应用非氟里昂抛射剂的硫酸沙丁胺醇气雾剂治疗支气管哮喘的随机对照临床试验

目的 评价应用非氟里昂抛射剂的国产硫酸沙丁胺醇气雾剂治疗支气管哮喘疗效与安全性。方法 以进口硫酸沙丁胺醇气雾剂为阳性对照药,采用多中心、随机、双盲、阳性药物平行对照试验设计,试验组予以单次吸入国产硫酸沙丁胺醇气雾剂,对照组单次吸入进口硫酸沙丁胺醇气雾剂,观察给药后肺功能及症状评分改善情况。结果 两组给药后15 min,30 min,120 min,240 min第一秒用力呼气容积(FEV1)较给药前均有改善,FEV1增加绝对值在给药后30 min达到最大,各个时间点FEV1改善值和改善率组内比较差异有统计学意义(P<0.05),组间比较均无统计学意义(P >0.05);用力肺活量(FVC)、呼吸困难评分、咳嗽评分、呼气相干音评分等症状体征在用药后各个时间点较用药前均改善且差异有统计学意义(P <0.05),组间比较差异无统计学意义(P>0.05)。两组用药后不良反应率差异无统计学意义(P>0.05),均表现出较好的安全性。结论 应用非氟里昂抛射剂的国产硫酸沙丁胺醇气雾剂作为支气管哮喘缓解药物的疗效与安全性均较好。     

Nebuhaler versus wet aerosol for domiciliary bronchodilator therapy. A multi-centre clinical comparison.

OBJECTIVE: To compare the clinical effectiveness and patient acceptance of a large spacer device (Nebuhaler) for delivery of metered dose aerosol (MDI) terbutaline with nebulised wet aerosol terbutaline. DESIGN: Randomised open crossover study over two sequential four week treatment periods, following a two week run-in. SETTING: Multi-centre including five adult thoracic units and three paediatric centres throughout Australia. PATIENTS: Thirty-eight adults and 23 children with clinical asthma and reversible airflow obstruction (increase in forced expiratory volume in one second [FEV1] of greater than or equal to 15% in response to inhaled bronchodilator) entered the study proper. Six adults and one child withdrew. INTERVENTIONS: Terbutaline was administered four times daily via Nebuhaler/MDI or nebuliser. Clinical assessment with spirometry and peak flow readings was made after run-in and at the end of each treatment period. Patients recorded on diary cards daily peak expiratory flow rates and symptom scores and comparisons of these results for each treatment period were made. At the completion of the study patients answered a treatment preference questionnaire. RESULTS: No differences were found between the two treatment periods in diary card peak flow recordings and symptom score data, and in clinical assessment of spirometry and peak expiratory flow rates. There were also no differences between spirometry and peak flow values recorded at the clinic at randomisation and at the end of each treatment period, suggesting stable basal airflow obstruction over the period of the study. Thirty-two per cent of adults and 52% of children preferred the Nebuhaler/MDI combination, mainly because of convenience of use. Treatment preference was not related to any measured index of lung function. CONCLUSIONS: MDI terbutaline delivered via Nebuhaler provides clinical benefit similar to that of wet aerosol terbutaline in the long-term domiciliary management of patients with stable airflow obstruction.     

体描仪测定哮喘儿童和成人肺功能的临床意义

目的探讨人体体积描记仪(人体体描仪)测定哮喘儿童和成人肺功能的临床意义.方法采用人体体描仪测定哮喘发作期儿童及成人治疗前后的肺功能,比较第1秒用力呼气容积(FEV1)、用力呼气肺活量(FVC)、第1秒用力呼气容积占用力呼气肺活量比值(FEV1/FVC)、最大呼气流量(PEF)和用力呼气25%、50%肺活量时瞬间流量(FEF25%、FEF50%)等肺功能指标的变化幅度.结果治疗前儿童和成人组PEF异常率分别为92.58%和86.36%,治疗后上述指标均有不同程度提高,差异显著(均为P<0.001);两组间肺功能变化幅度除PEF(P>0.05)外,FVC、FEV1、FEV1/FVC、FEF25%、FEF50%差异均有显著性(均为P<0.01).结论采用人体体描仪进行肺功能测定有利于哮喘诊断和发作期病情评估,更适合于年长儿童肺功能指标的监测.     

常规肺通气功能检测在儿童支气管哮喘规范化管理中的应用

目的 通过对比支气管哮喘患儿规范化治疗前后肺功能指标的变化,为本地区儿童哮喘规范化管理提供依据。方法 采用肺功能测定系统对33 例哮喘儿童在急性发作期、缓解期3、6 个月及1 年分别进行常规肺通气功能测定,比较各期实测值,以及异常比例的差异。结果 哮喘患儿急性发作期用力肺活量（FVC）、1 秒用力呼气量（FEV1）、最大呼气流量（PEF）及75%、50%、25%肺活量时用力呼气流速（FEF25~75）等实测值与预计值比较均下降,规范化治疗后3个月开始相关指标逐渐恢复,6个月后反映大气道功能相关指标（FVC、FEV1等）基本恢复。1年时反映小气道功能相关指标FEF25~75 恢复。结论 通过对支气管哮喘儿童肺功能的监测,可以动态观察患儿气道功能恢复情况,为儿童支气管哮喘规范化管理提供客观依据。     

震荡排痰器对老年肺功能的影响

目的探讨震荡排痰器对老年人的肺功能的影响。方法60例85岁或以上的老年人随机分为干预组和对照组。对两组均进行简易肺功能测定,检测指标包括峰流速（peak expiratoryflow,PEF）、1s用力呼气容积（ferced expiratory volume in the firstsecond）、用力肺活量（forced vital capacity,FVC）、1S用力呼气容积与用力肺活量的比值（FEV1／FVC％）。干预组予以震荡排痰器进行肺康复锻炼,对照组不作任何干预。28d后比较干预组与对照组的肺功能、发热天数、抗生素使用天数及外出就医例数。结果两组肺功能方面,干预前PEF、FEV1、FVC、FEV1／FVC％两组问均无显著性差异（P〉0．05）,干预后,PEF、FEV1、FEV1／FVC％干预组、对照组间无显著性差异（P〉0．05）;干预组较对照组用力肺活量有增加,FVC两组间有显著性差异（P〈0．05）,前后的差值分别为（0．33±0．30）L和（0．20±0．14）L。发热例数、抗生素使用例数和外出就医例数方面,干预组和对照组无显著性差异（P〉0．05）。结论高龄老年人肺功能减退,采用物理排痰器进行肺康复锻炼可以改善肺功能,改善肺活量。     

Spirometric indices of early airflow obstruction.

Thirty cigarette smokers and 25 non-smoking controls, all men were evaluated by history, physical examination and simple spirometry. The history and physical examination were not of much use in predicting airflow obstruction. Forced mid-expiratory flow (FEF 25-75%) was abnormally low in 23 of the 30 subjects, while forced expiratory volume in 1 second (FEV1) and FEV1/FVC (forced vital capacity) were less sensitive. Thus simple spirometry is a useful screening tool to detect early airflow obstruction even when it is clinically undetectable.     

使用扩张剂后支气管扩张的气道反应性变化

目的:评价支气管扩张剂在支气管扩张治疗中的效果。方法:43例支气管扩张患者,每例患者在测定基础肺功能后,通过带贮雾罐的定量气雾吸入装置吸入400μg沙丁胺醇,30 min后测定肺功能。次日通过射流雾化器雾化吸入5 mg沙丁胺醇,30 min后测定肺功能。之后再分别评价定量气雾吸入溴化异丙托品40μg及经雾化器雾化吸入500μg对肺功能的影响。结果:支扩患者在吸入400μg及5 mg沙丁胺醇后,肺功能各参数均有提高,其中最大呼气峰值流速(PEF)分别提高8.4%和14.2%,第1秒钟用力呼气容积(FEV1)分别提高7.5%、13.0%,用力肺活量(FVC)分别增加8.9%、14.3%。吸入40μg及500μg溴化异丙托品后,PEF、FEV1及FVC分别增加7.3%与11.6%、5.5%与8.2%、6.9%与9.4%。18例患者(41.9%)在使用沙丁胺醇或溴化异丙托品后,肺功能有显著改善(FEV1提高>15%),其中,6例对沙丁胺醇和溴化异丙托品都有良好反应,9例仅对沙丁胺醇,另3例仅对溴化异丙托品有良好反应。对每例患者使用14种过敏原进行皮肤针刺试验,结果13例(30.2%)阳性。结论:许多支气管扩张患者对支气管扩张剂有良好反应。支气管扩张患者治疗前应当进行支气管舒张试验。     

Prediction equations for spirometric parameters in Mexican adult population

BACKGROUND: Our objective was to develop prediction equations for spirometric parameters that included the following: forced vital capacity (FVC); 1st-sec forced expiratory volume (FEV1); FEV1/FVC ratio; peak expiratory flow (PEF); maximal expiratory flow 50% FVC (VF50) and maximal expiratory flow 75% FVC (VF75); maximal mid-expiratory flow (FEF25-75), and forced late expiratory flow rate (FEF75-85) in a sample of adult Mexican population of both sexes. Age and height variables were utilized. METHODS: Spirometric studies were carried out, observing the international recommendations and norms in force and effected under basal conditions and post-bronchodilator. Linear regression equations were generated based on gender, age, and height. For each spirometric parameter, we selected a linear model. Studies were carried out with spirometry that was in agreement with quality criteria recommended by the American Thoracic Society (ATS). Bronchodilatator administration allowed for elimination of subjects with subclinical bronchial hyperreactivity RESULTS: We studied 436 patients with normal clinical radiographic and pulmonary function, with negative smoking and age range between 17 and 63 years; 206 were females and 230, males. Linear regression equations obtained had direct linear correlation with height and inverse linear correlation with age; in addition, equations had a determination coefficient equal to or less than those reported by authors recommended by the ATS. CONCLUSIONS: Equations obtained in this study possessed the quality required for application in adult Mexican population exposed or not to occupational and environmental contaminants.     

Reduced pulmonary function in wind instrument players

BACKGROUND: Wind instrument playing requires a strenuous respiratory activity. Previous studies investigating effect of wind instrument playing on pulmonary function are equivocal. METHODS: In the present study, 34 male, non-smoker wind players in a military band were compared with 44 healthy non-smoker males by pulmonary function testing. RESULTS: All spirometric values including forced expiratory volume in 1 sec (FEV1), forced vital capacity (FVC), FEV1/FVC, peak expiratory flow rate, forced expiratory flow in 25, 50, 75% of FVC, and during the middle half of the FVC were found significantly diminished in wind players. The class of wind instrument, brass or wood, showed no significant differences. FVC was significantly and negatively correlated with duration of practice. CONCLUSIONS: It was concluded that pulmonary function in wind players might be diminished probably due to development of asthma or constant barotrauma during their playing. This fact should be considered in clinical evaluation of wind instrument players.     

系统化呼吸功能训练在老年慢性阻塞性肺疾病患者康复期中的应用

目的:评估系统化呼吸功能训练在老年慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者康复期中的应用价值。方法:选取老年COPD患者56例,待病情稳定进入康复期后开展系统化呼吸功能锻炼,包括缩唇呼吸、腹式呼吸、全身呼吸操和人工呼吸阻力训练,同时给予运动指导。观察干预前后患者肺功能指标、呼吸频率、心率的变化,比较干预前后6 min步行试验(6MWT)的距离。结果:干预后,患者第1秒用力呼气量(FEV1)、肺活量(FVC)、第1秒用力呼气量占用力肺活量比(FEV1/FVC)、呼气峰值流速(PEF)和最大呼气中段平均流速(MMEF)等指标均较干预前明显改善,差异有统计学意义(P<0.05或P<0.01);干预后,患者的呼吸频率、心率较干预前明显降低,6MWT距离较干预前明显延长(P<0.05或P<0.01)。结论:对老年COPD康复期患者开展系统化呼吸功能训练有助于改善肺功能,提高运动耐力,延缓病情进展。     

Study of pulmonary functions in tea industry workers in North Bengal

This study was intended to compare pulmonary function parameters in tea garden factory workers who are on chronic exposure to tea dust with tea garden plantation workers on the basis of dynamic ventilatory pulmonary function tests. The pulmonary function tests done on 128 subjects included 64 tea garden factory workers and 64 tea garden plantation workers. In tea factory workers the values of vital capacity (VC), forced vital capacity (FVC), forced expiratory volume in one second (FEV1), forced expiratory volume in first 0.75 second (FEV0.75), FEV1/FVC%, peak expiratory flow rate (PEFR) were found significantly lower (p < 0.001) than those of tea garden plantation workers. It may be concluded that pulmonary functions are more affected in tea factory workers than those of tea plantation workers.     

性别对肥胖哮喘患儿吸入糖皮质激素后肺功能的影响

目的研究性别对肥胖哮喘患儿吸入糖皮质激素（ICS）治疗前后肺功能的影响。方法190例哮喘患儿根据性别分为男性 组（102例,正常体质量组/肥胖组57/45）、女性组（88例正常体质量组/肥胖组46/42）,检测所有患儿治疗前及规范化ICS治疗1 年后肺功能,包括第1秒时间肺活量（FEV1）、用力肺活量（FVC）、用力呼气50%流量（MEF50）、用力呼气25%流量（MEF25）。结 果治疗前各组肺功能男女性比较无统计学差异（均P>0.05）。ICS治疗1年后,正常体质量男女性组FVC%、FEV1%较治疗前 均明显升高（P<0.05）;肥胖男性组FVC%、FEV1%较治疗前明显升高（P<0.05）,而肥胖女性组仅FVC%较治疗前升高（P< 0.05）。结论ICS治疗能够改善哮喘大气道通气功能,性别对哮喘ICS治疗大气道通气功能的改善依赖于体质量指数,表现为 性别对正常体质量哮喘患儿ICS治疗影响作用较小,而女性肥胖哮喘患儿肺功能改善程度明显低于男性肥胖哮喘患儿。     

不同级别慢性阻塞性肺疾病患者对支气管舒张剂的反应

目的: 探讨不同级别的慢性阻塞性肺疾病(chronic obstructive pulmonary disease,COPD)患者使用支气管舒张剂后的反应性差异。方法: 回顾性分析220例COPD患者,按病情程度分为Ⅰ~Ⅳ级,吸入支气管舒张剂沙丁胺醇后,分别比较肺功能流速指标1秒最大呼气容积(FEV1)与容量指标用力肺活量(FVC)的改变值。结果： 支气管舒张后,COPD患者的FEV1与FVC均较试验前有不同程度增加(P均<0.01)。Ⅰ~Ⅳ级COPD患者在吸入β2受体激动剂后FEV1、FVC均有显著改善。按改变值的大小分段排列,Ⅰ~Ⅱ级COPD患者ΔFEV1较Ⅲ~Ⅳ级患者改善明显(P<0.01);Ⅲ~Ⅳ级COPD患者ΔFVC较Ⅰ~Ⅱ级改善明显(P<0.01)。结论： 不同级别COPD患者在使用支气管舒张剂后,流速与容量均得以改善。FEV1可作为Ⅰ~Ⅱ级COPD患者对支气管舒张试验反应的重要指标,FVC可作为Ⅲ~Ⅳ级COPD患者对支气管舒张试验的重要指标。     

Prediction of postoperative pulmonary function in the patient undergoing pneumonectomy using combined pulmonary function test and ventilation/perfusion scintiphotography

A method to predict postoperative lung function following pneumonectomy has been used in 11 patients. Preoperative unilateral lung function can be predicted by combining the preoperative information on lung volumes obtained by spirometry with the distributional information obtained from ventilation and perfusion scintigrams in order to estimate lung function after pneumonectomy. There was a high degree of correlation between predicted and measured lung function for both FEV1 (r = 0.81, p less than 0.050, and FVC (r = 0.81, p less than 0.05). The postoperative FEV1 and FVC were within 200 ml of the predicted value in most of the patients. A more accurate and easy prediction of postoperative lung function is obtained using unilateral perfusion rather than ventilation scintigrams. We suggest that the combined the results of simple spirometric data and a quantitative right-vs-left perfusion lung scan using radioactive Tc-99m provides a simple non-invasive and accurate method for the pre-operative functional evaluation of the high risk patient.     

沙美特罗/丙酸氟替卡松治疗慢性阻塞性肺疾病的临床分析

目的观察吸入沙美特罗/丙酸氟替卡松（舒利迭）50/500μg干粉剂对慢性阻塞性肺疾病（COPD）急性期及稳定期中、重度的慢性阻塞性肺疾病（COPD）患者的临床疗效及生活质量的改善。方法将明确诊断的162例COPD病人随机分为治疗组（86例）和对照组（70例）,两组病人的基础治疗和合并症方面差异无统计学意义,治疗组给予吸入沙美特罗/丙酸氟替卡松（舒利迭）50/500μg,每次1吸,每日2次;两组治疗均有常规的基本用药如茶碱缓释胶囊,氨溴索,部分病人使用沙丁胺醇临时雾化吸入;疗程为3个月。观察治疗前后肺功能指标测定和圣乔治呼吸问卷（SGRQ）生活质量评分进行比较。结果在观察前,治疗组和对照组的一秒钟用力呼气容积（FEV1）/用力肺活量（FVC）和FEV1/预计值的差异无统计学意义（P〉0.05）。在观察结束时,治疗组FEV1/FVC和FEVI/预计值较观察前均有不同程度的提高（P〈0.05）;对照组FEV1/FVC和FEV1/预计值与试验前的差异无统计学意义（P〉0.05）;治疗组呼吸问卷生活质量评分比观察前明显减少（P〈0.05）,对照组除呼吸症状得到改善外其他指标无明显变化（P〉0.05）;两组因急性加重住院的比例治疗组明显低于对照组（P〈0.05）。结论吸入沙美特罗／丙酸氟替卡松（舒利迭）50／500μg干粉剂能够改善中、重度的慢性阻塞性肺疾病（60PD）患者急性期及稳定期的肺功能和生活质量,降低COPD患者住院率。     

老年肺癌患者肺叶切除术前、术后肺功能比较

目的：研究老年肺癌患者肺部手术前、后的肺功能变化。方法：对76例老年肺癌患者在肺部手术前、后进行肺功能测定，肺功能检查按常规方法进行。结果：一侧全肺切除肺活量(VC)下降47．17％；用力肺活量(FVC)下降44．77％；第一秒用力呼气容积(FEV1)下降39．68％；肺叶切除后VC、FVC、FEV。值平均下降约20％左右，一侧全肺切除后VC、FVC、FEV1下降值较肺叶切除有显著意义下降。结论：肺叶切除后VC、FVC和FEV1值平均下降值约20％，一侧全肺切除后VC、FVC和FEV1下降值较肺叶切除显著。     

阻塞性睡眠呼吸暂停低通气综合征患者肺功能的变化

目的探讨阻塞性睡眠呼吸暂停低通气综合征（OSAHS）患者肺功能的变化。方法对经多导睡眠图监测（PSG）确诊的142例OSAHS患者（OSAHS组）及52例体检健康者（对照组）,分别行肺通气功能[检测指标包括潮气量（VT）、每分通气量（MV）、最大肺活量（VCMAX）、补呼气量（ERV）、用力肺活量（FVC）、1秒用力呼气容积（FEV1）、1秒率（FEV1／FVC）、最大分钟通气量（MVV）、用力呼气峰流量（PEF）和75％用力呼气容积流量（FEF75）、50％用力呼气容积流量（FEF50）、25％用力呼气容积流量（FEF25）]测定及比较,并作呼吸暂停低通气指数（AHI）及体重指数（BMI）与上述指标的相关性分析。结果OSAHS组患者肺通气功能指标ERV、VCMAX、FVC、FEV1、FEF50、MV、MVV均较对照组显著下降（均P〈0．01）。OSAHS组患者AHI与MV、ERV、VCMAX、FVC、MVV呈负相关（r=-0.321～-0．244,均P〈0．01）;BMI与ERV、VCMAX、FVC、MVV、MV呈负相关（r==-0．375～-0205,P〈005或0．01）。与FEV1／FVC呈正相关（r=0．385,P〈001）。结论OSAHS患者存在肺功能损害,损害程度与BMI及AHI有关,需要引起重视。     

Spirometric standards for healthy Nigerian children and adolescents.

Forced vital capacity (FVC), forced expiratory volume in one second (FEV1.0) and peak expiratory flow rates (PEFR) were determined in 131 school children and adolescents aged between 5 and 20 years to determine normal values among Nigerian school children. The results were analyzed with respect to the ages, heights, weights, chest circumference and body surface areas of the subjects. A good correlation was observed between these anthropometric measurements and the indices of pulmonary function. The mean values of FVC, FEV1.0, and PEFR were lower than those reported in caucasian children but similar to the available data in the literature for African children. Mean FEV1.0, FVC and PEFR values were higher in males than in females at most ages.     

Metered-dose inhaler technique in asthmatic patients--a revisit of the Malaysian scene

Inefficient metered-dose inhaler (MDI) technique results in poor drug delivery, suboptimal disease control a possibility of inhaled medication overuse. The MDI technique of 134 government hospital and clinic followed-up adult asthmatic patients followed-up in a government hospital and a heath clinic was pragmatically assessed based on the 3 obligatory steps of adequate lip seal, appropriate hand-breath coordination and sufficient breath holding after inhalation. The relationship between technique efficiency and frequency of daily short-acting beta2-agonist (SABA) use via the MDI and asthma exacerbations over a 12-month period was also assessed. Fifty-six patients (42%) had inefficient MDI technique. All demographic and asthma-related variables between the 'efficient' and 'inefficient' technique groups of patients were comparable except for significantly longer mean years of MDI use in the 'efficient' technique group [mean (SD): 10 (7) vs. 7 (5); p=0.003]. There were no significant differences between the two groups in relation to frequency of daily SABA use or asthma exacerbations over the past 12 months. Despite having been available in Malaysia for a considerable period of time, the MDI device is still poorly handled by a large proportion of adult asthmatic patients. Changing to other more user-friendly devices or use of spacer devices to facilitate delivery should be considered for these patients.     

Body mass index correlated with forced expiratory volume in 1 second/forced vital capacity in a population with a relatively low prevalence of obesity

Background Obesity is the most common metabolic disease in the world. However, the relationship between obesity and lung function is not fully understood. Although several longitudinal studies have shown that increases in body weight can lead to reductions in pulmonary function, whether this is the case with the Japanese population and whether high body mass index （BMI） status alone represents an appropriate predictor of obstructive lung dysfunction remains unclear.The purpose of present study was to estimate the effect of BMI on lung function measured by spirometry of Japanese patients in general clinics. We measured BMI and performed spirometry on screening patients who had consulted general clinics.Methods Subjects comprised 1231 patients ≥40 years of age （mean age （65.0±12.0） years, 525 men, 706 women） who had consulted clinics in Nagasaki Prefecture, Japan, for non-respiratory disease. BMI was calculated and lung function was measured by spirometry.Results BMI was found to be positively correlated with forced expiratory volume in 1 second （FEV1）/forced vital capacity （FVC） in men and with maximum mid-expiratory flow （MMF） in all subjects. Following adjustment for relevant factors, a significant positive correlation between BMI and FEV1/FVC was identified for all subjects. Comparison between subjects with normal BMI （18.5-25.0） and higher BMI （25.1-30.0） also demonstrated that FEV1/FVC and percentage of predicted maximum mid-expiratory flow （%MMF） were significantly higher in the latter subjects.Conclusions In a population without marked respiratory disease, higher BMI subjects showed less obstructive pulmonary dysfunction compared to normal BMI subjects. High BMI status alone may be inappropriate as a predictor of obstructive lung dysfunction, particularly in populations with a low prevalence of obesity.