异丙托溴铵对儿童运动诱发性支气管痉挛的作用取决于迷走神经活动。

Effect of ipratropium bromide on EIB in children depends on vagal activity.

作者信息

Knöpfli Bruno H, Bar-Or Oded, Araújo Claudio G S

机构信息

Alpine Children's Hospital Davos, Davos, SWITZERLAND.

出版信息

Med Sci Sports Exerc. 2005 Mar;37(3):354-9. doi: 10.1249/01.mss.0000155436.31581.90.

DOI:10.1249/01.mss.0000155436.31581.90

PMID:15741830

Abstract

PURPOSE

Ipratropium bromide (IB) has been used to prevent exercise-induced bronchoconstriction (EIB), but its effect varies among individuals. We hypothesized that such variability may reflect individual differences in vagal activity (VA), and therefore determined whether a correlation exists between VA and the effect of IB on EIB in 13.0 (+/-0.8)-yr-old children with asthma and documented EIB.

METHODS

Subjects served as their own control and were tested on three occasions in an ambient temperature of 5 degrees C. Visit I included no treatment. In visits II and III (counterbalanced sequence) subjects inhaled either 500 microg IB or 0.9% NaCl as a placebo, 45 min before exercise provocation. Investigators and the subjects were blinded to the inhaled substance. VA was assessed by a 4-s exercise test (3). The ratio of resting ECG R-R-interval at full inspiration to the lowest R-R interval during 4-s cycling was taken as an index of VA. Eight-minute cycling at constant work rate (HR=173+/-4 bpm) at 5 degrees C was used to provoke EIB. A two-factor (treatment x time) repeated-measures ANOVA was used.

RESULTS

The exercise-induced drop in FEV1 was similar in the three sessions. However, because the IB caused a 15.7+/-4.1 increase in FEV1 preexercise, the postexercise values after a placebo or no treatment were consistently lower than after IB. The beneficial response to IB, compared with no treatment and with placebo, was positively correlated to VA (for FEV1: r=0.91, P=0.002; and r=0.90, P=0.002, respectively).

CONCLUSION

We suggest that the therapeutic effect of IB on exercise-induced asthma may be related to vagal activity.

摘要

目的

异丙托溴铵（IB）已被用于预防运动诱发的支气管收缩（EIB），但其效果存在个体差异。我们推测这种变异性可能反映了迷走神经活性（VA）的个体差异，因此确定了13.0（±0.8）岁患有哮喘且有EIB记录的儿童中，VA与IB对EIB的作用之间是否存在相关性。

方法

受试者自身作为对照，在5摄氏度的环境温度下进行了三次测试。第一次就诊未进行治疗。在第二次和第三次就诊（顺序平衡）时，受试者在运动激发前45分钟吸入500微克IB或0.9%氯化钠作为安慰剂。研究者和受试者对吸入物质不知情。通过4秒运动测试（3）评估VA。将完全吸气时静息心电图R-R间期与4秒骑行期间最低R-R间期的比值作为VA指标。在5摄氏度下以恒定工作率（心率=173±4次/分钟）进行8分钟骑行以诱发EIB。采用双因素（治疗×时间）重复测量方差分析。

结果

三次测试中运动诱发的第一秒用力呼气容积（FEV1）下降相似。然而，由于IB使运动前FEV1增加了15.7±4.1，安慰剂或未治疗后的运动后值始终低于IB后的运动后值。与未治疗和安慰剂相比，对IB的有益反应与VA呈正相关（对于FEV1：r = 0.91，P = 0.002；以及r = 0.90，P = 0.002）。