1Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.
2Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
J Aerosol Med Pulm Drug Deliv. 2019 Aug;32(4):189-199. doi: 10.1089/jamp.2018.1459. Epub 2019 Apr 8.
Little is known of the repeatability and reliability of mucociliary clearance (MCC) in former tobacco smokers who have both chronic obstructive pulmonary disease (COPD) and chronic bronchitis (CB). Less is known of the effect of roflumilast, a selective inhibitor of PDE4, on MCC in these patients. Former tobacco smokers with COPD and CB were treated for 4 weeks with either roflumilast, or placebo, in a randomized, crossover trial. The following were measured on two baseline and two posttreatment visits: MCC values through 90 minutes, following inhalation of technetium sulfur colloid and gamma camera imaging; outer:inner (O:I) deposition ratio; forced expiratory volume in 1 second (FEV); and symptom scores. Comparisons included: MCC measures through 30 minutes (MCC30), 60 minutes (MCC60), and 90 minutes (MCC90) on the two baseline visits ( = 9) and mean change [(roflumilast - baseline)-(placebo - baseline)] for MCC30, MCC60, MCC90, and FEV ( = 8). Associations between MCC measurements, FEV and O:I ratio with symptom scores were also examined. Pearson correlation tests indicated good repeatability for baseline measures of MCC30, MCC60, and MCC90 and intraclass correlation coefficients indicated good reliability. Only FEV (percent predicted) improved significantly following roflumilast treatment. There were no statistically significant correlations between MCC measures and symptom scores. Lower FEV values were significantly associated with increased shortness of breath (dyspnea), and lower O:I ratios (more inner region deposition) were significantly associated with increased cough and sputum. Measurements of MCC30, MCC60, and MCC90 are repeatable and reliable in former tobacco smokers with both COPD and CB. One month of treatment with roflumilast did not improve MCC in this limited study. Airway narrowing in the larger, central airways of these subjects could lead to decreased FEV, increased inner region deposition of the radiolabeled particles, and the associated increase in symptoms of dyspnea, cough, and sputum.
先前吸烟且患有 COPD 和 CB 的患者的 MCC 重复性和可靠性知之甚少，而 PDE4 选择性抑制剂罗氟司特对这些患者的 MCC 的影响知之甚少。在一项随机交叉试验中，先前吸烟且患有 COPD 和 CB 的患者接受了 4 周的罗氟司特或安慰剂治疗。在两次基线和两次治疗后访视中测量了以下指标：吸入锝硫胶体和伽马相机成像后 90 分钟内的 MCC 值；外：内（O：I）沉积比；第 1 秒用力呼气量（FEV）；和症状评分。比较包括：两次基线访视中的 MCC30（MCC30）、MCC60（MCC60）和 MCC90（MCC90）的 30 分钟（MCC30）、60 分钟（MCC60）和 90 分钟（MCC90）测量值（=9）和 MCC30、MCC60、MCC90 和 FEV 的平均变化[（罗氟司特-基线）-（安慰剂-基线）]（=8）。还检查了 MCC 测量值、FEV 和 O：I 比与症状评分之间的相关性。Pearson 相关检验表明 MCC30、MCC60 和 MCC90 的基线测量值具有良好的可重复性，组内相关系数表明可靠性良好。只有 FEV（预测百分比）在罗氟司特治疗后显著改善。MCC 测量值与症状评分之间无统计学显著相关性。FEV 值较低与呼吸急促（呼吸困难）显著相关，O：I 比值（内区沉积增加）较低与咳嗽和痰量增加显著相关。MCC30、MCC60 和 MCC90 的测量值在 COPD 和 CB 并存的先前吸烟患者中具有可重复性和可靠性。在这项有限的研究中，罗氟司特治疗 1 个月并未改善 MCC。这些患者较大的中央气道的气道狭窄可能导致 FEV 下降、放射性标记颗粒的内区沉积增加以及相关的呼吸困难、咳嗽和痰量增加症状。
