Chungsangboha-tang for the Treatment of Asthma

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This entry is adapted from the peer-reviewed paper 10.3390/jcm11144035

In traditional Korean medicine, Chungsangboha-tang (CSBHT) and its modified forms are used to treat various respiratory disorders, including asthma.

asthma Chungsangboha-tang Gamichungsangboha-tang herbal medicine

1. Introduction

Asthma is a chronic respiratory disease characterized by chronic airway inflammation, bronchial hyper-responsiveness, and airway obstruction, with varying degrees of severity. It is an important public health challenge worldwide and is prevalent across all ages ^[1]. In addition, as reports of asthma exacerbating the clinical outcomes of COVID-19 have been published in several countries, including Korea, the management of asthma has recently emerged as a more important issue ^[2]^[3].

The prevalence of asthma varies among countries. In the United States, the overall prevalence of asthma in 2020 was 7.8%, 5.8% in children (age < 18 years) and 8.4% in adults (age 18+ years), according to Most Recent National Asthma Data published by the Centers for Disease Control and Prevention (CDC) ^[4]. In Korea, the prevalence of asthma in adults over the age of 19 was about 3.2% in 2020 and has been around 3% since 2010, according to the National Health and Nutrition Survey ^[5]. In terms of economic burden, the total cost of managing asthma in Korea in 2014 was estimated at USD 635 million ^[6].

In pharmacology therapies, bronchodilators and anti-inflammatory agents, including steroids, leukotriene antagonists, mast cell stabilizers, and, the most recent, anti-immunoglobulin (Ig) E antibodies, are currently in use. However, despite their efficacy, some limitations exist. A bronchodilator may even worsen or deteriorate asthma control, and repeated beta-agonist use may result in a loss of bronchoprotective effect ^[7]. Long-term high-dose inhaled corticosteroid use can cause systemic symptoms such as easy bruising, increased risk of osteoporosis, cataracts, glaucoma, and adrenal suppression, as well as local side effects, including oral thrush and dysphonia ^[8].

Due to these limitations, complementary and alternative medicine (CAM) are widely used for the treatment of asthma. According to previous studies, CAM, including breathing techniques, acupuncture, homeopathy, and herbal products, was used for asthma treatment in 4–79% of adult patients and 33–89% of children and adolescents ^[9]. According to a nationwide survey of allergists conducted in the United States, 80.6% of doctors noted patients who stopped conventional therapy and received CAM treatment, among whom 67.6% reported receiving herbal medicine and 60.9% had used CAM for asthma. Among the practitioners, 30.8% recommended CAM for asthma ^[10].

Among the CAM treatments, various studies have been conducted on herbal medicines. In clinical studies, herbal medicines have been shown to be safe and effective for reducing symptom scores and augmenting lung function. They have also been used as adjuvant therapy to standard medication to enforce the effect of standard therapy, relieve asthmatic symptoms, and reduce drug use ^[11].

To date, several clinical and experimental studies on Chungsangboha-tang (CSBHT) have been reported. CSBHT is a herbal prescription that has been widely used to treat various chronic respiratory diseases in traditional Korean medicine. It first appeared in “Shoushi baoyuan” ^[12], a classic traditional Chinese medicine (TCM), within literature written by Tingxian Gong in 1615. In Korea, CSBHT was first recorded in “Bangyak happyeon” ^[13] in 1884, and it has been continuously used in clinical practice to treat chronic asthma ^[14]. CSBHT is a prescription based on Yukmijihwang-tang, a representative yin-tonifying formula consisting of six herbs: Rehmanniae Radix Preparata, Dioscoreae Rhizoma, Corni Fructus, Poria Sclerotium, Moutan Radicis Cortex, and Alismatis Rhizoma. It also includes Liriopis seu Ophiopogonis Tuber, Asparagi Tuber, Coptidis Rhizoma, and Scutellariae Radix to clear heat and engender fluid, and Schisandrae Fructus, Ponciri Fructus Immaturus, Fritillariae Thunbergii Bulbus, Platycodonis Radix, Armeniacae Semen, Pinelliae Tuber, Trichosanthis Semen, and Glycyrrhizae Radix et Rhizoma to diffuse the lung to resolve phlegm (Table 1).

Table 1. Composition of herbal medicines in CSBHT.

Latin Name	Academic Name	Parts Used	Dose (g)
Rehmanniae Radix Preparata	Rehmannia glutinosa Liboschitz ex Steudel	Root	4
Dioscoreae Rhizoma	Dioscorea batatas Decaisne	Rhizome	4
Corni Fructus	Cornus officinalis Siebold et Zuccarini	Fruit	4
Poria Sclerotium	Poria cocos Wolf	Sclerotium	4
Moutan Radicis Cortex	Paeonia suffruticosa Andrews	Root bark	4
Alismatis Rhizoma	Alisma orientale Juzepzuk	Rhizome	4
Schisandrae Fructus	Schisandra chinensis (Turcz.) Baillon	Fruit	3
Ponciri Fructus Immaturus	Poncirus trifoliata Rafinesque	Immature Fruit	3
Liriopis seu Ophiopogonis Tuber	Liriope platyphylla Wang et Tang	Tuber	3
Asparagi Tuber	Asparagus cochinchinensis Merrill	Tuber	3
Fritillariae Thunbergii Bulbus	Fritillaria thunbergii Miquel	Bulb	3
Platycodonis Radix	Platycodon grandiflorum A. De Candolle	Root	3
Coptidis Rhizoma	Coptis japonica Makino	Rhizome	3
Armeniacae Semen	Prunus armeniaca Linné var. ansu Maximowicz	Kernel	3
Pinelliae Tuber	Pinellia ternate Breitenbach	Tuber	3
Trichosanthis Semen	Trichosanthes kirilowii Maximowicz	Seed	3
Scutellariae Radix	Scutellaria baicalensis Georgi	Root	3
Glycyrrhizae Radix et Rhizoma	Glycyrrhiza uralensis Fischer	Root, Rhizome	2
	Total amount		59

Three types of prescriptions were used in the studies related to CSBHT: Gamichungsangboha-tang (GMCSBHT), AF-365, and PM014. GMCSBHT has the same composition as CSBHT. However, it is a prescription for increased doses of Rehmanniae Radix Preparata, Dioscoreae Rhizoma, and Corni Fructus, which have the effect of tonifying the kidney yin (Table 2) ^[15]. Therefore, it has been used to treat patients with severe yin deficiency syndrome in real-world clinical practice. Subsequently, AF-365 is an extract that reduces the composition of GMCSBHT by half for long-term administration ^[16]. PM014 (HL301), a herbal medicine that focuses on the anti-inflammatory effects of chronic inflammatory lung disease, was developed from CSBHT as a clinical drug to solve the difficulty of standardization ^[17].

Table 2. Composition of herbal medicines in GMCSBHT.

Latin Name	Academic Name	Parts Used	Dose (g)
Rehmanniae Radix Preparata	Rehmannia glutinosa Liboschitz ex Steudel	Root	8
Dioscoreae Rhizoma	Dioscorea batatas Decaisne	Rhizome	6
Corni Fructus	Cornus officinalis Siebold et Zuccarini	Fruit	6
Poria Sclerotium	Poria cocos Wolf	Sclerotium	4
Moutan Radicis Cortex	Paeonia suffruticosa Andrews	Root bark	4
Alismatis Rhizoma	Alisma orientale Juzepzuk	Rhizome	4
Schisandrae Fructus	Schisandra chinensis (Turcz.) Baillon	Fruit	3
Ponciri Fructus Immaturus	Poncirus trifoliata Rafinesque	Immature Fruit	3
Liriopis seu Ophiopogonis Tuber	Liriope platyphylla Wang et Tang	Tuber	3
Asparagi Tuber	Asparagus cochinchinensis Merrill	Tuber	3
Fritillariae Thunbergii Bulbus	Fritillaria thunbergii Miquel	Bulb	3
Platycodonis Radix	Platycodon grandiflorum A. De Candolle	Root	3
Coptidis Rhizoma	Coptis japonica Makino	Rhizome	3
Armeniacae Semen	Prunus armeniaca Linné var. ansu Maximowicz	Kernel	3
Pinelliae Tuber	Pinellia ternate Breitenbach	Tuber	3
Trichosanthis Semen	Trichosanthes kirilowii Maximowicz	Seed	3
Scutellariae Radix	Scutellaria baicalensis Georgi	Root	3
Glycyrrhizae Radix et Rhizoma	Glycyrrhiza uralensis Fischer	Root, Rhizome	2
	Total amount		67

2. Clinical Studies

Fourteen clinical studies were reviewed, including four case series studies and ten before-and-after studies (Table 3).

Table 3. Clinical studies on CSBHT for asthma. Acronyms: CS: Case series, BAS: Before-and-after study, TCM: Traditional Chinese medicine, ESG: Excess syndrome group, DSG: Deficiency syndrome group, PFT: Pulmonary function test, QLQAKA: Quality of Life Questionnaire for Adult Korean Asthmatics, FEV1: Forced expiratory volume at one second, PEFR: Peak expiratory flow rate, ICSG: Inhaled corticosteroid group, NICSG: Non-inhaled corticosteroid group, FVC: Forced vital capacity, NEG: Normal eosinophil group, AEG: Abnormal eosinophil group, NIG: Normal IgE group, AIG: Abnormal IgE group, GINA: Global Initiative for Asthma, CSG: Coexistence syndrome group, SD: Standard deviation, AST: Aspartate aminotransferase, ALT: Alanine aminotransferase.

First Author (Year)	Study Type	Sample (Follow-Up)	Treatment	Duration of Administration	Evaluation	Result
Jung (1986) ^[18]	CS	62 (27)	CSBHT *	Mostly 1~9 days	Total effective rate of general symptom	85.2% (23/27) of patients showed improvement
Rhee (1989) ^[19]	CS	554 (358)	CSBHT * (n = 194) Gamijinhae-tang (n = 100) Gamimaekdong-tang (n = 89) Jeongcheonhwadamganggi-tang (n = 41) Others (n = 29)	Mostly 1~9 days	Total effective rate of general symptom	79.9% (286/358) of patients showed improvement
Jung (2002), ^[20] Hwang (2002), ^[21] Choi (2003) ^[22]	BAS	36	CSBHT decoction (Patients were divided into two groups according to the TCM pattern in the main analysis—ESG and DSG. There were groups according to the TCM pattern in subgroup analysis—phlegm-dampness, phlegm-heat, cold-phlegm, external contraction to wind-cold, heart and kidney deficiency, upper excess and lower deficiency, and lung deficiency	4 weeks	PFT, QLQAKA, blood eosinophil count, and serum IgE, IL-4, IL-5, and IFN-γ levels	Overall patients: FEV1, PEFR, and QLQAKA total score increased, and IFN-γ decreased DSG: QLQAKA total score increased ESG: QLQAKA total score (2 weeks) increased Heart and kidney deficiency group: PEFR and QLQAKA total scores increased IFN-γ decreased Phlegm-dampness group and phlegm-heat group: QLQAKA total score increased
Hwang (2003) ^[23]	BAS	36	CSBHT decoction (patients were divided into two groups according to the use of steroids: ICSG and NICSG	4 weeks	PFT, QLQAKA, blood eosinophil count, serum IgE, IL-4, IL-5, and IFN-γ levels, changes in inhaled corticosteroid dose, and number of users	Overall patients: FEV1, PEFR, and QLQAKA total scores increased IFN-γ decreased NICSG: FVC, FEV1, PEFR, and QLQAKA total score (2 weeks) increased, and IFN-γ decreased ICSG: QLQAKA increased Steroid-sparing effect (8/13 discontinued, 5/13 reduced dose more than half)
Hwang (2003) ^[24]	BAS	36 (24)	CSBHT decoction	4 weeks	PFT, QLQAKA, blood eosinophil count, serum IgE, IL-4, IL-5, and IFN-γ levels (3 months after discontinuing CSBHT)	No significant change in FEV1 and PEFR from baseline QLQAKA total score decreased
Choi (2004) ^[25]	BAS	32 (30)	GMCSBHT extract (patients were divided into two groups according to eosinophil counts (NEG andAEG), and according to IgE levels (NIG and AIG)	4 weeks	PFT, QLQAKA, blood eosinophil count, and serum IgE, IL-4, IL-5, and IFN-γ levels	Overall patients: FEV1, PEFR, IL-4, and QLQAKA total scores increased NEG: FEV1, PEFR, blood eosinophil, IL-4, and QLQAKA total score (2 weeks) increased AEG: PEFR and QLQAKA total score increased NIG: FEV1 and IL-4 increased AIG: PEFR, IL-4, and QLQAKA total score increased
Jung (2004) ^[15]	BAS	32 (30)	GMCSBHT extract (patients were divided into four groups according to the GINA classification: step 1, step 2, step 3, and step 4	4 weeks	PFT and QLQAKA	Overall patients: FEV1, PEFR, and QLQAKA total scores increased Step 3: QLQAKA total score increased Step 4: FEV1 and PEFR increased
Choi (2004) ^[26]	BAS	32 (30)	GMCSBHT extract (Patients were divided into three groups according to the TCM pattern—ESG, DSG, and CSG	4 weeks	PFT and QLQAKA	Overall patients: FEV1, PEFR, and QLQAKA total scores increased DSG: QLQAKA total score (2 weeks), FEV1, and PEFR increased ESG: QLQAKA total score (4 weeks), FEV1, and PEFR increased CSG: no significant change in QLQAKA total score and PFT
Lee (2004) ^[27]	BAS	30 (27)	GMCSBHT extract	4 weeks	PFT and QLQAKA (4 weeks after discontinuing GMCSBHT)	FEV1, PEFR, and QLQAKA total score increased from baseline, but there was no significant change from before discontinuation
Jeong (2005) ^[16]	BAS	30 (27)	AF-365 extract (patients were divided into four groups according to the GINA classification: step 1, step 2, step 3, and step 4	4 weeks	PFT and QLQAKA	Overall patients: PEFR and QLQAKA total score (2 weeks) increased Step 3: PEFR increased, QLQAKA total score (4 weeks) decreased Step 4: QLQAKA total score (2 weeks) increased
Bang (2011) ^[28]	CS	107(66)	CSBHT decoction (patients were divided into three groups according to treatment periods (<4 weeks, 4–8 weeks, and ≥8 weeks), and two groups according to the use of steroids (ICSG and NICSG)	Various(min-max, 1–216 weeks; mean ± SD, 27.02 ± 36.09 weeks)	PFT, blood eosinophil count, and serum IgE, AST, and ALT levels	Overall patients: FVC and FEV1 increased IgE decreased AST and ALT decreased within the normal range <4 weeks: FVC and FEV1 increased 4–8 weeks: FEV1 increased ICSG: no significant change NICSG: FVC and FEV1 increased IgE decreased ≥8 weeks: IgE decreased
Baek (2016) ^[29]	CS	51	CSBHT decoction or extract (patients were divided into four groups according to treatment periods (<4 weeks, 4–8 weeks, 8–12 weeks, and ≥12 weeks)	Various	Blood eosinophil count, serum IgE level (51 patients), AST and ALT levels (44 patients) level, and PFT (11 patients)	Overall patients: IgE decreased FEV1, FVC, FEV1/FVC increased ≥12 weeks: IgE decreased

* The composition and weight proportion of the herbs were modified from the original formula.

Two case series studies were conducted to evaluate the characteristics of patients with asthma who were prescribed CSBHT for its efficacy.

Jung et al. ^[18] conducted an observational study at Kyung Hee University Korean Medicine Hospital from 1983 to 1986. In total, 62 patients complaining of sputum (48 cases), cough (46 cases), and dyspnea (33 cases) were enrolled, and patient satisfaction with CSBHT as the chief complaint was investigated. Among the patients, 35 patients dropped out; therefore, 27 patients who revisited the hospital showed “improvement” (17 [63.0%] patients), “mild improvement” (6 [22.2%] patients), and “no change” (4 [14.8%] patients) ^[18].

Rhee et al. ^[19] conducted a retrospective chart review of 554 patients (including all age groups, men and women) who visited the hospital with asthma. The chief complaints of the patients were cough (286 cases), sputum production (283 cases), and dyspnea (260 cases). Seven prescriptions were used, of which the prescription rate of CSBHT was 42.8% (194 cases). A total of 196 patients who did not revisit the clinic were excluded, and patient satisfaction was investigated in 358 cases. The results showed “improvement” and “mild improvement” in 79.9% (286) of cases ^[19].

Ten before-and-after studies were designed as prospective open-label studies, patients were recruited based on the inclusion criteria, and objective measurement tools were used. Jung et al. ^[20] conducted a prospective, open-label clinical trial (pilot study) in which 92 patients were initially screened. The inclusion criteria were clinical symptoms, including dyspnea, cough, sputum, chest discomfort, and doctor-diagnosed asthma (>15% increase in forced expiratory volume at 1 s [FEV1] of the pulmonary function test [PFT] with the administration of bronchodilators) ^[30]. In total, 36 patients were included in the study and analyzed. The data were compared to those of healthy control subjects who were recruited simultaneously. The decoctions were prepared at the Kyung Hee University Korean Medicine Hospital. Briefly, 118 g of each CSBHT herb was placed in 800 mL of cold water and boiled for 2 h to obtain three packs of approximately 100 mL of decoction. The patients consumed a water decoction three times daily for 4 weeks. The primary outcome was changes in PFT results, and the secondary outcomes were changes in QLQAKA scores and results of hematologic analysis, including serum eosinophil count, IgE level, and cytokine (IL-4, IL-5, and IFN-γ) levels. Administration of a water decoction improved FEV1 and peak expiratory flow rate (PEFR) compared to baseline values. The QLQAKA scores from 2 weeks after administration were also improved and were maintained for 4 weeks. However, hematologic analysis results showed no significant differences compared to baseline values ^[20].

The patients were divided into two groups according to the Korean medicine pattern identification questionnaire: the excess syndrome group (ESG) and the deficiency syndrome group (DSG). The ESG (21 patients) was further divided into four groups: phlegm-dampness (seven patients), phlegm-heat (seven patients), cold-phlegm (two patients), and external contraction to wind-cold (five patients). The DSG (15 patients) was further divided into three groups: heart and kidney deficiency (nine patients), upper excess and lower deficiency (four patients), and lung deficiency (two patients) ^[21]^[22]. In the DSG, QLQAKA scores increased significantly for 4 weeks, but in the ESG, QLQAKA scores increased significantly for up to 2 weeks ^[22]. The heart and kidney deficiency group showed a significant increase in the PEFR and QLQAKA scores and a significant decrease in IL-5 and IFN-γ levels. The phlegm dampness and phlegm heat groups showed a significant increase in QLQAKA scores ^[21]. In this trial, patients treated with CSBHT decoctions were also divided into a group of 13 patients who received low-dose inhaled corticosteroids for ≥2 months and another group of 23 patients who did not receive steroids. Eight of the thirteen patients who received steroids discontinued steroid therapy, and five patients received steroids at less than half the usual dose after initiation of CSBHT. However, when steroids were reduced or discontinued due to CSBHT administration, the PFT results remained similar to the previous results, and the QLQAKA scores improved without significant side effects ^[23].

Of the 36 patients who participated in the test and received CSBHT for 4 weeks, 24 were enrolled in a follow-up study to observe changes 3 months after CSBHT discontinuation. All outcomes returned to baseline values. The results showed that the symptom-relieving effects in patients with asthma treated with CSBHT for 4 weeks were not maintained for 3 months, and re-administration was required within 3 months ^[24].

Choi et al. ^[25] administered GMCSBHT, a modified prescription of CSBHT, in 2003 (Table 2). Thirty-two patients diagnosed with asthma based on PFT results were recruited for the study, of whom two dropped out. Thirty patients with asthma were compared to healthy humans. They were administered one pack of GMCSBHT extract after meals three times a day for 4 weeks, and the outcome measurements were changes in PFT results, hematologic analysis findings, and QLQAKA scores. The PFT (FEV1 and PEFR) and QLQAKA scores showed significant improvement after 4 weeks. In hematologic analysis, the serum eosinophil, IgE, and IFN-γ levels in patients with asthma increased at baseline. After treatment, the IL-4 levels increased, while the IL-5, IFN-γ, eosinophil, and IgE levels did not change significantly ^[25]. A detailed analysis according to the Global Initiative for Asthma classification revealed that 2 patients had stage 1 mild intermittent asthma, 5 patients had stage 2 mild persistent asthma, 12 patients had stage 3 moderate persistent asthma, and 11 patients had stage 4 severe persistent asthma. The QLQAKA scores improved in patients with stage ≥2 persistent asthma, although only patients with stage 3 moderate persistent asthma showed significant changes, and PFT (FEV1 and PEFR) results significantly improved in patients with stage 4 severe persistent asthma. During the 4 weeks of treatment, there were no major side effects requiring treatment. The minor side effects included heartburn (n = 1), diarrhea (n = 5), constipation (n = 2), throat dryness (n = 1), increased sputum dryness (n = 2), headache (n = 2), change in mouth taste (n = 1), and abdominal fullness (n = 1). However, after 4 weeks of treatment, most side effects disappeared, but headaches (n = 1) and abdominal fullness (n = 1) remained ^[15].

These patients were further subdivided into smaller groups: ESG (14 patients), DSG (11 patients), and Coexistence Syndrome Group (CSG), which is a newly classified group with characteristics of both ESG and DSG (5 patients), and evaluated using the pattern identification questionnaire, QLQAKA. It was observed that QLQAKA scores significantly increased in the first 2 weeks in the DSG and in the last 2 weeks in the ESG. Moreover, the FEV1 and PEFR values in both the DSG and ESG significantly increased, while there was no significant effect in the CSG ^[26]. In a previous study, CSBHT showed a significant increase in QLQAKA scores in the DSG for 4 weeks; in the ESG, there was a significant increase in the initial 2 weeks; and there was no significant improvement in PFT results ^[22]. However, after 2 weeks, when GMCSBHT showed a significant improvement in QLQAKA scores in the DSG, asthma symptoms were almost absent. Although there was no additional statistically significant effect after 4 weeks in the DSG, GMCSBHT may have the same quality of life improvement effect as CSBHT in the DSG. In the ESG group, there was a delay in the response, which may be because GMCSBHT is a modified prescription aimed at deficiency syndrome. GMCSBHT has shown a significant therapeutic effect in improving PFT results. Therefore, GMCSBHT may have a stronger effect in patients with deficiency syndromes ^[26].

In a follow-up investigation of 27 patients, the PFT results and QLQAKA scores were maintained until 4 weeks after discontinuation of GMCSBHT ^[27]. These patients also underwent a follow-up trial in which they took AF-365, half-dose GMCSBHT compared to the first administration using the same method to investigate the decision of re-treatment time (therapeutic time window of treatment interval) ^[16]. Subsequently, one pack of AF-365, which was extracted by reducing the amount of GMCSBHT by half, was administered three times a day for 4 weeks. The PEFR and QLQAKA scores significantly improved. Subgroup analysis according to the severity of asthma showed that the PEFR improvement effect was significant in patients with stage 3 disease, and the quality of life improved in patients with stages 3 and 4 disease. The study showed that GMCSBHT administration improved respiratory function and quality of life, which was maintained for 4 weeks.

Recently, two retrospective chart reviews were conducted. Bang et al. ^[28] conducted a case series of patients with asthma. From 2004 to 2009, 107 patients with asthma-related symptoms who were diagnosed based on PFT with bronchodilator reversibility test results were screened. Five patients with exacerbated clinical symptoms and thirty-six with insufficient medical records and follow-up data were excluded; thus, sixty-six patients were included in the study. The main symptoms were cough (86.4%), sputum (74.2%), wheezing (60.6%), dyspnea (42.4%), stuffy or runny nose (12.1%), sore throat (4.5%), and chest discomfort (3.0%). The average treatment period was 27.02 ± 36.09 weeks. The primary outcome was changes in PFT results, while the other supported outcomes were changes in QLQAKA scores and findings of hematologic analyses, such as serum IgE level, eosinophil count, aspartate aminotransferase (AST) level, and alanine transaminase (ALT) level. The results were as follows: FEV1 and forced vital capacity (FVC) on PFT improved compared to the baseline values. The improvement rate in men was higher than that in women despite the older mean age, longer smoking history, and longer period of morbidity. Hematologic analysis revealed that IgE levels decreased without changes in eosinophil count or AST and ALT levels.

Baek et al. ^[29] conducted a chart review of 51 patients with chronic pulmonary diseases who were treated with CSBHT from 2006 to 2016. The patients presented with the following medical histories: asthma, 66.67% (34 patients); unspecified cough, 21.57% (11 patients); COPD, 9.80% (5 patients); allergic rhinitis, 7.84% (4 patients); and others, 11.76% (6 patients). The primary outcome was changes in PFT results, and the other supported outcomes were changes in QLQAKA scores and findings of hematologic analyses such as serum IgE level, eosinophil count, AST level, and ALT level. The PFT results, including FEV1, FVC, and FEV1/FVC, were significantly improved. Serum IgE levels decreased significantly, but there were no significant changes in eosinophil count or AST and ALT levels.

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Subjects: Respiratory System

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Youngmin Bu

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1. Introduction

2. Clinical Studies

References