吸入型长效抗胆碱能药物及吸入型长效β_2受体激动剂在慢性阻塞性肺疾病患者中的应用评价
|
摘要
目的:探讨吸入型长效抗胆碱能药物(LAMA)及吸入型长效β_2受体激动剂(LABA)在稳定期慢性阻塞性肺疾病(COPD)综合评估B、C组患者中的单药应用价值,为COPD个体化治疗提供依据。方法:将91例COPD综合评估B、C组稳定期患者随机分成LAMA组和LABA组,在治疗前及治疗后2、4、6个月记录患者呼吸道症状、COPD评估测试(CAT)评分、第1秒用力呼出量(FEV1)、第1秒用力肺活量占预计值的百分比(FEV1%pred)等,并对两组患者的疗效、肺功能改善及安全性进行评价。结果:在治疗第2、4、6个月,两组患者CAT评分、FEV1值、FEV1%pred均有改善,第6个月与研究起始组内比较差异有统计学意义(P<0.05);在第6个月时LAMA组的FEV1及FEV1%pred均高于LABA组,组间比较差异有统计学意义(P<0.05)。结论:在COPD B、C组稳定期患者的治疗中,LAMA及LABA均可以改善COPD临床症状,在肺功能改善方面LAMA优于LABA。LAMA应用过程中可能引起排尿困难,虽发生率较低但需引起重视。
Objective: To investigate the application value of inhaled long-acting anticholinergic drug(LAAD) and long-acting β_2 receptor agonists(LABA) in the treatment of the patients designated as the B and C groups according to comprehensive evaluation of chronic obstructive pulmonary disease(COPD), in order to provide reference for the individualized treatment of COPD.Methods: Ninety-one patients designated as the B and C groups according to comprehensive evaluation of COPD were randomly divided into the LAAD group and the LABA group. The respiratory symptoms,COPD assessment test(CAT) scores,forced expiratory volume in one second(FEV1) and FEV1% pred were recorded at the time point of 0,2,4 and 6 months after treatment,and the efficacy,lung function improvement and safety were compared and evaluated between the two groups. Results: The CAT scores,FEV1 value and FEV1% pred of the patients in the two groups all improved,at the 4 and 6 months and the differences were statistically significant at the time point of the 6 month as compared with those of starting.The levels of FEV1 and FEV1% pred in the LAMA group were higher than those in the LABA group at the point of 6 month,and the difference was statistically significant. Conclusion: In the treatment of the stable patients in the B and C groups, both LAAD and LABA could improve clinical symptoms of COPD, and LAAD is superior to LABA in the improvement of pulmonary function.However, LAAD could induce dysuria in the course of medication, though the incidence of dysuria is relatively low, and attention should be paid to it.
Objective: To investigate the application value of inhaled long-acting anticholinergic drug(LAAD) and long-acting β_2 receptor agonists(LABA) in the treatment of the patients designated as the B and C groups according to comprehensive evaluation of chronic obstructive pulmonary disease(COPD), in order to provide reference for the individualized treatment of COPD.Methods: Ninety-one patients designated as the B and C groups according to comprehensive evaluation of COPD were randomly divided into the LAAD group and the LABA group. The respiratory symptoms,COPD assessment test(CAT) scores,forced expiratory volume in one second(FEV1) and FEV1% pred were recorded at the time point of 0,2,4 and 6 months after treatment,and the efficacy,lung function improvement and safety were compared and evaluated between the two groups. Results: The CAT scores,FEV1 value and FEV1% pred of the patients in the two groups all improved,at the 4 and 6 months and the differences were statistically significant at the time point of the 6 month as compared with those of starting.The levels of FEV1 and FEV1% pred in the LAMA group were higher than those in the LABA group at the point of 6 month,and the difference was statistically significant. Conclusion: In the treatment of the stable patients in the B and C groups, both LAAD and LABA could improve clinical symptoms of COPD, and LAAD is superior to LABA in the improvement of pulmonary function.However, LAAD could induce dysuria in the course of medication, though the incidence of dysuria is relatively low, and attention should be paid to it.
引文
[1] Vogelmeier C F,Criner G J,Martinez F J,et al.Global strategy for the diagnosis,management and prevention of chronic obstructive lung disease 2017 report:GOLD executive summary[J].Respirology,2017,22(3):575-601.
[2] Guirguis-Blake J M,Senger C A,Webber E M,et al.Screening for chronic obstructive pulmonary disease:evidence report and systematic review for the US preventive services task force[J].JAMA,2016,315(13):1378-1393.
[3] Wise R A,Anzueto A,Cotton D,et al.Tiotropium respimat inhaler and the risk of death in COPD[J].N Engl J Med,2013,369(16):1491-1501.
[4] Global Initiative for Asthma.2018 GINA Report,Global strategy for asthma management and prevention[EB/OL].[2018-06-30].(2018-10-24).http://ginasthma.org/gina-reports.
[5] Latorre M,Novelli F,Vagaggini B,et al.Differences in the efficacy and safety among inhaled corticosteroids(ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD):role of ICS[J].Pulm Pharmacol Ther,2015,30:44-50.
[6] Hizawa N.LAMA/LABA vs ICS/LABA in the treatment of COPD in Japan based on the disease phenotypes[J].Int J Chron Obstruct Pulmon Dis,2015,10:1093-1102.
[7] Singh D,Miravitlles M,Vogelmeier C.Chronic obstructive pulmonary disease individualized therapy:tailored approach to symptom management[J].Adv Ther,2017,34(2):281-299.
[8] Chong J,Karner C,Poole P,et al.Tiotropium versus long-acting beta-agonists for stable chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2012,12(9):CD009157.
[9] Mahler D A,Kerstjens H A,Donohue J F,et al.Indacaterol vs tiotropium in COPD patients classified as GOLD A and B[J].Respir Med,2015,109(8):1031-1039.
[10] ?ztürk C,Alda■ Y,Yilmaz Demirci N.Evaluation and importance of different types of inhaler device in patients with chronic obstructive lung disease[J].Tuberk Toraks,2017,65(2):69-79.
[11] Yamada H,Hida N,Satoh H,et al.Relationship between lung function and inhalation devices for LAMA/LABA therapy for chronic obstructive pulmonary disease[J].Chron Respir Dis,2018,15(4):419-420.
[12] Chrystyn H,Small M,Milligan G,et al.Impact of patients' satisfaction with their inhalers on treatment compliance and health status in COPD[J].Respir Med,2014,108(2):358-365.
[13] Bogart M,Stanford R H,Reinsch T,et al.Clinical characteristics and medication patterns in patients with COPD prior to initiation of triple therapy with ICS/LAMA/LABA:a retrospective study[J].Respir Med,2018,142:73-80.
[14] Stephenson A,Seitz D,Bell C M,et al.Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease:a population-based study[J].Arch Intern Med,2011,171(10):914-920.
[2] Guirguis-Blake J M,Senger C A,Webber E M,et al.Screening for chronic obstructive pulmonary disease:evidence report and systematic review for the US preventive services task force[J].JAMA,2016,315(13):1378-1393.
[3] Wise R A,Anzueto A,Cotton D,et al.Tiotropium respimat inhaler and the risk of death in COPD[J].N Engl J Med,2013,369(16):1491-1501.
[4] Global Initiative for Asthma.2018 GINA Report,Global strategy for asthma management and prevention[EB/OL].[2018-06-30].(2018-10-24).http://ginasthma.org/gina-reports.
[5] Latorre M,Novelli F,Vagaggini B,et al.Differences in the efficacy and safety among inhaled corticosteroids(ICS)/long-acting beta2-agonists (LABA) combinations in the treatment of chronic obstructive pulmonary disease (COPD):role of ICS[J].Pulm Pharmacol Ther,2015,30:44-50.
[6] Hizawa N.LAMA/LABA vs ICS/LABA in the treatment of COPD in Japan based on the disease phenotypes[J].Int J Chron Obstruct Pulmon Dis,2015,10:1093-1102.
[7] Singh D,Miravitlles M,Vogelmeier C.Chronic obstructive pulmonary disease individualized therapy:tailored approach to symptom management[J].Adv Ther,2017,34(2):281-299.
[8] Chong J,Karner C,Poole P,et al.Tiotropium versus long-acting beta-agonists for stable chronic obstructive pulmonary disease[J].Cochrane Database Syst Rev,2012,12(9):CD009157.
[9] Mahler D A,Kerstjens H A,Donohue J F,et al.Indacaterol vs tiotropium in COPD patients classified as GOLD A and B[J].Respir Med,2015,109(8):1031-1039.
[10] ?ztürk C,Alda■ Y,Yilmaz Demirci N.Evaluation and importance of different types of inhaler device in patients with chronic obstructive lung disease[J].Tuberk Toraks,2017,65(2):69-79.
[11] Yamada H,Hida N,Satoh H,et al.Relationship between lung function and inhalation devices for LAMA/LABA therapy for chronic obstructive pulmonary disease[J].Chron Respir Dis,2018,15(4):419-420.
[12] Chrystyn H,Small M,Milligan G,et al.Impact of patients' satisfaction with their inhalers on treatment compliance and health status in COPD[J].Respir Med,2014,108(2):358-365.
[13] Bogart M,Stanford R H,Reinsch T,et al.Clinical characteristics and medication patterns in patients with COPD prior to initiation of triple therapy with ICS/LAMA/LABA:a retrospective study[J].Respir Med,2018,142:73-80.
[14] Stephenson A,Seitz D,Bell C M,et al.Inhaled anticholinergic drug therapy and the risk of acute urinary retention in chronic obstructive pulmonary disease:a population-based study[J].Arch Intern Med,2011,171(10):914-920.