Cazzola M, Califano C, Di Perna F, D'Amato M, Terzano C, Matera M G, D'Amato G, Marsico S A
A Cardarelli Hospital, Department of Respiratory Medicine, Naples, Italy.
Respir Med. 2002 Oct;96(10):790-5. doi: 10.1053/rmed.2002.1353.
Worsening of underlying bronchospasm may be associated with acute exacerbations of chronic obstructive pulmonary disease (COPD). As airway obstruction becomes more severe, the therapeutic option is to add salbutamol, but not salmeterol, as needed to cause rapid relief of bronchospasm. Unfortunately the most effective dosage of beta2-agonists may increase above that recommended during acute exacerbations. In this study, we compared the acute effects of higher than customary doses of salmeterol and salbutamol in 20 patients with acute exacerbation of COPD. A dose-response curve to salmeterol pMDI, 25 microg/puff or salbutamol pMDI, 100 microg/puff, was constructed using 1, 1, and 2 puff' i.e., a total cumulative dose of 100 microg salmeterol or 400 microg salbutamol on 2 consecutive days. After baseline measurements, dose increments were given at 30-min intervals with measurements being made 25 min after each dose. Hear rate (HR) and pulse-oximetry (SpO2) measurements were then taken. Both salmeterol and salbutamol induced a larg and significant (P < 0.05) dose-dependent increase in FEV1 [mean differences from baseline (L) = after 100 microg salmeterol 0.174 (95% CI: 0.112 to 0.237); after 400 microg salbutamol: 0.165 (95% CI: 0.080 to 0.249)], in IC [mean differences from baseline (L) = after 100 microg salmeterol: 0.332 (95% CI: 0.165 to 0.499); after 400 microg salbutamol: 0.281 (95% CI: 0.107 to 0.456)] (Fig. 2), and in FVC mean differences from baseline (L) = after 100 microg salmeterol: 0.224 (95% CI: 0.117 to 0.331); after 400 microg salbutamol: 0.242 (95% CI: 0.090 to 0.395)]. There was no significant difference between the FEV1 values (P=0.418), the ICvalues (P=0.585), and the FVCvalue (P=0.610) after 100 microg salmeterol and 400 microg salbutamol. HR [mean differences from baseline (beats/min) = after 100 microg salmeterol: 3.15 (95% CI: -0.65 to 6.96); after 400 microg salbutamol: 2.30 (95% CI: -0.91 to 5.51)] and SpO2 [mean differences from baseline (%) = after 100 microg salmeterol: -0.20 (95% CI: -1.00 to 0.60); after 400 microg salbutamol: -0.11 (95% CI: -1.00 to 0.79)] did not change significantly from baseline (P > 0.05). These data indicate that salmeterol is effective and safe in the treatment of acute exacerbation of COPD and support its use in this clinical condition.
潜在支气管痉挛的恶化可能与慢性阻塞性肺疾病（COPD）的急性加重有关。随着气道阻塞变得更加严重，治疗选择是根据需要加用沙丁胺醇而非沙美特罗，以迅速缓解支气管痉挛。不幸的是，β2受体激动剂的最有效剂量可能会高于急性加重期推荐的剂量。在本研究中，我们比较了高于常规剂量的沙美特罗和沙丁胺醇对20例COPD急性加重患者的急性影响。使用1吸、1吸和2吸（即连续2天沙美特罗总累积剂量为100μg或沙丁胺醇为400μg）构建沙美特罗定量吸入器（pMDI）25μg/吸或沙丁胺醇pMDI 100μg/吸的剂量反应曲线。在基线测量后，每隔30分钟增加一次剂量，并在每次给药后25分钟进行测量。然后测量心率（HR）和脉搏血氧饱和度（SpO2）。沙美特罗和沙丁胺醇均引起FEV1[与基线的平均差值（L）=100μg沙美特罗后为0.174（95%可信区间：0.112至0.237）；400μg沙丁胺醇后为0.165（95%可信区间：0.080至0.249）]、IC[与基线的平均差值（L）=100μg沙美特罗后为0.332（95%可信区间：0.165至0.499）；400μg沙丁胺醇后为0.281（95%可信区间：0.107至0.456）]（图2）以及FVC[与基线的平均差值（L）=100μg沙美特罗后为0.224（95%可信区间：0.1到0.331）；400μg沙丁胺醇后为0.242（95%可信区间：0.090至0.395）]出现大幅且显著（P<0.05）的剂量依赖性增加。100μg沙美特罗和400μg沙丁胺醇后的FEV1值（P=0.418）、IC值（P=0.585）和FVC值（P=0.610）之间无显著差异。HR[与基线的平均差值（次/分钟）=100μg沙美特罗后为3.15（95%可信区间：-0.65至6.96）；400μg沙丁胺醇后为2.30（95%可信区间：-0.91至5.51）]和SpO2[与基线的平均差值（%）=100μg沙美特罗后为-0.20（95%可信区间：-1.00至0.60）；400μg沙丁胺醇后为-0.11（95%可信区间：-1.00至0.79）]与基线相比无显著变化（P>0.05）。这些数据表明，沙美特罗在治疗COPD急性加重方面有效且安全，并支持其在这种临床情况下的应用。
