Teramoto S, Fukuchi Y, Orimo H
Department of Geriatrics, Faculty of Medicine, University of Tokyo, Japan.
Chest. 1993 Jun;103(6):1774-82. doi: 10.1378/chest.103.6.1774.
To elucidate the effect of oxitropium bromide (OTB), an anticholinergic drug, on dyspnea and gas exchange during exercise in patients with chronic obstructive pulmonary disease (COPD), we performed the cycle exercise test on 19 patients with COPD (mean age, 72.0 +/- 1.9 years; mean FEV1, 1.28 +/- 0.07 L) before and after inhalation of OTB, 300 micrograms, or placebo, 300 micrograms, in randomized fashion. Spirometry was performed immediately before and 30 min after inhalation of either OTB or placebo. Dyspnea during exercise was evaluated using the Borg scale (BS) and the slope of the regression between BS and oxygen uptake (VO2) during exercise (Borg scale slope: BSS). Arterial oxygen saturation (SaO2) was continuously monitored by pulse oximeter during and after exercise. We also measured the recovery time, which was defined as the time to recover decreases in SaO2 after exercise. After OTB, spirometric indices were improved (delta FEV1 16.8 +/- 0.9 percent) and maximal VO2 during exercise increased significantly (from 986 +/- 46 ml/min to 1,156 +/- 55 ml/min, p < 0.01), but not after placebo. The maximal scores of BS and the BSS were significantly decreased after OTB, but not after placebo. Although the SaO2 at rest and during exercise did not differ with or without either OTB or placebo, the recovery time after OTB (77.3 +/- 6.8 s) was significantly shorter than that before administration (98.4 +/- 14.6 s) (p < 0.01). We conclude that the inhaled OTB produces small but significant improvement both in dyspnea during exercise and in exercise performance in stable COPD and may contribute to improve the quality of life in some patients with COPD. However, gas exchange during exercise of COPD patients is little affected by OTB.
为阐明抗胆碱能药物氧托溴铵（OTB）对慢性阻塞性肺疾病（COPD）患者运动期间呼吸困难及气体交换的影响，我们以随机方式，对19例COPD患者（平均年龄72.0±1.9岁；平均第一秒用力呼气容积[FEV1]为1.28±0.07升）在吸入300微克OTB或300微克安慰剂之前和之后进行了周期运动试验。在吸入OTB或安慰剂之前及之后30分钟立即进行肺量计检查。运动期间的呼吸困难采用Borg量表（BS）以及运动期间BS与摄氧量（VO2）之间的回归斜率（Borg量表斜率：BSS）进行评估。运动期间及运动后通过脉搏血氧仪持续监测动脉血氧饱和度（SaO2）。我们还测量了恢复时间，其定义为运动后SaO2下降恢复所需的时间。吸入OTB后，肺量计指标得到改善（FEV1变化值为16.8±0.9%），运动期间的最大VO2显著增加（从986±46毫升/分钟增至1156±55毫升/分钟，p<0.01），但吸入安慰剂后无此变化。吸入OTB后，BS和BSS的最大分值显著降低，但吸入安慰剂后无此变化。尽管无论是否使用OTB或安慰剂，静息及运动期间的SaO2并无差异，但吸入OTB后的恢复时间（77.3±6.8秒）显著短于给药前（98.4±14.6秒）（p<0.01）。我们得出结论，吸入OTB可使稳定期COPD患者运动期间的呼吸困难及运动表现出现虽小但显著的改善，可能有助于提高部分COPD患者的生活质量。然而，COPD患者运动期间的气体交换受OTB的影响较小。
