Chhabra Sunil K, Bhatnagar Shaleen
Department of Cardiorespiratory Physiology, Vallabhbhai Patel Chest Institute, University of Delhi, India.
Indian J Chest Dis Allied Sci. 2002 Apr-Jun;44(2):91-7.
While asthmatics are known to have a greater response to bronchodilators than patients of chronic obstructive pulmonary disease (COPD), whether the pattern of response also differs has not been explored. Forced vital capacity (FVC) and forced expiratory volume in 1st second (FEV1) were measured before and 20 minutes after inhalation of 200 microg salbutamol in patients of bronchial asthma (n=133) and (COPD) (n=116). Three types of responses (defined as > or = 12% and 200 ml increase in FEV1 or FVC) were identified: increase in (i) only FVC (FVC response), (ii) only FEV1 (FEV1 response), and, (iii) both FVC and FEV1 (double response). The mean +/- SEM absolute increase in FEV1 was significantly greater in asthmatics (307+/-17ml) as compared to 120+/-12 ml in COPD patients (p<0.0001). On the other hand, the increase in FVC was not different in the two groups (296+/-22 ml and 230+/-24 ml, respectively, p>0.05). The proportion of subjects showing a > or = 200 ml increase in FEV1 was greater among asthmatics as compared to COPD (p<0.0001) but the proportions showing a > or = 200 ml in FVC were similar (p>0.05). All the three types of responses were observed in asthmatics with a double response being the commonest. In COPD, an FVC response was the predominant response while the FEV1 response was rare. Multinomial logistic regression revealed that younger subjects (below 45 years) were more likely to have a double or exclusive FEV1 response. Greater severity of obstruction was associated with higher odds for each of the three responses, the odds being especially very high for an exclusive FEV1 response. The odds for a double response and an exclusive FEV1 response were significantly increased in asthmatics as compared to COPD. For FVC response, age category and disease were not significant determinants. It was concluded that bronchodilator responsiveness in asthma and COPD differs not only quantitatively but also in the pattern.
虽然已知哮喘患者对支气管扩张剂的反应比慢性阻塞性肺疾病（COPD）患者更大，但反应模式是否也不同尚未得到探讨。在133例支气管哮喘患者和116例COPD患者中，测量了吸入200微克沙丁胺醇前及吸入后20分钟的用力肺活量（FVC）和第1秒用力呼气量（FEV1）。确定了三种类型的反应（定义为FEV1或FVC增加≥12%且增加200毫升）：（i）仅FVC增加（FVC反应），（ii）仅FEV1增加（FEV1反应），以及（iii）FVC和FEV1均增加（双重反应）。哮喘患者FEV1的平均±标准误绝对增加量（307±17毫升）显著高于COPD患者的120±12毫升（p<0.0001）。另一方面，两组的FVC增加量无差异（分别为296±22毫升和230±24毫升，p>0.05）。与COPD相比，哮喘患者中FEV1增加≥200毫升的受试者比例更高（p<0.0001），但FVC增加≥200毫升的比例相似（p>0.05）。在哮喘患者中观察到了所有三种类型的反应，其中双重反应最为常见。在COPD中，FVC反应是主要反应，而FEV1反应很少见。多项逻辑回归显示，较年轻的受试者（45岁以下）更有可能出现双重或单纯的FEV1反应。阻塞程度越严重，三种反应中每种反应的几率越高，单纯FEV1反应的几率尤其高。与COPD相比，哮喘患者双重反应和单纯FEV1反应的几率显著增加。对于FVC反应，年龄类别和疾病不是显著的决定因素。得出的结论是，哮喘和COPD中支气管扩张剂反应性不仅在数量上不同，而且在模式上也不同。
