Tsai C F, Tsai J J
Kang-Ning College of Nursing, Department of Medicine, Cathay General Hospital-Taipei, Taiwan, ROC.
J Microbiol Immunol Infect. 2001 Jun;34(2):92-6.
Patients with asthma often show increased airway hyperreactivity and mucus hypersecretion. Although beta2-agonist therapy is one of the most common and effective ways used to relieve airway obstruction, the use of a positive expiratory pressure device (PEPD) is also effective in mucus clearance. However, no previously reported study has examined the effectiveness of these two therapies used in combination. This study assessed the effectiveness of a PEPD on beta2-agonist nebulization therapy by measuring the pulmonary function before and after nebulization therapy in 54 asthmatic patients. The results show that the use of PEPD after beta2-agonist nebulization therapy improved pulmonary function compared with the use of beta2-agonist nebulization therapy alone, as shown by the increases in forced midexpiratory flow and forced vital capacity (FVC). Patients with forced expiratory volume in 1 sec (FEV1) below 85% FVC obtained a significant improvement in FEV1 and FVC after using PEPD. When PEPD was used before beta2-agonist nebulization therapy, there were no obvious direct bronchodilative effects. The use of PEPD after beta2-agonist therapy, however, significantly enhanced the bronchodilative effect of beta2-agonist therapy in patients with an FEV1 below 85% FVC. The additional effect of PEPD use in improving pulmonary function after beta2-agonist nebulization therapy might be a result of an enhancement in mucus clearance.
哮喘患者常表现出气道高反应性增加和黏液分泌过多。尽管β2受体激动剂疗法是缓解气道阻塞最常用且有效的方法之一，但使用呼气正压装置（PEPD）在清除黏液方面也很有效。然而，此前尚无研究探讨这两种疗法联合使用的效果。本研究通过测量54例哮喘患者雾化治疗前后的肺功能，评估了PEPD对β2受体激动剂雾化治疗的效果。结果显示，与单独使用β2受体激动剂雾化治疗相比，在β2受体激动剂雾化治疗后使用PEPD可改善肺功能，表现为用力呼气中期流速和用力肺活量（FVC）增加。1秒用力呼气容积（FEV1）低于FVC 85%的患者在使用PEPD后，FEV1和FVC有显著改善。在β2受体激动剂雾化治疗前使用PEPD时，没有明显的直接支气管舒张作用。然而，在β2受体激动剂治疗后使用PEPD，可显著增强FEV1低于FVC 85%患者的β2受体激动剂治疗的支气管舒张作用。在β2受体激动剂雾化治疗后使用PEPD改善肺功能的额外效果可能是黏液清除增强的结果。
