Study On The Therapeutic Effect Of LAMA On Different TCM Syndrome Types Of COPD In Stable Stage

Objective:To observe the therapeutic effect of tiotropium bromide in the treatment of patients with chronic obstructive pulmonary disease(COPD)of different types of TCM.and to provide clinical basis for syndrome differentiation and treatment of COPD.Methods:196 patients with COPD from December 2018 to November 2019 who met the inclusion criteria were selected as the study objects.According to the diagnostic criteria of TCM syndrome,the subjects were divided into six groups:lung qi deficiency(34 cases).Lung and spleen qi deficiency(35 cases),lung and kidney qi deficiency(34 cases),lung and Kidney Qi Yin deficiency(31 cases),phlegm turbid syndrome(32 cases)and blood stasis syndrome(30 cases).In addition to routine treatment,patients were given tiotropium bromide inhalation treatment.The changes of pulmonary function,dyspnea index,exercise tolerance and quality of life of the patients before and after treatment were observed and analyzed,and the incidence of adverse reactions in the six groups was counted.Results:(1)There was no significant difference in FEV1,FEV1/predicted%and FEV1/FVC among the six groups before treatment(P>0.05).After 6 weeks of treatment,the lung function of 6 groups was no significant difference.there was no significant difference among the six groups(P>0.05).(2)There was no significant difference in mMRC score among the six groups before treatment(P>0.05).After 6 weeks of treatment,the score of mMRC in 6 groups was lower than that before treatment.The lowest scores were found in the lung qi deficiency and Lung and spleen qi deficiency group,and the difference was statistically significant compared with the other groups(P<0.05),but there was no significant difference between the two groups(P>0.05).The second group was lung and kidney qi deficiency group and lung and Kidney Qi Yin deficiency group,and the difference was statistically significant compared with the other groups(P<0.05),but there was no significant difference between the two groups.The scores of the patients in the phlegm turbid syndrome and blood stasis syndrome group were higher(P<0.05).there was no significant difference between the two groups(P>0.05).(3)There was no significant difference in 6-minute walking distance between the 6 groups before treatment(P>0.05).After 6 weeks of treatment,the 6-minute walking distance of patients in 6 groups increased compared with that before treatment.The longest 6-minute walking distance was found in lung qi deficiency group and lung and spleen qi deficiency group(P<0.05),but there was no significant difference between the two groups(P>0.05).The second group was lung and kidney qi deficiency group and lung and Kidney Qi Yin deficiency group(P<0.05),but there was no significant difference between the two groups(P>0.05).The 6-minute walking distance of the patients in the phlegm turbid syndrome and blood stasis syndrome group were minimum(P<0.05),there was no significant difference between the two groups(P>0.05).(4)There was no significant difference in CAT score of 6 groups before treatment(P>0.05).After 6 weeks of treatment,CAT scores of 6 groups were lower than before treatment.The lowest CAT scores were found in the lung qi deficiency group and the lung and spleen qi deficiency group(P<0.05),but there was no significant difference between the two groups(P>0.05).The second group was lung and kidney qi deficiency group and lung and Kidney Qi Yin deficiency group(P<0.05),but there was no significant difference between the two groups(P>0.05).The CAT scores of the patients in the phlegm turbid syndrome and blood stasis syndrome group were highest(P<0.05),there was no significant difference between the two groups(P>0.05).(5)All the patients in the 6 groups had adverse reactions and recovered after treatment.The incidence of adverse reactions was 8.82%in the lung qi deficiency group,11.43%in the Lung and spleen Qi deficiency group,11.76%in the lung and kidney qi deficiency group.9.68%in the lung and Kidney Qi Yin deficiency group,and 9.38%in the phlegm turbid syndrome,10.00%in the blood stasis syndrome group.The incidence of adverse reactions was lower in the six groups,and there was no significant difference in each group(P>0.05).Conclusions:The therapeutic effect of tiotropium bromide is the best in patients with chronic obstructive pulmonary disease of lung qi deficiency and lung spleen qi deficiency.The therapeutic effect of tiotropium bromide is obvious in patients with chronic obstructive pulmonary disease of lung kidney qi deficiency and lung Kidney Qi Yin deficiency.The therapeutic effect of phlegm turbid syndrome and blood stasis syndrome is relatively poor.