Department of Medicine, Federal University of Sao Paulo, Sao Paulo, Brazil.
Respir Med. 2010 Sep;104(9):1288-96. doi: 10.1016/j.rmed.2010.05.017. Epub 2010 Jun 26.
It is currently unclear whether the additive effects of a long-acting beta(2)-agonist (LABA) and the antimuscarinic tiotropium bromide (TIO) on resting lung function are translated into lower operating lung volumes and improved exercise tolerance in patients with chronic obstructive pulmonary disease (COPD).
On a double-blind and cross-over study, 33 patients (FEV(1) = 47.4 +/- 12.9% predicted) were randomly allocated to 2-wk formoterol fumarate 12 microg twice-daily (FOR) plus TIO 18 microg once-daily or FOR plus placebo (PLA). Inspiratory capacity (IC) was obtained on constant-speed treadmill tests to the limit of tolerance (Tlim).
FOR-TIO was superior to FOR-PLA in increasing post-treatment FEV(1) and Tlim (1.34 +/- 0.42 L vs. 1.25 +/- 0.39 L and 124 +/- 27% vs. 68 +/- 14%, respectively; p < 0.05). FOR-TIO slowed the rate of decrement in exercise IC compared to FOR-PLA (Deltaisotime-rest = -0.27 +/- 0.40 L vs. -0.45 +/- 0.36 L, p < 0.05). In addition, end-expiratory lung volume (% total lung capacity) was further reduced with FOR-TIO (p < 0.05). Of note, patients showing greater increases in Tlim with FOR-TIO (16/26, 61.6%) had more severe airways obstruction and lower exercise capacity at baseline. Improvement in Tlim with FOR-TIO was also related to larger increases in FEV(1) (p < 0.05).
Compared to FOR monotherapy, FOR-TIO further improved effort-induced dynamic hyperinflation and exercise endurance in patients with moderate-to-severe COPD. These beneficial consequences were more likely to be found in severely-disabled patients with larger resting functional responses to the combination therapy.
Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov].
目前尚不清楚长效β2-激动剂（LABA）和抗毒蕈碱类药物噻托溴铵（TIO）的附加效应是否会转化为较低的运动肺容积和改善慢性阻塞性肺疾病（COPD）患者的运动耐量。
在一项双盲交叉研究中，33 名患者（FEV1 = 47.4 +/- 12.9%预计值）被随机分配到福莫特罗富马酸盐 12 微克，每日两次（FOR）加 TIO 18 微克，每日一次或 FOR 加安慰剂（PLA）。在恒速跑步机试验中，通过耐受力限制（Tlim）获得吸气容量（IC）。
FOR-TIO 比 FOR-PLA 更能增加治疗后的 FEV1 和 Tlim（1.34 +/- 0.42 L 比 1.25 +/- 0.39 L 和 124 +/- 27% 比 68 +/- 14%，分别为 p < 0.05）。与 FOR-PLA 相比，FOR-TIO 减缓了运动 IC 递减的速度（Deltaisotime-rest = -0.27 +/- 0.40 L 比 -0.45 +/- 0.36 L，p < 0.05）。此外，用 FOR-TIO 进一步降低了呼气末肺容积（%总肺容量）（p < 0.05）。值得注意的是，在 FOR-TIO 中 Tlim 增加更大的患者（16/26，61.6%）在基线时具有更严重的气道阻塞和更低的运动能力。FOR-TIO 改善 Tlim 也与 FEV1 更大的增加有关（p < 0.05）。
与 FOR 单药治疗相比，FOR-TIO 进一步改善了中重度 COPD 患者的运动诱发动态过度充气和运动耐力。这些有益的后果更可能在对联合治疗有更大静息功能反应的严重残疾患者中发现。
Clinicaltrials.gov 标识符：NCT00680056 [ClinicalTrials.gov]。
