A Clinical Research On Airway Hyperreactivity Of Patients With Chronic Obstructive Pulmonary Disease By Applying Atomization Inhalation Of Terbutaline And Budesonide

Background Recently, The morbility and mortality of the Chronic obstructive pulmonary disease(COPD) have an increased tendency year by year in many countries and regions as reasons of smoking, air pollution, infection, job, heredity factors et al. As this reason, there are more and more researches on the mechanism and treatment of COPD.According to the Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2006, It is defined that COPD is a syndrome of chronic and progressive airflow limitation which occurs as a result of chronic inflammation of the airways and lung parenchyma. This disease can be prevented and treated, and the airflow limitation cannot be reversed completely. The pathologic basis of the airflow limitation is the abnormal Inflammatory reaction to the airway which is stimulated by the harmful granules and gas. The cytes effecting the abnormal Inflammatory reaction maybe include the Inflammatory cells and mediators such as neutrophil, lymphocytes and cytokines, macrophages, eosinophile granulocytes, C-reactive protein et al. The disturbance of immunologic function which is caused by the imbalance of T- lymphocyte subsets has important effects on the onset of both COPD and AECOPD. Currently, researches show that asthma maybe one risk factor of COPD, thus, abnormal immunologic mechanisms potentially exist in the patients with COPD. It is definitely that the eosinophile granulocytes have significant role in the airway hyper-reactivity of patients with asthma, it is showed that there is also airway hyper-reactivity(AHR) in the patients with COPD, and the eosinophile granulocytes also play an important effect in the airway inflammation of the patients with COPD.As the progression of the morbility mechanisms of COPD, especiallly the research on the chronic airway inflammation, the treatments on COPD also have progressed. Bronchodilators are the fist choice in treating COPD, especially in controlling the symptoms of the patients. Of course, systemic glucocorticosteroid has clinic efficiency on COPD, however, glucocorticosteroid which is given through intravenous injection or peros usually ineluctably has a lot of side effects. In order to reduce the side effects of glucocorticosteroid, inhaled glucocorticosteroid (ICS) was advanced, it can reach to the target organ quickly, becomes effective fast, and have lower blood drug level, so it is widespread used in clinic. As GCS can enhance the transcription of theβ2-receptors, and can reverse the fall-off of sensitivity, and the resistance, meanwhile, theβ2-receptors can stimulate the glucocorticosteroid receptors(GR), enhance the combination of GCS and GR. Thus, the anti-inflammatory action is strengthened. Researches both in domestic and abroad confirm applying combination of ICS and long actingβ2- agonists (LABA) is more effective than respectively used. The GOLD of 2006 and the Canadian Thoracic Institutes recommend applying combination of ICS and LABA to treat COPD, which is consistent with the guidance of diagnosis and treatment on COPD 2007 in China. Budesonide is a new ICS, which has more anti- inflammation effects, when applied withβ2-agonists together, can retrieve the immunologic imbalance and the airway hyper-reactivity, improve the lung function, raise the life quality, reduce the exacerbations,and so the combination of inhaling treatment cannot be placed by other methods or medicine, and it has more and more attention.Objective Investigate the effects of inhaling Budesonide and Terbutaline in treating AECOPD through determining the T cell subsets, IL-2, eosinophile granulocyte count, C-reactive protein, lung function, and expand a new pathway of treatment on COPD.Method Forty samples who are hospitalized in our hospital and definitely diagnosed as AECOPD (stage II or III) are randomly divided into two groups, the control group and the treatment group, 20 samples for each other. The control group uses conventional therapy contain antibiotics, doxofylline, apophlegmatisant and antitussive, and the treatment group gets an additional treatment by applying combination of Budesonide suspl (which contains Budesonide 0.25 mg and 0.9% isotonic Na chloride 3ml ) and Terbutaline (which contains Terbutaline 2 mg and 0.9% isotonic Na chloride 3ml), twice a day. The gender, ages, the time of onset all have no statistical difference, the course of the treatments are two weeks. We determining the T cell subsets, IL-2, eosinophile granulocyte count, C-reactive protein, lung function before and after the treatments on both two groups to compare whether the indexes have differences in statistics. Result 1. The level of IL-2 in the peripheral blood of patients with AECOPD was lower than the level of the health group, and the level raised after treatment in both two groups (P<0.05), the level in the treatment group was significantly higher than that in the control group (P<0.05), which has statistical difference. 2. The level of CD3, CD4, CD4/CD8 in both two groups raised after treatment, and the level in the treatment group is obviously higher than that in the control group (P<0.05), but is still lower than that in the health group. 3. Eosinophile granulocyte count increased in the patients with AECOPD, after treatment, the level in the two groups both decreased, and the level in the treatment group is much lower (P<0.05). 4. In the serum of patients with AECOPD, the level of C-reactive protein raised, and it decreased after treatment in both the control group and the treatment group, the later decreased more (P<0.05), but is still higher than that in the health group, which has statistical difference. 5. Compared to the control group, the lung function of the treatment group is improved more obviously after the treatment (P<0.05).Conclusion 1. COPD is a syndrome of chronic and progressive airflow limitation which occurs as a result of chronic inflammation of the airways and lung parenchyma, the inflammatory factors and mediators changed in patients with AECOPD, the level of EOS and CRP raised, atomization inhalation of Terbutaline and budesonide has importants effect in inhibiting the inflammatory factors and mediators and relieve the AHR. 2. Inhaling Terbutaline and Budesonide together can reverse the imbalance of the T cell subsets in the patients with AECOPD, raise the level of IL-2, therefore, can improve the immunological function of the patients. 3. Combination of Inhaling Terbutaline and Budesonide can improve the lung function of AECOPD efficiently. 4. Even though the patients with AECOPD have relieved, the immunological function is stilled inhibited, there is also inflammatory reaction and airway hyper-reactivity, the patients should continue to receive treatment. 5. Atomization inhaling of Terbutaline and Budesonide can cure AECOPD in many ways, such as controlling and preventing the exacerbation of COPD, this teatment has wide clinical perspective.