噻托溴铵联合沙美特罗/氟替卡松对慢阻肺稳定期患者肺功能影响

目的:探讨联合吸入噻托溴铵和沙美特罗/氟替卡松对稳定期中重度慢性阻塞性肺疾病(COPD)患者肺功能的影响。方法:60例稳定期中重度COPD患者随机分成两组,治疗组给予噻托溴铵及沙美特罗/氟替卡松吸入治疗12周,对照组给予沙美特罗/氟替卡松吸入治疗12周,比较两组治疗前后肺功能主要指标变化及急性发作次数。结果:两组治疗后肺功能均明显改善,治疗组较对照组FEV1/FVC及FEV1占预计值百分比改善更明显(P<0.05);治疗后治疗组急性发作次数较对照组明显减少(P<0.05);两组不良反应发生率分别为14.3%和11.1%,差异无统计学意义(P>0.05)。结论:吸入噻托溴铵联合沙美特罗/氟替卡松更有效改善肺功能,减少患者急性发作次数。     

沙美特罗联合丙酸氟替卡松吸入剂对老年稳定期慢性阻塞性肺疾病的治疗作用的临床分析

目的研究沙美特罗／丙酸氟替卡松吸入剂对稳定期慢性阻塞性肺疾病老年患者的治疗效果。方法对我院收治的100例符合条件的老年慢性阻塞性肺疾病患者随机分成两组,每组50人,在综合治疗的基础上,实验组使用沙美特罗联合丙酸氟替卡松吸入剂进行治疗,对照组使用丙酸倍氯米松进行治疗,治疗90天后对两组患者进行一秒用力呼气量（FEV1）、用力肺活量（FVC）、FEV／FVC及FEV1占预计值比例等肺通气功能的测试和呼吸困难症状MRC量表评价。结果两组患者通气困难症状均有不同程度的改善,实验组患者MRC评分（3．84±0．78）、FEV1（1．54±0．43）、FEV／FVC（69．37±5．12）％等均优于对照组[（4．15±0．82）,（1．47±0．42）,（64．36±4．98）％1其差异有统计学意义（P〈0．05）。结论沙美特罗联合丙酸氟替卡松吸入剂能有效改善老年稳定期慢性阻塞性肺疾病患者的肺功能,缓解通气困难症状,提高其生活质量。     

沙美特罗替卡松联合噻托溴铵治疗COPD的疗效

目的观察沙美特罗替卡松联合噻托溴铵治疗慢性阻塞性肺疾病（COPD）的疗效。方法入选的60例COPD患者随机分为观察组和对照组,两组各30例。对照组采用沙美特罗替卡松（舒利迭,50／500μg,英国葛兰素史克公司生产）治疗;观察组联合应用噻托溴铵（思力华,18μg／粒,德国勃林格殷格翰药业有限公司）。结果治疗6个月后,观察组的临床症状评分为（7．2±2．3）分,对照组为（4．0±1．6）分,两组比较差异显著（P〈0．05）。观察组的总有效率（93．33％）明显高于对照组（73．33％）,差异具有统计学意义（P〈0．05）。两组患者均未见明显的不良反应。结论沙美特罗替卡松联合噻托溴铵治疗慢性阻塞性肺疾病（COPD）的疗效确切,能明显改善临床症状,安全性好,值得广泛推广和应用。     

Salmeterol/fluticasone treatment reduces circulating C-reactive protein level in patients with stable chronic obstructive pulmonary disease

Background Evidence suggests that systemic inflammation may play an important role in the progression and morbidity of chronic obstructive pulmonary disease. It remains controversial whether inhaled corticosteroid in combination with a long-acting β2-adrenoceptor agonist can attenuate systemic inflammation. We evaluated the effect of salmeterol/fluticasone propionate on circulating C-reactive protein level in stable chronic obstructive pulmonary disease patients.Methods An open-label clinical trial was conducted to recruit 122 outpatients with stable moderate-to-severe chronic obstructive pulmonary disease from department of respiratory medicine in two teaching hospitals between June 2007 and March 2008. Patients were randomized into two groups (1:1) to receive either the combination of 50 ug salmeterol and 500 ug fluticasone twice daily (n=61), or the combination of 206 ug albuterol and 36 ug ipratropium q.i.d (n=61) over 6 months. Circulating C-reactive protein concentrations were measured before randomization and during the follow-up. The efficacy of treatment was also assessed by spirometry, as well as health status and dyspnea score at baseline and after 6-month treatment.Results Baseline characteristics of two groups were similar. Compared with ipratropium/albuterol, the combination of salmeterol/fluticasone significantly reduced circulating level of C-reactive protein (-1.73 vs. 0.08 mg/L, respectively, P <0.05) after 6-month treatment. Forced expiratory volume in one second (FEV1) and health status also improved significantly in salmeterol/fluticasone group compared with ipratropium/albuterol. Salmeterol/fluticasone treatment subjects who had a decrease of circulating C-reactive protein level had a significant improvement in FEV1 and St George's Respiratory Questionnaire total scores compared with those who did not (185 vs. 83 ml and -5.71 vs. -1.79 units, respectively, both P<0.01).Conclusion Salmeterol/fluticasone treatment reduced circulating C-reactive protein concentration in clinically stable moderate-to-severe chronic obstructive pulmonary disease patients after 6-month treatment.     

Surface energy changes and their relationship with the dispersibility of salmeterol xinafoate powders for inhalation after storage at high RH

This study investigated the relationship between surface energy of micronized lactose, coarse lactose and salmeterol xinafoate and dispersibility from a mixture after storage at 75% RH. Surface energies, dispersibility, morphology, and the presence of amorphous domains were determined by inverse gas chromatography, twin stage impinger, scanning electron microscope and dynamic vapour sorption, respectively. The fine particle fraction of mixture decreased significantly in 4 weeks (P < 0.05), reaching a static level in 3 months. Amorphous content was not detected in the micronized lactose, coarse lactose and salmeterol xinafoate. After conditioning stored samples at 75% RH for 2 h, dispersive surface energy of both micronized and coarse lactose significantly decreased (P < 0.05), while the polar surface energy of all significantly increased (P < 0.05) resulting in significant increase in total surface energy after storage. After conditioning stored samples at 0% RH for 2 h, no significant difference was observed in any surface energy parameter. This study concluded that the total surface energy increased during storage at high RH due to the adhered surface moisture. The mechanism of decreased dispersibility was related to increased capillary/solid bridging interactions and to possible increased interaction of contiguous particles due to increased polar surface energy.     

沙美特罗替卡松粉吸入剂治疗中重度儿童哮喘48例疗效观察

目的：观察沙美特罗替卡松粉吸入剂治疗儿童哮喘的疗效。方法：48例患儿,给予沙美特罗替卡松粉吸入,50μg／100μg／次,每日2次。观察治疗前、治疗1月、3月的呼气峰流速值（PEF）及其占个人预计值的百分比。结果：治疗前患儿PEF值占预计值的百分比与治疗1月后比较差异有统计学意义,治疗3月与治疗前及治疗1月时相比差异亦有统计学意义。治疗3月后病人主观感受明显好转占89．5％,无加重及恶化病人。治疗过程中有3例出现轻微不良反应。结论：沙美特罗替卡松粉吸入治疗儿童中重度哮喘,能够有效控制症状,显著提高哮喘患者的生活质量,不良反应小。     

Combination of fluticasone propionate and salmeterol potentiates the suppression of cigarette smoke-induced IL-8 production by macrophages

Cigarette smoke is the major risk factor for the development of chronic obstructive pulmonary disease (COPD). Macrophages are suggested to orchestrate the chronic inflammatory response and tissue destruction associated with COPD by secreting interleukin (IL)-8, a major neutrophil chemoattractant. The combination of inhaled corticosteroids and long-acting beta(2)-adrenoceptor agonists are increasingly used as maintenance therapy in patients with COPD. The aim of this study was to determine whether combined fluticasone propionate, a corticosteroid, and salmeterol, a long-acting beta(2)-adrenoceptor agonist, can suppress IL-8 production by human macrophages. To mimic resident macrophages in the lung, human monocytes were cultured for 5 days in medium containing Granulocyte Macrophage Colony Stimulating Factor (GM-CSF) and Macrophage Colony Stimulating Factor (M-CSF). In human Monocyte-Derived Macrophages, we found that cigarette smoke medium strongly enhanced IL-8 release in a time- and concentration-dependent manner. IL-8 release by cigarette smoke was significantly suppressed in a concentration-dependent manner by fluticasone and salmeterol. Coincubation of the drugs potentiated the inhibitory effect on cigarette smoke medium-induced IL-8 production and longer preincubation times resulted in more IL-8 inhibition. Interestingly, preincubation of cells with suboptimal concentration of salmeterol for 4 h before fluticasone administration for 30 min potentiates the inhibitory effect of fluticasone on IL-8 release. In conclusion, combination therapy may provide benefits over monotherapy for the treatment of COPD patients.     

Comparing the efficacy and safety of salmeterol/fluticasone pMDI versus its mono-components,other LABA/ICS pMDIs and salmeterol/fluticasone Diskus in patients with asthma

Introduction: Pressurized metered dose inhalers (pMDIs) are evolving to be a very effective drug delivery option in patients with airway diseases. They offer comparable lung deposition and reduced oropharyngeal deposition similar with the dry powder inhalers. As recommended by the Global Initiative for Asthma guidelines, the ideal maintenance treatment for asthma is a combination of long acting β₂-agonists (LABAs) and inhaled corticosteroids (ICSs). One of the available LABA/ICS combinations is the salmeterol/fluticasone propionate combination (SFC) and a plethora of evidence supports its clinical efficacy and safety.

Areas covered: This article focuses on the SFC hydrofluroalkane pMDI and compares the efficacy and tolerability with salmeterol and fluticasone given individually, and with other fixed-dose combinations namely formoterol/fluticasone, formoterol/beclometasone and formoterol/mometasone furoate, all delivered via pMDI. Also discussed is the efficacy and tolerability of the SFC delivered via a pMDI, as compared to the SFC via Diskus.

Expert opinion: pMDIs play an important role in inhalation therapy given the low price, low maintenance and convenience of use. LABA/ICS combinations are the preferred choice of medication for asthma treatment and will remain the mainstay for the decades to come. In our opinion, pMDI should be the choice of device to administer LABA/ICS maintenance therapy, as it is already being used by the patients for reliever therapy, which may eventually improve patient adherence and compliance.