Department of Respiratory Medicine, Atami Hospital, International University of Health and Welfare, Atami, Japan.
Respiration. 2013;86(4):280-7. doi: 10.1159/000351116. Epub 2013 Jul 20.
Triple inhalation therapy with tiotropium (Tio) and salmeterol/fluticasone propionate combination (SFC) is widely used in the treatment of chronic obstructive pulmonary disease (COPD). However, the effects of triple therapy on airway structural changes remain unknown.
The aim of the study was to assess the effects of Tio, salmeterol (SM), SFC and Tio plus SFC on airway dimensions in COPD.
A randomized, open-label, 4-way study (n = 60) was conducted comparing 16-week treatment periods of Tio (18 μg once daily), SM (50 μg twice daily), SFC (50/250 μg twice daily) and Tio (18 μg once daily) plus SFC (50/250 μg twice daily). Airway dimensions were assessed by a validated CT technique, and airway wall area (WA) corrected for body surface area (BSA), percentage WA (WA%), wall thickness/√BSA and luminal area (Ai)/BSA at the right apical segmental bronchus were measured. Pulmonary function and the St. George's Respiratory Questionnaire (SGRQ) were evaluated.
Tio plus SFC resulted in a significant decrease in WA corrected for BSA and WA% compared with Tio, SM and SFC (p < 0.05 for all). The changes in WA% and Ai/BSA were significantly correlated with changes in forced expiratory volume in 1 s (r = -0.86, p < 0.001, and r = 0.48, p < 0.05, respectively). There were more significant improvements in SGRQ scores after treatment with triple therapy than after the 3 other treatments.
Tio plus SFC therapy is more effective than Tio, SM and SFC for reducing airway wall thickness in COPD.
噻托溴铵（Tio）与沙美特罗/氟替卡松丙酸酯联合制剂（SFC）三联吸入疗法广泛用于治疗慢性阻塞性肺疾病（COPD）。然而，关于三联疗法对气道结构变化的影响尚不清楚。
本研究旨在评估噻托溴铵、沙美特罗（SM）、SFC 和噻托溴铵加 SFC 对 COPD 患者气道直径的影响。
这是一项随机、开放标签、四组交叉研究（n=60），比较了 16 周的噻托溴铵（18μg，每日 1 次）、SM（50μg，每日 2 次）、SFC（50/250μg，每日 2 次）和噻托溴铵加 SFC（50/250μg，每日 2 次）治疗。采用经过验证的 CT 技术评估气道直径，校正体表面积（BSA）后的气道壁面积（WA）、WA%、壁厚度/√BSA 和右尖段支气管腔内面积（Ai）/BSA。评估肺功能和圣乔治呼吸问卷（SGRQ）。
与噻托溴铵、SM 和 SFC 相比，噻托溴铵加 SFC 治疗可显著降低校正 BSA 后的 WA 和 WA%（p<0.05）。WA%和 Ai/BSA 的变化与 1 秒用力呼气量（FEV1）的变化显著相关（r=-0.86，p<0.001；r=0.48，p<0.05）。三联疗法治疗后 SGRQ 评分的改善较其他 3 种治疗更为显著。
噻托溴铵加 SFC 治疗比噻托溴铵、SM 和 SFC 更能有效降低 COPD 患者的气道壁厚度。
