Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 5. Acute Bronchitis_Chinese Journal of Evidence-Based Medicine

Authors：

WANG Yingqiang , LI Honghao ,  LI Youping , LI Cuicui , WANG Li , YANG Xiaoyan , SHEN Jiantong , LI Xiao , LI Xianglian

Chinese Evidence-Based Medical Center, West China Hospital, Sichuan University, Chengdu 610041, China;

Corresponding author：

LI Youping, Email: yzmylab@hotmail.com

Keywords：

Township health center; Essential medicine; Evidence-based evaluation and selection; Acute bronchitis

DOI：

10.7507/1672-2531.20120144

Video：

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Objective 　To evaluate and select essential medicine for acute bronchitis using evidence-based methods based on the burden of disease.
Methods 　By means of the approaches, criteria, and workflow set up in the second article of this series, we referred to the recommendations of evidence-based or authority guidelines from inside and outside China, collected relevant evidence from domestic clinical studies, and recommended essential medicine based on evidence-based evaluation. Data were analyzed by Review Manager (RevMan) 5.1 and GRADE profiler 3.6 to evaluate quality of evidence.
Results 　(1) Eight guidelines were included (seven foreign guidelines, one domestic guideline; five based on evidence, three based on expert consensus). (2) A result of six RCTs (n=816, low quality) indicated that pentoxyverine had efficiencies of 53% to 82% for cough relief. Among the six RCTs, a result of three RCTs (n=283) indicated that pentoxyverine was slightly less efficient than procaterol (RR=0.86, 95%CI 0.78 to 0.94, P=0.001); a result of two RCTs (n=233) indicated that pentoxyverine was slightly less efficient than Chinese medicinals decoction (RR=0.82, 95%CI 0.74 to 0.91, P lt;0.001). Adverse reaction of pentoxyverine (incidence: 0% to 2.4%) mainly covered nausea, palpitation, etc. Pentoxyverine cost 0.20 yuan (for adult) or 0.08 yuan (for child) daily, which was orally taken and applicable to the target population. (3) A result of six RCTs (n=403, low quality) indicated that the efficiencies of dextromethorphan for cough relief was 47.0% to 95.3%. Among the six RCTs, a result of one RCT (n=283) indicated that dextromethorphan hydrobromide (nasal drop) was more efficient than blank intervention (RR=3.71, 95%CI 1.91 to 7.21); a result of one RCT (n=43) indicated that dextromethorphan (for oral use) was more efficient than placebo (RR=1.74, 95%CI 1.13 to 2.66); a result of one RCT (n=300, moderate quality) indicated that dextromethorphan was more efficient than pentoxyverine (RR=1.16, 95%CI 1.07 to 1.26); a result of one observational study (n=121, low quality) indicated that dextromethorphan given for 5 days had an efficiency of 66.5%. Adverse reaction of dextromethorphan (incidence: 2% to 30%) mainly covered mouth dryness, dizziness, nausea, etc.
Conclusion 　(1) We offer a b recommendation for dextromethorphan used in relieving dry cough due to acute bronchitis. (2) We offer a weak recommendation for pentoxyverine as symptomatic treatment for cough relief. (3) We make a recommendation against antibiotics, β2-agonist bronchodilators and mucolytic agents as routine use. (4) More large-scale, multi-center, double-blinded RCTs are needed in clinical and pharmacoeconomic studies of acute bronchitis in hopes of producing high-quality local evidence.

Citation： WANG Yingqiang,LI Honghao,LI Youping,LI Cuicui,WANG Li,YANG Xiaoyan,SHEN Jiantong,LI Xiao,LI Xianglian. Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 5. Acute Bronchitis. Chinese Journal of Evidence-Based Medicine, 2012, 12(8): 888-894. doi: 10.7507/1672-2531.20120144 Copy

1.	李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2010年住院疾病构成分析. 中国循证医学杂志, 2012, 12(3): 260-266.
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4.	中华医学会, 编著. 临床诊疗指南: 呼吸病学分册. 人民卫生出版社, 2009: 6-7.
5.	Barman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 95S-103S.
6.	Ross HA. Diagnosis and treatment of acute bronchitis. American Academy of Family Physican, 2010, 82(11): 1345-1350.
7.	Management of uncomplicated acute bronchitis in adults: Michigan quality improvement consortium guideline. 2010.
8.	Woodhead M, Blasi F, Huchon G, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J, 2005, 26: 1138-1180.
9.	Respiratory tract infections--antibiotic prescribing: prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. NICE clinical guideline 69. 2008. Available from: http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf.
10.	Bolser DC. Cough Suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. American College of Chest Physicians, 2006. 129: 238S-249S.
11.	Guideline for the management of acute bronchitis. Alberta clinical practice guideline working group. 2008: 1-6.
12.	Morice AH, McGarvey L, Pavord I. Recommendations for the management of cough in adults. Thorax, 2006, 61: i1-i24.
13.	WHO Model Lists of Essential Medicines (17th edition). March 2011. Available from: http://www.who.int/medicines/publications/essentialmedicines/en/index.html.
14.	国家基本药物目录化学药品和生物制品(2009版基层部分). 人民卫生出版社, 2009.
15.	中国国家处方集化学药品与生物制品卷. 人民军医出版社, 2010.
16.	CKS topic review: chest infections. Available from: http://www.cks.nhs.uk/chest_infections_adult.
17.	吴琦, 陈光瑾, 朱宝玉, 等. 美喘清对症治疗急性支气管炎36例. 世界医学杂志, 1997, 76-77.
18.	袁古治. 美喘清治疗急性支气管炎52例. 广东医学, 1998, 19(10): 788-789.
19.	张正才. 美喘清对急性支气管炎镇咳疗效观察. 实用医学杂志, 2000, 16(7): 595-596.
20.	吴雪荣. 参苏散加减治疗冬季咳嗽的临床观察. 中国中医药咨讯, 2010, 2(35): 109-101.
21.	金朝晖, 范伏元. 宣肺止咳汤治疗感冒后咳嗽32例. 湖南中医杂志, 2011, 27(3): 93-94.
22.	吴家蓉, 陈曙霞, 吴凤宝, 等. 右美沙芬和喷托维林镇咳作用的比较. 新药与临床, 1993, 12(2): 92-94.
23.	韩雪梅. 孟鲁司特钠治疗感染后咳嗽疗效观察. 海南医学, 2011, 22(8): 53-55.
24.	陶晓南, 辛建保, 张晓菊, 等. 左羟丙哌嗪镇咳作用的临床研究. 医药导报, 2005, 24(1): 23-24.
25.	朱建幸, 鲍一笑, 陈培丽, 等. 右美沙芬缓释混悬液治疗儿童咳嗽疗效的多中心随机对照临床研究, 临床儿科杂志, 2007, 25(11): 950-952, 956.
26.	辛建保, 张建初, 熊先智, 等. 氢溴酸右美沙芬滴鼻剂镇咳的临床试验. 医药导报, 2011, 20(11): 676-677.
27.	张勤, 张执玉, 俞英, 等. 右美沙芬和左旋延胡索治疗干咳的临床疗效观察. 四川省卫生管理干部学院学报, 1999, 18(1): 29-30.
28.	李文琳. 右美沙芬缓释混悬液的临床疗效及安全性观察. 现代中西医结合杂志, 2009, 18(12): 1385-1386.
29.	中华人民共和国国家发展和改革委员会. 国家发展改革委关于公布国家基本药物零售指导价格的通知. 发改价格[2009]2489号. Available from: http: //www.sdpc.gov.cn/zcfb/zcfbtz/2009tz/t20091002_305945.htm.
30.	中华人民共和国国家发展和改革委员会. 国家发展改革委关于制定吡喹酮等260种药品最高零售价格的通知. 发改价格[2007]751号Available from: http://www.sdpc.gov.cn/zfdj/jggg/yaopin/t20070509_134187.htm.
31.	吕勇. 滥用抗生素产生的危害及滥用的原因. 辽宁中医药大学学报, 2008, 10(9): 108-109.
32.	中华人民共和国卫生部. 《健康在你手中》(连载2). 2011. Available from: http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohltxgbj/s10750/201104/51210.htm.
33.	O’Brien KL, Dowell SF, Schwartz B, et al. Cough illness/bronchitis--principles of judicious use of antimicrobial agents. Paediatrics, 1998, 101(Suppl I): 178-181.
34.	Wilson AA, Crane LA, Barrett PH, et al. Public beliefs and use of antibiotics for acute respiratory illness. J Gen intern Med, 1999, 14(11): 658-662.
35.	李耘, 吕媛, 薛峰, 等. 我国2009至2010年MOHNARIN项目临床分离常见病原菌的耐药检测. 中华检验医学杂志, 2012, 35(1):.
36.	2008年国际麻醉品管制局报告(中译本). 国际麻醉品管制局, 纽约, 2008: 55.
37.	逄立艳, 梁伟, 王秀娟. 右美沙芬的滥用及合理使用. 中国药物依赖性杂志, 2010, 19(3): 233-235.

1. 李鸿浩, 王应强, 李幼平, 等. 循证评价与遴选中国东中西部乡院基本药物系列之一: 我国东中西部8家示范乡院2010年住院疾病构成分析. 中国循证医学杂志, 2012, 12(3): 260-266.
2. 李鸿浩, 李幼平, 王莉, 等. 循证评价与遴选中国东中西部基本药物系列之二: 评价标准、方法与流程研究. 中国循证医学杂志, 2012, 12(3): 347-356.
3. Knutson D, Braun C. Diagnosis and management of acute bronchitis. American Family Physician, 2002, 65(10): 2039-2044.
4. 中华医学会, 编著. 临床诊疗指南: 呼吸病学分册. 人民卫生出版社, 2009: 6-7.
5. Barman SS. Chronic cough due to acute bronchitis: ACCP evidence-based clinical practice guidelines. Chest, 2006, 129: 95S-103S.
6. Ross HA. Diagnosis and treatment of acute bronchitis. American Academy of Family Physican, 2010, 82(11): 1345-1350.
7. Management of uncomplicated acute bronchitis in adults: Michigan quality improvement consortium guideline. 2010.
8. Woodhead M, Blasi F, Huchon G, et al. Guidelines for the management of adult lower respiratory tract infections. Eur Respir J, 2005, 26: 1138-1180.
9. Respiratory tract infections--antibiotic prescribing: prescribing of antibiotics for self-limiting respiratory tract infections in adults and children in primary care. NICE clinical guideline 69. 2008. Available from: http://www.nice.org.uk/nicemedia/pdf/CG69FullGuideline.pdf.
10. Bolser DC. Cough Suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. American College of Chest Physicians, 2006. 129: 238S-249S.
11. Guideline for the management of acute bronchitis. Alberta clinical practice guideline working group. 2008: 1-6.
12. Morice AH, McGarvey L, Pavord I. Recommendations for the management of cough in adults. Thorax, 2006, 61: i1-i24.
13. WHO Model Lists of Essential Medicines (17th edition). March 2011. Available from: http://www.who.int/medicines/publications/essentialmedicines/en/index.html.
14. 国家基本药物目录化学药品和生物制品(2009版基层部分). 人民卫生出版社, 2009.
15. 中国国家处方集化学药品与生物制品卷. 人民军医出版社, 2010.
16. CKS topic review: chest infections. Available from: http://www.cks.nhs.uk/chest_infections_adult.
17. 吴琦, 陈光瑾, 朱宝玉, 等. 美喘清对症治疗急性支气管炎36例. 世界医学杂志, 1997, 76-77.
18. 袁古治. 美喘清治疗急性支气管炎52例. 广东医学, 1998, 19(10): 788-789.
19. 张正才. 美喘清对急性支气管炎镇咳疗效观察. 实用医学杂志, 2000, 16(7): 595-596.
20. 吴雪荣. 参苏散加减治疗冬季咳嗽的临床观察. 中国中医药咨讯, 2010, 2(35): 109-101.
21. 金朝晖, 范伏元. 宣肺止咳汤治疗感冒后咳嗽32例. 湖南中医杂志, 2011, 27(3): 93-94.
22. 吴家蓉, 陈曙霞, 吴凤宝, 等. 右美沙芬和喷托维林镇咳作用的比较. 新药与临床, 1993, 12(2): 92-94.
23. 韩雪梅. 孟鲁司特钠治疗感染后咳嗽疗效观察. 海南医学, 2011, 22(8): 53-55.
24. 陶晓南, 辛建保, 张晓菊, 等. 左羟丙哌嗪镇咳作用的临床研究. 医药导报, 2005, 24(1): 23-24.
25. 朱建幸, 鲍一笑, 陈培丽, 等. 右美沙芬缓释混悬液治疗儿童咳嗽疗效的多中心随机对照临床研究, 临床儿科杂志, 2007, 25(11): 950-952, 956.
26. 辛建保, 张建初, 熊先智, 等. 氢溴酸右美沙芬滴鼻剂镇咳的临床试验. 医药导报, 2011, 20(11): 676-677.
27. 张勤, 张执玉, 俞英, 等. 右美沙芬和左旋延胡索治疗干咳的临床疗效观察. 四川省卫生管理干部学院学报, 1999, 18(1): 29-30.
28. 李文琳. 右美沙芬缓释混悬液的临床疗效及安全性观察. 现代中西医结合杂志, 2009, 18(12): 1385-1386.
29. 中华人民共和国国家发展和改革委员会. 国家发展改革委关于公布国家基本药物零售指导价格的通知. 发改价格[2009]2489号. Available from: http: //www.sdpc.gov.cn/zcfb/zcfbtz/2009tz/t20091002_305945.htm.
30. 中华人民共和国国家发展和改革委员会. 国家发展改革委关于制定吡喹酮等260种药品最高零售价格的通知. 发改价格[2007]751号Available from: http://www.sdpc.gov.cn/zfdj/jggg/yaopin/t20070509_134187.htm.
31. 吕勇. 滥用抗生素产生的危害及滥用的原因. 辽宁中医药大学学报, 2008, 10(9): 108-109.
32. 中华人民共和国卫生部. 《健康在你手中》(连载2). 2011. Available from: http://www.moh.gov.cn/publicfiles/business/htmlfiles/mohltxgbj/s10750/201104/51210.htm.
33. O’Brien KL, Dowell SF, Schwartz B, et al. Cough illness/bronchitis--principles of judicious use of antimicrobial agents. Paediatrics, 1998, 101(Suppl I): 178-181.
34. Wilson AA, Crane LA, Barrett PH, et al. Public beliefs and use of antibiotics for acute respiratory illness. J Gen intern Med, 1999, 14(11): 658-662.
35. 李耘, 吕媛, 薛峰, 等. 我国2009至2010年MOHNARIN项目临床分离常见病原菌的耐药检测. 中华检验医学杂志, 2012, 35(1):.
36. 2008年国际麻醉品管制局报告(中译本). 国际麻醉品管制局, 纽约, 2008: 55.
37. 逄立艳, 梁伟, 王秀娟. 右美沙芬的滥用及合理使用. 中国药物依赖性杂志, 2010, 19(3): 233-235.

Chinese Journal of Evidence-Based Medicine

Evidence-Based Evaluation and Selection of Essential Medicine for Township Health Centre in China: 5. Acute Bronchitis

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