噻托溴铵治疗慢性阻塞性肺疾病临床观察

目的 观察噻托溴铵在治疗慢性阻塞性肺疾病(COPD)的疗效.方法 选择临床合乎标准的病例94例,随机分为两组,即对照组48例和治疗组46例.治疗组用噻托溴铵,对照组给予空白安慰剂.结果 治疗组在临床症状缓解和肺功能改善情况较对照组均明显,差异有显著意义(P＜0.05).结论 使用噻托溴铵治疗治疗COPD,可取得较好的临床疗效,安全性好,值得临床推广应用.     

噻托溴铵治疗慢性阻塞性肺疾病缓解期疗效观察

目的:观察噻托溴铵治疗慢性阻塞性肺疾病缓解期的临床疗效。方法:将69例慢性阻塞性肺疾病缓解期患者分为治疗组35例,对照组34例,治疗组予噻托溴铵吸入,每次18μg,每日1次,对照组予异丙托溴胺吸入,每次40μg,每日3次,疗程均为30d。结果:两组疗效比较,治疗组呼吸困难分级评分,6min步行距离,肺功能改善情况明显好于对照组(P<0.05)。结论:噻托溴铵对缓解阻塞性肺疾病缓解期患者呼吸困难,改善肺功能有明显疗效。     

噻托溴铵治疗慢性阻塞性肺疾病的临床疗效观察

目的探讨噻托溴铵治疗慢性阻塞性肺疾病(COPD)的临床疗效。方法选取60例COPD患者,随机分为观察组和对照组,对照组仅给常规治疗,观察组采用常规治疗加噻托溴铵治疗,比较两组患者第1s用力呼气容积(FEV1)、第1s用力呼气容积用力肺活量(FEV1/FVC)、动脉血氧分压(PO2)、二氧化碳分压(PCO2)及临床症状评分。结果采用噻托溴铵治疗COPD患者,可明显提高FEV1、FEV1/FVC、PO2,降低PCO2和临床症状评分,与常规治疗相比差异显著(P0.05)。结论采用噻托溴铵治疗COPD可有效改善患者肺功能和生活质量,值得临床推广应用。     

噻托溴铵治疗中重度慢性阻塞性肺疾病稳定期的疗效观察

目的:观察中重度慢性阻塞性肺疾病(COPD)稳定期患者吸入噻托溴铵的临床疗效.方法:44例中重度COPD稳定期患者随机分为两组,治疗组(n=22)对患者吸入噻托溴铵,对照组(n=22)为空白对照组,不吸入噻托溴铵.观察两组用药12周后肺功能的变化,St George'8呼吸问卷(SGRQ)等情况,通过6 min步行试验(6MWT)观察运动耐力的变化以及随访3～6个月急性加重的人次、住院人次.结果:用药12周后治疗组FEV1、FVC、最大肺活最(FVC)、FEV1/FVC及FEV1占预计值(％)比对照组明显改善,差异具有统计学意义(P＜0.05),治疗组运动耐力(6MWT)增加,随访3～6个月治疗组急性加重人次明显减少,与对照组比较差异有显著性(P＜0.05).结论:吸入噻托溴铵可以改善中重度COPD稳定期患者肺功能与运动耐力,减少急性加重的发作,并且其发生不良反应的危险性小.     

噻托溴铵在重度慢性阻塞性肺疾病治疗中的依从性及疗效评价

目的:探讨噻托溴铵干粉吸入剂治疗慢性阻塞性肺疾病(COPD)的疗效、依从性、安全性及影响疗效的因素.方法:采用调查表对98例吸入噻托溴铵干粉剂(思力华,18μg,每日1次)治疗重度COPD患者的依从性、基础治疗方法、疗效评价与副作用等临床资料进行回顾性分析.结果:72.45%的患者评价噻托溴铵(思力华)治疗效果好,81.64%的患者依从性好.多因素分析结果显示年龄及治疗的依从性影响疗效.27例患者出现副反应,发生率为27.55%,其中口干25例(25.50%)为最常见不良反应;排尿困难2例(2.04%).18例患者依从性差,发生率为18.37%,其中11例(11/18)因药物价格贵而未能持续治疗;7例(7/18)自我感觉疗效差而停药.本组病例还显示噻托溴铵能显著减少气流受限、有助于难治性气胸闭合、活动能力和生存质量明显改善.结论:吸入噻托溴铵干粉刺(思力华)对重度COPD患者显示良好的疗效和依从性,其疗效与年龄和依从性有关.     

噻托溴铵吸入剂治疗稳定期慢性阻塞性肺疾病的疗效评估

目的观察评估使用噻托溴铵粉吸入剂治疗稳定期慢性阻塞性肺疾病(COPD)的临床疗效。方法选取2010年4月²013年8月收治的稳定期COPD患者52例,随机分为观察组与对照组,在常规治疗基础上,观察组使用噻托溴铵吸入治疗,对照组使用异丙托溴铵吸入治疗,对比观察两组患者临床疗效。结果观察组患者治疗后各通气功能指标以及运动耐量(6min步行距离)、生活质量评估(呼吸困难指数)等均显著优于对照组,P<0.05,差异有统计学意义。结论使用噻托溴铵吸入剂治疗稳定期COPD,能够有效改善其肺部通气功能及生活质量,相比异丙溴胺具有更为理想的临床疗效。     

噻托溴铵治疗慢性阻塞性肺疾病稳定期的疗效观察

目的观察噻托溴铵吸入治疗稳定期慢性阻塞性肺疾病（COPD）的临床效果。方法67例稳定期COPD患者随机分成两组,对照组给予口服茶碱缓释片100 mg,每日2次,并按需吸入β2受体激动药。治疗组给予单剂量吸入噻托溴铵18μg,每日1吸。比较两组治疗前及治疗后3个月临床症状体征变化,并行肺功能、6 min步行距离（6MWD）及生活质量评分检测等。结果治疗组治疗3个月后的症状及体征评分与对照组治疗后比较,差异均具有统计学意义（P〈0.05）;肺功能、6MWD及生活质量评分与对照组治疗后比较,差异亦均具有统计学意义（P〈0.05）。结论噻托溴铵能明显改善稳定期COPD患者的临床症状体征及肺功能,提高生活质量。     

噻托溴铵联合运动训练治疗慢性阻塞性肺疾病

目的：观察吸入噻托溴铵联合运动训练对慢性阻塞性肺疾病（COPD）稳定期患者的临床疗效。方法将72例COPD稳定期患者随机分为两组,治疗组和对照组各36例。治疗组给予长效M-受体阻滞剂噻托溴铵粉吸入剂18μg,每日一次,同时联合进行运动训练,包括：呼吸训练、上肢肌力训练及全身有氧耐力训练。对照组仅运动训练治疗。观察两组治疗期间急性发作情况、生活质量评估和肺功能改善情况。结果6个月后,治疗组患者治疗后COPD急性发作次数、天数及呼吸困难量表（mMRC）评分均较治疗前明显减少,肺活量（FVC）、第1秒用力呼出量（FEV1）、FEV1占预计值百分比均较治疗前增加,差异均有统计学意义（t分别=4.55、3.56、3.12、2.86、2.90、1.51、3.31,P均＜0.05）;对照组患者治疗前后无明显变化,差异均无统计学意义（t分别=0.93、0.18、0.19、0.13、0.11、0.20、0.18,P均＞0.05）。治疗组患者各指标治疗前后差值均较对照组差值比较,差异均有统计学意义（t分别=5.62、4.66、3.67、2.65、2.70、4.03、2.89, P均＜0.05）。结论吸入噻托溴铵联合运动训练治疗COPD稳定期患者疗效确切,可明显改善患者的肺功能和运动耐力,减少急性发作,提高患者的生存质量。     

噻托溴铵治疗中重度稳定期慢性阻塞性肺疾病疗效观察

选取我院2014年9月~2015年10月的重度稳定期慢性阻塞性肺疾病患者84例,随机分为治疗组和对照组,各42例。对照组给予常规药物治疗,治疗组加用噻托溴铵治疗。对比分析两组的呼吸困难评分、肺功能变化、运动耐力情况及不良反应情况。治疗后治疗组的呼吸困难评分、肺功能及运动耐力显著优于对照组,差异具有统计学意义(P0.05)。噻托溴铵治疗中重度稳定期慢性阻塞性肺疾病可以改善患者的呼吸状况、增强肺功能,提高运动耐力,值得推广应用。     

噻托溴铵治疗中度慢性阻塞性肺疾病稳定期的临床疗效观察

目的:观察噻托溴铵(思力华)治疗支气管舒张试验不同结果的中度慢性阻塞性肺疾病(COPD)稳定期的临床疗效.方法:对入选的45例中度COPD稳定期患者在常规治疗基础上根据肺功能检查支气管舒张试验结果分为舒张试验阳性组和舒张试验阴性组.两组均连续给予噻托溴铵(18 *9滋g吸入,1天1次) 12周,观察治疗前后患者运动耐量和肺功能情况.结果:舒张试验阳性组肺功能FEV1/预计值及6 min步行试验判定(6MWT)均优于舒张试验阴性组 (P ＜ 0.05).结论:噻托溴铵在治疗中度慢性阻塞性肺疾病舒张试验阳性的患者中更显优势.     

Hydrotherapy in the management of chronic obstructive pulmonary disease: a qualitative systematic review

Abstract

Background: Many people worldwide suffer from chronic obstructive pulmonary disease (COPD). Diverse medical conditions have been treated using hydrotherapy for many years but its use in the treatment of COPD is a recent development. Its use in the COPD population may lead to improvements in cardiopulmonary outcomes and quality of life (QoL) and the mastery of activities of daily living (ADL) in people with this disease.

Objectives: To determine the effects of hydrotherapy on cardiopulmonary function, QoL, and ADL in people with COPD.

Method: Studies relating to adults with non-acute, non-terminal COPD were located by searching electronic databases. Included studies were critically appraised by two independent reviewers using the Lewis, Olds, and Williams tool.

Results: Nine studies met the inclusion criteria (n?=?207 subjects). Sample sizes of individual studies varied between 10 and 43 subjects. Three studies were of above average methodological quality, two were of average, and four were of a poor quality. Thirty-five outcome measures were identified. Cardiopulmonary parameters showed positive increases when the immersed COPD subjects exhaled into water. Aspects of QoL improved with physical training in water. Group hydrotherapy improved ADL performance.

Conclusions: The few included studies, which address the use of hydrotherapy in the management of COPD, had small sample sizes and were mainly of low to moderate methodological quality. Hydrotherapy may improve cardiopulmonary, QoL, and ADL outcomes in the COPD population. Investigation into the effects of combined breathing and physical exercise during hydrotherapy, in the COPD population, is needed.     

Tiotropium: a bronchodilator for chronic obstructive pulmonary disease

OBJECTIVE: To review the scientific literature evaluating the efficacy and tolerability of tiotropium bromide, a new bronchodilator indicated for treatment of chronic obstructive pulmonary disease (COPD). DATA SOURCES: Articles were identified through searches of MEDLINE (1966-January 2005) using the key words tiotropium, BA 679 BR, chronic obstructive pulmonary disease, and anticholinergic agents. Additional citations were identified from bibliographies of publications cited. STUDY SELECTION AND DATA EXTRACTION: Experimental and observational studies of tiotropium bromide were selected. Trials of the efficacy of the drug in humans were the focus of the review. DATA SYNTHESIS: Tiotropium bromide is an effective bronchodilator for patients with COPD. It produces clinically important improvements in lung function, symptoms of dyspnea, quality of life, and exacerbation rates compared with placebo. In comparative studies, tiotropium does not appear to be more efficacious than salmeterol or ipratropium. CONCLUSIONS: Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD. Although similar to ipratropium in efficacy and tolerability, it has the advantage of once-daily dosing.     

Symptom clusters in chronic obstructive pulmonary disease: A systematic review

AimTo conduct a comprehensive literature review to identify symptom clusters commonly present in Chronic obstructive pulmonary disease (COPD) patients.BackgroundCOPD is the fourth leading cause of death worldwide. Substantial research has been studied regarding single symptoms that burden patients with this disease and the profound impacts that these symptoms can have on physical and psychological health. However, these symptoms rarely occur in isolation and limited research has been conducted identifying clinically significant relationships or clusters of symptoms associated with COPD afflicted patients.MethodsPubMed, Web of Science, and Embase databases were used to identify potential articles limited to records published between 2005 and 2018 with human-conducted trials on adults with COPD, examining symptom clusters in this population. Only 5 studies met inclusion criteria.ResultsAcross the five studies, 596 participants were included with a mean age of 70.49. Two themes emerged including psychological symptom clusters and respiratory-related symptom clusters. Anxiety-related symptoms appeared to be a common theme among psychological symptom clusters and varied greatly based on instrument selection. Inconsistent results were found in respiratory-related symptom clusters, but included difficulty breathing as a common symptom component. Only one study examined for stability of symptoms over time.ConclusionThere were inconsistent results across all studies which may be contributed to the heterogeneity amongst patients, instruments administered, and statistical approach. Future research should be conducted to further elucidate COPD related symptom clusters, their effects on somatic and cognitive health, and the stability of these symptom clusters over time.     

Tiotropium bromide: a new long-acting bronchodilator for the treatment of chronic obstructive pulmonary disease

BACKGROUND: Tiotropium bromide is a new inhaled anticholinergic agent approved for once-daily, long-term maintenance treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). OBJECTIVE: This article reviews the pharmacology, pharmacokinetic and pharmacodynamic properties, clinical efficacy, tolerability, and cost of tiotropium therapy in patients with COPD. METHODS: The MEDLINE (1966-October 2004), Iowa Drug Information Service (1966-October 2004), and International Pharmaceutical Abstracts (1970-November 2004) databases were searched for original research and review articles published in English. The search terms were tiotropium, Ba 679 BR, and HandiHaler. Reference lists from these articles were also consulted, as was selected information provided by the manufacturer of tiotropium. All relevant identified studies were included in the review, with preference given to Phase II/III trials. Pharmacoeconomic studies were limited to those conducted in the United States. RESULTS: Tiotropium is a nonselective anticholinergic agent that exhibits kinetic receptor selectivity for the muscarinic M1 and M3 receptors. After inhalation, tiotropium has an onset of action within 30 minutes, a peak effect within 3 to 4 hours, and a > or = 24-hour duration of action that allows once-daily dosing. In clinical trials, patients receiving tiotropium 18 microg QD had significant improvements in trough, peak, and mean forced expiratory volume in 1 second (FEV1), dyspnea, and health-related quality of life, as well as fewer COPD exacerbations and hospitalizations, compared with patients receiving placebo and ipratropium (all, P < 0.05). Improvement in FEV1 was also significantly greater in patients who received tiotropium compared with those who received salmeterol (P < 0.05), although the number of exacerbations and extent of health resource use were comparable between groups. Dry mouth was the most commonly reported adverse effect. One analysis found tiotropium to be cost-effective compared with ipratropium. CONCLUSIONS: Tiotropium offers several advantages over ipratropium in the management of COPD. Long-term (> 1 year) studies are necessary to determine the impact of tiotropium on disease progression and life expectancy.     

Pulmonary rehabilitation outcomes in individuals with chronic obstructive pulmonary disease: A systematic review

BackgroundThe magnitude of response to pulmonary rehabilitation (PR) is influenced by the selection of outcomes and measures.ObjectivesThis systematic review aimed to review all outcomes and measures used in clinical trials of PR for individuals with chronic obstructive pulmonary disease (COPD).MethodsThe review involved a search of Scopus, Web of Knowledge, Cochrane Library, EBSCO, Science Direct and PubMed databases for studies of stable individuals with COPD undergoing PR. Frequency of reporting for each domain, outcome and measure was synthesized by using Microsoft Excel.ResultsWe included 267 studies (43153 individuals with COPD). A broad range of domains (n = 22), outcomes (n = 163) and measures (n = 217) were reported. Several measures were used for the same outcome. The most reported outcomes were exercise capacity (n = 218) assessed with the 6-min walk test (n = 140), health-related quality of life (n = 204) assessed with the Saint George's respiratory questionnaire (n = 99), and symptoms (n = 158) assessed with the modified Medical Research Council dyspnoea scale (n = 56). The least reported outcomes were comorbidities, adverse events and knowledge.ConclusionsThis systematic review reinforces the need for a core outcome set for PR in individuals with COPD because of high heterogeneity in reported outcomes and measures. Future studies should assess the importance of each outcome for PR involving different stakeholders.PROSPERO IDCRD42017079935     

Tiotropium bromide: a long-acting anticholinergic bronchodilator for the treatment of patients with chronic obstructive pulmonary disease

Prevention and relief of symptoms by regular use of bronchodilators is central to the management of patients with chronic obstructive pulmonary disease (COPD). The bronchodilators in use are beta2-agonists, anticholinergics and theophylline. Since the 1970s the anticholinergic ipratropium bromide has been widely used for the treatment of patients with regular symptoms, but because it has a relatively short duration of action, it needs to be administered four times a day. Tiotropium bromide is a long-acting anticholinergic suitable for once daily administration. It has been developed as a dry powder inhaler for the treatment of patients with COPD. Large clinical trials with administration of the drug for one year have now been published. Compared with placebo and ipratopium bromide, significant and long-lasting bronchodilatation was observed, which was maintained over the year. The bronchodilator effect of tiotropium bromide was accompanied by improvements in other health outcomes. A significant decrease in dyspnoea, improvement in health-related quality of life, and a reduction in the number of COPD exacerbations and hospitalisations were noted. In this review we summarise the clinical development of this compound.     

Smoking cessation interventions in chronic obstructive pulmonary disease and the role of the family: a systematic literature review

AIM: This paper is a report of a systematic review to assess the effectiveness of family-focused smoking cessation interventions for people with chronic obstructive pulmonary disease and to determine what data on families are documented in studies of smoking cessation interventions. BACKGROUND: Chronic obstructive pulmonary disease is a major public health problem and cigarette smoking is the most important factor contributing to its development and progression. However, smoking cessation rates are low and relapse is common. The role of families in smoking cessation efforts has received little attention. METHODS: All studies were included in the review that (i) addressed an evaluation of a psycho-social/educational smoking cessation intervention for people with chronic obstructive pulmonary disease, (ii) addressed some information on the family (i.e. living arrangements, marital status, smoking history of family members, support for quitting) and/or included the family as part of the intervention and (iii) were published between 1990 and 2006. Electronic data sources, existing systematic reviews of smoking cessation interventions and the grey literature were reviewed. RESULTS: Seven studies were included. Six studies (11 papers) included data on marital status, smoking status of household members, support for quitting smoking and related variables. In two of the studies, the variable on the family was used to analyse smoking cessation outcomes. One additional study met the inclusion criterion of an evaluation of a smoking cessation intervention, which also included a family focus in the intervention. CONCLUSION: No conclusions about the effectiveness of a family-focused smoking cessation intervention could be drawn from this review. Further research is needed to determine if a more family-focused intervention, in conjunction with pharmacological and counselling approaches, would lead to improved smoking cessation outcomes.     

The use of pursed lips breathing in stable chronic obstructive pulmonary disease: a systematic review of the evidence

Abstract

Objective: A systematic review was carried out to determine the evidence for teaching pursed lips breathing (PLB) to patients with stable chronic obstructive pulmonary disease (COPD). Exertional dyspnoea is the single most important factor limiting function for people with COPD and PLB is commonly advocated for its management.

Method: A literature search of Medline, PEDro and CINAHL Plus was conducted. Articles were included if they studied the effects of PLB in stable COPD and excluded when proxy interventions or significant modifications of PLB were used. Where comparable data were available they were pooled using weighted means.

Results: Eleven studies involving 226 participants were included; four of the studies were of moderate quality according to the grading of recommendations assessments, development and evaluation (GRADE) system; the remaining studies were of low quality. Although no high quality evidence was identified, the direction of effect for PLB was consistently towards benefit, with the exception of one low quality study. Moderate quality evidence demonstrates that in stable COPD pursed lips breathing increases oxygen saturation and tidal volume, reduces respiratory rate at rest and reduces time taken to recover to pre-exercise breathlessness levels. One RCT showed reduction in exertional dyspnoea and improvement in functional performance at 3 months. Additionally, the evidence suggests that not all patients with COPD respond equally to PLB: those with moderate to severe COPD are most likely to benefit.

Conclusion: High quality studies are required to identify PLB responders from non-responders and to determine whether short-term effects translate into clinically significant benefit.