Reduction in exacerbation of COPD in patients of advanced age using the Japanese kampo medicine dai-kenchu-to: A retrospective cohort study

Taisuke Jo, Nobuaki Michihata, Hayato Yamana, Yusuke Sasabuchi, Hiroki Matsui, Hirokazu Urushiyama, Akihisa Mitani, Yasuhiro Yamauchi, Kiyohide Fushimi, Takahide Nagase, Hideo Yasunaga

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Purpose: 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. Patients and methods: 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. Results: 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. Conclusion: 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.

Original languageEnglish
Pages (from-to)129-139
Number of pages11
JournalInternational Journal of COPD
Publication statusPublished - 2019 Jan 1
Externally publishedYes



  • Herbal medicine
  • Muscarinic receptor antagonists
  • Propensity score
  • Survival analysis
  • TU-100

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Health Policy
  • Public Health, Environmental and Occupational Health

Cite this

Jo, T., Michihata, N., Yamana, H., Sasabuchi, Y., Matsui, H., Urushiyama, H., Mitani, A., Yamauchi, Y., Fushimi, K., Nagase, T., & Yasunaga, H. (2019). Reduction in exacerbation of COPD in patients of advanced age using the Japanese kampo medicine dai-kenchu-to: A retrospective cohort study. International Journal of COPD, 14, 129-139.