LeDoux E J, Morris J F, Temple W P, Duncan C
Pulmonary Disease Section, Veterans Administration Medical Center, Portland, Oregon 97207.
Chest. 1989 May;95(5):1013-6. doi: 10.1378/chest.95.5.1013.
Inhaled ipratropium bromide (IPR) is effective in the management of COPD. The purpose of this study was to determine if doubling the standard dose of IPR resulted in greater bronchodilation and if the addition of an inhaled beta-agonist was superior to standard dose IPR alone. Twelve male patients with stable COPD completed a double blind, randomized trial. On each of three consecutive days, following baseline spirometry, all patients inhaled two puffs of IPR. This was followed by either two additional puffs of IPR, two puffs of metaproterenol (META), or two puffs of placebo. All inhalants were delivered by an InspirEase spacer. Spirometry was repeated at 30, 60, 120, and 180 minutes. The group mean percentage increases in the FEV1 and FVC from baseline were similar at all times tested for the three protocols. In conclusion, for the group, there was no objective benefit to doubling the standard dose of IPR or combining IPR with META. Two of 12 patients benefited from combining the two bronchodilators. A potential sequence for bronchodilator testing is suggested.
吸入用异丙托溴铵（IPR）对慢性阻塞性肺疾病（COPD）的治疗有效。本研究的目的是确定将IPR标准剂量加倍是否会导致更大程度的支气管扩张，以及添加吸入性β受体激动剂是否优于单独使用标准剂量的IPR。12名稳定期COPD男性患者完成了一项双盲随机试验。在连续三天的每一天，在基线肺活量测定后，所有患者吸入两喷IPR。随后，要么再吸入两喷IPR，要么吸入两喷间羟异丙肾上腺素（META），要么吸入两喷安慰剂。所有吸入剂均通过InspirEase储雾罐给药。在30、60、120和180分钟时重复进行肺活量测定。在三种方案的所有测试时间点，FEV1和FVC相对于基线的组平均百分比增加相似。总之，对于该组患者，将IPR标准剂量加倍或IPR与META联合使用没有客观益处。12名患者中有2名从两种支气管扩张剂联合使用中获益。提出了一种支气管扩张剂测试的潜在顺序。
