Suruda T, Nakamura H, Kobayashi H, Uetani K, Nishio M, Higashimoto Y, Funasako M, Ohata M
Department of Internal Medicine, Wakayama Medical College Kihoku Hospital, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1993 Sep;31(9):1089-95.
To examine the effects of bronchodilators on maximal exercise capacity and their correlation with airflow during exercise in patients with chronic obstructive pulmonary disease (COPD), we conducted a double-blind, randomized comparison between inhaled fenoterol (beta 2-agonist) and oxitropium bromide (anticholinergic agent) in 8 patients with stable COPD (mean age 73 years, mean FEV1 1.1 L, mean FEV1% 50%). Only oxitropium bromide resulted in statistically significant improvement in FEV1 40 min after inhalation. On maximal exercise, fenoterol did not affect oxygen uptake (VO2 max), minute ventilation (VEmax), respiratory frequency (Rfmax), ventilatory efficacy (VEmax/VO2 max), peak expiratory flow during exercise (PEFmax), heart rate (HRmax) and dyspnea (Borg Scale Slope). After oxitropium bromide, dyspnea during exercise and HRmax decreased significantly, but PEFmax and other parameters did not change significantly compared with control. There was no correlation between changes in dyspnea during exercise and changes in FEV1 and PEFmax after oxitropium bromide inhalation. We conclude that inhaled oxitropium bromide, an anticholinergic agent, reduces dyspnea during exercise in patients with COPD. This favorable effect was not due to change of airflow limitation during exercise, and other factors can thus influence reduction of dyspnea during exercise in these patients.
为了研究支气管扩张剂对慢性阻塞性肺疾病（COPD）患者最大运动能力的影响及其与运动期间气流的相关性，我们对8例稳定期COPD患者（平均年龄73岁，平均第一秒用力呼气容积[FEV1]1.1L，平均FEV1%50%）进行了吸入非诺特罗（β2受体激动剂）和氧托溴铵（抗胆碱能药物）的双盲、随机对照研究。仅氧托溴铵在吸入后40分钟导致FEV1有统计学意义的改善。在最大运动时，非诺特罗不影响摄氧量（最大摄氧量[VO2 max]）、分钟通气量（最大分钟通气量[VEmax]）呼吸频率（最大呼吸频率[Rfmax]）、通气效率（VEmax/VO2 max）、运动期间的呼气峰值流速（最大呼气峰值流速[PEFmax]）、心率（最大心率[HRmax]）和呼吸困难（Borg量表斜率）。使用氧托溴铵后，运动期间的呼吸困难和HRmax显著降低，但与对照组相比，PEFmax和其他参数没有显著变化。吸入氧托溴铵后运动期间呼吸困难的变化与FEV1和PEFmax的变化之间没有相关性。我们得出结论，吸入抗胆碱能药物氧托溴铵可减轻COPD患者运动期间的呼吸困难。这种有益效果并非由于运动期间气流受限的改变，因此其他因素可影响这些患者运动期间呼吸困难的减轻。
