Tellier P
Presse Med. 1984 Oct 4;13(34):2049-53.
The mechanisms of exercise-induced dyspnoea in chronic obstructive bronchitis are diverse and complex. Dyspnoea develops simultaneously with ventilatory obstruction and constitutes a major symptom in view of its frequency, prognostic value and functional repercussions. It is not the most common reason for seeking medical advice, but because ventilatory obstruction is of poor prognosis it should be systematically looked for by precise, directed questioning in all patients with chronic bronchitis. In some cases, the effects of drugs on dyspnoea can be evaluated by means of a clinical score, but such an evaluation requires a strictly controlled double-blind trial with separate assessments by the clinician and the patient. The effectiveness of almitrine bismesylate on exercise-induced dyspnoea in chronic bronchitis has been demonstrated by this method. A multicentre, drug versus placebo controlled trial conducted on 200 patients during 6 months has shown that almitrine bismesylate significantly lowered dyspnoea scores measured according to the Sadoul scale and that the symptomatic improvement observed correlated with the effects of the drug on blood gases. By promoting tissue oxygenation, almitrine bismesylate may antagonize one or several of the mechanisms underlying exercise-induced dyspnoea in chronic bronchitis patients who have reached the stage of respiratory failure.
慢性阻塞性支气管炎中运动诱发呼吸困难的机制多样且复杂。呼吸困难与通气障碍同时出现，鉴于其发生频率、预后价值及功能影响，它构成了主要症状。它并非就医的最常见原因，但由于通气障碍预后不良，因此应对所有慢性支气管炎患者通过精确、有针对性的询问进行系统排查。在某些情况下，可通过临床评分评估药物对呼吸困难的影响，但这种评估需要严格控制的双盲试验，并由临床医生和患者分别进行评估。已通过该方法证实了二甲磺酸阿米三嗪对慢性支气管炎运动诱发呼吸困难的有效性。一项在200名患者中进行的为期6个月的多中心、药物与安慰剂对照试验表明，二甲磺酸阿米三嗪显著降低了根据萨杜尔量表测量的呼吸困难评分，且观察到的症状改善与药物对血气的影响相关。通过促进组织氧合，二甲磺酸阿米三嗪可能对抗已发展至呼吸衰竭阶段的慢性支气管炎患者运动诱发呼吸困难的一种或多种潜在机制。
