Relationship between improved airflow limitation and changes in airway calibre induced by inhaled anticholinergic agents in COPD
Relationship between improved airflow limitation and changes in airway calibre induced by inhaled anticholinergic agents in COPD
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DOI：
10.1136/thx.2008.103671
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发表时间：
2009-04-01
期刊：
影响因子：
10
通讯作者：
Nishimura, M.
中科院分区：
文献类型：
--
作者：
Hasegawa, M.;Makita, H.;Nishimura, M.
背景资料：尽管吸入抗胆碱能药物改善的气流受限在慢性阻塞性肺疾病（COPD）患者中各不相同，但实际支气管扩张和肺功能改善之间的关系以及这种支气管扩张发生在肺的何处仍然未知。采用三维计算机断层扫描（CT）进行研究，以确定COPD患者吸入抗胆碱能药物后气道不同部位的肺功能改善与气道口径变化之间的关系。在15例临床上患有哮喘的患者中，在每日吸入噻托溴铵之前和之后1周，在深吸气时进行CT扫描，并进行详细的肺功能检查。稳定的COPD。结果：右肺8支气管第3代（节段性）至第6代的气道管腔面积平均增加39%，第1秒用力呼气容积（FEV 1）平均值（SE）从1.23（0.11）l增加到1.47（0.13）l。支气管扩张程度与肺功能改善密切相关，尤其与FEV 1改善密切相关（r = 0.843，p < 0.001）。这种相关性是显着的，在第四至第六代，但不是在第三代的支气管，从第三代到第六代的回归线的斜率变得更陡。结论：吸入性抗胆碱能药物诱导整体支气管扩张，这是成比例的改善FEV 1在COPD患者。远端而非近端气道的支气管扩张是功能改善的决定因素。
Background: Although airflow limitation improved by inhaled anticholinergic drugs varies among individuals with chronic obstructive pulmonary disease (COPD), the relationship between actual bronchodilation and improved pulmonary function and where in the lung such bronchodilation occurs remains unknown. A study was undertaken to determine the relationship between improved pulmonary function and changes in airway calibre at various sites in the airways in response to inhaled anticholinergic agents in patients with COPD using three-dimensional computed tomography (CT).Methods: CT scans were performed at deep inspiration and detailed pulmonary function tests before and 1 week after daily inhalations of tiotropium bromide in 15 patients with clinically stable COPD. The airway luminal area was examined at the third (segmental) to the sixth generations of eight bronchi in the right lung.Results: Bronchodilation was demonstrated by an overall average increase of 39% in the inner luminal area, and the mean (SE) forced expiratory volume in 1 s (FEV1) increased from 1.23 (0.11) l to 1.47 (0.13) l. The magnitude of bronchodilation was closely correlated with improved pulmonary function, particularly with that of FEV1 (r = 0.843, p < 0.001). Such correlations were significant at the fourth to the sixth generation but not at the third generation of bronchi, and the slope of the regression lines became steeper from the third to the sixth generation.Conclusions: Inhaled anticholinergic agents induce overall bronchodilation which is in proportion to improvements in FEV1 in patients with COPD. Bronchodilation at the distal rather than the proximal airways is the determinant of functional improvement.