OBM Geriatrics

(ISSN 2638-1311)

OBM Geriatrics is an Open Access journal published quarterly online by LIDSEN Publishing Inc. The journal takes the premise that innovative approaches – including gene therapy, cell therapy, and epigenetic modulation – will result in clinical interventions that alter the fundamental pathology and the clinical course of age-related human diseases. We will give strong preference to papers that emphasize an alteration (or a potential alteration) in the fundamental disease course of Alzheimer’s disease, vascular aging diseases, osteoarthritis, osteoporosis, skin aging, immune senescence, and other age-related diseases.

Geriatric medicine is now entering a unique point in history, where the focus will no longer be on palliative, ameliorative, or social aspects of care for age-related disease, but will be capable of stopping, preventing, and reversing major disease constellations that have heretofore been entirely resistant to interventions based on “small molecular” pharmacological approaches. With the changing emphasis from genetic to epigenetic understandings of pathology (including telomere biology), with the use of gene delivery systems (including viral delivery systems), and with the use of cell-based therapies (including stem cell therapies), a fatalistic view of age-related disease is no longer a reasonable clinical default nor an appropriate clinical research paradigm.

Precedence will be given to papers describing fundamental interventions, including interventions that affect cell senescence, patterns of gene expression, telomere biology, stem cell biology, and other innovative, 21st century interventions, especially if the focus is on clinical applications, ongoing clinical trials, or animal trials preparatory to phase 1 human clinical trials.

Papers must be clear and concise, but detailed data is strongly encouraged. The journal publishes research articles, reviews, communications and technical notes. There is no restriction on the length of the papers and we encourage scientists to publish their results in as much detail as possible.

Indexing: DOAJ-Directory of Open Access Journals.

Archiving: full-text archived in CLOCKSS.

Rapid publication: manuscripts are undertaken in 6 days from acceptance to publication (median values for papers published in this journal in the first half of 2020, 1-2 days of FREE language polishing time is also included in this period). A first decision provided to authors of manuscripts submitted to this journal are approximately 3.3 weeks (median values) after submission.

Current Issue: 2020  Archive: 2019 2018 2017
Open Access Review
Aspiration Pneumonia and the Traditional Chinese Medicine Banxia Houpu Tang

Koh Iwasaki *

Natori Kumanodoh Hospital, Natori, Japan

Correspondence: Koh Iwasaki

Academic Editor: David G Smithard

Special Issue: Stroke in Older Adults

Received: August 25, 2020 | Accepted: October 21, 2020 | Published: October 27, 2020

OBM Geriatrics 2020, Volume 4, Issue 4, doi:10.21926/obm.geriatr.2004136

Recommended citation: Iwasaki K. Aspiration Pneumonia and the Traditional Chinese Medicine Banxia Houpu Tang. OBM Geriatrics 2020;4(4):5; doi:10.21926/obm.geriatr.2004136.

© 2020 by the authors. This is an open access article distributed under the conditions of the Creative Commons by Attribution License, which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is correctly cited.

Abstract

Aspiration pneumonia is one of the most common reasons for death in stroke patients. Recently, a traditional herbal medicine banxia houpu tang is remarked to prevent the aspiration pneumonia. This review tells the history of study of banxia houpu tang for prevent aspiration pneumonia.

Keywords

Aspirartion pneumonia; banxia houpu tang; traditional Chinese medicine; the swallowing reflex; the cough reflex

Aspiration pneumonia is one of the most common reasons for death in stroke patients. In the patients with aspiration pneumonia, marked depressions in the swallowing and cough reflexes are observed [1]. Once this condition occurs, antibiotics and inanition are the only treatment options. Even after improvement, the patients are often unable to consume food orally and require tube feeding. Although tube feeding is good for nutritional management, it significantly reduces the quality of life (QOL) of the patient. Therefore, prevention of aspiration pneumonia as well as improvement of oral food intake is crucial for the QOL for these patients. Angiotensin-converting enzyme inhibitors (ACEI) are reported to prevent pneumonia in elderly patients [2]. The effects of ACEI on swallowing [3] and cough [4] reflexes may prevent pneumonia. However, whether receiving ACEI is capable of reducing post-stroke aspiration pneumonia in the current clinical environment remains unclear [5].

Banxia Houpu Tang (半夏厚朴湯, BHT) is an ancient traditional Chinese medicine (TCM) with a medical usage history of over 2000 years. In Japan, BHT extracts (4.5 g) are prepared from a mixture of five dried plants: Pinelliae tuber (Pinellia ternate Breitenbach), 6 g; Hoelen (Poria cocos Wolf), 3 g; Magnoliae cortex (Magnolia obovata Thunberg), 3 g; Perillae herba (Perilla frutescens Britton ar. Acuta Lubo), 2 g; and Zingiberis rhizoma (Zingiber officcinale Roscoc), 1 g. This medical-grade extract powder is commercially available as the traditional medicine named Hange-Koboku Toh (the Japanese name for BHT) from Tsumura Co. Ltd. (Tokyo, Japan). Each of the five herbs was first registered in the Pharmacopoeia of Japan, and the herb quality was controlled as specified in the Pharmacopoeia of Japan. Generally, this medicine is used for neurotic disorders and depression. In an ancient TCM textbook, Jinkuiyaolue (金匱要略) states that this medicine was effective in women who complained of a feeling similar to a fruit seed being stuck in the throat, which is nowadays considered a symptom of throat dysesthesia.

In our randomized control study [6], BHT was observed to ameliorate the swallowing [7] and cough [8] reflexes and reduce the risk of aspiration pneumonia in stroke patients (Figure 1 and 2). In a recent double-blinded randomized control study [9], BHT was observed to reduce aspiration pneumonia. Therefore, BHT is a useful tool for preventing aspiration pneumonia in stroke patients. Unfortunately, according to the Cochrane Database, there is no evidence that the other TCM herbs and acupuncture improved aspiration pneumonia [10]. However, a meta-analysis has reported that acupuncture is effective in dysphagia in post-stroke patients [11].

Click to view original image

Figure 1 Study protocol.

Click to view original image

Figure 2 Accumulated rate of pneumonia onset. Pneumonia developed in four (9.1%) patients in the BHT group and 14 (29.2%) patients in the control group. There was a statistically significant difference in the rate of pneumonia (p = 0.008) between the two groups. Taken from an earlier study [8].

According to the global standard perspective, tube feedings should be performed only in certain stroke patients, particularly the brainstem stroke patients. However, in Japan, the doctors in acute phase hospitals often prescribe tube feeding to stroke and dementia patients as the acute phase hospitals lack time to wait for the dysphagia improvement to occur. Nonetheless, this is a corrupt practice in Japan, as a consequence of which, several stroke patients who are unable to consume food orally are managed on tube feeding for a long time. Although tube feeding has an advantage of nutritional management, it significantly reduces the quality of life of the patients. Therefore, discontinuing tube feeding and switching to oral intake is crucial for improving the quality of life of the patients and maintaining their dignity. In this context, the present study involved shifting to nutritional management by oral intake after receiving tube feeding through a nasogastric tube or gastrostomy for over 12 months [12]. Fourteen participants (male/female ratio = 6: 8; age = 83.9 ± 2.6 years) attempted to discontinue tube feeding and resume oral feeding. The diagnosis, duration of tube feeding, gender, swallowing reflex time, and the consciousness levels (Kohnan score) [13] of these participants were analyzed. The patients who required over 4 s for the swallowing reflex were administered BHT. Seven of the 14 patients recovered oral feeding, while seven failed in the attempt. The mean age, duration of tube feeding, swallowing reflex time, and gender demonstrated no significant differences. Consciousness level exhibited a significant difference between the success group and the failure group. BHT significantly improved the swallowing reflex time in seven patients. The results revealed that half of the patients who received tube feeding for over 12 months were able to return to oral intake, and there was a difference in the state of consciousness represented by the Konan score between the successful cases and the failed cases. Therefore, in patients with a good level of consciousness, it may be possible to discontinue tube feeding and resume oral feeding.

1. Conclusion

As mentioned above, BHT is one choice to improve dysphagia in the stroke patients. Some methods to improve swallowing reflex for example ACE inhibitors and cilostazol. We did not know yet how to use these methods in complex. In daily practice, we combined ACE inhibitors and BHT when the patient has hypertension, and cilostazol and BHT to patient having cardiac coronary disease. But we do not know interaction with each other. Farther examinations are needed.

Author Contributions

Koh Iwasaki completed all work for this manuscript.

Competing Interests

The author has declared that no competing interests exist.

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