布地奈德在慢性阻塞性肺疾病急性加重期的临床疗效观察

目的评价局部吸入布地奈德治疗慢性阻塞性肺疾病急性加重期的疗效及安全性。方法选择60例COPD急性加重期住院患者随机均分为3组：①布地奈德组给予布地奈德雾化液雾化吸入2 mg/次,每8小时1次;②泼尼松组给予口服泼尼松片30 mg/次,每日1次;③空白对照组不使用任何糖皮质激素。观察3组患者治疗后呼吸困难评分、肺功能和动脉血气变化。结果与空白对照组比较,布地奈德组、泼尼松组在治疗后呼吸困难评分、动脉血气及肺功能的改善有显著性差异（P〈0.05）。布地奈德组与泼尼松组在提高FEV1、PaO2,改善呼吸困难评分方面无显著性差异（P〉0.05）。但在PaCO2值下降方面,在治疗7 d后布地奈德组下降（4.4±1.5）mmHg,泼尼松组下降（5.3±2.2）mmHg,两组比较有显著性差异（P〈0.05）。布地奈德组的不良反应少于泼尼松组。结论布地奈德组的疗效明显优于空白对照组,但与泼尼松组的无显著性差异。局部吸入布地奈德溶液是COPD急性加重期有效选择。     

布地奈德在慢性阻塞性肺疾病急性加重期的临床疗效观察

目的评价局部吸入布地奈德治疗慢性阻塞性肺疾病急性加重期的疗效及安全性。方法选择60例COPD急性加重期住院患者随机均分为3组:①布地奈德组给予布地奈德雾化液雾化吸入2 mg/次,每8小时1次;②泼尼松组给予口服泼尼松片30 mg/次,每日1次;③空白对照组不使用任何糖皮质激素。观察3组患者治疗后呼吸困难评分、肺功能和动脉血气变化。结果与空白对照组比较,布地奈德组、泼尼松组在治疗后呼吸困难评分、动脉血气及肺功能的改善有显著性差异(P0.05)。布地奈德组与泼尼松组在提高FEV1、PaO2,改善呼吸困难评分方面无显著性差异(P0.05)。但在PaCO2值下降方面,在治疗7 d后布地奈德组下降(4.4±1.5)mmHg,泼尼松组下降(5.3±2.2)mmHg,两组比较有显著性差异(P0.05)。布地奈德组的不良反应少于泼尼松组。结论布地奈德组的疗效明显优于空白对照组,但与泼尼松组的无显著性差异。局部吸入布地奈德溶液是COPD急性加重期有效选择。     

复方异丙托溴铵联合布地奈德雾化吸入对慢性阻塞性肺疾病急性加重期患者肺功能的影响

目的观察复方异丙托溴铵联合布地奈德雾化吸入对慢性阻塞性肺疾病急性（COPD）加重期患者肺功能的影响。方法将78例COPD急性加重期患者按照肺功能分级分为A（FEV1≥50％预计值）、B（FEV1〈50％预计值）两组,两组患者分别在常规治疗基础上联合复方异丙托溴铵联合布地奈德雾化吸入2次／d,治疗后第7天测定肺功能,观察第一秒用力呼气容积（FEV1）、FEV1占用力肺活量（FVC）百分比（FEV1／FVC）、最大呼气流量（PEF）、最大呼气中段流量（MMEF）是否有差异。结果COPD急性加重期雾化吸入复方异丙托溴铵联合布地奈德能显著改善肺功能,其中B组改善明显。结论COPD急性加重期雾化吸入复方异丙托溴铵联合布地奈德能扩张支气管平滑肌、解除气道痉挛、局部抗感染,从而快速有效控制病情,尤其对于肺功能严重受损患者能取得更好的疗效。     

足量雾化布地奈德循证治疗慢性阻塞性肺疾病急性加重期1例

目的了解足量雾化吸入布地奈德用于慢性阻塞性肺疾病（COPD）急性加重期治疗的有效性及安全性,为1例COPD急性加重期患者制定治疗方案。方法计算机检索Cochrane图书馆（2009年第4期）、MEDLINE（1990～2010.2）、ACP Journal Club（1991～2010.2）及中国期刊全文数据库（1979～2010.2）,查找足量雾化吸入布地奈德治疗COPD急性加重期的系统评价、临床随机对照试验,并对所获证据进行质量评价,进而应用于本例患者的临床治疗。结果共纳入4篇临床随机对照试验,研究质量较高。现有证据表明足量雾化吸入布地奈德可减轻COPD急性加重期患者的临床症状,改善肺功能,且无严重不良反应。我们将上述证据应用于临床,对1例COPD急性加重期患者行足量雾化吸入布地奈德治疗,该患者症状控制良好,未发生不良反应。结论足量雾化吸入布地奈德安全有效,可替代全身激素而应用于COPD急性加重期的治疗。     

足量布地奈德溶液雾化在重度慢性阻塞性肺疾病急性加重期的临床应用

目的：评价足量布地奈德溶液雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法：90例30%≤FEV1〈50%的重度COPD急性加重期患者随机分为3组：布地奈德组给予布地奈德溶液雾化吸入2mg/次,每8小时1次;甲泼尼龙组给予口服甲泼尼龙片24mg/次,1/日;对照组不使用任何糖皮质激素。疗程10d,观察3组患者治疗后肺功能,动脉血气和呼吸困难评分变化,以及糖皮质激素主要不良反应。结果：与对照组相比,吸入布地奈德组和口服甲泼尼龙组在FEV1,PaO2,PaCO2和呼吸困难评分改善值方面,有显著差异性（P〈0.05）;吸入布地奈德组和口服甲泼尼龙组两组各项指标改善程度相似（P〉0.05）;吸入布地奈德组和对照组的不良反应少于口服甲泼尼龙组（P〈0.05）。结论：足量布地奈德溶液雾化治疗与口服糖皮质激素疗效相近,全身副作用小,安全性好,是重度COPD急性加重期糖皮质激素的有效选择。     

布地奈德雾化吸入治疗慢性阻塞性肺疾病急性加重期的临床疗效

目的观察吸入布地奈德治疗慢性阻塞性肺疾病（COPD）急性加重期患者的临床疗效。方法将50例COPD急性加重期患者随机分为治疗组（25例）和对照组（25例）。两组均在常规治疗基础上每日3次雾化吸入布地奈德,治疗组每次2 mg,对照组每次1 mg。对比治疗7 d后患者症状缓解情况及第1秒钟用力呼吸容积（FEV1）、FEV1占预计值（FEV1%）、FEV1/FVC%的变化。结果治疗组临床缓解有效率明显高于对照组,P〈0.05,治疗组FEV1和FEV1/FVC%较对照组明显改善（P〈0.05）。结论每日吸入6 mg布地奈德对COPD急性加重期有更好的疗效,能显著缓解胸闷、喘息、气短症状,有效改善肺功能。     

雾化吸入普米克令舒与口服强的松治疗慢性阻塞性肺疾病急性加重期临床观察

目的观察雾化吸入普米克令舒（布地奈德）与口服强的松治疗慢性阻塞性肺疾病急性加重期临床疗效及不良反应。方法选择我院呼吸内科2006年1月～2007年3月间入院的80例COPD急性加重期患者，随机分为A、B、C三组，A组（常规治疗组包括氧疗、抗生素、平喘、止咳、化痰等），B组（在常规治疗基础上加用口服强的松30g／L，共10d），C组（在常规治疗基础上加用雾化吸入普米克今舒1mg，2次／d，共10d），观察三组在治疗前后临床症状肺功能改善、血气分析、不良反应情况。结果雾化吸入普米克令舒与口服强的松两组临床症状及肺功能、血气改善明显好于常规治疗组（P〈0．05），但雾化吸入普米克令舒组不良反应发生率明显低于口服强的松组。结论雾化吸入普米克今舒（布地奈德）治疗COPD急性加重期患者，能明显改善患者的气道阻塞，安全疗效显著，不良反应小，可作为COPD急性加重期的常规治疗措施。     

雾化吸入布地奈德治疗重度慢性阻塞性肺疾病急性加重中的作用

目的:评价布地奈德雾化治疗重度慢性阻塞性肺疾病急性加重期患者的临床应用价值。方法:选择重度COPD急性加重期患者150例随机分3组,布地奈德组给予布地奈德雾化液2mg雾化吸入,每8h1次;注射甲基强的松龙组给予甲基强的松龙40mg静脉推注,每天1次;对照组不使用任何糖皮质激素。观察期为48h、7d。结果:布地奈德组、甲基强的松龙组和对照组比较,FEV1、PaO2、PaCO2改善值具有显著性差异(P<0·05);布地奈德组、甲基强的松龙组两组各项指标改善程度相似(P>0·05),但布地奈德组副作用明显低于甲基强的松龙组(P<0·05)。结论:雾化布地奈德混悬液可有效改善AECOPD的气流受限,疗效与注射甲基强的松龙相似,全身副作用小,可作为皮质激素治疗的另一种选择。     

甲泼尼松龙与布地奈德治疗加重期慢性阻塞性肺疾病的疗效比较

目的探讨甲泼尼松龙与布地奈德在治疗加重期慢性阻塞性肺疾病(AECOPD)的疗效。方法 60例AECOPD患者随机分为布地奈德组、甲泼尼松龙组、对照组,各20例。所有患者治疗期间均接受常规治疗:给予支气管扩张剂、抗生素,并进行氧疗。布地奈德组雾化吸入布地奈德;甲泼尼松龙组给予甲泼尼松龙静脉滴注;对照组不使用任何激素。所有患者入院当天和治疗后进行肺功能测定、动脉血气测定、临床症状评分。观察2组治疗期间不良反应发生情况。结果各组治疗后临床症状评分均明显降低;布地奈德组和甲泼尼松龙组明显低于对照组,甲泼尼松龙组明显低于布地奈德组。与治疗前比较,各组治疗后第一秒用力呼气容量(FEV1)明显升高,布地奈德组与甲泼尼松龙组治疗后FEV1明显高于对照组,甲泼尼松龙组治疗后FEV1明显高于布地奈德组。布地奈德组和甲泼尼松龙组治疗后PaO2明显升高,PaCO2明显降低;且与对照组治疗后差异显著。结论布地奈德雾化吸入能明显改善AECOPD患者肺功能,其疗效与甲泼尼松龙一致。     

布地奈德联合复方异丙托溴铵雾化治疗COPD急性加重期的临床研究

目的 研究布地奈德联合复方异丙托溴铵雾化治疗慢性阻塞性肺疾病（Chronic obstructive pulmonary disease,COPD）急性加重期的临床疗效。方法 选取2020年1月至2022年6月在我院接受治疗的62例COPD急性加重期患者，采用随机数表法分为对照组和观察组各31例。对照组给予布地奈德雾化治疗，观察组采用布地奈德联合复方异丙托溴铵雾化治疗。比较两组临床疗效、肺功能、气道炎症及不良反应。结果观察组治疗总有效率为96.77%，高于对照组的70.97%，差异有统计学意义（P<0.05）；治疗3周后，FEV1、PEF、FVC均显著高于治疗前，且观察组高于对照组，差异有统计学意义（P<0.05）；治疗3周后，两组PCT、CRP、IL-6均显著低于治疗前，且观察组低于对照组，差异有统计学意义（P<0.05）；观察组不良反应发生率为12.90%，与对照组的6.45%比较，差异无统计学意义（P>0.05）。结论 布地奈德联合复方异丙托溴铵雾化治疗COPD急性加重期疗效确切，可有效恢复肺功能，抑制气道炎症，且安全性较好。     

慢阻肺急性发作期布地奈德雾化吸入的疗效与安全性评价

目的:比较雾化吸入布地奈德与口服强的松对慢性阻塞性肺病(COPD)急性发作期的疗效与安全性。方法:选择急性发作期COPD患者84例,随机分为治疗组43例和对照组41例,在均给予常规治疗的同时,治疗组雾化吸入布地奈德2mg,1次/12h,3d,后改为1mg,2次/d,连服7d;对照组口服强的松20mg 2次/d,连服3d,后改为25mg(分两次服),连服7d。分别在入院时及治疗后前3d的每12h及出院前检测肺功能,在入院时及治疗后24、48、72h及出院前测动脉血气,并注意住院前后血糖、血钾、钠等变化。结果:两组中各有3例因症状加重行无创通气治疗,其余所有患者治疗后肺功能、动脉血气等均明显改善,组间比较无显著差异。治疗组血糖增高发生率明显低于对照组。结论:雾化吸入布地奈德可明显改善COPD急性发作期患者的肺功能和动脉血气,与口服强的松无明显差异,但不良反应发生率较低。     

Role of antimicrobial therapy in acute exacerbations of chronic obstructive pulmonary disease

OBJECTIVE: To define the role of antimicrobial therapy in the treatment of acute bronchitic exacerbations of chronic obstructive pulmonary disease (COPD) through review of placebo-controlled clinical trials. Specificalty, to determine the benefit of antimicrobial therapy on patient outcome. DATA SOURCES: Placebo-controlled dinical trials identified by MEDLINE search (1957-December 1999). STUDY SELECTION AND DATA EXTRACTION: All placebo-controlled clinical trials that included COPD patients with no evidence of pneumonia or underlying asthma were included in the evaluation. DATA SYNTHESIS: The role of antimicrobial agents in the treatment of acute exacerbations of COPD is controversial. Patients with COPD are often chronically colonized with bacteria, and many exacerbations are due to nonbacterial causes. Four placebo-controlled clinical trials and a meta-analysis have demonstrated significant improvements in outcome for patients treated with an antibiotic versus placebo. In contrast, six studies failed to demonstrate statistical differences, possibly due to the small sample size and the subjectivity of outcome measures. Overall, the data suggest that the benefit of antimicrobial therapy in acute exacerbations of COPD may be related to exacerbation severity. CONCLUSIONS: Antimicrobial agents may have a beneficial effect in the treatment of acute exacerbations of COPD in certain patients. Pending further research in this area, we recommend antimicrobial therapy only for COPD patients with acute bronchitic exacerbations characterized by increased dyspnea, sputum volume, and purulence.     

Usefulness of the modified 0-10 Borg scale in assessing the degree of dyspnea in patients with COPD and asthma.

INTRODUCTION: Rapid assessment and monitoring is essential for patients with acute bronchospasm. However, tools for measuring dyspnea or the state of being short of breath are often limited to peak flow, blood gas analysis, and asking patients multiple questions about their breathing at a time when they find speaking difficult. We thus decided to examine a tool called the modified Borg scale (MBS) that had the potential to provide quick, easy, and rapid information about a patient's subjective state of dyspnea. This 0 to 10 rated scale gave our ED patients a device they could use to measure and evaluate their dyspnea. For this reason, we added it to the triage assessment practice and included it in all posttreatment assessment notes on patients with exacerbations of asthma or chronic obstructive pulmonary disease (COPD) who were seen in the emergency department and urgent care clinic. STUDY QUESTIONS: (1) Can patients with acute bronchospastic asthma or COPD adequately communicate their level of dyspnea using the MBS? (2) Does subjective improvement in the patient's dyspnea using the MBS correlate with improvements in pulmonary functions as measured by the peak flow meter and cutaneous oxygen saturation (Sao(2))? METHODS: Routine and triage assessment of subjective dyspnea using the MBS was instituted at a hospital emergency department serving adult veterans. Concurrently, the MBS was added to our standardized treatment protocol for management of patients with bronchospasm. ED and urgent care records were reviewed to collect baseline and postrespiratory treatment data on peak expiratory flow rates (PEFR), MBS scores, and Sao(2) percentages. RESULTS: Four hundred male veterans aged 24 to 87 years presented with a chief complaint of dyspnea. The assessing physician identified 102 of these patients as having acute bronchospasm; 42 were diagnosed with asthma, and 60 were diagnosed with COPD. All study patients with acute bronchospasm were able to use the MBS to rate their perception of severity of dyspnea. As the peak flow measurements increased, the MBS scores of difficulty breathing decreased. For the asthma groups, the mean MBS score decreased from 5.1 at triage baseline to 2.4 after treatment. This finding indicated that a significant correlation existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = -.31, P <.05). As the peak flow increased, the MBS scores decreased. Sao(2) only slightly improved in the asthma group compared with the COPD group. For patients with COPD, the mean MBS score decreased from 6.0 at triage baseline to 3.0 after treatment. This finding indicated that a significant correlation also existed between the change in MBS scores and the change in PEFR from pretreatment to posttreatment scores (r = -.42, P <.001). Cutaneous oxygen saturation also improved in the COPD group after treatment. The modality of treatment ordered by the physician was metered dose inhaler or nebulizer. These treatment modalities had no effect on the aforementioned results in the asthma or COPD group. CONCLUSIONS: The MBS is a valid and reliable assessment tool for dyspnea. This study demonstrated that it correlated well with other clinical parameters and could be useful when assessing and monitoring outcomes in patients with acute bronchospasm. Patients who used the MBS rated it with a high degree of satisfaction on ease of use and found that the language in this scale adequately expressed their dyspnea. The ED triage and primary care nursing staff rated the MBS as highly satisfactory, stating that it was quick and easy to use. Respiratory assessment in the triage notes and nursing notes were streamlined to consistently include 3 respiratory measures: PEFR, MBS, and Sao(2). Long respiratory narratives were found to be unnecessary in many cases. In addition, the MBS helped to include an important element of subjective assessment when evaluating the severity of dyspnea.     

孟鲁司特联合布地奈德治疗老年COPD的疗效观察

目的观察研究孟鲁司特联合布地奈德对于老年慢性阻塞性肺疾病（COPD）的临床疗效。方法选取老年c0PD患者94例,对照组30例和治疗组64例。其中对照组为常规治疗,治疗组分为A组（布地奈德治疗）、B组（孟鲁司特联合布地奈德治疗）,2个亚组分别为31例和33例。治疗1个月后,分别观察两组患者的肺功能及呼吸困难程度。结果A、B组与对照组比较各指标均明显改善,差异有统计学意义（P〈0．05）,其中B组差异显著（P〈0．01）。结论孟鲁司特联合布地奈德对于老年COPD的临床疗效确切。     

溴化异丙托品、沙丁胺醇联合雾化吸入对慢性阻塞性肺病急性加重期的疗效观察

目的:探讨联合雾化吸入溴化异丙托品、沙丁胺醇治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效。方法:60例COPD急性加重期患者随机分为对照组和治疗组。两组均给予抗感染、吸氧、氨茶碱静脉注射及对症等治疗,治疗组加用溴化异丙托品、沙丁胺醇联合雾化吸入。比较两组治疗前和治疗后2h的1s用力呼气容积(FEV1)、FEV1占用力肺活量(FVC)百分比(FEV1/FVC)及动脉血气分析的变化。结果:治疗后,两组肺功能及动脉血气较治疗前均有明显改善(P<0.05),治疗组与对照组比较,FEV1、FEV1/FVC、PaO2和PaCO2差异显著(P<0.05)。结论:联合雾化吸入溴化异丙托品、沙丁胺醇治疗慢性阻塞性肺疾病(COPD)急性加重期的疗效显著。     

慢性阻塞性肺疾病急性加重患者频繁再入院与其危险因素

目的　评价慢性阻塞性肺疾病 (COPD)患者急性加重频繁入院的危险因素。方法　调查两家大型医院因COPD急性加重入院的 196名中重度COPD患者。在患者出院时和出院后一个月稳定状态 ,收集患者的临床性状、社会性状、日常护理因素和过去一年中急性加重入院的频率 ,测定肺功能指标及精神状态。结果　 196例COPD患者中 ,72 %过去一年中有一次以上再入院 ,4 8%有 2次以上 ,8%有超过 10次再入院。单变量分析显示男性、病程长、嗜用镇痛剂和安眠药、第 1秒用力呼气容量占预计值的百分比 (FEV1% ) <4 5 %、缺乏肺康复训练和严重气促与频繁再入院有显著相关性 (P <0 .0 5 )。多变量分析显示病程长 (OR =2 .6 0 )、FEV1% <4 5 % (OR =2 .0 3)、严重气促 (OR =2 .5 0 )和男性 (OR =3.13)与COPD急性加重再入院有独立显著相关性 (P <0 .0 5 )。结论　COPD急性加重频繁再入院与COPD严重程度、患者精神抑郁状态及照料这些可改善因素有关     

Clinical efficacy and safety of Chinese herbal medicine versus placebo for the treatment of chronic obstructive pulmonary disease: A systematic review and meta-analysis

ObjectiveRandomized clinical trials and published meta-analyses assessing the clinical effectiveness of Chinese herbal medicine (CHM) on the treatment of stable chronic obstructive pulmonary disease (COPD) yielded inconsistent results in terms of disease outcomes, in which the design of placebo-controlled studies can contribute to the heterogeneity. This study aimed to evaluate the efficacy and safety of CHM compared to placebo on the treatment of stable COPD, to provide robust evidence for the use of CHM in COPD.MethodsNine electronic databases were searched from inception to October 1, 2019 to identify placebo controlled randomized trials of CHM for the treatment of stable COPD and studies in English or Chinese were included. The primary outcomes were symptom score (CAT score), quality of life (SGRQ) and frequency of acute exacerbations. The secondary outcomes included lung function, clinical total effective rate and adverse events. The selection of studies, data extraction and coding and assessment of risk of bias of the included studies were conducted by two reviewers independently. Mean difference (MD) was used to analyze continuous variable and relative risk ratio (RR) for dichotomous data.ResultsA total of eleven studies involving 1223 patients were included. While maintaining routine western pharmacotherapies (WP), CHM had significant advantage over the treatment of placebo in improving CAT score (MD -3.93; 95 %CI -6.01 to -1.85) and SGRQ score (MD -6.20; 95 %CI -10.13 to -2.28), reducing the frequency of acute exacerbations (MD -0.78; 95 %CI -1.40 to -0.16) and improving clinical effective rate (RR 1.29; 95 %CI 1.14 to 1.45), but had no significant effect on improving FEV₁%pred (MD 8.18; 95 %CI -4.22 to 20.58). High heterogeneity was found for the changes in exacerbation frequency and FEV₁%pred. No serious adverse events related to CHM were reported.ConclusionsThis meta-analysis of placebo-controlled RCTs demonstrated that the use of CHM in addition to WP could alleviate clinical symptoms, improve quality of life and clinical efficiency and reduce the frequency of exacerbations, which could be an alternative approach for treatment adjustment of COPD. CHM was a relatively safe treatment. These findings need to be verified in future with high-quality clinical trials.