茶碱和异丙托溴铵对稳定期慢性阻塞性肺疾病患者运动能力的影响。

Effects of theophylline and ipratropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease.

作者信息

Tsukino M, Nishimura K, Ikeda A, Hajiro T, Koyama H, Izumi T

机构信息

Chest Disease Research Institute, Kyoto University, Japan.

出版信息

Thorax. 1998 Apr;53(4):269-73. doi: 10.1136/thx.53.4.269.

DOI:10.1136/thx.53.4.269

PMID:9741369

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC1745182/

Abstract

BACKGROUND

The effects of theophylline or anticholinergic agents on exercise capacity in patients with chronic obstructive pulmonary disease (COPD) remain controversial. The aim of the present study was to compare the effect of an oral theophylline with an inhaled anticholinergic agent and to examine the effects of combined therapy on exercise performance using progressive cycle ergometry.

METHODS

Twenty one men with stable COPD and a mean (SD) forced expiratory volume in one second (FEV1) of 1.00 (0.40) 1 were studied. Theophylline (600 or 800 mg daily), ipratropium bromide (160 micrograms), a combination of both drugs, and placebo were given in a randomised, double blind, four period crossover design study. Spirometric data, pulse rate, and blood pressure were assessed before and at 90 and 120 minutes after inhalation. Symptom limited progressive cycle ergometer exercise tests (20 watts/min) were performed 90 minutes after each inhalation, and dyspnoea was measured during exercise using the Borg scale.

RESULTS

The mean (SD) serum theophylline concentration was 18.3 (6.3) micrograms/ml, and seven patients had side effects during treatment with theophylline. Theophylline and ipratropium bromide produced greater increases in FEV1, maximal oxygen consumption, maximal minute ventilation, and several dyspnoea ratios than placebo. There were no differences between theophylline and ipratropium bromide except in maximal heart rate. A combination of both drugs produced greater improvements in pulmonary function and exercise capacity than either drug alone.

CONCLUSIONS

Both high dose theophylline and high dose ipratropium bromide improved exercise capacity in patients with stable COPD. Although data based on short term effects cannot be directly applied to long term therapy, theophylline added to an inhaled anticholinergic agent may have beneficial effects on exercise capacity in patients with COPD.

摘要

背景

茶碱或抗胆碱能药物对慢性阻塞性肺疾病（COPD）患者运动能力的影响仍存在争议。本研究的目的是比较口服茶碱与吸入抗胆碱能药物的效果，并使用递增式自行车测力计检查联合治疗对运动表现的影响。

方法

对21名稳定期COPD男性患者进行研究，其一秒用力呼气容积（FEV1）的平均值（标准差）为1.00（0.40）升。采用随机、双盲、四期交叉设计研究，给予患者茶碱（每日600或800毫克）、异丙托溴铵（160微克）、两种药物的组合以及安慰剂。在吸入前以及吸入后90分钟和120分钟评估肺功能数据、脉搏率和血压。每次吸入后90分钟进行症状限制的递增式自行车测力计运动测试（20瓦/分钟），并在运动期间使用Borg量表测量呼吸困难程度。

结果

血清茶碱浓度的平均值（标准差）为18.3（6.3）微克/毫升，7名患者在茶碱治疗期间出现副作用。与安慰剂相比，茶碱和异丙托溴铵使FEV1、最大摄氧量、最大分钟通气量以及几个呼吸困难比值有更大的增加。除最大心率外，茶碱和异丙托溴铵之间没有差异。两种药物联合使用比单独使用任何一种药物在肺功能和运动能力方面都有更大的改善。