Comparative effectiveness of ten traditional Chinese herbal formulas for acute exacerbation of chronic obstructive pulmonary disease: a systematic review and Bayesian network meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Background Traditional Chinese medicine (TCM) has emerged as a valuable adjunctive approach for respiratory diseases, with accumulating evidence supporting its efficacy in Acute Exacerbation of Chronic Obstructive Pulmonary Disease (AECOPD) management. However, most existing randomized controlled trials (RCTs) and meta-analyses have focused on evaluating single traditional Chinese herbal formulas as an add-on to conventional therapy (CT). The comparative efficacy among these formulas remains uncertain, creating a critical evidence gap that hampers clinical decision-making. Network meta-analysis (NMA) provides a methodological framework to address this limitation by enabling simultaneous comparison of multiple interventions. Methods RCTs of these ten herbal formulas in combination with CT for the treatment of AECOPD were searched in five English and four Chinese databases. The search covered the period from the date of database inception to 20 August 2024, with a final update performed on 28 November 2025. The risk of bias of the included RCTs was critically assessed using the Cochrane Risk-of-Bias tool for randomized trials, version 2 (RoB 2). Bayesian NMA, pairwise meta-analysis (PMA), meta-regression, subgroup and sensitivity analyses, and publication bias analysis were carried out. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results A total of 132 eligible RCTs involving 13,177 participants were included. Both PMA and NMA demonstrated that all ten herbal formulas combined with CT were more effective than CT alone in treating AECOPD. Based on the ranking results, Qingqihuatan decoction (QQHT), Erchen decoction combined with Sanziyangqin decoction (ECSZYQ), and Weijing decoction (WJ) had the highest probability of being the most efficacious interventions in improving lung function (FEV 1 , FEV 1 %pred, FEV 1 /FVC). For the correction of arterial blood gas abnormalities (PaO 2 , PaCO 2 ), Maxingshigan decoction (MXSG), Xiaoqinglong decoction (XQL), and Yuebi Jia Banxia decoction (YBBX) were ranked highest. However, the GRADE framework rated the certainty of evidence for NMA and most PMA results as “very low”. Conclusion Based on the current evidence, QQHT and XQL appear to be the most promising herbal formulas. Nevertheless, given the low certainty of evidence, caution is warranted in interpreting these findings. The final selection in clinical practice should be guided by a comprehensive assessment of the patient’s specific pathophysiological profile and individual factors. Further high-quality, head-to-head comparative studies are needed to validate these findings. Systematic Review Registration https://www.crd.york.ac.uk/PROSPERO/ , identifier CRD42024622734.
Source: Frontiers in Pharmacology
Authors: Enze Yu, Chunyan Tian, Pengna Jiang, Xingyi Wang, Yuting Yin, Zhuying Li
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $3,801
OpenAlex ID: W7124278732