Jo Taisuke, Michihata Nobuaki, Yamana Hayato, Sasabuchi Yusuke, Matsui Hiroki, Urushiyama Hirokazu, Mitani Akihisa, Yamauchi Yasuhiro, Fushimi Kiyohide, Nagase Takahide, Yasunaga Hideo
Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
Department of Respiratory Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan,
Int J Chron Obstruct Pulmon Dis. 2018 Dec 27;14:129-139. doi: 10.2147/COPD.S181916. eCollection 2019.
Patients with symptomatic COPD are recommended to use inhaled bronchodilators containing long-acting muscarinic receptor antagonists (LAMAs). However, bronchodilators may cause gastrointestinal adverse effects due to anticholinergic reactions, especially in advanced-age patients with COPD. Dai-kenchu-to (TU-100, Da Jian Zhong Tang in Chinese) is the most frequently prescribed Japanese herbal Kampo medicine and is often prescribed to control abdominal bloating and constipation. The purpose of this study was to evaluate the role of Dai-kenchu-to as a supportive therapy in advanced-age patients with COPD.
We used the Japanese Diagnosis Procedure Combination inpatient database and identified patients aged ≥75 years who were hospitalized for COPD exacerbation. We then compared the risk of re-hospitalization for COPD exacerbation or death between patients with and without Dai-kenchu-to using 1-to-4 propensity score matching. A Cox proportional hazards model was used to compare the two groups. We performed subgroup analyses for patients with and without LAMA therapy.
Patients treated with Dai-kenchu-to had a significantly lower risk of re-hospitalization or death after discharge; the HR was 0.82 (95% CI, 0.67-0.99) in 1-to-4 propensity score matching. Subgroup analysis of LAMA users showed a significant difference in re-hospitalization or death, while subgroup analysis of LAMA non-users showed no significant difference.
Our findings indicate that Dai-kenchu-to may have improved the tolerability of LAMA in advanced-age patients with COPD and, therefore, reduced the risk of re-hospitalization or death from COPD exacerbation. Dai-kenchu-to may be recommended as a useful supportive therapy for advanced-age patients with COPD.
有症状的慢性阻塞性肺疾病（COPD）患者被推荐使用含有长效毒蕈碱受体拮抗剂（LAMA）的吸入性支气管扩张剂。然而，支气管扩张剂可能因抗胆碱能反应而导致胃肠道不良反应，尤其是在老年COPD患者中。大建中汤（TU - 100，中文为大建中汤）是日本最常用的汉方药物，常用于控制腹胀和便秘。本研究的目的是评估大建中汤在老年COPD患者中作为辅助治疗的作用。
我们使用了日本诊断流程组合住院患者数据库，确定了因COPD急性加重而住院的≥75岁患者。然后，我们采用1比4倾向评分匹配法比较了使用和未使用大建中汤的患者因COPD急性加重再次住院或死亡的风险。使用Cox比例风险模型对两组进行比较。我们对接受和未接受LAMA治疗的患者进行了亚组分析。
接受大建中汤治疗的患者出院后再次住院或死亡的风险显著降低；在1比4倾向评分匹配中，风险比（HR）为0.82（95%置信区间，0.67 - 0.99）。LAMA使用者的亚组分析显示在再次住院或死亡方面有显著差异，而LAMA非使用者的亚组分析未显示显著差异。
我们的研究结果表明，大建中汤可能提高了老年COPD患者对LAMA的耐受性，因此降低了因COPD急性加重而再次住院或死亡的风险。大建中汤可能被推荐作为老年COPD患者有用的辅助治疗方法。
