Moayyedi P, Congleton J, Page R L, Pearson S B, Muers M F
Regional Cardiothoracic Centre, Killingbeck Hospital, Leeds, UK.
Thorax. 1995 Aug;50(8):834-7. doi: 10.1136/thx.50.8.834.
Patients admitted with acute exacerbation of chronic obstructive pulmonary disease (COPD) are often prescribed ipratropium bromide in combination with a beta 2 agonist such as salbutamol. Studies have not shown any benefit in adding ipratropium bromide to salbutamol in acute exacerbations of COPD, but these studies have only assessed patients for 60-90 minutes and short term studies may not predict long term clinical response. Combination therapy with the two drugs was compared with salbutamol alone in the treatment of acute exacerbations of COPD during a hospital admission.
Seventy patients admitted to hospital with an acute exacerbation of COPD were randomly allocated to receive either nebulised salbutamol 5 mg and ipratropium bromide 500 micrograms, or nebulised salbutamol 5 mg alone (all four times a day) on admission. All other treatment was prescribed at the discretion of the attending physician. Length of stay in hospital and spirometric values on days 1, 3, 7, 14, and discharge were assessed. Patients completed a subjective symptom score each day.
There was no difference between the two groups in the mean (SD) length of stay (salbutamol 10.5 (4.7) days, salbutamol + ipratropium bromide 11.8 (4.4) days; 95% CI -1.02 to 3.62). There was no difference in spirometric values on days 1, 3, 7, 14, or discharge between the two groups. The subjective improvement was similar with both treatments.
The routine addition of nebulised ipratropium bromide to salbutamol appears to be of no benefit in the treatment of acute exacerbations of COPD.
慢性阻塞性肺疾病（COPD）急性加重期入院患者常被处方异丙托溴铵联合β2受体激动剂如沙丁胺醇。研究未显示在COPD急性加重期将异丙托溴铵添加到沙丁胺醇中有任何益处，但这些研究仅对患者评估了60 - 90分钟，短期研究可能无法预测长期临床反应。在住院期间，将这两种药物的联合治疗与单独使用沙丁胺醇治疗COPD急性加重期进行了比较。
70例因COPD急性加重期入院的患者被随机分配，入院时分别接受雾化吸入5毫克沙丁胺醇和500微克异丙托溴铵，或仅雾化吸入5毫克沙丁胺醇（均每日4次）。所有其他治疗由主治医师酌情开处方。评估住院时间以及第1、3、7、14天和出院时的肺功能测定值。患者每天完成一份主观症状评分。
两组的平均（标准差）住院时间无差异（沙丁胺醇组10.5（4.7）天，沙丁胺醇 + 异丙托溴铵组11.8（4.4）天；95%可信区间 -1.02至3.62）。两组在第1、3、7、14天或出院时的肺功能测定值无差异。两种治疗的主观改善情况相似。
在沙丁胺醇治疗中常规添加雾化异丙托溴铵似乎对治疗COPD急性加重期无益处。
