Ramlal S K, Visser F J, Hop W C J, Dekhuijzen P N R, Heijdra Y F
Dept. of Pulmonology, IJsselland Ziekenhuis, Capelle a/d IJssel, The Netherlands.
Dept. of Pulmonology, Canisius Wilhelmina Ziekenhuis, Nijmegen, The Netherlands.
Pulm Pharmacol Ther. 2014 Aug;28(2):158-64. doi: 10.1016/j.pupt.2013.09.002. Epub 2013 Sep 25.
In chronic obstructive pulmonary disease (COPD), there is a poor correlation between forced expiratory volume in 1 s (FEV1) and dyspnea following bronchodilator use. Better correlations have been observed between inspiratory lung function parameters (ILPs) and dyspnea, which drives our interest in ILPs. However, the acute and prolonged effects of long-acting bronchodilators and oral corticosteroids on ILPs have not been well investigated. Therefore, the aim of this study was to investigate the effects of these treatments on the ILPs, FEV1, dyspnea (visual analog scale (VAS)) and clinical COPD questionnaire (CCQ).
Twenty-eight stable COPD patients had their ILPs and FEV1 measured both before and 2 h after the use of a single dose of 18 mcg bronchodilator tiotropium and 50 mcg salmeterol. Thereafter, the patients were randomized to 2 weeks of treatment with 30 mg oral prednisolone once daily or oral placebo in combination with daily treatment with these two bronchodilators. Four weeks after the cessation of the randomized treatment, the ILPs and FEV1 were again measured. After each intervention, any change in the VAS score was assessed.
With both bronchodilators, significant improvements in ILPs were demonstrated (p < 0.005), with the exception of changes in ILPs inspiratory capacity (IC) and forced inspiratory flow at 50% of the vital capacity (FIF50) after tiotropium inhalation. After 2 weeks of treatment with prednisolone, significant differences were found for ILP forced inspiratory volume in 1 s (FIV1) and FEV1 compared with placebo. These differences were no longer present 4 weeks after the cessation of prednisolone. Significant relationships between ILPs and VAS scores were only found after 2 weeks of treatment with prednisolone or placebo.
After a single dose of long-acting bronchodilator salmeterol, significant improvements are observed in all ILPs and in FIV1 and PIF after tiotropium. Two weeks of oral corticosteroid treatment improved the FIV1 and FEV1. The dyspnea VAS score was only significantly correlated with the ILPs after 2 weeks of oral corticosteroid treatment.
在慢性阻塞性肺疾病（COPD）中，使用支气管扩张剂后1秒用力呼气容积（FEV1）与呼吸困难之间的相关性较差。吸气肺功能参数（ILP）与呼吸困难之间的相关性更好，这引发了我们对ILP的兴趣。然而，长效支气管扩张剂和口服皮质类固醇对ILP的急性和长期影响尚未得到充分研究。因此，本研究的目的是调查这些治疗对ILP、FEV1、呼吸困难（视觉模拟评分（VAS））和慢性阻塞性肺疾病临床问卷（CCQ）的影响。
28例稳定期COPD患者在使用单剂量18微克支气管扩张剂噻托溴铵和50微克沙美特罗之前和之后2小时测量其ILP和FEV1。此后，患者被随机分为两组，一组接受为期2周的每日一次30毫克口服泼尼松龙治疗，另一组接受口服安慰剂，并联合每日使用这两种支气管扩张剂治疗。随机治疗停止4周后，再次测量ILP和FEV1。每次干预后，评估VAS评分的任何变化。
使用两种支气管扩张剂后，ILP均有显著改善（p<0.005），吸入噻托溴铵后ILP吸气容量（IC）和肺活量50%时的用力吸气流量（FIF50）变化除外。泼尼松龙治疗2周后，与安慰剂相比，ILP 1秒用力吸气容积（FIV1）和FEV1有显著差异。泼尼松龙停药4周后，这些差异不再存在。仅在使用泼尼松龙或安慰剂治疗2周后，才发现ILP与VAS评分之间存在显著关系。
单剂量长效支气管扩张剂沙美特罗治疗后，所有ILP以及吸入噻托溴铵后的FIV1和PIF均有显著改善。口服皮质类固醇治疗2周可改善FIV1和FEV1。口服皮质类固醇治疗2周后，呼吸困难VAS评分才与ILP显著相关。
