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

    Research output: Contribution to journalArticle

    Abstract

    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
    Volume14
    DOIs
    Publication statusPublished - 2019 Jan 1

    Fingerprint

    Kampo Medicine
    Chronic Obstructive Pulmonary Disease
    Cohort Studies
    Retrospective Studies
    Muscarinic Antagonists
    Muscarinic Receptors
    Hospitalization
    Propensity Score
    Bronchodilator Agents
    dai-kenchu-to
    Herbal Medicine
    Cholinergic Antagonists
    Constipation
    Proportional Hazards Models
    Inpatients
    Therapeutics

    Keywords

    • 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

    Reduction in exacerbation of COPD in patients of advanced age using the Japanese kampo medicine dai-kenchu-to : A retrospective cohort study. / Jo, Taisuke; Michihata, Nobuaki; Yamana, Hayato; Sasabuchi, Yusuke; Matsui, Hiroki; Urushiyama, Hirokazu; Mitani, Akihisa; Yamauchi, Yasuhiro; Fushimi, Kiyohide; Nagase, Takahide; Yasunaga, Hideo.

    In: International Journal of COPD, Vol. 14, 01.01.2019, p. 129-139.

    Research output: Contribution to journalArticle

    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, vol. 14, pp. 129-139. https://doi.org/10.2147/COPD.S181916
    Jo, Taisuke ; Michihata, Nobuaki ; Yamana, Hayato ; Sasabuchi, Yusuke ; Matsui, Hiroki ; Urushiyama, Hirokazu ; Mitani, Akihisa ; Yamauchi, Yasuhiro ; Fushimi, Kiyohide ; Nagase, Takahide ; Yasunaga, Hideo. / Reduction in exacerbation of COPD in patients of advanced age using the Japanese kampo medicine dai-kenchu-to : A retrospective cohort study. In: International Journal of COPD. 2019 ; Vol. 14. pp. 129-139.
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    abstract = "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.",
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    T1 - Reduction in exacerbation of COPD in patients of advanced age using the Japanese kampo medicine dai-kenchu-to

    T2 - A retrospective cohort study

    AU - Jo, Taisuke

    AU - Michihata, Nobuaki

    AU - Yamana, Hayato

    AU - Sasabuchi, Yusuke

    AU - Matsui, Hiroki

    AU - Urushiyama, Hirokazu

    AU - Mitani, Akihisa

    AU - Yamauchi, Yasuhiro

    AU - Fushimi, Kiyohide

    AU - Nagase, Takahide

    AU - Yasunaga, Hideo

    PY - 2019/1/1

    Y1 - 2019/1/1

    N2 - 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.

    AB - 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.

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    KW - Muscarinic receptor antagonists

    KW - Propensity score

    KW - Survival analysis

    KW - TU-100

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