Neder J Alberto, Fuld Jonathan P, Overend Tim, Thirlwell Jackie, Carter Roger, Stevenson Robin, Ward Susan A
Respiratory Division, Department of Medicine, Federal University of Sao Paulo, Rua Professor Francisco de Castro 54, CEP:04020-050, Brazil.
Respir Med. 2007 Oct;101(10):2056-64. doi: 10.1016/j.rmed.2007.06.006. Epub 2007 Jul 19.
We wished to evaluate the effects of inhaled formoterol, a long-acting beta(2)-adrenergic agonist, on exercise tolerance and dynamic hyperinflation (DH) in severely disabled chronic obstructive pulmonary disease (COPD) patients.
In a two-period, crossover study, 21 patients with advanced COPD (FEV(1)=38.8+/-11.7% predicted, 16 patients GOLD stages III-IV) were randomly allocated to receive inhaled formoterol fumarate 12 microg twice daily for 14 days followed by placebo for 14 days, or vice versa. Patients performed constant work-rate cardiopulmonary exercise tests to the limit of tolerance (Tlim) on a cycle ergometer: inspiratory capacity (IC) was obtained at rest and each minute during exercise. Baseline and transitional dyspnoea indices (BDI and TDI) were also recorded.
Eighteen patients completed both treatment periods. Formoterol treatment was associated with an estimated increase of 130 s in Tlim compared with placebo (P=0.052): this corresponded to a 37.8% improvement over placebo (P=0.012). Enhanced exercise tolerance after bronchodilator was associated with diminished DH marked by higher inspiratory reserve and tidal volumes at isotime and exercise cessation (P<0.05). There was no significant difference between formoterol and placebo on exercise dyspnoea ratings; however, all domains of the TDI improved (P<or=0.02) following formoterol, compared with placebo.
Inhaled formoterol 12 microg twice daily is effective in ameliorating DH, daily dyspnoea and exercise intolerance even in patients with advanced COPD.
我们希望评估吸入用福莫特罗（一种长效β₂肾上腺素能激动剂）对重度失能慢性阻塞性肺疾病（COPD）患者运动耐量和动态肺过度充气（DH）的影响。
在一项为期两阶段的交叉研究中，21例晚期COPD患者（预测FEV₁=38.8±11.7%，16例为GOLDⅢ-Ⅳ期）被随机分配，接受每日两次吸入12微克富马酸福莫特罗，共14天，随后接受14天安慰剂治疗，或反之。患者在功率自行车上进行恒定负荷心肺运动试验，直至耐受极限（Tlim）：在静息状态及运动期间每分钟测量吸气容量（IC）。同时记录基线和过渡性呼吸困难指数（BDI和TDI）。
18例患者完成了两个治疗阶段。与安慰剂相比，福莫特罗治疗使Tlim估计增加了130秒（P=0.052）：这相当于比安慰剂改善了37.8%（P=0.012）。支气管扩张剂治疗后运动耐量增强与DH减轻相关，表现为在相同时间和运动停止时吸气储备量和潮气量增加（P<0.05）。福莫特罗和安慰剂在运动性呼吸困难评分上无显著差异；然而，与安慰剂相比，福莫特罗治疗后TDI的所有方面均有改善（P≤0.02）。
每日两次吸入12微克福莫特罗即使对晚期COPD患者也能有效改善DH、日常呼吸困难和运动不耐受。
