噻托溴胺对慢性阻塞性肺疾病稳定期治疗的临床观察

目的 观察噻托溴胺粉吸入剂对慢性阻塞性肺疾病(COPD)患者的临床疗效.方法 将我院呼吸科门诊就诊的确诊为稳定期COPD(Ⅱ-Ⅲ级)患者60例,随机分成对照组和治疗组,治疗组(n=30)患者给予噻托溴胺粉吸入剂治疗,对照组(n=30)按需使用短效抗胆碱能支气管扩张剂,观察期为12个月,以治疗前后肺功能的变化、6分钟步行试验、急性加重和住院的次数为观察指标.结果 经3个月治疗后,对照组治疗前后FEV1、FEV1%、FEVl/FVC、6MWD比较,差异无统计意义(P>0.05);治疗组治疗前后FEV1、FEV1%、FEV1/FVc、6MWD比较及两组治疗后各项指标比较,差异有显著性(P<0.01),随访3-12个月治疗组急性加重的次数明显减少,与对照组比较有显著性差异(P<0.05),治疗组用药后3个月、6个月、1年后肺功能比较无显著差异.结论 噻托溴胺吸入治疗能够改善COPD稳定期(Ⅱ-Ⅲ级)患者的肺功能和运动耐力,减少急性发作.     

噻托溴铵治疗稳定期慢性阻塞性肺疾病疗效观察

目的评价噻托溴铵治疗稳定期慢性阻塞性肺疾病(COPD)的疗效和安全性。方法将50例年龄40～75岁稳定期Ⅰ、Ⅱ级COPD患者随机分为治疗组和对照组。治疗组吸入噻托溴铵干粉剂(18μg,每日1次)治疗13周。在治疗前,治疗4周及12周分别测定肺功能。结果治疗组第一秒用力呼气容积(FEV1)、用力肺活量(FVC)、FEV1/FVC、FEV1占预计值的百分比上升值较对照组有有显著性差异(P<0.05)。噻托溴铵的常见不良反应为口干(2例,8%),无心血管系统异常和心电图异常报告。结论噻托溴铵对于稳定期Ⅰ、Ⅱ级COPD患者疗效显著且安全可靠。     

噻托溴铵治疗慢性阻塞性肺疾病的疗效

慢性阻塞性肺疾病(COPD)是一种不完全可逆的气流受限为特征的疾病,是世界上第二大非传染性疾病,每年引起270多万人死亡,其病因与肺部对有害气体或有害颗粒的异常炎症反应有关[1].药物仍是目前治疗COPD的主要手段(主要应用支气管扩张药物改善气流受限、缓解气促等对症治疗).笔者应用肺功能仪分析探讨噻托溴铵对COPD患者的治疗效果.     

噻托溴胺治疗稳定期COPD

目的观察噻托嗅胺对稳定期慢性阻塞性肺疾病（COPD）患者的临床疗效。方法 40例稳定期COPD患者随机分成两组,实验组应用噻托嗅铵18 ug吸入,1次/天,对照组口服茶碱缓释片100 mg,2次/天.观察记录患者治疗前后肺功能、6min步行距离、生活质量评分。结果两组治疗后肺功能、临床症状等较治疗前均有好转,但实验组较对照组FEVl占预计值百分比明显增加,生活质量明显改善,6 min步行距离、临床症状明显改善。两组治疗前后各项指标比较,差异具有统计学意义（P〈0.05或P〈0.01）。结论长期规律吸入噻托溴胺可有效改善慢阻肺患者肺功能并缓解临床症状,提高患者的生活质量。     

吸入长效M受体阻滞剂噻托溴胺治疗慢性阻塞性肺疾病的临床研究

噻托溴胺(tiotropiumbromide)是一个新型的用于治疗慢性阻塞性肺疾病(COPD)的吸入型支气管扩张药物,通过与M3受体结合,拮抗乙酰胆碱的作用,缓解支气管平滑肌的痉挛。吸入一次疗效持续24小时以上。几个大样本的临床试验结果表明,该药物对中重度COPD具有良好的疗效,在改善呼吸困难、生活质量、减少住院次数方面要优于沙美特罗,每日吸入一次噻托溴胺对支气管的舒张作用要明显好于每日吸入四次的溴化异丙托品和每日吸入两次的沙美特罗。而且该药物能够改善通气功能和肺容积,用药的耐受性和安全性也比较好。     

噻托溴胺粉吸入剂对稳定期COPD患者运动耐量及肺功能的疗效

目的探讨稳定期COPD患者予噻托溴胺粉吸入剂治疗后运动耐量及肺功能的改善作用。方法 60例稳定期COPD患者,随机分成治疗组、对照组以及空白对照组。观察三组治疗不同时期肺功能的变化和St Georges呼吸问卷(SGRQ)情况,进行6 min步行试验观察运动耐力的变化。结果用药6个月后治疗组患者咳嗽、咳痰、气促等症状明显好转,前后比较(P<0.05),用药6个月后治疗组FEV1、FVC、FEV1/FVC及FEV1占预计值(%)、运动耐力较对照组及空白对照组改善,三组比较差异有显著性(P<0.05)。治疗组运动耐力(6MWT)增加,SGRQ评分比较治疗组明显下降(P<0.05)。结论吸入噻托溴胺粉吸入剂对稳定期COPD患者运动耐量及肺功能有改善作用,并可以减少急性发作次数,改善患者生活质量,且副反应少。     

规律吸入噻托溴铵对慢性阻塞性肺疾病稳定期患者的长期疗效

噻托溴铵是一种长效的吸入型支气管扩张剂,通过选择性地拮抗M3受体发挥作用,吸入一次,疗效可维持24 h以上.目前已有的临床证据表明,规律使用该药对中、重度慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)具有良好疗效,除了改善肺功能参数外,它在改善呼吸困难、生活质量、减少急性加重次数和住院次数方面要优于安慰剂、异丙托溴胺和长效β2受体激动剂.本品用药方便,安全性好,可作为一线和基础药物长期用于稳定期COPD患者.噻托溴铵的远期疗效及其与其他药物联合治疗的作用还有待进一步研究.     

噻托溴铵治疗慢性阻塞性肺疾病缓解期患者的临床观察

慢性阻塞性肺疾病的远期愈后较差,肺功能逐渐下降,呼吸困难逐渐加重,运动耐量和生活质量亦逐渐下降.我院在治疗慢性阻塞性肺疾病缓解期患者时使用噻托溴铵干粉吸入治疗,使患者的肺功能和运动耐量得到改善.现报道如下.     

噻托溴胺粉雾剂对稳定期慢性阻塞性肺疾病患者深吸气量的改善作用

目的观察噻托溴胺对稳定期慢性阻塞性肺疾病(COPD)患者深吸气量的影响,探讨深吸气量(IC)对评价支气管扩张剂疗效评估的价值。方法将2003年8月至2005年3月南京医科大学附属南京第一医院呼吸内科收治的60例稳定期COPD患者,随机分成观察组(A组)噻托溴胺粉雾剂吸入;对照组(B组)安慰剂吸入。于研究第1天、第43天(约6周)、第85天(约12周)检测1秒钟用力呼气量(FEV1)、FEV1占预计值的百分比[FEV1(%)]、用力呼气量(FVC)、FEV1/FVC、IC等指标。结果观察组FEV1在第6周与对照组比较显著升高(t=2.018,P=0.048),12周差异无显著性(t=1.723,P=0.090);FEV1(%)在第6周、12周与对照组比较差异无显著性(t分别为1.761、1.387,P分别为0.083、0.171);FVC在第6周、12周与对照组比较,均有显著升高(t分别为2.762、2.255,P分别为0.008、0.029);FEV1/FVC在第6周、12周与对照组比较,差异无显著性(t分别为0.370、0.668,P分别为0.713、0.507);IC在第6周、12周较对照组显著增高(t分别为3.204、3.109,P分别为0.002、0.003)。结论噻托溴胺可使稳定期COPD患者IC增大。对于判断COPD气流受限的指标FEV1/FVC、FEV1(%),用于判断支气管扩张剂的疗效方面则不够敏感。IC是评价支气管扩张剂疗效的可靠指标。     

老年中重度稳定期慢性阻塞性肺疾病患者应用噻托溴铵的疗效与安全性

目的探讨老年中重度稳定期慢性阻塞性肺疾病(COPD)患者应用噻托溴铵(吸入剂量18μg,1次/d)的疗效和安全性。方法在中重度稳定期96例COPD患者,连续3年应用噻托溴铵,每3个月检测肺功能第1秒用力呼吸气量占预计值的百分比(FEV1)和用力肺活量(FVC),圣·乔治呼吸问卷计分(SGRQ)评估生活质量,观察急性加重的发生率及用药的不良反应。结果经连续3年的治疗观察,与对照组比较,噻托溴铵治疗组用药后的FEV1较基线值显著增加,FEV1增加0.26 L(P0.01),并且重度COPD患者肺功能改善明显,治疗组在6个月后肺功能下降趋势明显变缓。噻托溴铵组患者SGRQ评分低于对照组,在重度治疗后的第3个月,噻托溴铵治疗组SGRQ总评分较基线低了6.85,对照组SGRQ总评分较基线低了1.14,SGRQ总评分治疗组较对照组明显改善(P0.01);在中度患者中治疗6个月后SGRQ总评分治疗组较对照组比较有明显改善。COPD急性加重率治疗组与对照组之比为0.75(95%CI 0.58~0.96;P0.05)。在安全指标方面治疗组与对照组没有显著差异。结论噻托溴胺对于改善肺通气功能、健康状态及降低急性发作频率等方面显示出了独特的长处,且耐受性良好,是目前稳定期COPD患者的有效药物。     

噻托溴铵联合沙美特罗替卡松治疗慢性阻塞性肺疾病稳定期患者的疗效观察

目的 观察噻托溴铵联合沙美特罗替卡松对慢性阻塞性肺疾病(COPD)稳定期的治疗效果.方法 采用随机、双盲的方法将62例COPD患者分为观察组和对照组,观察组给予噻托溴铵和沙美特罗替卡松治疗,对照组给予沙美特罗替卡松治疗,分别对两组患者治疗前后呼吸困难评分和肺功能检测进行比较.结果 治疗两个月后,与对照组比较观察组肺功能FEV1、FVC、FEV1/FVC%,呼吸困难评分改善差异有统计学意义(P＜0.05).结论 噻托溴铵与沙美特罗替卡松联合吸入治疗COPD,疗效优于沙美特罗替卡松单药治疗.     

噻托溴铵治疗慢性阻塞性肺疾病稳定期的临床疗效研究

目的探讨噻托溴铵治疗慢性阻塞性肺疾病(COPD)稳定期的临床疗效。方法选取2012年在南昌大学第一附属医院进行治疗的COPD稳定期患者200例,随机分为治疗组和对照组,各100例。对照组患者给予COPD常规治疗,治疗组患者在COPD常规治疗基础上给予噻托溴铵治疗,均连续治疗8周后随访6个月。比较两组患者治疗前后肺功能指标,包括:第一秒用力呼气末容积(FEV1)、用力肺活量(FVC)及FEV1/FVC比值;观察两组患者治疗前和随访3、6个月时呼吸困难指数(m MRC)和6分钟步行距离(6MWT)及治疗期间不良反应发生情况。结果两组患者治疗前FEV1、FVC及FEV1/FVC比值比较,差异无统计学意义(P0.05);治疗组患者治疗后FEV1、FVC及FEV1/FVC比值均高于对照组(P0.05)。两组患者治疗前m MRC和6MWT比较,差异无统计学意义(P0.05);治疗组患者随访3个月、6个月时m MRC低于对照组,6MWT长于对照组(P0.05)。治疗组患者不良反应发生率为7%,与对照组的8%比较,差异无统计学意义(P0.05)。结论噻托溴铵能改善COPD稳定期患者肺功能,缓解临床症状,提升运动耐量,且安全性良好。     

Single Dose of Tiotropium Improves the 6-Minute Walk Distance in Chronic Obstructive Pulmonary Disease

The aim of this study was to evaluate the effect of a single dose of tiotropium on the exercise capacity of stable chronic obstructive pulmonary disease (COPD) patients. The study was a randomized, placebo-controlled, double-blind, cross-over study. Forty-four stable COPD patients with moderate to severe airway obstruction were selected according to the GOLD criteria. The regular anticholinergic therapies of the patients were interrupted one week before the test. In the morning hours of the first day, half the group was given one capsule (18 mcg) of tiotropium and the other half was given placebo as inhalation using the HandiHaler device. Before and 120 min after the medication, the 6-min walk test was performed. Oxygen saturation, modified Borg dyspnea ratings, blood pressure, and heart rate were recorded before and after the test. The same procedure was repeated at the same time on the third day but this time the patients were given placebo if they used tiotropium on the first day and vice versa. Before using tiotropium or placebo there was no difference between 6-min walk distances. The 6-min walk distance after the use of tiotropium (429.3 +/- 70.6 m) was significantly longer than that after the use of placebo (414.7 +/- 74.6 m). The changes in Borg dyspnea ratings and arterial oxygen saturation values with tiotropium and placebo use were not significant. We conclude that exercise capacity might be improved by using a single-dose tiotropium inhalation in moderate to severe COPD patients.     

沙美特罗/丙酸氟替卡松治疗稳定期COPD患者的临床观察

目的探讨吸入型沙美特罗/丙酸氟替卡松(50/500)对非吸烟、稳定期COPD的治疗效果。方法因AECOPD住院后经治疗缓解的出院患者133例,随机分成3组,吸烟组52例,非吸烟组36例,吸入沙美特罗/丙酸氟替卡松(50/500)治疗,对照组45例,不吸入上述药物;3组患者随访12月,记录治疗前后SGRQ、肺功能、急性加重次数等。结果吸烟组治疗前后比较,肺功能、SGRQ明显改善,急性加重次数明显减少(P<0.05);而在非吸烟组和对照组上述指标治疗前后无显著差别(P>0.05)。结论沙美特罗/丙酸氟替卡松(50/500)可以改善吸烟组COPD患者生存状态、改善肺功能和减少急性加重,而非吸烟、稳定期COPD患者并没有从沙美特罗/丙酸氟替卡松(50/500)治疗中获益。     

Rationale and design of the Early Chronic Obstructive Pulmonary Disease (ECOPD) study in Guangdong,China: a prospective observational cohort study

BackgroundChronic obstructive pulmonary disease (COPD) is a heterogeneous disease and its clinically relevant subtypes are not well understood. Which clinical characteristics are more likely to be present among individuals who develop COPD remains to be studied in depth. Therefore, we designed a prospective observational cohort study, entitled the Early Chronic Obstructive Pulmonary Disease (ECOPD) study, to fill this evidence gap. The ECOPD study has four specific aims: (I) identification of characteristics, parameters, and biomarkers that may predict the development of airflow obstruction and annual decline in lung function with normal spirometry; (II) identification of clinically relevant early COPD subtypes; (III) identification of characteristics, parameters, and biomarkers that may predict disease progression in these early COPD subtypes; (IV) development and validation of machine learning models to predict development of airflow obstruction and disease progression.MethodsWe will recruit approximately 2,000 participants aged 40–80 years, including approximately 1,000 with COPD [post-bronchodilator forced expiratory volume in 1 second (FEV1)/forced vital capacity (FVC) <0.7] and approximately 1,000 without COPD, using a population-based survey for COPD. We will assess all participants using standard respiratory epidemiological questionnaires, pulmonary function tests [pre-bronchodilator and post-bronchodilator spirometry, and impulse oscillometry (IOS)], health outcomes [modified British Medical Research Council (mMRC) dyspnea scale, COPD assessment test (CAT), COPD clinical questionnaire (CCQ)], inspiratory and expiratory chest computed tomography (CT), and biomarker measurements (blood and urine), as well as satellite remote sensing pollutant exposure measures. Subgroup will additionally complete induced sputum, exercise capacity tests [6-minute walk test (6MWT) and cardiopulmonary exercise testing (CPET)] and home monitoring/personal sampling as pollutant exposure measures. Study procedures will be performed at baseline and every 1 year thereafter.DiscussionThe ECOPD study will provide insight into many aspects of early COPD and improve our understanding of COPD development, which may facilitate therapeutic interventions with the potential to modify the course of disease.Trial RegistrationChinese Clinical Trial Registry, ChiCTR1900024643. Registered on 19 July, 2019.     

沙美特罗替卡松联合噻托溴铵吸入治疗中重度COPD 40例疗效观察

目的观察沙美特罗替卡松（舒利迭）联合噻托溴铵粉吸入剂（思力华）对中重度COPD的治疗效果。方法将40例临床诊断为中重度COPD的患者随机分为两组。A组：22例,舒利迭（50/500 ug）吸人,每天2次,加用思力华,使用吸入装置（HandiHaler）吸入,每次1粒胶囊（18 ug）,每天1次。B组：18例,单纯舒利迭（50/500 ug）吸人,每天2次.疗程3个月。观察两组患者治疗前后呼吸困难的评分、血气分析及肺功能情况。结果治疗3个月后,所有患者呼吸困难均减轻,但A组呼吸困难下降值明显高于B组（P〈0.001）。与B组比较,治疗后A组肺功能指标（FVC、FEV1及FEV1/FVC）及血气指标（SaO2、PaO2）明显升高,而PaCO2则明显下降（P〈0.01）。结论长效抗胆碱药噻托溴铵与舒利迭联合应用可明显改善中重度COPD患者的呼吸困难、血气和肺功能,优于单纯应用舒利迭,可使COPD得到良好的控制。     

Prevalence and Risk Factors for Depressive Symptoms in Persons with Chronic Obstructive Pulmonary Disease

Background  Although depression is a risk factor for adverse outcomes in chronic illness, little is known about the prevalence or risk factors for depressive symptoms in chronic obstructive pulmonary disease (COPD). Objective  To determine the prevalence of depressive symptoms in COPD as compared to other chronic illnesses and to identify risk factors for depressive symptoms in COPD. Design and Patients  Cross-sectional study of 18,588 persons (1,736 subjects with self-reported COPD), representing a sample of the US population aged ≥50 years who participated in the 2004 Health and Retirement Survey. Measurements  Presence of COPD and other chronic conditions was defined by self-report. Presence of depressive symptoms was assessed using the CES-D8 scale. Participants with a score ≥3 on CES-D8 were classified as having clinically significant depressive symptoms. Main Results  Of 1,736 participants with COPD, 40% had ≥3 depressive symptoms. Depressive symptoms were more common in COPD than in coronary heart disease, stroke, diabetes, arthritis, hypertension, and cancer. Risk factors for ≥3 depressive symptoms in COPD: younger age (OR 1.02/per year younger, 95% CI [1.02–1.03]), female gender (1.2 [1.1–1.3]), current smoking (1.5 [1.3–1.7]), marital status [divorced/separated (1.8 [1.6–2.1]), widowed (1.8 [1.6–2]), never married (1.4 [1.1–1.8]), ≤high school degree (1.6 [1.5–1.8]), dyspnea (2.3 [2.1–2.6]), difficulty walking (2.8 [2.5–3.2]), and co-morbid diabetes (1.2 [1.1–1.4]), arthritis (1.3 [1.2–1.5]) or cancer (1.2 [1.1–1.4]). Conclusions  Depressive symptoms are common in COPD and are more likely to occur in COPD than in other common chronic illnesses. The risk factors identified may be used for targeted depression screening in COPD patients. An erratum to this article can be found at