Effectiveness Analysis Of Chinese Patent Medicine Combination With Antibiotics Used In Hospitalized AECOPD Based On Electronic Medical Data

Chronic obstructive pulmonary disease (COPD) is a common respiratory disease which seriously affects the quality of life of patients. The symptoms of COPD are described in the diseases according to the diagnostic criteria of Traditional Chinese Medicine (TCM), such as cough, wheezing, dyspnea, and lung distention. The current focus is to explore the effective treatment of COPD with integration method.Section I the research of Traditional Chinese Medicine and Western Medicine in diagnosing and treatment COPDIt is the introduction of COPD epidemiology, definition, staggered, Chinese understanding of COPD, as well as progress in Western Medicine and TCM for COPD drug therapy. The incidence and mortality of COPD are high. The main pathological mechanisms of COPD are Oxidative stress, protease/anti-protease imbalance, the presence of inflammatory cells and inflammatory factors. Traditional Chinese Medicine (TCM) pathogenesis of COPD was lung deficiency and the body’s ability to withstand exogenous pathogen decline. TCM treatments of stable COPD methods include invigorating lung, spleen and kidney and removing blood stasis. TCM treatments of AECOPD methods are promoting blood circulation and removing blood stasis, expectorant cough. Inhaled bronchodilators and corticosteroids are treatment methods for stable COPD in Western medicine.The drugs for acute exacerbation include antibiotics, bronchodilators, and corticosteroids. It can be concluded that there are a good theoretical basis and clinical efficacy of combination therapy with Western Medicine and TCM. COPD is closely related with infection. Adenovirus, Chlamydia pneumoniae, lower respiratory bacterial colonization associated with the occurrence of COPD. Infection is the main cause of AECOPD. The pathogens include viruses, bacteria, mycoplasma and Chlamydia. Anti-infective therapy plays an important role in the treatment of AECOPD. Anti-bacterial treatment can prolong time of AECOPD again, improve the condition and prognosis. Some Chinese herbs which may be single or compound have an effect on anti-virus and inhibiting drug-resistant bacteria occur. Chinese herbs can inhibit the bacteria generate energy in the body, enhance neutrophil phagocytosis, reduce the release of bacterial endotoxin and inhibit the formation of bacterial biofilms. Chinese herbs reverse bacterial resistanc by eliminating R plasmids, inhibiting bacterial efflux pump, inhibition β-lactamase inhibition resistance gene expression.It can be inferred that the use of antibiotics and Chinese herbs in combination may have a synergistic effect and could lead to better treatment outcomes.Section II Effectiveness analysis of Chinese Patent Medicine combination with antibiotics used in hospitalized AECOPD based on electronic medical data.Background: Anti-infective therapy plays an important role in the treatment of AECOPD. Studies have shown that Chinese medicine can improve the condition of patients AECOPD. These studies have strict inclusion and exclusion criteria, strict drug dose, duration of treatment, strict clinical criteria. These well-designed ideal world researchs do not represent our true medical practice environment. The Chinese Patent Medicine (CPM) is widely used in the real clinical circumstances. However treatment with CPM under the rule of syndrome differentiation may not be implemented very well. And the effect of CPM on hospitalized COPD patients using antibiotic is not clear.Objective:To determine, from a large multi-hospital information system database, incidence, associated factors, and treatment strategy, the influence of CPM in patients undergoing chronic obstructive pulmonary diseas. To assess the actual effect of the combination of CPM and antibiotics.Methods:Data in this study are electronic medical records (EMR) from hospital information system (HIS) from 20 hospitals (including both Western Medicine (WM) and Traditional Chinese Medicine (TCM) hospitals) in China, which were standardized and integrated into a centralized data warehouse by Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Science. The data warehouse included baseline characteristics, diagnoses, treatment and lab examinations information of inpatients. The bias of confounding factors was balanced with propensity score analysis. Multiple Logistic Regression Model was used to estimate the treatment effects of CPM on hospital mortality, the incidence of respiratory failure and heart failure in hospital between CPM combination with antibiotics group (using CPM group) and antibiotic group (nonusing CPM group)Results:26,491 cases that were above 18-years-old were enrolled. Median age was 75 years old.18,352 cases were male, accounting for 69.28%, female 6,811,25.71%. The peak age section was 75-89 years. Cardiovascular disease was at top of comorbiditis list (8996 patients with hypertension,8149 patients with coronary heart disease; 6030 patients with heart failure). The ratio of patients with acute illness is 20.55%, the rate of emergency admissions 19.75%. The median days in hospital were 11 days. And it was longer in men than women. The median length of hospital stay decreased from 2008 to 2010. The median costs of hospitalization for all patients were 11,221 Yuan. It did not change significantly from 2008 to 2010. The cost paid by medical insurance increased and personal commitment reducing year by year from 2008 to 2010. The hospital mortality of patients with COPD was 2.28%,2.30% for male and 2.23% for female. There were 1167 cases with discharged TCM syndromes description. Major syndromes of patients were phlegm and blood stasis obstructing lung (32.90%), phlegm dampness obstructing the lung (26.56%), Qi deficiency syndrome (28.96%) including lung and kidney Qi deficiency, lung spleen Qi deficiency, and spleen Qi deficiency. The major elements of syndrome were phlegm (60.67%), blood stasis (45.33%), deficiency (29.13%) and dampness (27.85%). And the injured TCM locations of COPD were mainly involving the lung (82.26%), followed by the kidney (10.20%) and spleen (6.86%). The order of the top 5 categories of CPM were promoting blood circulation for removing blood stasis (22.43-34.32%), relieving cough and plegm (21.86-24.6%), righting drugs (11.33-13.38%), heat clearing and detoxifying (11.39-12.69%), and Tongfu (10.41-11.76%). The β-lactam antibiotics, theophylline, dexamethasone were as the commonly used medicine for respiratory system.20064 hospitalized COPD cases using antibiotics were between 45 and 89 years old. And 90.8% cases among them came from Western Hospital,80.7% cases using Chinese patent medicine and 57.6% cases were complicated with cardiovascular disease. The utilization rate of CPM in COPD-CVD was higher than COPD-NOCVD (86.4% vs.72.9%, p< 0.05). And then the patients using antibiotics were divided into patients with cardiovascular disease (COPD-CVD) and those without cardiovascular disease (COPD-NOCVD). Statistical differences were found between between using CPM and nonusing CPM group such as number, sex, age, condition hospitalization (acute and general), manner of admission (emergency, outpatient) and the combined disease, length of stay, hospital costs, drug treatment (p< 0.05). Data were processed by age, sex, admission condition for 1:1 matching. And then thirty-nine confounding factors such as age, sex, and cost were balanced with the propensity score analysis method between using CPM and nonusing CPM. Multiple Logistic Regression results was as followed:In the hospitalized COPD-CVD patients negative relationship existed between using CPM and hospital mortality (r=-12.944, p< 0.005). No relationships were found between using CPM and the incidence of respiratory failure (r=-0.402, p=0.6874) and heart failure in hospital (r=-0.584,p=0.55905). In the hospitalized COPD-NOCVD patients, the incidence of respiratory failure was negative related to the application of CPM (r=-2.378, p< 0.05). No relationship was found between using CPM and hospital mortality (r= 1.498, p=0.13425).Conclusion:COPD hospitalization increased with increasing age, more men than women. It is weakening that the effect of shorten days in hospital on reducing costs in recent years. Increased proportions of costs are paid by Medicare.The most common complication of COPD hospitalization was cardiovascular disease. The incidence of lung cancer in male was significantly higher than females. Traditional Chinese Medicine (TCM) pathogenesis of COPD were mainly phlegm, blood stasis, deficiency, wet and injured TCM location of COPD mainly involving the lung, followed by the spleen and kidney. Phlegm and blood stasis obstructing the lung, phlegm and wet obstructing the lung, Qi deficiency syndrome were the main TCM syndrome. Commonly used in Chinese patent medicine were promoting blood circulation for removing blood stasis, relieving cough and plegm, righting drugs, heat clearing and detoxifying, and Tongfu. Infection may be the main reason for hospitalization. Application of antibiotics was in line with the guidelines recommend, and bronchodilators and corticosteroids application did not meet the guidelines recommend. Clinical application of Chinese medicine as a whole meets the basic TCM pathogenesis of COPD patients hospitalized. The ratio of using CPM and antibiotics were high in hospitalized COPD. Propensity analysis applied to balance the impact of confounding factors, was suitable for analyzing HIS data. Some types of CPM, such as promoting blood circulation for removing blood stasis, relieving cough and plegm, righting drugs, heat clearing and detoxifying, and Tongfu, may have a synergistic effect with antibiotics.CPM combination with antibiotics can reduce incidence of respiratory failure of hospitalized patients with COPD, and decreased the mortality of hospitalized COPD patients with cardiovascular disease.