinese Medicine, 37(4), 522-529.
doi: 10.1016/S0254-6272(17)30159-0 a randomized controlled trial: comparing the effects of TCM formula & WM medication
Mahuang 9g, Ku Xing Ren 9g, She Gan 6g, Huang Qin 9g, Jiang Can 9g, Huang Qi 9g, Bai Zhu 9g, Shan Yao 15g, Tai Zi Shen 9g, Fu Ling 12g Ba Ji Tian 9g WM Prescribed: salbutamol, montelukast Result: TCM more effective ( P < 0.001)
Strength the childhood asthma control test
(CACT: sore in LU fucntions)
Limitation single blinded test (less demand characteristics and more risk of placebo effect rather than double or triple blind setup) small sample size exampted severe cases (light evidence for the true effectiveness of TCM formula)
STUDY3
(Chang et al., 2005)
Chang, T.T., Hsu, C.H., Lu, C.M. (2005).
Efficacy and safety of modified Mai-Men-Dong-Tang for treatment of allergic asthma.
Participants: QT: 100 (children age: 5 - 18. mild to moderate asthma cases; 3 groups (Gorup A: 40, Group B: 40, Group C (Placebo): 20), Duration - 4 months Mai Men Dong Tang (dosage: 80 & 40 mg differently.
Results measured via Forced Expiratory Volume in one second (FEV1: reliable measurement) TCM group showed effectiveness (P < 0.05)
Limitation no dose response effect between the two TCM treated groups. small sample size higher withdrawals rate: 17.5%, 27.5% and 15% of each groups standard in recruit: not mentioned
STUDY4
(Liang et al., 2016)
Liang, Z., Ou, A., Song, P., Wang, Q., Zeng, L. (2016).
Clinical Efficacy and Safety of Chinese Herbal Medicine Auxiliary Therapy for Childhood Cough Variant Asthma: A Systematic Review and Meta-analysis of 20 Randomized Controlled Trials.
Internal Medicine, 55, 2135-2143.
doi: 10.2169/internalmedicine.55.5546 Systematic Review: Meta Analysis of Randomized Controlled Trials
Participants: QT: 20 trials, 1590 patients in cough variant asthma (age: 0 to 14) Interventions were Chinese herbal medicine plus pharmacotherapy (PT) comparing with PT alone
Results evaluate through the assessment tool for risk of bias & analysed base on the Cochrane Handbook Herbal Medicine Group showed a significant difference
(3.52, 95%CI 2.57-4.82, P<0.00001
Limitation unclear trials
(missing or omitted information in trials) Insufficient blinding all trials does not present same placebos for the blinding operation
Participants QT: 90 (age: 7-15; Duration - 6 months. Group A: 43 Group B: 47) Group A: 5 herbal formula capsule 3g/day Group B: Pleacebo pts were recruited @ 2 major government hospital in Hong Kong
Result Significant LU function improvement @ Group A (used FEV1. P< 0.05) various type of diagnosis were used
Strength small drop out number
Limitation small sample size lack of description of herbal medicine
Evaluation of efficacy of traditional Chinese medicines in the treatment of childhood bronchial asthma: clinical trial, immunological tests and animal study.
(random group; 6 months Group A, B: Liu Wei Di Huang Wan, Shen Ling Bai Zhu San, Jia Wei Si Jun Zi Tang,
Group C: Placebo
Result Both TCM and Placebo group = overall improved symptoms much better result in TCM group (P< 0.05)
Strength Various types of measurement were used
(clear result in the immunoregulatory function, inflammatory mediators and effect of TCM asthmatic reaction) TCM practitioner & Pharmacis involved to exam compliance and adverse effects of medications Detailed composition of TCM medication