CHU Lille, Pneumologie et Immuno-Allergologie, F-59000 Lille, France; Univ. Lille, CHU Lille, CNRS, Inserm, Institut Pasteur de Lille, U1019 - UMR 9017 - CIIL - Center for Infection and Immunity of Lille, F-59000 Lille, France.
CH Tourcoing, Respiratory disease department, F-59200 Tourcoing, France.
Respir Med Res. 2024 Jun;85:101082. doi: 10.1016/j.resmer.2023.101082. Epub 2024 Jan 26.
Dyspnea is a complex symptom of chronic obstructive pulmonary disease (COPD) which is not strongly correlated with lung function measures. Long-acting bronchodilators (LAB) may reduce this dyspnea, but some patients report persistent chronic dyspnea despite this treatment. This study aims to assess residual reversibility and clinical response after short-acting bronchodilator (SAB) in COPD patients already treated by LAB and reporting persistent dyspnea.
COPD patients with a persistent dyspnea (modified Medical Research Council scale (mMRC) ≥1) despite current stable treatment with at least one LAB were included. Spirometry, plethysmography and impulse oscillometry (IOS) were performed at peak effect of their LAB and repeat 45 min after the intake of two SAB (400 µg of salbutamol and 80 µg of ipratropium). Dyspnea improvement was assessed at 45 min after SAB through a comparative two-sided VAS (-100 mm for maximal improvement; +100 mm for maximal degradation).
Twenty-two COPD patients were analyzed, mainly men (59.1 %) with a mean age of 60.6 years and a median FEV1 of 54 % of predicted values. Fifty percent of patients reported a severe basal dyspnea (mMRC ≥2). After SAB, spirometric and plethysmographic measurements were statistically improved. For IOS measurement, reactance at 5 Hz (X5) and area of reactance (AX) were also improved. Fifty percent of patients reported a clinically relevant improvement of their resting dyspnea. However, no correlation was found between dyspnea improvement and functional measures.
Fifty percent of COPD patients regularly treated with one or two LAB still report a relevant improvement of resting dyspnea after the adjunctive intake of double short-acting bronchodilators. Physiological mechanisms associated with this improvement remain to be determined.
NCT02928744.
呼吸困难是慢性阻塞性肺疾病（COPD）的一种复杂症状，与肺功能测量指标的相关性不强。长效支气管扩张剂（LAB）可减轻这种呼吸困难，但有些患者尽管接受了这种治疗，仍报告持续存在慢性呼吸困难。本研究旨在评估已接受 LAB 治疗且报告持续呼吸困难的 COPD 患者在使用短效支气管扩张剂（SAB）后残留的可逆性和临床反应。
纳入了呼吸困难持续存在（改良的医学研究理事会呼吸困难量表（mMRC）≥1）且当前稳定接受至少一种 LAB 治疗的 COPD 患者。在 LAB 的峰值效应时进行肺量计、体积描记法和脉冲震荡（IOS）检查，并在吸入 2 次 SAB（400 µg 沙丁胺醇和 80 µg 异丙托铵）后 45 分钟重复检查。在 SAB 后 45 分钟通过比较双侧 VAS（-100 毫米为最大改善；+100 毫米为最大恶化）评估呼吸困难改善情况。
分析了 22 名 COPD 患者，主要为男性（59.1%），平均年龄 60.6 岁，FEV1 占预计值的 54%。50%的患者报告有严重的基础呼吸困难（mMRC≥2）。在 SAB 后，肺量计和体积描记法测量值均有统计学改善。对于 IOS 测量，5Hz 时的电抗（X5）和电抗面积（AX）也有所改善。50%的患者报告静息呼吸困难有临床相关的改善。然而，呼吸困难改善与功能测量值之间无相关性。
定期接受一种或两种 LAB 治疗的 COPD 患者中有 50%在额外使用双短效支气管扩张剂后仍报告静息呼吸困难有显著改善。与这种改善相关的生理机制仍有待确定。
NCT02928744。
