Eguchi Yohsuke, Tateishi Yoshitaka, Umeda Nobuaki, Yoshikawa Takahiro, Kamoi Hiroshi, Kanazawa Hiroshi, Kudoh Shinzoh, Hirata Kazuto, Fujimoto Shigeo
Department of Sports Medicine, Osaka City University, Graduate School of Medicine, Japan.
Osaka City Med J. 2007 Jun;53(1):25-34.
Hyperinflation is widely accepted as an abnormal state affecting clinical symptoms, activities of daily living and exercise tolerance in chronic obstructive pulmonary disease (COPD). Reducing hyperinflation is an essential theme in COPD treatment. In this study, we let patients with COPD hyperventilate to evoke hyperinflation, and evaluated the effects of tiotropium alone or in combination with salmeterol on hyperventilation-evoked hyperinflation.
Thirty-eight patients with COPD received pulmonary function tests including hyperventilation-evoked hyperinflation testing and the St. George's Respiratory Questionnaire (SGRQ) before treatment, after tiotropium administration for 8 weeks, and after combined therapy with salmeterol for 8 weeks.
Before treatment, inspiratory capacity (IC) after hyperventilation decreased significantly in a breathing frequency-dependent manner. After tiotropium administration, forced expiratory volume in one second (FEV1) increased significantly. IC after hyperventilation decreased significantly in a breathing frequency-dependent manner; however, IC was significantly greater than that before treatment (at rest, p=0.001; after hyperventilation at twice the resting respiratory rate, p=0.0009; and after hyperventilation at three times the resting respiratory rate, p<0.0001). The SGRQ score also improved significantly. After combined therapy with salmeterol, FEV1 increased significantly compared with after tiotropium alone. However, there was no significant difference between the IC after tiotropium alone and that after combined therapy, at each stage. However, after combined therapy the SGRQ score significantly improved compared with that after tiotropium alone.
Tiotropium improved airflow obstruction and hyperventilation-evoked hyperinflation. In combination with salmeterol, the improvement in airflow obstruction was greater, but hyperventilation-evoked hyperinflation was not further improved.
肺过度充气被广泛认为是一种影响慢性阻塞性肺疾病（COPD）临床症状、日常生活活动及运动耐量的异常状态。减轻肺过度充气是COPD治疗的一个重要主题。在本研究中，我们让COPD患者进行过度通气以诱发肺过度充气，并评估噻托溴铵单药治疗或与沙美特罗联合治疗对过度通气诱发的肺过度充气的影响。
38例COPD患者在治疗前、噻托溴铵给药8周后以及与沙美特罗联合治疗8周后接受了包括过度通气诱发的肺过度充气测试及圣乔治呼吸问卷（SGRQ）在内的肺功能测试。
治疗前，过度通气后的吸气容量（IC）以呼吸频率依赖的方式显著降低。给予噻托溴铵后，一秒用力呼气容积（FEV1）显著增加。过度通气后的IC以呼吸频率依赖的方式显著降低；然而，IC显著高于治疗前（静息时，p = 0.001；静息呼吸频率两倍的过度通气后，p = 0.0009；静息呼吸频率三倍的过度通气后，p < 0.0001）。SGRQ评分也显著改善。与单独使用噻托溴铵后相比，沙美特罗联合治疗后FEV1显著增加。然而，在每个阶段，单独使用噻托溴铵后的IC与联合治疗后的IC之间无显著差异。但是，联合治疗后SGRQ评分与单独使用噻托溴铵后相比显著改善。
噻托溴铵改善了气流受限及过度通气诱发的肺过度充气。与沙美特罗联合使用时，气流受限的改善更大，但过度通气诱发的肺过度充气未进一步改善。
