Cazzola M, Vinciguerra A, Di Perna F, Matera M G
Division of Pneumology and Allergology, A. Cardarelli Hospital, Naples, Italy.
Respir Med. 1998 Aug;92(8):1012-6. doi: 10.1016/s0954-6111(98)90347-x.
The assessment of reversibility is recognized as being an essential part of the management of airways obstruction, but testing for reversibility of airways obstruction may not be useful for identifying patients with chronic obstructive pulmonary disease (COPD) who are likely to benefit from bronchodilator treatment. We studied 100 patients with stable COPD. Early reversibility of airways obstruction to 200 mg salbutamol and peak bronchodilation to 50 micrograms salmeterol or 200 micrograms salbutamol were evaluated in four different sessions (two for salbutamol and two for salmeterol), using a double-blind, cross-over, randomized study. Fifteen minutes after inhalation of salbutamol, 47 patients presented an increase in FEV1 greater than 15% of baseline, whereas 48 showed an increase of FEV1 of at least 160 ml from basal value and 33 an increase in FEV1 greater than both 15% of baseline and 200 ml. On the contrary, 69 patients presented an increase in FEV1 greater than 15% of baseline, 65 an increase of FEV1 of at least 160 ml from basal value and 60 an increase in FEV1 greater than both 15% of baseline and 200 ml as maximum increase over baseline usually 2-4 h after inhalation of salmeterol. Twenty-seven other subjects defined as irreversible by the lack of acute improvement in FEV1 after salbutamol, showed an increase in FEV1 greater than 15% of baseline, 20 showed an increase of FEV1 of at least 160 ml from basal value, and 18 showed an increase in FEV1 greater than both 15% of baseline and 200 ml; all had the maximum degree of bronchodilation usually 1-2 h after salbutamol administration. These findings clearly demonstrate that many patients suffering from stable COPD show early reversibility to a short-acting beta 2-agonist and patients who do not manifest early reversibility to salbutamol can still benefit from salbutamol or salmeterol. Therefore, treatments with beta 2-agonists must always be tried.
气道阻塞可逆性的评估被认为是气道阻塞管理的重要组成部分，但气道阻塞可逆性测试对于识别可能从支气管扩张剂治疗中获益的慢性阻塞性肺疾病（COPD）患者可能并无用处。我们研究了100例稳定期COPD患者。采用双盲、交叉、随机研究，在四个不同时段（两个时段使用沙丁胺醇，两个时段使用沙美特罗）评估气道阻塞对200mg沙丁胺醇的早期可逆性以及对50μg沙美特罗或200μg沙丁胺醇的最大支气管扩张作用。吸入沙丁胺醇15分钟后，47例患者的第一秒用力呼气容积（FEV1）较基线值增加超过15%，48例患者的FEV1较基础值至少增加160ml，33例患者的FEV1较基线值增加超过15%且增加超过200ml。相反，吸入沙美特罗后，通常在2 - 4小时达到超过基线的最大增加量，69例患者的FEV1较基线值增加超过15%，65例患者的FEV1较基础值至少增加160ml，60例患者的FEV1较基线值增加超过15%且增加超过200ml。另外27名因吸入沙丁胺醇后FEV1缺乏急性改善而被定义为不可逆的受试者，其FEV1较基线值增加超过15%，20名受试者的FEV1较基础值至少增加160ml，18名受试者的FEV1较基线值增加超过15%且增加超过200ml；所有这些受试者在使用沙丁胺醇后通常1 - 2小时达到最大支气管扩张程度。这些发现清楚地表明，许多稳定期COPD患者对短效β2激动剂显示出早期可逆性，而对沙丁胺醇未表现出早期可逆性的患者仍可从沙丁胺醇或沙美特罗中获益。因此，必须始终尝试使用β2激动剂进行治疗。
