The Effect Of Ipratrpoium Bromide In The Treatment Of AECOPD

In recent years there has been an increase in prevalence rate and fatalityrate associated with chronic obstructive pulmonary disease (COPD) year byyear and it will become the third leading cause of death worldwide by2020.Each acute exacerbation in patient with COPD will not only speeds up theprogress of course, causes the lung function drops sharply, but also leads to themain factor of the financial burden and the patients died.It is necessary to makeactive treatment on AECOPD to suspend the clinical course as well as cut thecase fatality rate.Because the hyperfunction of cholinergic neuron is the maincomponent of the airflow limitation,anticholinerg become the most commonlyused drugs in COPD.Objective:The aim of this study is to discuss the effect of ipratrpoium bromideinhalation on AECOPD,and to furter verify whether anticholinergic drugs haveanti-inflammatory effect through determining the changes of the before andafter treatment on clinical symptoms, the lung function, cytokines interleukin17(IL-17) and the leukotriene B4(LT-B4) in the serum and the induced sputumof patients with AECOPD.Methods:Selecting48inpatients with the diagnosis for the acute exacerbation ofchronic obstructive pulmonary disease (AECOPD)(the lung functionⅡLeveland Ⅲ Level) in the First Clinical Hospital of Jilin University betweenJanuary2011and october2011.20healthy volunteers who took physicalexamination at examination center in the First Clinical Hospital of jilin Univer-sity were control group.48inpatients were randomized to divide in two groups,namely inhalation group and non-inhalation group, there was no statistical deference in gender and age of patients between two groups.23cases in thenon-inhalation group accepted the routine cure, such as the antibiotics, thedoxofylline injection,the bromine b new glucose injection etc. The course oftreatment was a week.25cases in the inhalation group accepted ipratrpoiumbromide inhaled (500ug+0.9%saline2ml) depending on actuation of highpressure oxygen(Oxygen flow rate between the4L/min and5L/min,15-20minevery time and rinse the mouth after the atomization treatmen) twice daily,onthe bases of above treatment.The course of treatment was a week.There are2research objects could not take medicine regularly,so took leave withoutfinishing the experiment.Clinical symptoms grading, the lung function, thelevel of IL-17and LT-B4in the serum and the sputum were measured forpatients of inhalation group and non-inhalation group before and after treatmentrespectively,and demonstrated whether there was statistics difference of eachindex between two groups.Results：1. Before the treatment, the patients’ condition in the non-inhalation groupand inhalation group were no statistical deferences （p>0.05）.After thetreatment the symptom and sign score decreased significantly in two groups（p<0.01）, and the inhalation group reduced more（p<0.01）.2. Compared with the control group,the lung function index（FEV1,FVCand FEV1/FVC）in non-inhalation group and the inhalation group decreased（p<0.01）and was considered to be of significance.There was no significantdifference （p>0.05）in the lung function index in non-inhalation group and theinhalation group before the treatment respectively. After the treatment the lungfunction index increased significantly in two groups（p<0.01）, and theinhalation groupincreased more（p<0.05）.3. The sputum in healthy crowd is scarce, so the IL-17can’t be detected. Before the treatment, the level of IL-17in serum and sputum has no significantdifference in non-inhalation group and the inhalation group（p>0.05）. Theleveal of IL-17in serum was higher than in sputum（p<0.05）. Compared withthe control group,the leveal of IL-17in serum in non-inhalation and theinhalation group increased significantly（p<0.05）and was considered to be ofsignificance．After the treatment the level of IL-17in serum and sputumdecreased significantly in two groups（p<0.05）, and the inhalation groupreduced more（p<0.05）.4. The sputum in healthy crowd is scarce, so the LT-B4can’t be detected.Before the treatment, the level of LT-B4in serum and sputum has no significantdifference （p>0.05）. The leveal of LT-B4in sputum was higher than in serum（p<0.05）. Compared with the control group,the leveal of LT-B4in serum inthe non-inhalation and the inhalation group increased significantly（p<0.05）andwas considered to be of significance.After the treatment the level of LT-B4inserum and sputum decreased significantly in two groups（p<0.05）, and theinhalation group reduced more（p<0.05）.5. There was a significantly negative correlation between the level ofIL-17, LT-B4in serum, sputum and FEV1,FEV1/FVC respectively (p<0.05).Conclusion:1. Inhaled ipratrpoium bromide can relieve clinical sysmptoms moreeffectively, improve lung function such as FEV1、FVC and FEV1/FVC. It canlessen airway obstruction and excessive gas filing and improve laborendurance.2. There was a significantly negative correlation between the level ofIL-17, LT-B4in serum, sputum and FEV1,FEV1/FVC respectively.3. IL-17and LT-B4involved the inflammation process of COPD. Sodetecting the change of the leveal of IL-17and LT-B4can be used as the index about the condition and the treatment in patients.4. Ipratrpoium bromide has potential anti-inflammatory effect, but thespecific mechanism needs further study.