O'Driscoll B R, Bernstein A
Salford Royal Hospitals NHS Trust, Hope Hospital, U.K.
Respir Med. 1996 Oct;90(9):561-6. doi: 10.1016/s0954-6111(96)90149-3.
Although home nebulizers are widely used to deliver bronchodilator medication to patients with asthma and chronic obstructive pulmonary disease (COPD), the long-term benefits and hazards are unknown. The present authors have previously reported a prospective 12-month study of home nebulizer use involving 49 patients (15 asthma, mean forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) 1.3/2.1 1; 34 COPD, mean FEV1/FVC 0.7/1.8 1). Thirty-two of these patients were treated with long-term domiciliary nebulized bronchodilator treatment, the other 17 patients chose metered dose inhaler (MDI) therapy. The present paper reports the progress of these patients over 5 yr. Five-year survival was similar in both groups (nebulizer users 56%, MDI users 53%). Most deaths were due to respiratory failure (14 deaths) or lung cancer (four deaths). Survival was determined mainly by FEV1 (R = 0.54, P = 0.0001) and age (R = -0.47, P = 0.0007). Laboratory lung function tests (16 nebulizer users) showed that FEV1 and FVC were still higher than pre-nebulizer baseline measurements after 36 months of nebulizer use, but PEFR had fallen by 7%. Twenty-one of 23 surviving nebulizer users completed a questionnaire after 36 months of treatment. All used their nebulizer at least once per day and 20 of 21 patients reported that they still obtained full benefit from each nebulized treatment. The morning peak flow response to nebulized treatment was the same at baseline and at 36 months (48 1 min-1). All patients remained breathless (mean subjective score 4.8 on seven-point scale) but the subjective response to nebulized treatment was unchanged at 36 months. Tachyphylaxis did not develop among 13 patients who underwent repeated reversibility studies using 200 micrograms of salbutamol at 6, 12 and 36 months. It is concluded that home nebulizer therapy is safe and effective for a small number of carefully selected patients with severe asthma or COPD, who have been evaluated by a rigorous home nebulizer assessment protocol prior to commencing home nebulizer therapy.
尽管家用雾化器被广泛用于为哮喘和慢性阻塞性肺疾病（COPD）患者输送支气管扩张剂药物，但其长期益处和危害尚不清楚。本文作者此前报告了一项为期12个月的家用雾化器使用前瞻性研究，涉及49名患者（15名哮喘患者，第1秒用力呼气容积/用力肺活量（FEV1/FVC）平均为1.3/2.1升；34名COPD患者，FEV1/FVC平均为0.7/1.8升）。其中32名患者接受长期家庭雾化支气管扩张剂治疗，另外17名患者选择定量吸入器（MDI）治疗。本文报告了这些患者5年的病情进展。两组的5年生存率相似（雾化器使用者为56%，MDI使用者为53%）。大多数死亡是由于呼吸衰竭（14例死亡）或肺癌（4例死亡）。生存率主要由FEV1（R = 0.54，P = 0.0001）和年龄（R = -0.47，P = 0.0007）决定。实验室肺功能测试（16名雾化器使用者）显示，在使用雾化器36个月后，FEV1和FVC仍高于雾化器使用前的基线测量值，但呼气峰值流速（PEFR）下降了7%。23名存活的雾化器使用者中有21名在治疗36个月后完成了一份问卷。所有人每天至少使用一次雾化器，21名患者中有20名报告称他们仍能从每次雾化治疗中获得充分益处。雾化治疗的早晨峰值流量反应在基线时和36个月时相同（48升/分钟）。所有患者仍有呼吸急促（七点量表上的平均主观评分为4.8），但在36个月时对雾化治疗的主观反应没有变化。在13名在6个月、12个月和36个月时使用200微克沙丁胺醇进行重复可逆性研究的患者中，未出现快速耐受现象。得出的结论是，对于少数经过严格的家用雾化器评估方案评估后，精心挑选的重度哮喘或COPD患者，家用雾化器治疗是安全有效的，且在开始家用雾化器治疗之前。
