Evaluating the Effects of Heat-Clearing Traditional Chinese Medicine in Stable Bronchiectasis by a Series of N-of-1 Trials

Suna Zi; Haiyin Huang; Peilan Yang; Minhua Xu; Yingen Wu; Zhenwei Wang; Fei Ge; Xinlin Chen

doi:10.1155/2022/6690638

Evaluating the Effects of Heat-Clearing Traditional Chinese Medicine in Stable Bronchiectasis by a Series of N-of-1 Trials

Evid Based Complement Alternat Med. 2022 Jan 17:2022:6690638. doi: 10.1155/2022/6690638. eCollection 2022.

Authors

Suna Zi^{1

2}, Haiyin Huang¹, Peilan Yang¹, Minhua Xu¹, Yingen Wu³, Zhenwei Wang¹, Fei Ge¹, Xinlin Chen⁴

Affiliations

¹ Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, Shanghai 200437, China.
² Shanghai Guanghua Integrated Traditional Chinese and Western Medicine Hospital, Shanghai 200052, China.
³ Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
⁴ Basic Medical College of Guangzhou University of Traditional Chinese Medicine, Guangzhou 510006, China.

Abstract

Purpose: The purpose of this study is to study the effects of heat-clearing Traditional Chinese Medicine (TCM) in the stable stage of bronchiectasis via N-of-1 trials.

Methods: The N-of-1 trials in this study were randomized and double-blinded with crossover comparisons consisting of three pairs. Each pair was of two 4-week periods. Each patient took the individualized decoction in the experimental period and the individualized decoction was removed of heat-clearing drugs, mainly including heat-clearing and detoxifying drugs, in the control period for three weeks. After three weeks, the patients stopped taking the decoction for one week. The primary outcome was from patients' self-reporting symptoms scores on a 1-7-point Likert scale. Mixed-effects models were used to conduct statistical analysis on these N-of-1 trials.

Results: Of the 21 patients enrolled, 15 completed three pairs of N-of-1 trials (71.43%). (1) Seen from the individual level, no statistical difference between the experimental decoction and the control (P > 0.05) was observed. However, 5 patients found better decoctions according to the clinical criteria. (2) As revealed by the group data of all the N-of-1 trials, the control was better than the individualized decoction in terms of symptom scores on the Likert scale (1.94 ± 0.69 versus 2.08 ± 0.68, P = 0.04, mean difference, and 95% CI: 0.19 (0.01, 0.37)) and on CAT scores (13.66 ± 6.57 versus 13.95 ± 6.97, P = 0.04, mean difference, and 95% CI: 0.86 (0.042, 1.67)), but such differences were not clinically significant. The other outcomes, such as Likert scale score of respiratory symptoms and 24-hour sputum volume, showed no statistical difference.

Conclusion: The experimental design of this study can make the TCM individualized treatment fully play its role and can detect the individualized tendencies according to the severity of phlegm and heat in some subjects. With the intermittent use or reduced use of heat-clearing drugs, most of the subjects, at the group level, enrolled in the series of N-of-1 trials may improve the symptoms and quality of life while saving the cost of TCM and reducing the potential side effects of heat-clearing TCM. This trial is registered with clinicaltrials.goc (NCT03147443).

Associated data

ClinicalTrials.gov/NCT03147443