Matsushima Sayomi, Inui Naoki, Yasui Hideki, Kono Masato, Nakamura Yutaro, Toyoshima Mikio, Shirai Toshihiro, Suda Takafumi
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, 1-20-1 Handayama, Hamamatsu 431-3192, Japan.
Pulm Pharmacol Ther. 2015 Feb;30:11-5. doi: 10.1016/j.pupt.2014.10.003. Epub 2014 Oct 30.
Combination therapy with a long-acting antimuscarinic agent and a long-acting β2-agonist are recommended in chronic obstructive pulmonary disease (COPD) if control is not adequate with one long-acting bronchodilator alone. We evaluated the effects of indacaterol and tiotropium combination therapy, including the effects of adding indacaterol to tiotropium (indacaterol add-on group) and adding tiotropium to indacaterol (tiotropium add-on group).
We recruited 79 patients with COPD already treated with tiotropium or indacaterol. We undertook pulmonary function tests, the COPD assessment test (CAT), and the multi-frequency forced oscillation technique (to measure respiratory resistance and reactance) before and after 8 weeks of indacaterol and tiotropium combination therapy.
The median age was 72.1 years and the mean forced expiratory volume in 1 s (FEV1) as a proportion of predicted was 57.2 ± 18.3%. After 8 weeks of combination therapy, FEV1 and %predicted FEV1 had increased significantly. There was no change in CAT score. For respiratory impedance, combination therapy improved resistance at 5 Hz (R5) and resistance at 20 Hz (R20) in the whole-breath, inspiratory and expiratory phases, and resonant frequency (Fres) in the inspiratory phase. The indacaterol add-on group (43 patients) and tiotropium add-on group (36 patients) showed improvements in FEV1 and %predicted FEV1 over monotherapy, although the CAT score fell significantly in the indacaterol add-on group (p = 0.005).
Indacaterol and tiotropium combination therapy improved airflow limitation and respiratory resistances. Adding indacaterol to tiotropium, or tiotropium to indacaterol, had similar effects on airflow limitation.
对于慢性阻塞性肺疾病（COPD）患者，如果单独使用一种长效支气管扩张剂控制效果不佳，则推荐使用长效抗胆碱能药物与长效β2受体激动剂联合治疗。我们评估了茚达特罗与噻托溴铵联合治疗的效果，包括在噻托溴铵基础上加用茚达特罗（茚达特罗加用组）以及在茚达特罗基础上加用噻托溴铵（噻托溴铵加用组）的效果。
我们招募了79例已接受噻托溴铵或茚达特罗治疗的COPD患者。在茚达特罗与噻托溴铵联合治疗8周前后，我们进行了肺功能测试、慢性阻塞性肺疾病评估测试（CAT）以及多频强迫振荡技术（用于测量呼吸阻力和电抗）。
患者的中位年龄为72.1岁，1秒用力呼气容积（FEV1）占预计值的平均比例为57.2±18.3%。联合治疗8周后，FEV1及FEV1占预计值的百分比均显著增加。CAT评分无变化。对于呼吸阻抗，联合治疗改善了全呼吸、吸气和呼气阶段5Hz时的阻力（R5）、20Hz时的阻力（R20）以及吸气阶段的共振频率（Fres）。茚达特罗加用组（43例患者）和噻托溴铵加用组（36例患者）的FEV1及FEV1占预计值的百分比相较于单药治疗均有所改善，尽管茚达特罗加用组的CAT评分显著下降（p = 0.005）。
茚达特罗与噻托溴铵联合治疗改善了气流受限和呼吸阻力。在噻托溴铵基础上加用茚达特罗或在茚达特罗基础上加用噻托溴铵对气流受限的影响相似。
