Meta-analysis of spleen-strengthening and phlegm-resolving herbal therapy for airway mucus hypersecretion in chronic
Mengyao Chen1, Jiamin Lu1, Yu Wei1
1Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, Jiangsu, China.
Objective:
To systematically evaluate the clinical efficacy and safety of Chinese herbal medicine based on spleen-strengthening and phlegm-resolving (SSPR) therapy for airway mucus hypersecretion in chronic obstructive pulmonary disease (COPD) from an evidence-based medicine perspective, and to provide a scientific basis for TCM diagnosis and treatment of COPD-related mucus hypersecretion.
Methods:
This study was conducted following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We systematically searched CNKI, Wanfang Data, VIP, CBM, PubMed, Embase, and Cochrane Library for clinical studies published between January 1, 2010, and September 1, 2025, on SSPR-based herbal interventions for COPD mucus hypersecretion. Two researchers independently screened the studies according to predefined inclusion/exclusion criteria, extracted data, performed cross-checking, and assessed study quality. Meta-analysis was performed using RevMan 5.4, with publication bias evaluated by Egger's test in Stata 18.
Results:
Sixteen studies involving 1,468 COPD patients with mucus hypersecretion were included. Meta-analysis showed that for acute exacerbation of COPD: SSPR combined with conventional Western therapy significantly improved Treatment effectiveness rate (P < 0.0001), FVC (P = 0.02), and absolute FEV1 (P < 0.00001). SSPR also significantly reduced MUC5AC (P = 0.001), TCM syndrome scores (P < 0.00001), and IL-8 (P < 0.00001) compared to Western therapy alone. No significant difference in FEV1/FVC ratio improvement (P = 0.22) was observed. For stable COPD: SSPR combination therapy significantly improved Treatment effectiveness rate (P < 0.0001), FVC (P < 0.00001), absolute FEV1 (P < 0.00001), and FEV1/FVC ratio (P = 0.001). SSPR also significantly reduced TCM syndrome scores (P = 0.0004) and IL-8 (P < 0.00001). No significant difference in MUC5AC reduction (P = 0.23) was observed. Three studies reported no adverse events, while two showed no statistically significant difference in adverse event rates between groups.
Conclusion:
SSPR herbal therapy combined with conventional Western treatment demonstrates superior clinical efficacy for managing airway mucus hypersecretion in both acute exacerbation and stable COPD compared to Western therapy alone, with comparable safety profiles. However, the included studies were generally of low methodological quality, highlighting the need for larger, higher-quality RCTs for further validation.
Systematic Review Registration:
The protocol was registered on PROSPERO (CRD420251171076).
