噻托溴铵联合沙美特罗替卡松治疗支气管哮喘的临床观察

目的:观察噻托溴铵联合中剂量沙美特罗替卡松吸入治疗支气管哮喘的临床效果。方法:研究组18例原使用中剂量沙美特罗替卡松未控制,联合噻托溴铵粉吸入剂18μg,qd;对照组18例原使用中剂量沙美特罗替卡松未控制,加用泼尼松片5 mg,tid,病情控制后逐渐减量至5 mg/d,治疗3个月。观察治疗前后肺功能、哮喘控制测试(ACT)评分、3个月内按需吸入沙丁胺醇气雾剂次数及不良反应。结果:治疗后第1秒用力呼气量(FEV1)占预计值百分比、呼气峰流速(PEF)、ACT评分两组患者较治疗前均有明显提高(P<0.01),治疗后两组间FEV1占预计值百分比(t=1.382,P>0.10)、PEF(t=0.253,P>0.50)、ACT评分(t=0.693,P>0.40)差异均无统计学意义;3个月内按需吸入沙丁胺醇气雾剂的人均次数,研究组较对照组少,差异有统计学意义(t=2.274,P<0.05)。研究组有3例口干、5例声音嘶哑;对照组有1例口干、4例声音嘶哑、2例口腔霉斑、4例胃部不适及反酸、3例向心性肥胖。结论:噻托溴铵联合中剂量沙美特罗替卡松用于治疗支气管哮喘,与中剂量沙美特罗替卡松加用泼尼松同样能促进症状的缓解和肺功能的改善,在吸入沙丁胺醇气雾剂的次数上甚至优于后者,副作用也较轻。

Clinical Observation of Tiotropium Bromide Combined with Salmeterol Fluticasone in the Treatment of Bronchial Asthma

OBJECTIVE： To observe clinical efficacy of tiotropium bromide combined with salmeterol fluticasone in the treat- ment of bronchial asthma. METHODS： Study group （n= 18） was additional treated with Tiotropium bromide inhalant 18 ~tg once a day when the effects of medium dose of salmeterol fluticasone were unsatisfactory. Control group （n=18） was additionally giv- en prednisone 5 mg 3 times a day when the effects of medium dose of salmeterol fluticasone were unsatisfactory; the patients re- ceived prednisone 5 mg/d for 3 months once the disease had been controlled. The lung function, ACT score, the times of inhaling additional salbutamol according to needs within 3 months, ADR were observed before and after treatment. RESULTS： After treat- ment, FEV~%, PEF and ACT score of 2 groups were significantly improved （P〈0.01） ; there was no statistical significance in FEV~% （t=1.382,P〉0.10）, PEF（t=0.253,P〉0.50）and ACT score（t=0.693,P〉0.40）between 2 groups. The times of inhaling additional salbutamol according to needs within 3 months in study group were less than in control group; there was statistical sig- nificance （t=2.274,P〈0.05）. There were 3 cases of dry mouth and 5 cases of hoarse in study group; there were 1 case of dry mouth, 4 cases of hoarseness, 2 cases of oral mildew spot, 4 cases of stomach discomfort and acid reflux and 3 cases of centripe- tal obesity in control group. CONCLUSIONS： Tiotropium bromide combined with medium dosage of salmeterol fluticasone in the treatment of bronchial asthma could alleviate symptoms and promote lung function, like the medium dosage of salmeterol flutica- sone combined with prednisone. According to the time of inhaling additional salbutamol, the former is even better than the latter with slighter side effects.