JOURNAL REVIEW“Aspiration pneumonia and bronchopneumonia in

progressive supranuclear palsy treated with qing fei tang: two case reports”

By:

Ichiro Nozaki, Yuko Kato-Motozaki, Tokuhei Ikeda, Kazuya Takahasi, Atsuro Tagami, Chiho Ishida and Kiyonobu Komai

1. Rosmayda Ria J (1413010002)

2. Rima Nur Annisa (1413010003)

3. Silka Reslia R (1413010004)

4. Karunia M. N (1413010005)

5. Ferdian Rifqy N (1413010011)

6. Bagus Susetio W (1413010014)

7. Nur Husnina D (1413010020)

8. Alevia Miranti P (1413010022)

9. Arsya Firdaus (1413010032)

10. Tsara Arbiaty K (1413010046)

“Aspiration pneumonia and bronchopneumonia in progressive supranuclear palsy treated with qing fei tang: two case reports”

Case presentation

Abstract

Introduction

Case presentation

Discussion

Conclusions

ABSTRACT

Qing fei tang, which is used for various respiratory diseases, is useful for reducing relapse of aspiration pneumonia and bronchopneumonia in stroke.

The case reports the use of Qing fei tang in two Japanese patients with progressive supranuclear palsy and relapsing aspiration pneumonia and bronchopneumonia, which was successfully prevented by qing fei tang.

INTRODUCTION

• Aspiration pneumonia and bronchopneumonia frequenly happend in Parkinson’s Syndrom’s patient in later stage. People with Progressive Supranuclear Palsy (PSP) may get aspiration penumonia & bronchopneumonia too.

• Qing fei tang kind of CTM (Japan: seihai-to) with main component of 16 herbs powdered extract, has been used for the teatment of productive cough, bronchitis, bronchiectasis, pneumonia etc.

Fritillariae bulbus

Armeniacae semen

Auranti nobilis pericarpium

Angelicae radix Caulis bambusae

in taeniis

Gardenia fructus

Zingeribis siccatum rhizoma Glycyrrhizae

radixMori cortex

Ophiopogonis tuber

Platycodi radix

Asparagi radix

Schisandrae fructus

Scutellariae radix

Zizyphi fructus

• In this case, reported that qing fei tang would be effective for prevention of relapsing aspiration pneumonia and bronchopneumoni in PSP compared with conventional therapy

CASE PRESENTATION

Patient 1

• A 63 y.o Japanese Man• Speech Difficulty• Standing Instability• Slow Movement

At 12 month after that

• Cognitive Decline• Dysathria• Bradykinesia• Trunk Dominant Muscular

Rigidity• Tendency to Fall• Mild Atrophy of the Midbrain

tegmentum.

At 10 months after that

• Using Wheelchair• Aspiration Pneumonia

( 3 times at monthly intervals )

• Percutaneous Endoscopic Gastrostomy

• Treatment for Percutaneous Endoscopic Gastrostomy with Clarythromycin and Amantadine.

• Qing Fei Thang 9g -> Aspiration Pneumonia reoccured only 1 at 5,5 months.

• The bacteria is Staphylococcus Aureus except for Streptococcus Agalactiae.

Patient 2

• A 74 y.o Japanaese Man• Difficulty in moving his upper limb• A tendency to fall• Slow Movements

Diagnosed

• Supranuclear Vertical Gaze Palsy

• Dysarithria• Bradykinesia• Musculus Rigidity• Loss of postural reflex

After 23 months -> Percutaneous Endoscopic Gastrostomy

• 10 months (9times) -> Aspiration Pneumonia and Bronchopneumonia -> One Month (Ambroxo, L-carbocystein, Clarythromicyne, Bromhexine, Amantadine.

• Qing Fei Thang 9g -> Aspiration Pneumonia occurred 1x 6months.

• The bacteria is Pseudomonas Aeruginosa, MRSA, Klebsiella Pneumoniase.

DISCUSSION

Patient one -> twice at intervals of two months

Patient two -> recurrence nine times at almost monthly intervals.

The respiratory infection developed only once, at 5.5 months (patient one) and six months (patient two) after the administration of qing fei tang.

The effectivity of Qing fei tang

This patient use conventional treatment before use qing fei tang the result is unsatisfied

Qing fei tang effect in respiratory infection reoccurred twice in a relatively short period.

There’s no advere effect

Comparations between Qing fei tang and conventional therapy

Qing fei tang• Reduced of relapsing

aspiration pneumonia & bronchopneumonia in 7 patients (including: 4 patients without oral intake)

Conventinal therapy• Reduced of relapsing

aspiration pneumonia & bronchopneumonia in 8 patients (including: 6 patients without oral intake)

Mechanism of Qing fei tang

Inhibit the activation of xantine oxidase.

Pretreatment with qing fei tang is considered to reduce oxygen radicals produced by inflammation in the lungs, and to reduce the mortality rate of mice with aspiration pneumonia

New finding of administration of Qing fei tanga. Reduced the incidence of

aspiration pneumonia & bronchopneumonia

b. Prolong the interval until the onset of

respiratory infection in PSP

c. Available option for preventive therapy recurrent

aspiration penumonia & bronchopneumonia

d. Reduction of respiratory infection may prolong the

survival time in PSP

e. Qing fei tang could be used when aspiration pneumonia &

bronchopneumonia cannot be kept under control in patients with PSP

using conventional therapy.

Conclusions

Qing Fei Tang

Could prevent recurrent aspiration pneumonia and bronchopneumonia in patients with PSP, and may be an option

for treatment in addition to conventional therapy.

THANK YOU