Oga Toru, Nishimura Koichi, Tsukino Mitsuhiro, Sato Susumu, Hajiro Takashi, Mishima Michiaki
Respiratory Division (Drs. Oga and Nishimura), Kyoto-Katsura Hospital, Kyoto, Japan.
Chest. 2003 Jun;123(6):1810-6. doi: 10.1378/chest.123.6.1810.
Inhaled bronchodilators are the first-line pharmacotherapy against COPD. The purpose of the present study was to investigate the effects of beta(2)-agonists and anticholinergic agents on the exercise capacity of patients with COPD.
A total of 67 stable patients with COPD were recruited at the Kyoto University Hospital. After inhaling 400 micro g salbutamol, 80 micro g ipratropium bromide, or an identical placebo in a randomized, double-blind, crossover fashion, the patients performed cycle endurance tests at a constant workload of 80% of the maximum work rate reached on progressive cycle ergometry, and the endurance time was recorded.
Both salbutamol and ipratropium bromide significantly improved the endurance time by 29 s (15%; p < 0.001) and 27 s (14%; p < 0.001), respectively, in comparison with the placebo. However, there was no statistically significant difference between them (p = 0.71). The dyspnea ratios were also similarly reduced by both bronchodilators. The difference in the endurance time between therapy with salbutamol and placebo was significantly, but moderately, related to the difference between therapy with ipratropium bromide and placebo. In addition, there were no relationships, or only weakly significant relationships, between the change in FEV(1) and the change in the endurance time, the highest oxygen uptake, and the highest minute ventilation for both salbutamol and ipratropium bromide.
Therapy with both salbutamol and ipratropium bromide improved exercise capacity, as evaluated by the endurance time, and reduced dyspnea similarly in patients with COPD. In addition, the effects of the different bronchodilators on exercise capacity varied within individuals, and a complex mechanism may be responsible for the different effects of these two bronchodilators on exercise capacity vs airflow limitation. These results support the conclusion that both types of inhaled bronchodilators can be used as first-line drugs for the treatment of stable patients with COPD.
吸入性支气管扩张剂是慢性阻塞性肺疾病（COPD）的一线药物治疗方法。本研究的目的是调查β2受体激动剂和抗胆碱能药物对COPD患者运动能力的影响。
京都大学医院共招募了67例稳定期COPD患者。患者以随机、双盲、交叉方式吸入400μg沙丁胺醇、80μg异丙托溴铵或相同的安慰剂，然后在递增式自行车测力计上以达到最大工作率80%的恒定工作量进行自行车耐力测试，并记录耐力时间。
与安慰剂相比，沙丁胺醇和异丙托溴铵分别使耐力时间显著延长29秒（15%；p<0.001）和27秒（14%；p<0.001）。然而，两者之间无统计学显著差异（p=0.71）。两种支气管扩张剂也同样降低了呼吸困难比率。沙丁胺醇治疗与安慰剂治疗之间耐力时间的差异与异丙托溴铵治疗与安慰剂治疗之间的差异显著但中度相关。此外，沙丁胺醇和异丙托溴铵的第1秒用力呼气容积（FEV1）变化与耐力时间变化、最高摄氧量和最高每分通气量之间均无关系或仅有微弱的显著关系。
沙丁胺醇和异丙托溴铵治疗均改善了以耐力时间评估的运动能力，并同样减轻了COPD患者的呼吸困难。此外，不同支气管扩张剂对运动能力的影响在个体间存在差异，两种支气管扩张剂对运动能力和气流受限的不同影响可能由复杂机制所致。这些结果支持以下结论：两种类型的吸入性支气管扩张剂均可作为稳定期COPD患者的一线治疗药物。
