Traditional Chinese Medicine (TCM) could represent a a potential approach in the treatment of chronic obstructive pulmonary disease (COPD), fostering a reduction in the frequency of adverse events, containment of symptoms, and improvements in dyspnea and exercise capacity. This is suggested by a Chinese study, recently published in Chinese Medicine.
Clinical Context
COPD, a chronic airway disease characterized by persistent respiratory symptoms such as chronic cough, sputum production, and progressively worsening dyspnea, along with airflow limitation, is associated with frequent acute exacerbations (AEs) and chronic respiratory failure, severely compromising the patient’s quality of life and carrying a poor prognosis. The global prevalence and mortality rates of COPD remain high, at about 11.7%, in individuals over 40 years of age, with substantial economic burdens for patients and health systems.
For example, it is estimated an annual per capita cost of hospitalization in the United States of $6,852. Over the past decades, progress in COPD research has significantly slowed the progression of the disease, yet in many patients—especially those with severe or advanced disease—rapid deterioration continues to be observed.
AEs remain, therefore, critical events that accelerate the decline of lung function, increase hospitalizations, and worsen outcomes, including higher mortality rates. Hence, reducing their frequency is a key goal in the management of severe and very severe COPD.
Current Therapeutic Options
Chronic inflammation plays a central role in COPD development, making oral glucocorticoids a key therapeutic option, although they are associated with significant adverse events, including osteoporosis, pneumonia, and metabolic disturbances such as Cushing’s syndrome, impaired glucose metabolism, and electrolyte imbalances.
Moreover, their use can correlate with increased mortality among patients with stable COPD, prompting a shift toward inhaled corticosteroids (ICS) as the preferred treatment. Long-acting beta-2 agonists (LABA) and long-acting muscarinic antagonists (LAMA), alone or in combination, also represent appealing treatment options.
Triple therapy, which combines ICS, LABA, and LAMA, appears to improve lung function in severe and very severe cases, but evidence suggests this therapy does not significantly reduce the frequency of AEs or mortality, and the overall prognosis may remain unchanged.
Thus, there is an urgent need for new therapeutic strategies capable of improving efficacy and outcomes in COPD management: among these, TCM stands out. Broad clinical practice appears to demonstrate its effectiveness in terms of symptom reduction and lower severity, fewer AEs, and better quality of life.
TCM Approach Options
The study identified three predominant TCM patterns for managing patients with severe and very severe COPD: deficiency of Lung-Spleen Qi, deficiency of Lung-Kidney Qi, and deficiency of Lung-Kidney Qi and Yin. Consequently, researchers developed a comprehensive therapy based on these TCM patterns that emphasizes individualized treatment, with time-based modulation aligned to clinical practice and basic research.
Studies have confirmed that this therapy can contribute to reducing the frequency and duration of AEs in moderate-to-severe stable COPD, relieve symptoms, and improve exercise capacity and quality of life. However, long-term studies on the efficacy and safety of this comprehensive therapy in severe and very severe COPD are lacking or scarce; the current study—the first long-duration randomized controlled trial based on TCM theory—intends to address this gap.
Methodology and Results
The multicenter, randomized, double-blind, placebo-controlled study enrolled eligible patients randomly and equally to receive a TCM-based therapy with Bu-Fei Jian-Pi, Bu-Fei Yi-Shen, and Yi-Qi Zi-Shen granules, pattern-specific for TCM syndromes (intervention group) or a Chinese medicine–matched placebo (control group). Both groups also received complementary conventional Western medicine treatments.
Acute exacerbations, lung function, dyspnea scores, the 6-minute walk test (6MWT), and the COPD Assessment Test (CAT) were evaluated over 12 months of treatment, with a further 12 months of follow-up. The results appear to support the combined TCM and Western medicine approach in improving therapeutic outcomes: among a total of 467 patients, with 228 in the experimental group and 239 in the control group, those treated with Chinese herbal granules showed a significant reduction in AEs (0.63 vs. 1.03 events, P = 0.002), improvement in mMRC scores (−0.17 points, 95% CI −0.30 to −0.03; P = 0.015), gains in the 6MWT by 29.24 m (95% CI 10.71 to 47.77; P = 0.002), and in CAT by −3.11 points (95% CI −4.13 to −2.09, P < 0.001), compared with the control group. No significant differences were observed between groups in FVC (L) or FEV1, neither in liters nor in percentage.
Conclusion
The comprehensive therapy based on TCM patterns appears to demonstrate efficacy in patients with COPD from severe to very severe stages, reducing the frequency of AEs, improving dyspnea and exercise capacity, and alleviating symptoms.
Source
Li J, Xie Y, Wang M et al. Effect of traditional Chinese medicine combined with conventional Western medicine for patients with severe/very severe chronic obstructive pulmonary disease: a multi-center, randomized, double-blind, controlled study. Chinese Medicine, 2025, 20, Article number 66. Doi: 10.1186/s13020-025-01117-x
Subscribe to Integrative Medicine
