“Because there is no cure for COPD, treatments for the disease can only help slow its progression and control symptoms,” says Nan Huo, MD, PhD. “Treatment goals include managing symptoms, reducing or preventing recurrent exacerbations, improving lung function, and enhancing quality of life by using various medications, such as β-agonists, corticosteroids, and leukotriene modifiers.”

However, with long-term use of COPD medications, especially corticosteroids, treatment-related side effects can reduce quality of life. “Increasingly, Americans with chronic diseases are pursuing complementary and alternative medicine (CAM) to improve general health or quality of life,” Dr. Huo says. “Botanical dietary supplements (BDS), among the most popular types of CAM, have been used to help manage other chronic diseases like asthma, diabetes, arthritis, and cancer.”

Research is lacking on real-world patterns of BDS use and its impact on clinical outcomes in patients with COPD. “It’s important to know if BDS use is popular in patients with COPD,” says Dr. Huo. “The risks of drug–drug interactions may increase when patients use multiple drugs. Although BDS may be beneficial, it’s important to carefully monitor outcomes in patients with COPD who use BDS.”

Emerging Trends of BDS Use

For a study published in PLoS One, Dr. Huo and colleagues examined trends of BDS use from 1999 to 2016 among US patients with COPD using NHANES data. They also examined associations between BDS use and COPD-related clinical outcomes, including all-cause hospitalization and abnormal hemoglobin levels. In total, 2,580 COPD cases were identified using a self-reported diagnosis history. BDS use was defined as using any BDS in the past 30 days. Results were then weighted to represent national estimates.

“Our most important finding was that overall use of BDS decreased during the study period for US adults with COPD, especially after 2006,” Dr. Huo says (Figure). “However, the overall mean of BDS users among patients with COPD was still higher than the general population. Simply put, BDS was more popular in patients with COPD than in the general population. Another key finding was that only socioeconomic factors, such as higher income or higher education level, were associated with BDS use. Other factors—such as smoking, age, sex, and race—were not.”

Associations between BDS use and clinical outcomes, including all-cause hospitalization and abnormal hemoglobin levels, we also assessed. “We found that use of BDS among adults with COPD was associated with a 36% lower likelihood of self-reported all-cause hospitalization and 33% lower hemoglobin levels when compared with those who did not use BDS,” says Dr. Huo. “These data indicate that using BDS potentially benefitted patients with COPD with regard to important clinical outcomes.”

Carefully Monitor BDS Use

Although BDS may improve patient outcomes in patients with COPD, Dr. Huo cautions that physicians should carefully monitor individuals who use these products for side effects from drug–drug interactions. “We recommend collaborating closely with patients and considering BDS use as an alternative treatment when other COPD therapies are not working as effectively as we would hope,” he says. The study authors also note that physicians should educate their patients with COPD, especially the elderly, that use of BDS products may have an impact on other comorbidities, especially cardiac diseases like heart failure.

Results from the analysis indicate that BDS had the potential to improve all-cause hospitalization rates and low hemoglobin levels in COPD, but these findings warrant further investigation. “Future clinical trials should seek to determine whether BDS is truly useful for patients with COPD and what types of BDS products are most beneficial,” Dr. Huo says. “In the meantime, physicians should monitor patterns of BDS use among their patients with COPD and balance the benefits and risks of these therapies with regard to patient wellness and clinical outcomes.”


Sun Y, Wang R, Tang W, Li C, Huo N. Trends and factors of botanical dietary supplement use among US adults with COPD from 1999 to 2016. PLoS One. 2020;15(9):e0239674. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7523968/.

Huo N, Qian J. Associations of herbs and nonvitamin dietary supplements use with clinical outcomes among adult and pediatric patients with asthma in the United States. J Allergy Clin Immunol: In Pract. 2018;6(3):936-943.

Huo N, Ray GE, Mehta S, LoBello SG. Complementary and alternative medicine use among people with asthma and health-related quality of life. J Asthma. 2015;52(3):308-313.

Kantor ED, Rehm CD, Du M, White E, Giovannucci EL. Trends in dietary supplement use among US adults from 1999–2012. JAMA. 2016;316(14):1464-1474.