Baldi Bruno Guedes, de Albuquerque André Luis Pereira, Pimenta Suzana Pinheiro, Salge João Marcos, Kairalla Ronaldo Adib, Carvalho Carlos Roberto Ribeiro
Pulmonary Division, Heart Institute (InCor), University of São Paulo Medical School, São Paulo, Brazil.
Respir Med. 2013 Nov;107(11):1773-80. doi: 10.1016/j.rmed.2013.08.045. Epub 2013 Sep 8.
Positive responses to bronchodilators (BDs) on spirometry can be found in up to 30% of patients with lymphangioleiomyomatosis (LAM). However, no previous studies have investigated the impact of BDs on exercise outcomes, including dynamic hyperinflation (DH).
A randomised, double-blind, placebo-controlled, crossover trial was conducted on 38 patients with LAM, comparing inhaled placebo versus salbutamol. Pulmonary function tests and a cycle endurance test at 75% of the maximal work capacity, with evaluation of DH by serial measurement of inspiratory capacity (IC), which was the primary endpoint, were performed after each intervention.
Although salbutamol produced a slight improvement in airway obstruction, compared with placebo, there was no significant variation in resting IC or air trapping. A total of 18% of the patients met the criteria for a positive response to BD. During submaximal exercise, BD did not reduce DH or dyspnoea nor did it improve exercise tolerance in the entire population. In addition, BD produced only slight improvement in FEV1 and air trapping in patients who had DH during incremental cardiopulmonary exercise testing, without the beneficial effects on exercise outcomes.
Although salbutamol produced a slight improvement in airway obstruction, it did not lead to a reduction in DH or increase in exercise tolerance in patients with LAM.
Brazilian Registry of Clinical Trials (ReBEC); www.ensaiosclinicos.gov.br; registration number: RBR-49sk2j.
在高达30%的淋巴管平滑肌瘤病（LAM）患者中，可通过肺功能测定发现对支气管扩张剂（BDs）有阳性反应。然而，此前尚无研究调查BDs对运动结果的影响，包括动态肺过度充气（DH）。
对38例LAM患者进行了一项随机、双盲、安慰剂对照的交叉试验，比较吸入安慰剂与沙丁胺醇的效果。每次干预后进行肺功能测试以及在最大工作能力的75%时进行的自行车耐力测试，并通过连续测量吸气容量（IC）评估DH，IC为主要终点。
尽管与安慰剂相比，沙丁胺醇使气道阻塞有轻微改善，但静息IC或气体潴留无显著变化。共有18%的患者符合对BD阳性反应的标准。在次最大运动期间，BD并未降低DH或呼吸困难，也未改善整个人群的运动耐量。此外，在递增心肺运动测试期间有DH的患者中，BD仅使FEV1和气体潴留略有改善，对运动结果无有益影响。
尽管沙丁胺醇使气道阻塞有轻微改善，但并未使LAM患者的DH降低或运动耐量增加。
巴西临床试验注册中心（ReBEC）；www.ensaiosclinicos.gov.br；注册号：RBR-49sk2j。
