| Background Chinese herbal medicine (CHM) alone and combination with conventional medications (CoM) may be effective in treating chronic obstructive pulmonary disease (COPD). In the present study, the effectiveness and safety of CHM in patients with COPD were evaluated with systematic review and meta-analysis. Methods Systematic research was conducted and analyzed. Meta-analysis was further performed on high-quality randomized controlled trials (RCTs). The most frequently used individual CHMs were identified. Results A total of 6919 of abstracts in publications and thesis were retrieved and screened. 579 of full articles were assessed for eligibility, and 171 of studies were included. Results from the studies showed that clinical symptoms improvement ≥ 30% were significantly high in CHM or CoM (overall effect: P < 0.00001, heterogeneity: P=0.98). Quality of life (QoL) assessment showed that CHM or CoM had advantage in activities of daily living (F1) and depression symptoms (F3) (overall effect: P<0.00001 heterogeneity: P=0.96; overall effect: P=0.00001 heterogeneity: P=0.32, respectively), while had no advantage in social activities (F2) compared to conventional medications (CVMs) (overall effect: P=0.44 heterogeneity: P=0.01). Total score, activities and impacts scores of SGRQ showed that CHM or CoM had an advantage COPD patients compared to OM (overall effect: P<0.0006, heterogeneity: P=0.06; overall effect: P=0.001, heterogeneity: P=0.50;overall effect: P=0.0003, heterogeneity: P=0.46, respectively). Analysis from 14 high quality studies showed that CHM or CoM had no advantage on pulmonary function including FEV1 (overall effect: P=0.09, heterogeneity: P=0.32), predicted FEV% (overall effect: P=0.18, heterogeneity: P=0.07), FVC (overall effect: P=0.17, heterogeneity: P=0.98) and FEV1/FVC (overall effect: P=0.57; heterogeneity: P=0.90). Furthermore, eight Chinese medicines used at the highest frequency in treating AECOPD and SCOPD were identified, and were further confirmed in the studies which recruited both AECOPD and SCOPD patients. In addition, each three Chinese medicines were also identified for AECOPD and SCOPD respectively. No serious adverse effect was reported in these studies. Conclusions Evidence from the studies shows that CHM is safe and effective in improving some symptoms and QoL while has no advantage on pulmonary function compared with OM. The Chinese medicines identified may represent basic formulae for COPD. The study guarantees a large scale, double-bind, randomized controlled trial for confirming the findings of meta-analysis. |