Efficacy and safety of Chinese herbal medicine for cough variant asthma: A network meta-analysis of randomized clinical trials

Cough variant asthma (CVA) can lead to chronic cough or typical asthma. Though western medications have shown benefit, many patients do not achieve long term effects. Chinese herbal medicine (CHM) has been used for patients with CVA, however its benefit is unclear. This review aimed to evaluate the efficacy of different CHM for patients with CVA using network meta-analysis. Embase, Cochrane Library, PubMed, Web of Science, CNKI and WanFang databases were searched to identify randomized controlled trials (RCTs) that compared the efficacy of CHM with Montelukast (western medicine). Studies selection, data extraction, and quality evaluation were independently conducted by two reviewers. Network meta-analysis was performed to rank different therapies according to efficacy and adverse rates. A total of 25 RCTs involving 2635 participants were included in the study. The study indicated that compared with Montelukast, the efficacy rate of CHM was significantly higher (Odd ratio (OR) = 4.13; 95% credible intervals (CI): 3.29–5.20). Only 8 RCTs reported the adverse reactions. The study suggested fewer adverse effects of CHM (OR = 0.26; 95% CI: 0.16-0.43) when compared with Montelukast. In the network meta-analysis, Suhuang Zhike Capsule (SZC) + Montelukast, Xiaoqinglong Decoction (XQLD) + Montelukast, Zhisousan + Montelukast and ephedra soup + Montelukast were most likely to take effect in CVA patients, while SZC + Montelukast and Montelukast were more likely to have adverse effects. Compared with Montelukast, CHMs were more effective and had less adverse effects in the treatment of CVA.