噻托溴铵替代氧托溴铵对慢性阻塞性肺疾病患者肺功能的影响：一项随机研究。

Effects of replacing oxitropium with tiotropium on pulmonary function in patients with COPD: a randomized study.

作者信息

Incorvaia Cristoforo, Riario-Sforza Gian Galeazzo, Pravettoni Chiara, Dugnani Natale, Paterniti Fulvia, Pessina Laura, Fumagalli Mario

机构信息

Unit of Pulmonary Rehabilitation, ICP Hospital, via Bignami 1, Viale Molise 69, Milan, Italy.

出版信息

Respir Med. 2007 Mar;101(3):476-80. doi: 10.1016/j.rmed.2006.07.008. Epub 2006 Aug 21.

DOI:10.1016/j.rmed.2006.07.008

PMID:16919926

Abstract

BACKGROUND

Inhaled bronchodilators are first line drugs in the treatment of chronic obstructive pulmonary disease (COPD). Tiotropium bromide is a recently introduced long-acting anticholinergic agent able to reduce dyspnoea and COPD exacerbations and to improve pulmonary function and quality of life. We designed a study to compare the short-term efficacy of tiotropium bromide with that of oxitropium bromide in improving pulmonary function in patients with COPD.

METHODS

Eighty patients were randomized either to continue oxitropium 800 mcg/day or to receive tiotropium 18 mcg/day. Seventy-six (39 in the tiotropium and 37 in the oxitropium group) completed the study. Plethysmography was performed at baseline and after 72 h in all patients. The changes in functional parameters in the two groups were compared by the Mann-Whitney U-test.

RESULTS

There were no differences between the two groups regarding age (72.5 vs. 74.2 years), male/female ratio (25/14 vs. 23/14) and pulmonary function at baseline. The changes in spirometric parameters were significantly greater in tiotropium- than in oxitropium-treated patients: mean forced expiratory volume in 1s (FEV(1)) increased significantly by 15% vs. 3% (P=0.017), mean FVC by 10.5% vs. 2.2% (P=0.044), and FEF 25, 50, and 75 by 34% vs. 14% (P<0.05), 33% vs. 7% (P<0.05), and 50% vs. 6% (P<0.0001), respectively; mean FRC and RV decreased nonsignificantly by 7.5% and 10% with tiotropium vs. 4.3% and 6.5% with oxitropium, respectively.

CONCLUSION

The replacement of oxitropium with tiotropium significantly increases pulmonary function in patients with COPD. The improvement involves also small airways that have not been investigated thus far.

摘要

背景

吸入性支气管扩张剂是慢性阻塞性肺疾病（COPD）治疗的一线药物。噻托溴铵是一种最近引入的长效抗胆碱能药物，能够减轻呼吸困难和COPD急性加重，并改善肺功能和生活质量。我们设计了一项研究，比较噻托溴铵与氧托溴铵在改善COPD患者肺功能方面的短期疗效。

方法

80例患者被随机分为两组，一组继续每日使用800微克氧托溴铵，另一组每日接受18微克噻托溴铵治疗。76例患者（噻托溴铵组39例，氧托溴铵组37例）完成了研究。所有患者在基线时和72小时后进行了体积描记法检查。两组功能参数的变化通过曼-惠特尼U检验进行比较。

结果

两组在年龄（72.5岁对74.2岁）、男女比例（25/14对23/14）和基线肺功能方面无差异。噻托溴铵治疗组患者肺量计参数的变化显著大于氧托溴铵治疗组：第1秒用力呼气容积（FEV(1)）平均显著增加15%，而氧托溴铵组为3%（P = 0.017）；平均用力肺活量（FVC）增加10.5%，而氧托溴铵组为2.2%（P = 0.044）；FEF 25、50和75分别增加34%，而氧托溴铵组为14%（P < 0.05），33%，而氧托溴铵组为7%（P < 0.05），50%，而氧托溴铵组为6%（P < 0.0001）；平均功能残气量（FRC）和残气量（RV）使用噻托溴铵时分别非显著下降7.5%和10%，而氧托溴铵分别下降4.3%和6.5%。