慢性阻塞性肺疾病（COPD）患者联合使用氟替卡松/沙美特罗治疗时振荡阻抗和氮清除的变化
Changes in oscillatory impedance and nitrogen washout with combination fluticasone/salmeterol therapy in COPD.
作者信息
Timmins Sophie C, Diba Chantale, Schoeffel Robin E, Salome Cheryl M, King Gregory G, Thamrin Cindy
机构信息
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Department of Respiratory Medicine Royal North Shore Hospital, St Leonards, NSW 2065, Australia; The Sydney Medical School, The University of Sydney, NSW 2006, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia.
The Woolcock Institute of Medical Research, Glebe, NSW 2037, Australia; Cooperative Research Centre for Asthma and Airways, Glebe, NSW 2037, Australia.
出版信息
Respir Med. 2014 Feb;108(2):344-50. doi: 10.1016/j.rmed.2013.10.004. Epub 2013 Oct 10.
INTRODUCTION
Combination inhaled corticosteroid/long-acting bronchodilator (ICS/LABA) therapy reduces the exacerbation rate and improves spirometry and quality of life in COPD. We hypothesized that ICS/LABA therapy also improves small airway function measured by FOT.
METHODS
14 subjects with COPD were commenced on combination fluticasone propionate/salmeterol therapy for 3 months. At baseline, subjects completed the St George Respiratory Questionnaire (SGRQ) and underwent standard pulmonary function tests as well as forced oscillation technique (FOT) and single and multiple breath nitrogen washouts. All tests were repeated at the completion of 3 months of therapy.
RESULTS
Subjects were of mean (SD) age 65.9 years (8.4), BMI 30.0 (5.6), pack years 51.4 (21.1), post-bronchodilator FEV1% predicted 62.7 (20). At baseline, mean SGRQ total was 39.0 (17.7) and FRC% predicted 125.4 (31.3). From FOT, Rrs-total was 5.69 (1.29) cmH2O/L/s, Xrs-total -3.48 (2.16) cmH2O/L/s, EFL Index 3.51 (2.45) cmH2O/L/s. After 3 months of therapy, there were significant improvements in SGRQ score (-13.81, p < 0.0001) despite no change in FEV1 (+40 mL, p = 0.14). From FOT, total resistance (-0.63 cmH2O/L/s, p = 0.0004), reactance (+1.2 cmH2O/L/s, p = 0.013), and expiratory flow limitation (-1.21 cmH2O/L/s, p = 0.02) also improved. There were no significant changes in ventilation heterogeneity indices.
CONCLUSION
Combination therapy is associated with improvements in small airways function in COPD, despite an absence of change in FEV1. FOT may be a clinically useful marker of small airway function in COPD that is responsive to treatment.
引言
吸入性糖皮质激素/长效支气管扩张剂（ICS/LABA）联合治疗可降低慢性阻塞性肺疾病（COPD）的急性加重率，并改善肺量计测量结果及生活质量。我们推测ICS/LABA联合治疗还可改善通过脉冲振荡法（FOT）测量的小气道功能。
方法
14例COPD患者开始接受丙酸氟替卡松/沙美特罗联合治疗，为期3个月。在基线时，患者完成圣乔治呼吸问卷（SGRQ），并接受标准肺功能测试以及脉冲振荡技术（FOT）和单次及多次呼气氮冲洗检查。在治疗3个月结束时重复所有测试。
结果
患者的平均（标准差）年龄为65.9岁（8.4），体重指数为30.0（5.6），吸烟包年数为51.4（21.1），支气管扩张剂后第一秒用力呼气容积（FEV1）预测值为62.7（20）。在基线时，SGRQ总分平均为39.0（17.7），功能残气量（FRC）预测值为125.4（31.3）。通过FOT测量，总气道阻力（Rrs-total）为5.69（1.29）cmH₂O/L/s，总气道电抗（Xrs-total）为 -3.48（2.16）cmH₂O/L/s，呼气流量限制指数（EFL Index）为3.51（2.45）cmH₂O/L/s。治疗3个月后，SGRQ评分有显著改善（-13.81，p < 0.0001），尽管FEV1无变化（增加40 mL，p = 0.14）。通过FOT测量，总气道阻力（-0.63 cmH₂O/L/s，p = 0.0004）、气道电抗（+1.2 cmH₂O/L/s，p = 0.013）和呼气流量限制（-1.21 cmH₂O/L/s，p = 0.02）也有所改善。通气异质性指数无显著变化。
结论
联合治疗与COPD患者小气道功能的改善相关，尽管FEV1没有变化。FOT可能是COPD中小气道功能的一个对治疗有反应的临床有用指标。
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