Loureiro Cláudia Chaves
Serviço de Pneumologia, Hospitais da Universidade de Coimbra, Portugal.
Acta Med Port. 2011 Mar-Apr;24(2):231-40. Epub 2011 May 20.
Changes of pulmonary mechanisms, receptor population and nervous control of the airway, that occur with ageing, are responsible for the different clinical presentation of pathologies like asthma, as well as different efficacy of bronchodilator therapeutics in the aged patient. To be explained are the effects of age in the bronchodilator response to beta-mimetics and cholinergics and the existent evidence is discordant. Some comparative studies of that pharmacological response, made on asthmatics, have shown an efficacy decline with age. Others didn't find any significant difference.
Individual evaluation of bronchodilator response in individuals of different age groups to salbutamol and ipratropium bromide.
Three groups of 12 patients - witness group (W), young healthy individuals; control group (C), elderly individuals without respiratory pathology; study group (S), elderly individuals with bronchial asthma - were submitted to functional ventilator evaluation followed by a bronchodilator test in two consecutive days (one day with salbutamol (s), other with ipratropium bromide (b). In S all were in a stable period, without anti-asthmatic medication in the previous 24 hours. Plethismography and spirometry followed ATS/ERS, 2005 criteria. To evaluate the bronchomotor response we used as criteria an increase of 12% or 200 ml in FEV1 or in FVC, after inhalation of 40 mcg of ipratropium bromide or 200+200 mcg of salbutamol.
The variability of response was constant. With age, (W Vs C) there was an increase on negative responses to both drugs (4 Vs 8); a decrease on responses simultaneously positives to s and negatives to b (4 Vs 2) and an increase on responses simultaneously positives to b and negatives to s (0 Vs 1). With age and associated disease (W Vs S) the number of responses simultaneously positives to both drugs has raised (1 Vs 3); the number of responses simultaneously negatives to both drugs kept constant (4 Vs 4); the number of responses simultaneously positives to s and negatives to b decreased (4 Vs 1); number of responses simultaneously positives to b and negatives to s increased (0 Vs 2).
An individual analysis of bronchomotricity in different groups leads to the conclusion that, with age, there was a decrease in bronchial lability, independently of the used drug. Globally, in aged asthmatics, the bronchial response was superior to the healthy ones, as expected. The individual analyses of the positive bronchodilatorresponses lead to the conclusion that, with age and disease, the ipratropium bromide showed an improvement in bronchomotricity, contrary to salbutamol. Such fact may be explained by the already, but not consensual, description of the decreasing efficacy of adrenergic drugs with age, aggravated by the chronic use of long acting betamimetics.
随着年龄增长，肺部机制、气道受体数量及神经控制发生变化，这导致哮喘等病症出现不同临床表现，以及老年患者使用支气管扩张剂治疗的疗效各异。年龄对β受体激动剂和胆碱能药物支气管扩张反应的影响有待解释，现有证据并不一致。一些针对哮喘患者的该药理反应比较研究表明，疗效随年龄下降。另一些研究则未发现显著差异。
对不同年龄组个体对沙丁胺醇和异丙托溴铵的支气管扩张反应进行个体评估。
三组各12名患者——见证组（W），年轻健康个体；对照组（C），无呼吸道疾病的老年人；研究组（S），患有支气管哮喘的老年人——连续两天接受功能性通气评估，随后进行支气管扩张试验（一天用沙丁胺醇（s），另一天用异丙托溴铵（b））。在S组中，所有患者均处于稳定期，前24小时未使用抗哮喘药物。体积描记法和肺量计法遵循2005年美国胸科学会/欧洲呼吸学会标准。为评估支气管运动反应，我们以吸入40微克异丙托溴铵或200 + 200微克沙丁胺醇后FEV1或FVC增加12%或200毫升为标准。
反应变异性恒定。随着年龄增长（W组与C组比较），对两种药物的阴性反应增加（4例对8例）；对s为阳性同时对b为阴性的反应减少（4例对2例），对b为阳性同时对s为阴性的反应增加（0例对1例）。随着年龄增长及合并疾病（W组与S组比较），对两种药物均为阳性的反应数量增加（1例对3例）；对两种药物均为阴性的反应数量保持不变（4例对4例）；对s为阳性同时对b为阴性的反应数量减少（4例对1例）；对b为阳性同时对s为阴性的反应数量增加（0例对2例）。
对不同组支气管运动功能的个体分析得出结论，随着年龄增长，支气管易激性降低，与所使用药物无关。总体而言，如预期的那样，老年哮喘患者的支气管反应优于健康个体。对支气管扩张阳性反应的个体分析得出结论，随着年龄增长及患病，异丙托溴铵显示出支气管运动功能改善，与沙丁胺醇相反。这一事实可能由肾上腺素能药物疗效随年龄下降的已有描述（虽未达成共识）来解释，长期使用长效β受体激动剂使其情况更严重。
