The Study On The Mechanism Of "Clearing Heat And Resolving Phlegm" In Treatment Of Acute Exacerbation Of Chronic Obstructive Pulmonary Disease By Improving Airway Inflammation And Mucus Hypersecretion

Objectives: To explore the mechanism of Tan-Re-Qing with "clearing heat and resolving phlegm" in treatment of acute exacerbation of chronic obstructive pulmonary disease by improving airway inflammation and airway mucus hypersecretion.Methods: A randomized controlled trial (RCT) was designed. Ninety in-patients with AECOPD were randomly and averagely allocated in Tan-Re-Qing group, Mucosolvin group and control group. Symptom scores of traditional Chinese medicine (TCM), lung function and the plasma concentration of interleukin (IL)-8 and IL-10 and neutrolphil elastase (NE) were detected.Results: (1)Baseline levels: there were no statistically significant in gender, age, body weight ,course of disease, body mass index, blood gas analysis, severity, symptom scores of TCM, pulmonary function among three groups at baseline (all P>0.05). (2) Signs and symptoms of TCMxough, sputum amount, expectoration, dyspnea, fever, coated tongue, pulse tracings were improved obviously in the Tan-Re-Qing group (P<0.05), and there was much more improvement in cough, sputum amount, expectoration in Tan-Re-Qing group compared with control group (P<0.05) but not Mucosolvin group. There was statistically significant in improvement of fever and coated tongue in the Tan-Re-Qing group in comparison with the Mucosolvin group and control group obviously (P<0.05). (3) Lung function: there was markedly improvement in FEV₁ and FVC among three groups after treatment but no statistically significance was found (P>0.05). (4) Laboratory index: plasma concentration of IL-8, IL-10, NE decreased markedly in the Tan-Re-Qing group and the Mucosolvin group (P<0.05), and only IL-8, IL-10 in the control group except NE. The change of IL-8 before and after treatment was higher in the Tan-Re-Qing group than in both the Mucosolvin group and control group, the change of IL-10 and NE was higher in the Mucosolvin group than in both the Tan-Re-Qing group and control group, but there was no statistical significance in the change of IL-8, IL-10, NE among three groups (all P>0.05). (5) Outcome of disease: the markedly effective rate and the effective rate were 82.14% and 92.85% in the Tan-Re-Qing group, 83.33% and 91.67% in the Mucosolvin group, and 57.69% and 84.61% in the control group respectively.Conclusion: Tan-Re-Qing injection with "clearing heat and resolving phlegm" could improve signs and symptoms of TCM in the treatment of AECOPD, in which it would be involved in the decrease of IL-8, NE level and delaying the decrease of IL-10 level in mechanism.