Maguire G P, Newman T, DeLorenzo L J, Brown R B, Stone D
Department of Medicine, New York Medical College, Valhalla.
Chest. 1991 Nov;100(5):1300-5. doi: 10.1378/chest.100.5.1300.
This study compared the effect of "standard" dose metaproterenol delivered by hand-held nebulizer (HHN) with two puffs of metaproterenol delivered by a metered dose inhaler (MDI) via a spacer (InspirEase) (MDI-spacer). Seventeen patients with an acute exacerbation of obstructive pulmonary disease were studied. Each patient received both MDI-spacer and HHN. Alternate patients were randomized to either MDI-spacer or HHN as initial treatment. Each subject was tested four different times: before and 30 minutes after the initial aerosol delivery technique, and before and 30 minutes after the alternate aerosol delivery technique. Testing consisted of spirometry, lung auscultation, and measurement of vital signs. The interval between treatments for all subjects was 2.96 +/- 0.27 hours (mean +/- SEM) and was not different for subjects who received therapy via MDI-spacer first or HHN first. The patient population studied demonstrated severe airways obstruction (baseline FEV1 33.3 percent predicted +/- 4.9 percent). There was a statistically significant improvement in FVC and FEV1 after metaproterenol delivered by HHN, but not after MDI-spacer. Metaproterenol treatment with HHN resulted in a greater improvement in FEV1 (p less than .05) than MDI-spacer when the data were reported as absolute improvement (0.19 +/- 0.05 L for HHN) vs (0.06 +/- 0.03 L for MDI-spacer) or reported as percent change (23.2 +/- 6.6 percent for HHN) vs (9.5 +/- 3.4 percent for MDI-spacer). Asthmatic patients exhibited a significantly greater (p less than 0.05) improvement in FEV1 after HHN (23.4 +/- 4.7 percent change) than after MDI-spacer (6.6 +/- 4.5 percent change). Patients with chronic obstructive pulmonary disease (COPD) exhibited a greater improvement in FVC (p less than 0.05) after HHN (25.2 +/- 6.7 percent change) than after MDI-spacer (5.8 +/- 4.7 percent change). We conclude that the "standard" dosage of metaproterenol delivered by HHN results in greater spirometric improvement in patients with acute obstructive pulmonary disease than the conventional dosage of metaproterenol delivered by MDI-spacer. It is likely that this reflects the fact that the recommended dose of metaproterenol delivered by MDI is too low and should be increased.
本研究比较了通过手持雾化器（HHN）给予“标准”剂量间羟异丙肾上腺素与通过定量吸入器（MDI）经储雾罐（InspirEase）（MDI - 储雾罐）给予两喷间羟异丙肾上腺素的效果。对17例慢性阻塞性肺疾病急性加重患者进行了研究。每位患者均接受MDI - 储雾罐和HHN治疗。将交替的患者随机分为MDI - 储雾罐组或HHN组作为初始治疗。每位受试者进行四次不同测试：在初始雾化给药技术前、给药后30分钟，以及在交替雾化给药技术前、给药后30分钟。测试包括肺功能测定、肺部听诊和生命体征测量。所有受试者治疗间隔为2.96±0.27小时（平均值±标准误），对于先接受MDI - 储雾罐治疗或先接受HHN治疗的受试者，该间隔无差异。所研究的患者群体表现出严重的气道阻塞（基线第一秒用力呼气容积[FEV1]为预测值的33.3%±4.9%）。通过HHN给予间羟异丙肾上腺素后，用力肺活量（FVC）和FEV1有统计学显著改善，但MDI - 储雾罐给药后未出现这种情况。当数据报告为绝对改善量（HHN为0.19±0.05L，MDI - 储雾罐为0.06±0.03L）或报告为变化百分比（HHN为23.2±6.6%，MDI - 储雾罐为9.5±3.4%）时，HHN治疗间羟异丙肾上腺素导致的FEV1改善大于MDI - 储雾罐（p＜0.05）。哮喘患者在接受HHN治疗后FEV1的改善（变化23.4±4.7%）显著大于MDI - 储雾罐治疗后（变化6.6±4.5%）（p＜0.05）。慢性阻塞性肺疾病（COPD）患者在接受HHN治疗后FVC的改善（变化25.2±6.7%）大于MDI - 储雾罐治疗后（变化5.8±4.7%）（p＜0.05）。我们得出结论，与通过MDI - 储雾罐给予的传统剂量间羟异丙肾上腺素相比，通过HHN给予的“标准”剂量间羟异丙肾上腺素在急性阻塞性肺疾病患者中导致更大的肺功能改善。这可能反映了MDI推荐的间羟异丙肾上腺素剂量过低，应予以增加这一事实。
