Tashkin Donald P, Klein Gerald L, Colman Shoshana S, Zayed Hany, Schonfeld Warren H
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, Calif 90095-1690, USA.
Am J Med. 2007 May;120(5):435-41. doi: 10.1016/j.amjmed.2006.07.043.
Patients using albuterol and ipratropium for treating chronic obstructive pulmonary disease (COPD) can use either nebulizers or metered dose inhalers. This study compared the 2 methods of delivering medication and the concomitant use of both nebulizer and inhaler, with respect to health-related quality of life, patient symptoms, and efficacy.
Patients over 50 years old with COPD were randomized into 3 groups: nebulizer, inhaler, or concomitant treatment. Quality of life was assessed using the St. George's Respiratory Questionnaire at baseline, and at 6 and 12 weeks. Other efficacy measurements at these time-points included pre- and post-dose forced expired volume in 1 second (FEV1). Symptom scores and peak flow measurements were recorded in patient diaries.
Of 140 patients enrolled, 126 completed at least one post-baseline assessment. At week 6, both groups using a nebulizer achieved statistically significant improvements from baseline in questionnaire symptoms, and the concomitant treatment group had clinically and statistically significant improvement in total questionnaire score. At week 12, the concomitant group still maintained significant improvement in symptom sub-scores. The 3 groups showed little change over time in peak flow or FEV1, with no significant difference among groups. Both groups using a nebulizer had significant improvement over time in diary symptom scores, although differences between groups were not significant.
Patients using combined nebulizer therapy morning and night with mid-day inhaler use had the most statistically significant improvements in quality of life indices. This concomitant regimen provides the additional symptom relief offered by a nebulizer with the convenience of an inhaler when patients are away from home.
使用沙丁胺醇和异丙托溴铵治疗慢性阻塞性肺疾病（COPD）的患者可以使用雾化器或定量吸入器。本研究比较了这两种给药方法以及雾化器和吸入器同时使用在健康相关生活质量、患者症状和疗效方面的差异。
年龄超过50岁的COPD患者被随机分为3组：雾化器组、吸入器组或联合治疗组。在基线、6周和12周时使用圣乔治呼吸问卷评估生活质量。在这些时间点的其他疗效指标包括给药前和给药后1秒用力呼气容积（FEV1）。症状评分和峰值流量测量记录在患者日记中。
在纳入的140名患者中，126名完成了至少一次基线后评估。在第6周时，使用雾化器的两组在问卷症状方面均较基线有统计学意义的显著改善，联合治疗组在问卷总分方面有临床和统计学意义的显著改善。在第12周时，联合治疗组在症状子评分方面仍保持显著改善。3组在峰值流量或FEV1方面随时间变化不大，组间无显著差异。使用雾化器的两组在日记症状评分方面随时间有显著改善，尽管组间差异不显著。
早晚使用雾化器联合治疗并在中午使用吸入器的患者在生活质量指标方面有最显著的统计学改善。这种联合治疗方案在患者离家时既提供了雾化器带来的额外症状缓解，又具备吸入器的便利性。
