Porszasz Janos, Carraro Nicolò, Cao Robert, Gore Ashwani, Ma Shuyi, Jiang Thomas, Maltais François, Ferguson Gary T, O'Donnell Denis E, Shaikh Asif, Rossiter Harry B, Casaburi Richard
Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Rehabilitation Clinical Trials Center, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, CA, USA.
Respir Physiol Neurobiol. 2018 May;251:8-15. doi: 10.1016/j.resp.2018.02.006. Epub 2018 Feb 10.
This substudy of a large, randomized, controlled trial (NCT01072396) examined tiotropium (18 μg qd) effects on dynamic hyperinflation during constant work rate treadmill exercise. Areas-under-the-spontaneous expiratory flow-volume (SEFV)-curves were compared in 20 COPD patients and 16 age-matched untreated controls, using rectangular area ratio (RAR) between peak intrabreath and end-expiratory flow. Seven patients exhibited SEFV curve concavity with RAR ≤ 0.5 (RAR) in ≥1 test without tiotropium; (mean ± SD FEV: 1.60 ± 0.59 L; 63.4 ± 14.0%predicted). In RAR patients, tiotropium increased end-exercise inspiratory capacity (IC, 2.10 ± 0.05 vs. 1.89 ± 0.05 L, tiotropium vs. placebo; p = 0.045) and RAR (0.57 ± 0.02 vs. 0.53 ± 0.02; p < 0.001). Patients without SEFV curve concavity with RAR > 0.5 (n = 13; RAR), had higher screening FEV (2.15 ± 0.47 L; 79.6 ± 10.1%predicted) versus RAR patients and no difference in end-exercise IC and RAR between tiotropium and placebo (IC: 2.24 ± 0.03 vs. 2.17 ± 0.03 L; RAR: 0.63 ± 0.005 vs. 0.62 ± 0.005). RAR and%predicted IC at peak exercise were positively correlated in RAR patients (R = 0.43, p = 0.0002). Tiotropium increased exercise RAR in GOLD 1-2 patients with SEFV curve concavity.
这项针对一项大型随机对照试验（NCT01072396）的子研究，考察了噻托溴铵（每日18μg）对恒定工作率跑步机运动期间动态肺过度充气的影响。在20例慢性阻塞性肺疾病（COPD）患者和16例年龄匹配的未治疗对照中，使用吸气峰值与呼气末流量之间的矩形面积比（RAR）比较了自发性呼气流量-容积（SEFV）曲线下面积。7例患者在至少1次未使用噻托溴铵的测试中表现出RAR≤0.5的SEFV曲线凹陷（平均±标准差第一秒用力呼气容积：1.60±0.59L；占预计值的63.4±14.0%）。在RAR患者中，噻托溴铵增加了运动结束时的吸气容量（IC，噻托溴铵组为2.10±0.05L，安慰剂组为1.89±0.05L；p=0.045）和RAR（0.57±0.02对0.53±0.02；p<0.001）。RAR>0.5且无SEFV曲线凹陷的患者（n=13；RAR），其筛查时的第一秒用力呼气容积（FEV）高于RAR患者（2.15±0.47L；占预计值的79.6±10.1%），且噻托溴铵与安慰剂在运动结束时的IC和RAR方面无差异（IC：2.24±0.03对2.17±0.03L；RAR：0.63±0.005对0.62±0.005）。在RAR患者中，运动峰值时的RAR与占预计值的IC呈正相关（R=0.43，p=0.0002）。噻托溴铵增加了具有SEFV曲线凹陷的GOLD 1-2级患者的运动RAR。
