Akamatsu K, Yamagata T, Takahashi T, Miura K, Maeda S, Yamagata Y, Ichikawa T, Yanagisawa S, Ueshima K, Hirano T, Nakanishi M, Matsunaga K, Minakata Y, Ichinose M
Third Department of Internal Medicine, Wakayama Medical University, School of Medicine, 811-1 Kimiidera, Wakayama 641-8509, Japan.
Pulm Pharmacol Ther. 2007;20(6):701-7. doi: 10.1016/j.pupt.2006.08.004. Epub 2006 Sep 14.
A combination of bronchodilators may be effective in the treatment of chronic obstructive pulmonary disease (COPD). We examined the effect of adding a long-acting anti-cholinergic agent (tiotropium) to a transdermal-type beta(2)-agonist (tulobuterol) on dyspnea as well as pulmonary function.
In a multicentre, randomized, parallel design study, 60 COPD patients treated with the transdermal beta(2)-agonist tulobuterol were divided into a tiotropium added group (Tulo+Tio group, n=40) or transdermal beta(2)-agonist tulobuterol alone group (Tulo group, n=20), and then treated for 4 weeks after a 2 week run-in period. Pulmonary function and a dyspnea (Medical Research Council (MRC)) scale were assessed before and after the treatment. Daily peak expiratory flow (PEF) monitoring was also performed.
After 4 weeks, the Tulo+Tio group showed a significant increase in pulmonary function compared with the Tulo group; DeltaFVC (0.31+/-0.06 L vs. 0.06+/-0.05 L, p< 0.01), DeltaFEV(1) (0.15+/-0.03 L vs. -0.02+/-0.02 L, p<0.0001), and DeltaPEF (41.0+/-5.1 L/min vs. 0.5+/-3.5 L/min, p<0.0001). The MRC dyspnea scale was also significantly improved in Tulo+Tio, but not in Tulo group.
These results suggest that tiotropium caused a significant improvement in both pulmonary function and dyspnea in COPD patients already treated with the transdermal beta(2)-agonist tulobuterol.
支气管扩张剂联合使用可能对慢性阻塞性肺疾病（COPD）的治疗有效。我们研究了在经皮型β₂受体激动剂（妥洛特罗）基础上加用长效抗胆碱能药物（噻托溴铵）对呼吸困难及肺功能的影响。
在一项多中心、随机、平行设计研究中，60例接受经皮β₂受体激动剂妥洛特罗治疗的COPD患者被分为加用噻托溴铵组（妥洛特罗+噻托溴铵组，n = 40）或单用经皮β₂受体激动剂妥洛特罗组（妥洛特罗组，n = 20），在经过2周导入期后进行4周治疗。在治疗前后评估肺功能和呼吸困难（医学研究委员会（MRC））量表。还进行了每日呼气峰值流速（PEF）监测。
4周后，妥洛特罗+噻托溴铵组与妥洛特罗组相比肺功能显著改善；用力肺活量变化量（DeltaFVC）（0.31±0.06 L对0.06±0.05 L，p < 0.01），第1秒用力呼气容积变化量（DeltaFEV₁）（0.15±0.03 L对 - 0.02±0.02 L，p < 0.0001），以及呼气峰值流速变化量（DeltaPEF）（41.0±5.1 L/min对0.5±3.5 L/min，p < 0.0001）。MRC呼吸困难量表在妥洛特罗+噻托溴铵组也显著改善，但在妥洛特罗组未改善。
这些结果表明，噻托溴铵使已接受经皮β₂受体激动剂妥洛特罗治疗的COPD患者的肺功能和呼吸困难均得到显著改善。
