Nishimura K, Koyama H, Ikeda A, Izumi T
Chest Disease Research Institute, Kyoto University, Japan.
Chest. 1993 Jul;104(1):179-84. doi: 10.1378/chest.104.1.179.
To investigate the additive effect of oral theophylline on combined inhaled anticholinergic agent and beta 2-agonist therapy, 12 patients with stable COPD (64.6 +/- 5.9 years) completed a randomized, double-blind placebo-controlled crossover trial of oral theophylline for a 4-week period (400 mg for 2 weeks, followed by 600 mg for 2 weeks). All of the patients continued to inhale both salbutamol, 200 micrograms, and ipratropium bromide, 40 micrograms, using a metered-dose inhaler four times a day. Spirometry was assessed before, and 15 and 60 min after the inhalation of bronchodilators at 2-week intervals. Even after the inhalation of salbutamol and ipratropium, theophylline significantly improved FEV1 and daily peak expiratory flow rate compared with the placebo. No significant improvement in the daily symptom scores for cough, sputum, wheezing, or shortness of breath was observed throughout the different phases of treatment. This study shows that the additive bronchodilating effect of theophylline, when used in combination with salbutamol, 200 micrograms, and ipratropium, 40 micrograms, is significant but small in stable COPD. The addition of theophylline did not significantly improve the patient's symptoms. Oral theophylline, when used in combination with an inhaled anticholinergic agent and an inhaled beta 2-agonist, may be of limited value in the treatment of stable COPD.
为研究口服茶碱对联合吸入抗胆碱能药物与β2受体激动剂治疗的附加作用，12例稳定期慢性阻塞性肺疾病（COPD）患者（64.6±5.9岁）完成了一项为期4周的口服茶碱随机、双盲、安慰剂对照交叉试验（2周服用400mg，随后2周服用600mg）。所有患者继续使用定量吸入器，每天4次吸入沙丁胺醇200μg和异丙托溴铵40μg。每隔2周在吸入支气管扩张剂前、吸入后15分钟和60分钟评估肺功能。即使在吸入沙丁胺醇和异丙托溴铵后，与安慰剂相比，茶碱仍能显著改善第1秒用力呼气容积（FEV1）和每日呼气峰值流速。在整个治疗的不同阶段，未观察到咳嗽、咳痰、喘息或气短的每日症状评分有显著改善。本研究表明，在稳定期COPD患者中，茶碱与200μg沙丁胺醇和40μg异丙托溴铵联合使用时，其附加支气管扩张作用显著但较小。添加茶碱并未显著改善患者症状。口服茶碱与吸入抗胆碱能药物和吸入β2受体激动剂联合使用时，在稳定期COPD的治疗中可能价值有限。
