Effectiveness and safety of Qianjinweijing decoction in the treatment of bronchiectasis: A systematic review and meta-analysis

Abstract

Introduction

Bronchiectasis is a chronic inflammatory airway disease marked by permanent dilation of the bronchi, recurrent infections, and associated complications. The traditional Chinese medicine Qianjinweijing Decoction (QJWJ) has shown promising results in bronchiectasis treatment with few side effects. However, there is a lack of recent comprehensive research evaluating its effectiveness. This review aims to examine the effectiveness and safety of QJWJ in treating bronchiectasis.

Methods

We searched 7 databases including China National Knowledge Infrastructure (CNKI), Wanfang Database, VIP Chinese Science Database, China Biology Medicine Disc (Sinomed), PubMed, Embase, and Cochrane Library, for relevant randomized controlled trials (RCTs) until May 2023, in both Chinese and English. Two researchers conducted a comprehensive review of literature, extracting data based on predefined criteria. The risk of bias was assessed using the Cochrane Collaboration tool, and meta-analysis was performed using RevMan 5.4.1 and RStudio software. Quality of evidence was evaluated using GRADEpro (V3.6.) software.

Results

This review analysed 35 studies with 2609 patients. The QJWJ group consisted of 1318 patients, while the routine pharmacotherapy (RP) group had 1291 patients. Combining QJWJ and RP in bronchiectasis treatment showed better with clinical effectiveness [risk ratio (RR)=1.17, 95 % confidence interval (CI) (1.13, 1.21), P < 0.00001], the percentage of forced expiratory volume in the first second to the predicted value (FEV₁ %) [mean difference (MD)=3.52, 95 % CI (1.48, 5.55), P = 0.0007], the ratio of forced expiratory volume to forced vital capacity in the first second (FEV₁/FVC) [MD=6.62, 95 % CI (1.52, 11.72), P = 0.01], peak expiratory flow rate (PEFR) [MD=7.14, 95 % CI (5.15, 9.12), P < 0.00001], white blood cell count (WBC) [MD=-1.42, 95 % CI (-2.53, -0.31), P = 0.01], c-reactive protein (CRP) [MD=-7.2, 95 % CI (-9.3, -5.1), P < 0.00001], and the procalcitonin (PCT) [standardized mean difference (SMD)=-1.39, 95 % CI (-2.02, -0.76), P < 0.0001], without increasing the incidence of adverse reactions [RR=0.79, 95 % CI (0.44, 1.42), P = 0.43]. QJWJ alone also significantly improved bronchiectasis treatment, enhanced clinical effectiveness [RR=1.19, 95 % CI (1.04, 1.36), P = 0.010], FEV₁ % [MD=7.09, 95 % CI (4.5, 9.68), P < 0.00001], and reduced WBC [MD=-2.7, 95 % CI (-3.7, -1.7), P < 0.00001], CRP [MD=-4.22, 95 % CI (-55.32, -3.12), P < 0.00001], without increasing the incidence of adverse reactions [RR=0.20, 95 % CI (0.01, 4.06), P = 0.29].

Conclusion

Evidence suggested that QJWJ, used alone or with RP, notably improved bronchiectasis treatment outcomes, enhanced lung function and reduced inflammation without raising adverse reaction risks. Yet, further support from high-quality, large-sample RCTs is needed to strengthen this conclusion.