Karpel J P, Pesin J, Greenberg D, Gentry E
Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467.
Chest. 1990 Oct;98(4):835-9. doi: 10.1378/chest.98.4.835.
Thirty-two patients presenting with acute exacerbations of chronic obstructive pulmonary disease were entered into the following double-blind, crossover study. First (time 0), patients inhaled either ipratropium bromide (54 micrograms) or metaproterenol sulfate (1.95 mg) via a metered dose inhaler (MDI) attached to a device (Inspirease) (phase 1). After 90 minutes, they inhaled whichever of the two medications they had not received in phase 1. This is referred to as phase 2. Pulmonary function (FEV1 and FVC) was measured at time 0, and at 30, 60, and 90 minutes following phase 1 treatment, and at 30, 60, and 90 minutes following phase 2 treatment (120, 150, and 180 minutes from the start of the study). Arterial blood gas samples (n = 20) were obtained at entry into the study and 30 and 90 minutes after phase 1 medication. The groups did not differ in age, degree of airway obstruction, hypoxemia, or theophylline usage at the start of the study. In phase 1, at 90 minutes, pulmonary function in both groups significantly and similarly improved. For ipratropium, FEV1 improved from 0.62 +/- 0.08 L to 0.88 +/- 0.11 L (p less than 0.01) and for metaproterenol FEV1 improved from 0.69 +/- 0.06 to 0.92 +/- 0.09 L (p less than 0.01). There was no further improvement with phase 2 treatment for either group. Thirty minutes after inhaling ipratropium, there was a small but significant rise in PO2 (5.8 +/- 3.0 mm Hg; p less than 0.05) while metaproterenol inhalation resulted in a 6.2 +/- 1.2 mm Hg decline in PO2 (p less than 0.05). These changes were not sustained at 90 minutes. We concluded that for acute exacerbations of COPD, both ipratropium and metaproterenol are effective medications when administered via an MDI attached to a device (Inspirease). However, ipratropium may be a safer choice as it initially did not cause a decline in blood oxygenation.
32例慢性阻塞性肺疾病急性加重期患者进入以下双盲交叉研究。首先（时间0），患者通过连接在一种装置（Inspirease）上的定量吸入器（MDI）吸入异丙托溴铵（54微克）或硫酸间羟异丙肾上腺素（1.95毫克）（第1阶段）。90分钟后，他们吸入在第1阶段未使用的两种药物中的另一种。这被称为第2阶段。在时间0以及第1阶段治疗后的30、60和90分钟，以及第2阶段治疗后的30、60和90分钟（从研究开始起120、150和180分钟）测量肺功能（FEV1和FVC）。在研究开始时以及第1阶段用药后30和90分钟采集动脉血气样本（n = 20）。在研究开始时，两组在年龄、气道阻塞程度、低氧血症或茶碱使用情况方面无差异。在第1阶段，90分钟时，两组的肺功能均有显著且相似的改善。对于异丙托溴铵，FEV1从0.62±0.08升改善至0.88±0.11升（p<0.01），对于硫酸间羟异丙肾上腺素，FEV1从0.69±0.06升改善至0.92±0.09升（p<0.01）。两组在第2阶段治疗后均无进一步改善。吸入异丙托溴铵30分钟后，PO2有小幅但显著的升高（5.8±3.0毫米汞柱；p<0.05），而吸入硫酸间羟异丙肾上腺素导致PO2下降6.2±1.2毫米汞柱（p<0.05）。这些变化在90分钟时未持续。我们得出结论，对于慢性阻塞性肺疾病急性加重期，通过连接在装置（Inspirease）上的MDI给药时，异丙托溴铵和硫酸间羟异丙肾上腺素都是有效的药物。然而，异丙托溴铵可能是更安全的选择，因为它最初不会导致血液氧合下降。
