Department of Respiratory Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan.
Respirology. 2011 Jan;16(1):95-101. doi: 10.1111/j.1440-1843.2010.01869.x.
Although salmeterol/fluticasone propionate combination (SFC) therapy has been widely used for the treatment of COPD, the relationship between airway dimensions and improvement in pulmonary function remains unknown. The aim of this study was to compare the effects of SFC in combination with tiotropium (Tio) and Tio alone, on airway dimensions and pulmonary function in COPD patients.
Thirty COPD patients were randomized to receive inhaled Tio (18 µg once daily) or inhaled SFC (50/250 µg twice daily) plus Tio for 12 weeks. Spirometry and CT were performed, and the St. George's Respiratory Questionnaire (SGRQ) was completed, before and after the trial. Airway dimensions were assessed by a validated CT technique, and airway wall area (WA) corrected for body surface area (BSA), percentage wall area (WA%), absolute wall thickness T/√BSA, and luminal area Ai/BSA at the right apical segmental bronchus, were measured.
Treatment with SFC plus Tio significantly decreased WA/BSA (P < 0.05), WA% (P < 0.01) and T/√BSA (P < 0.01), and increased Ai/BSA (P < 0.01), whereas treatment with Tio alone had no effect. The changes in WA/BSA and Ai/BSA were significantly correlated with increases in FEV1 (r = 0.48, P < 0.05, and r = 0.36, P < 0.05, respectively). There were significant improvements in SGRQ scores after treatment with SFC plus Tio.
Airway wall thickening and airway narrowing decreased after treatment with SFC plus Tio, and the changes in airway dimensions were proportional to the improvements in FEV1 . These results suggest that SFC plus Tio is more effective than Tio alone in the management of COPD patients.
尽管沙美特罗/氟替卡松丙酸酯联合（SFC）疗法已广泛用于 COPD 的治疗，但气道尺寸与肺功能改善之间的关系尚不清楚。本研究旨在比较 SFC 联合噻托溴铵（Tio）与单独使用 Tio 对 COPD 患者气道尺寸和肺功能的影响。
30 例 COPD 患者被随机分为吸入 Tio（18 μg，每日一次）或吸入 SFC（50/250 μg，每日两次）联合 Tio 治疗 12 周。在试验前后进行了肺量测定和 CT 检查，并完成了圣乔治呼吸问卷（SGRQ）。使用经过验证的 CT 技术评估气道尺寸，并测量右尖段支气管的气道壁面积（WA）校正体表面积（BSA）、WA%、绝对壁厚度 T/√BSA 和管腔面积 Ai/BSA。
SFC 联合 Tio 治疗可显著降低 WA/BSA（P<0.05）、WA%（P<0.01）和 T/√BSA（P<0.01），并增加 Ai/BSA（P<0.01），而单独使用 Tio 则无此作用。WA/BSA 和 Ai/BSA 的变化与 FEV1 的增加显著相关（r=0.48，P<0.05 和 r=0.36，P<0.05）。SFC 联合 Tio 治疗后 SGRQ 评分显著改善。
SFC 联合 Tio 治疗后气道壁增厚和气道狭窄减轻，气道尺寸的变化与 FEV1 的改善成正比。这些结果表明，SFC 联合 Tio 比单独使用 Tio 更能有效治疗 COPD 患者。
