1Emergency Department and Research Unit, Fattouma Bourguiba University Hospital, Monastir, Tunisia; 2Emergency Department, Tahar Sfar University Hospital, Mahdia, Tunisia; and 3Department of Preventive Medicine, University of Medicine, Monastir, Tunisia.
Am J Ther. 2014 May-Jun;21(3):152-8. doi: 10.1097/MJT.0b013e3182459a8e.
Treatment with short-acting β2-agonists for exacerbations of chronic obstructive pulmonary disease (COPD) results in clinical improvement. It has not been established whether combining short-acting β2-agonists to other bronchodilators is more effective than β2-agonists alone. We conducted a study in patients presenting to the emergency department with exacerbation of COPD. They were randomized to receive nebulized ipratropium bromide (IB group; n = 62) or combined nebulized and intravenous bolus of magnesium sulfate (MgSO4 group; n = 62). All nebulized drugs were administered at 30-minute intervals for 2 hours. Primary outcome included hospital admission, endotracheal intubation, and hospital death rates. Secondary outcome measures were improvement in peak expiratory flow, dyspnea score, and arterial blood gas changes within the first 3 hours. There were no significant differences in primary outcome between MgSO4 and IB groups. Patients given IB average 32 L greater improvement in peak expiratory flow rate compared with magnesium sulfate (95% confidence interval, 19-43 L) at 180 minutes. Simultaneously, there was a significant reduction in PaCO2 compared with baseline values in IB group but not in MgSO4 group. There was a statistically nonsignificant trend toward a decrease in dyspnea score in both groups although adverse events were similar. Although the improvement in peak expiratory flow rate and arterial blood gas favored nebulized IB over magnesium sulfate, there was a nonsignificant difference between both drugs with regard to hospital admission, intubation, and hospital death rates in patients with COPD treated in the emergency department for acute exacerbation.
治疗慢性阻塞性肺疾病（COPD）急性加重时使用短效β2-激动剂可改善临床症状。目前尚未确定短效β2-激动剂与其他支气管扩张剂联合使用是否比单独使用β2-激动剂更有效。我们对因 COPD 急性加重而就诊于急诊科的患者进行了一项研究。患者随机分为接受雾化吸入异丙托溴铵（IB 组；n = 62）或联合雾化吸入和静脉推注硫酸镁（MgSO4 组；n = 62）治疗。所有雾化药物均在 30 分钟间隔内使用，共 2 小时。主要结局包括住院、气管插管和住院死亡率。次要结局指标为治疗 3 小时内呼气峰值流量、呼吸困难评分和动脉血气变化的改善情况。MgSO4 组和 IB 组在主要结局方面无显著差异。与硫酸镁相比，接受 IB 治疗的患者在 180 分钟时呼气峰值流量平均改善 32 L（95%置信区间，19-43 L）。同时，IB 组 PaCO2 较基线值显著降低，但 MgSO4 组无此变化。两组患者呼吸困难评分均有显著降低趋势，但差异无统计学意义。尽管雾化吸入 IB 改善呼气峰值流量和动脉血气的效果优于硫酸镁，但在急诊科治疗急性加重 COPD 患者的住院、插管和住院死亡率方面，两种药物之间无显著差异。
