沙丁胺醇和异丙托溴铵对吸烟和非吸烟哮喘患者的相对及额外的支气管舒张反应
2010/07/06
摘要
目的：鉴于吸烟哮喘患者的症状与慢性阻塞性肺病患者类似，研究者试图从治疗上研究这些患者中重要的胆碱能效应。为阐述该效应的临床重要性，本项非盲和非随机性研究旨在研究肾上腺素能和胆碱能药物的支气管舒张效应。
方法：96名哮喘患者入选本研究，包括48名非吸烟者和48位吸烟者，连续吸入沙丁胺醇，达到最大舒张效应后，再给与异丙托溴铵，观察额外的支气管舒张反应。次日，给药次序颠倒。先给予异丙托溴铵，达最大舒张效应后再给予沙丁胺醇。
结果：首先给予沙丁胺醇时，第1秒内用力呼气量（FEV1）最大改善率在非吸烟者和吸烟者分别为67.04%+/-12.98%和60.64%+/-13.6%。异丙托溴铵的额外支气管舒张反应在吸烟者中为9.22%+/-2.08%，明显高于非吸烟者（0.13%+/-2.14%）(P<.001)。首先给予异丙托溴铵时，吸烟者FEV1的最大改善率为41.95%+/-4.57%，明显高于非吸烟者（20.06%+/-7.06%）(P <.001)。沙丁胺醇的额外支气管扩张效应在非吸烟者和吸烟者中分别为23.16%+/-5.07%和19.09%+/-4.9%。
结论：在吸烟的哮喘患者中，胆碱能张力更为明显，并且肾上腺素能受体下调，两种药物均引起明显的支气管舒张效应。所以在吸烟的哮喘患者中，给予抗胆碱能药物能更好地控制哮喘。而在非吸烟的患者中，给予抗胆碱能药物效果不明显或无效。
（林江涛 审校）
Ahmad Z, et al. J Asthma. 2010 Apr;47(3):340-343.
Relative and additional bronchodilator response of salbutamol and ipratropium in smoker and nonsmoker asthmatics.
Ahmad Z, Singh SK.
Department of Tuberculosis and Respiratory Diseases, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh, 202002 India. zrin amu@yahoo.com
Abstract
PURPOSE: This study was conducted in the Department of Tuberculosis and Respiratory Diseases, J. N. Medical College, Aligarh, India, from January 2006 to December 2007. The fact that smoker asthmatics can behave like chronic obstructive pulmonary disease (COPD) patients encourages the researcher to therapeutically exploit the important cholinergic influence in these patients. To clarify the clinical importance of the issue, the present nonblind and nonrandomized study was aimed at relative bronchodilator response to adrenergic and cholinergic agents.
METHODS: Ninety-six patients of asthma, 48 nonsmokers and 48 smokers, were given sequential doses of inhaled salbutamol and after achieving maximum bronchodilation, ipratropium was administered to observe the additional bronchodilation. On the next day, the sequence of drugs was reversed. Ipratropium was given first and after achieving maximal response, salbutamol was given.
RESULTS: On giving salbutamol first, maximal improvement in forced expiratory volume in one second (FEV(1)) was 67.04% +/- 12.98% in nonsmokers and 60.64% +/- 13.6% in smokers. The additional improvement with ipratropium was 9.22% +/- 2.08% in smokers and was significantly higher (p <.001) than in nonsmokers (0.13% +/- 2.14%). When ipratropium was given first, maximum improvement in FEV(1) was 41.95% +/- 4.57% in smokers, which was significantly higher (p <.001) than in nonsmokers (20.06% +/- 7.06%). The additional improvement with salbutamol was 23.16% +/- 5.07% and 19.09% +/- 4.9%, respectively, in nonsmokers and smokers.
CONCLUSIONS: With the above results, the authors concluded that in smoker asthmatics, cholinergic tone was more prominent and there was down-regulation of adrenergic receptors, as both drugs caused significant additional dilatation. So in smoker asthmatics, addition of a cholinergic agent will result in better control of asthma. In nonsmoker asthmatics, addition of cholinergic agent is of little or no value.
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孟鲁司特治疗能改变儿童哮喘患者免疫治疗的早期疗效
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