Bronchodilator responsiveness in patients with COPD
Bronchodilator responsiveness in patients with COPD
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DOI：
10.1183/09031936.00129607
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发表时间：
2008-04-01
影响因子：
24.3
通讯作者：
Kesten, S.
中科院分区：
文献类型：
--
作者：
Tashkin, D. P.;Celli, B.;Kesten, S.
慢性阻塞性肺疾病(COPD)患者吸入支气管扩张剂后，肺活量指数的急性改善程度有所不同，这取决于支气管扩张剂的类型和剂量以及给药的时机。在一项为期4年的随机双盲试验中，对一大批中重度COPD患者在基线时的急性支气管扩张剂反应性进行了检测。该试验是一项为期4年的随机双盲试验，评估了每天服用18 MU硫托溴铵在降低肺功能减退率方面的效果。停用呼吸系统药物后，患者先用异丙托品80毫克，然后再用沙丁胺醇400毫克。分别于给药前和给药后90min进行肺活量测定。1秒用力呼气容积(FEV1)反应的标准是：=较基线增加12%和200毫升；=较基线增加15%；以及=绝对百分比增加10%。在5,756名患者中，有5,756名患者的数据符合分析标准(年龄64.5岁；男性75%；基线FEV1 1.10 L(预测39.3%)和用力肺活量(FVC)2.63 L)。与基线相比，FEV1组和FVC组的平均改善分别为229和407毫升。在这些患者中，53.9%的患者FEV1改善了12%和200毫升，65.6%的患者FEV1改善了15%，38.6%的患者FEV1的Pre绝对值增加了10%。大多数中到极严重的慢性阻塞性肺疾病患者在吸入抗胆碱能药物和交感神经刺激性支气管扩张剂后肺功能显著改善。
The degree of acute improvement in spirometric indices after bronchodillator inhalation varies among chronic obstructive pulmonary disease (COPD) patients, and depends upon the type and dose of bronchodilator and the timing of administration.Acute bronchodilator responsiveness at baseline was examined in a large cohort of patients with moderate-to-very-severe COPD participating in the Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT) trial, a 4-yr randomised double-blind trial evaluating the efficacy of 18 mu g tiotropium daily in reducing the rate of decline in lung function. After wash-out of respiratory medications, patients received 80 mu g ipratropium followed by 400 mu g salbutamol. Spirometry was performed before and 90 min following ipratroplum administration. The criteria used for forced expiratory volume in one second (FEV1) responsiveness were: >= 12% increase over baseline and >= 200 mL; >= 15% increase over baseline; and >= 10% absolute increase in the percentage predicted value.Of the patients, 5,756 had data meeting the criteria for analysis (age 64.5 yrs; 75% male; baseline FEV1 1.10 L (39.3% predicted) and forced vital capacity (FVC) 2.63 L). Compared with baseline, mean improvements were 229 mL in FEV1 and 407 mL in FVC. Of these patients, 53.9% had >= 12% and >= 200 mL improvement in FEV1, 65.6% had >= 15% improvement in FEV1, and 38.6% had >= 10% absolute increase in FEV1 % pred.The majority of patients with moderate-to-very-severe chronic obstructive pulmonary disease demonstrate meaningful increases in lung function following administration of inhaled anticholinergic plus sympathomimetic bronchodilators.