CAJ | 학술논문

目的采用慢性阻塞性肺疾病(COPD)诊断、处理和预防全球策略2011修订版(简称COPD全球策略修订版)制定的COPD评估系统,综合评估长效β2受体激动剂/吸入性皮质激素(LABA/ICS)治疗高风险COPD的疗效.方法选择25例经COPD综合评估为高风险COPD患者(年龄49～86岁,男20例,女5例,合并高血压病3例,合并糖尿病2例),给予沙美特罗/氟替卡松(50 μg/500μg)吸入治疗,1吸q12h,24周.治疗前后进行4方面综合评估:①症状评估:COPD评估测试(CAT)问卷;②肺功能评估:FEV1、FEV1占预计值百分比(FEV1％pred)、FEV1/FVC;③急性加重风险评估:实验期间急性加重次数;④合并症评估.结果沙美特罗/氟替卡松(50 μg/500 μg)吸入治疗24周后,CAT评分(16.160±4.110)分与治疗前(19.280±5.103)分比较有改善,差异有统计学意义(P＜0.001).治疗后FEV1(1.174±0.219)L、FEV1％pred(45.480±6.125)％、FEV1/FVC(39.360±5.507)％与治疗前[(1.068±0.224)L、(41.240±5.600)％、(36.200±5.268)％]比较均有改善,差异有统计学意义(P＜0.001).治疗期间有8例急性加重次数1次,平均(0.320±0.476)次/24周,均为合并肺部感染.未观察到增加沙美特罗/氟替卡松(50 μg/500 μg)吸入治疗后,合并高血压病、糖尿病者的血压、血糖波动超出原有药物控制的范围.结论 COPD综合评估系统反映了COPD的复杂性,与先前应用单一的肺功能分级进行疾病分期相比,对患者评估更加全面、合理、可靠.LABA/ICS一线治疗高风险组COPD患者,可改善症状、肺功能,降低急性加重的风险.
목적 채용만성조새성폐질병(COPD)진단、처리화예방전구책략2011수정판(간칭COPD전구책략수정판)제정적COPD평고계통,종합평고장효β2수체격동제/흡입성피질격소(LABA/ICS)치료고풍험COPD적료효.방법 선택25례경COPD종합평고위고풍험COPD환자(년령49～86세,남20례,녀5례,합병고혈압병3례,합병당뇨병2례),급여사미특라/불체잡송(50 μg/500μg)흡입치료,1흡q12h,24주.치료전후진행4방면종합평고:①증상평고:COPD평고측시(CAT)문권;②폐공능평고:FEV1、FEV1점예계치백분비(FEV1％pred)、FEV1/FVC;③급성가중풍험평고:실험기간급성가중차수;④합병증평고.결과 사미특라/불체잡송(50 μg/500 μg)흡입치료24주후,CAT평분(16.160±4.110)분여치료전(19.280±5.103)분비교유개선,차이유통계학의의(P＜0.001).치료후FEV1(1.174±0.219)L、FEV1％pred(45.480±6.125)％、FEV1/FVC(39.360±5.507)％여치료전[(1.068±0.224)L、(41.240±5.600)％、(36.200±5.268)％]비교균유개선,차이유통계학의의(P＜0.001).치료기간유8례급성가중차수1차,평균(0.320±0.476)차/24주,균위합병폐부감염.미관찰도증가사미특라/불체잡송(50 μg/500 μg)흡입치료후,합병고혈압병、당뇨병자적혈압、혈당파동초출원유약물공제적범위.결론 COPD종합평고계통반영료COPD적복잡성,여선전응용단일적폐공능분급진행질병분기상비,대환자평고경가전면、합리、가고.LABA/ICS일선치료고풍험조COPD환자,가개선증상、폐공능,강저급성가중적풍험.
Objective To assess the efficacy of long-acting beta2-agonists/inhaled corticosteroids (LABA/ICS) in high risk chronic obstructive pulmonary disease (COPD),by adopting the approach instituted by Global strategy for the diagnosis,management,and prevention of chronic obstructive pulmonary disease (Revised 2011).Methods Twenty-five high risk COPD patients (age 49-86years,male 20 cases,female 5 cases,coexisting with hypertension 3 cases,coexisting with diabetes 2 cases) received salmeterol/fluticasone (50 μg/500 μg) 1 inhalation q12h,24weeks.Four aspects of combined assessment were proceeded before and at the end of the trial:①Assessment of symptoms:COPD Assessment TEST (CAT).②Spirometric assessment:FEV1,FEV1％pred,FEV1/FVC.③ Assessment of exacerbation risk:the frequency of exacerbation.④Assessment of comorbidities.Results At the end of the trial,the CAT scores (16.160±4.110) scores,FEV1 (1.174±0.219) L,FEV1％pred(45.480±6.125)％,FEV1/FVC (39.360±5.507)％ were better than before the trail [(19.280±5.103) scores,(1.068±0.224) L,(41.240±5.600) ％,(36.200±5.268)％](P ＜0.001).During the trial,there were 8 cases with once of exacerbation [(0.320 ±0.476) time/24weeks].All of them were pneumonias.The blood pressure or blood glucose of patients with hypertension or diabetes were controlled well by original medicine in spite of salmeterol/fluticasone (50 μg/500 μg).Conclusions The combined assessment of COPD shows the complexity of COPD.It is more integral,reasonable and reliable,compared with the original staging system based upon the FEV1.As the first choice of high risk COPD,LABA/ICS could improve symptoms and pulmonary function,decrease the risk of exacerbation.