Mestitz H, Copland J M, McDonald C F
Department of Thoracic Medicine, Repatriation General Hospital, Heidelberg, Victoria, Australia.
Chest. 1989 Dec;96(6):1237-40. doi: 10.1378/chest.96.6.1237.
Eighteen patients (nine asthmatic patients and nine with poorly reversible airflow obstruction) with stable, severe chronic airflow obstruction, completed a four-week randomized, doubled-blind, placebo-control, crossover trial comparing the acute and chronic effects of terbutaline administered by metered-dose inhaler (MDI) and nebulizer (NEB). Equipotent doses of terbutaline were selected from the comparison of separate cumulative dose-response curves for MDI and NEB. The MDI and NEB given acutely produced similar bronchodilatation and improvement in exercise performance. Spirometric indices, 6 min walking distance, symptom scores and extra beta-agonist use were no different between MDI and NEB treatment fortnights in the outpatient study. We conclude that the degree of bronchodilatation achieved in these patients is a reflection of the dose of bronchodilator administered and not the mode of administration. There is no justification for the preferred outpatient use of nebulized bronchodilators in patients with stable chronic airflow obstruction who can use adequate doses of bronchodilators via a metered-dose inhaler.
18例稳定期重度慢性气流受限患者（9例哮喘患者和9例气流可逆性差的患者）完成了一项为期4周的随机、双盲、安慰剂对照、交叉试验，比较了通过定量吸入器（MDI）和雾化器（NEB）给予特布他林的急性和慢性效应。从MDI和NEB各自的累积剂量-反应曲线比较中选择等效剂量的特布他林。急性给予MDI和NEB产生相似的支气管扩张和运动能力改善。在门诊研究中，MDI和NEB治疗两周期间的肺功能指标、6分钟步行距离、症状评分和额外β-激动剂使用情况无差异。我们得出结论，这些患者实现的支气管扩张程度反映的是给予的支气管扩张剂剂量，而非给药方式。对于能够通过定量吸入器使用足够剂量支气管扩张剂的稳定期慢性气流受限患者，门诊优先使用雾化支气管扩张剂没有依据。
