| ObjectivesIn 2004,the World Allergy Organization(WAO)proposed the new medical diagnostic term of Combined Allergic Rhinitis and Asthma Syndrome(CARAS),which mainly manifests as concurrent,chronic inflammation of both upper and lower respiratory tract coupled with high reactivity symptoms,such as nasal itching,runny nose,nasal congestion,sneezing,coughing and wheezing.Epidemiological surveys show that 60-78%of asthma patients have comorbid allergic rhinitis[16],and 20-38%of allergic rhinitis patients have comorbid asthma[25].At present,diagnosis is based on the criteria of both allergic rhinitis and bronchial asthma;and the relevant guidelines recommend inhaled glucocorticoid-based treatment that targets the upper and lower respiratory tract inflammation.In clinical practice,however,a failure in establishing a joint diagnosis of rhinitis and asthma often results in the two being treated separately,leading to repeat treatment,overlapping prescription,bringing about increased economic burden,poor compliance and efficacy,and higher chances of side effects.Therefore,it is imperative to find a safe and effective Traditional Chinese Medicine(TCM)therapy.Through long-term clinical observation,my supervisor has summarized the pathomechanism of adult CARAS to be "yang and qi deficiency,phlegm damaging lung,lung failing to control ascent and descent of qi";and has proposed "reinforcing qi and warming yang,expelling wind and treating phlegm,diffusing lung to calm panting" as a treatment method.Preliminary results have shown that using "Shenge Canglong Decoction" as the basic formula along with additional herbs improves upper and lower respiratory tract symptoms and reduces the frequency of acute episodes.On the basis of joint diagnosis,the study adopts internationally-accepted study design,reporting standards and evaluation indices to carry out an observational study of the above-mentioned treatment method to assess its efficacy,discuss its possible mechanism of action,and lay the foundation for future,confirmatory studies of TCM treatment of CARAS.MethodsAdopting a prospective,observational study design(case series report),CARAS patients(TCM syndrome:yang and qi deficiency,phlegm damaging lung,lung failing to control ascent and descent of qi)were recruited from the Respiratory and Otolaryngology outpatient clinics of Dongzhimen Hospital from June 2015 to March 2017.After 2 consecutive courses of treatment(12 weeks per course)with "Shenge Canglong Decoction",the rhinitis and asthma symptom scores and related laboratory test results(including the efficacy and safety indices)at various time points,before and after treatment,were observed.Results:1.General Situation Analysis:A total of 45 patients were included and currently,24 patients have completed the study-15 cases completed 6 months of treatment and 9 cases dropped out.There were 7 males and 17 females,between 17 and 68 years of age,with an average age of 43.79±12.29(years).The longest history of rhinitis was 37 years,while the shortest was 4 months;with the average at 141.67±97.88(months).The longest history of asthma was 25 years,while the shortest was 1 month;with the average at 60.92±70.432(months).Among rhinitis cases,there were 4 intermittent cases,20 persistent cases;in terms of severity,there were 5 mild cases and 19 moderate to severe cases.Among asthma patients,there were 2 acute cases and 22 chronic cases;in terms of severity,there were 3 intermittent cases,10 mild sustained cases and 11 moderate persistent cases.2.Efficacy Analysis:Statistical analysis of the 24 cases demonstrated that the treatment can improve the main efficacy indicators of CARAS patients,but the results was not obvious for all laboratory indicators.Details are as follows:2.1 Main Efficacy Indicators?Allergic rhinitis visual analogue score,allergic rhinitis main symptom score,asthma symptom score and TCM syndrome score quantification points were improved after treatment.This indicates that the treatment can improve both rhinitis and asthma clinical symptoms.?After treatment,the ACT score and the AQLQ score were higher.This indicates that the treatment can improve the level of asthma control in patients and their quality of life.?Whether the use of TCM treatment or combined with Western medicine treatment can improve the clinical symptoms of rhinitis and asthma patients,improve the clinical control of asthma,improve patient quality of life.2.2 Secondary Efficacy Indicators? For patients using Western medicine,TCM allows them to gradually reduce the dosage.? There were no significant differences in all laboratory indicators before and after treatment,suggesting that the treatment regimen had no significant effect on lung function index,blood T-cell subsets,total blood IgE and blood EOS%.3.Analysis of Safety IndicatorsIn the observation period,the treatment did not lead to any serious adverse events,indicating that this treatment is safe.Conclusion:The results of this study show that it is safe and effective to use TCM to "reinforce qi and warm yang,diffuse the lung to calm panting"on adult CARAS with "yang and qi deficiency,phlegm damaging lung" syndrome.Chinese medicine treatment can not only improve rhinitis and asthma symptoms,improve asthma control level,improve the quality of life,but also reduce the amount of Western medicine in a portion of patients.No adverse reactions were recorded during the treatment observational period. |
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