Comparing With The Efficacy And Safety Between Inhalating Salmeterol/Fluticasone50/250ug And50/500ug In Elderly Patients With Moderate To Severe Stable COPD

【Objective】The aim of this study to find the best optimal dosage of inhalating salmeterol/fluticasone50/250ug or50/500ug among elderly patients with stable COPD by comparing with the efficacy and safety. Collecting the datas to provide evidence for the medicine of clinical reasonable medication among elderly patients.[Methods]64elder cases which was diagnosed moderate to severe COPD in inpatient or outpatient from2010August to2011April in cadre medical department of first hospital of Kunming Medical University were included in this analysis. Randomized to receive either SAL/FP50/250ug or SAL/FP50/250ug twice daily for36weeks. We compared the the results which including post-bronchodilator FEV1and Cytokines of TNF-a,IL-6and IL-8before treatment and during the12th week,24th week and36th week, and also compared the the results SGRQ and the BMD of L1-4between before treatment and after, not noly between groups, but also within groups. The proportion of patients with COPD related healthcare events in the subsequent36weeks were calculated too.【Results】1. Multivariate analysis showed that TNF-a, SGRQ, SI was a significant positive correlation and L1was a significant negative correlation with FEV1.2. Afert treatment the levels of TNF-a, IL-8, IL-6decreased within those two groups (p<0.05), TNF-a decreasd greately in SAL/FP50/500ug group than SAL/FP50/250ug group (p<0.05).3. The levels of FEV1increased in two group (p<0.05), subgroup analysis results show that the FEV1increased highly in moderate patients who use SAL/FP50/250ug(p<0.05), but severe not(P>0.05).4. SGRQ score decreased in two groups after treatment (P<0.05).5. Severe COPD patients have lower BMD than moderate before treatment (P<0.05), Comparing with the BMD had no significant decreased between before treatment and after (P>0.05) and the BMD had no significant decreased between SAL/FP50/250and SAL/FP50/500(P>0.05).6. Comparing between the two group, the times of AECOPD, pneumonia, discomfort with oropharyngeal and upper respiratory tract infection incidence had no significant difference (P>0.05), but SAL/FP50/500ug group had highly rates of hoarseness and oropharyngeal candidiasis infection (P<0.05).【Conclusion】 Analys the result of inhalating Salmeterol/Fluticasone50/250ug and50/500ug, we find that SAL/FP50/250ug or SAL/FP50/500ug can improving lung function and health related quality of life and decreased the inflammatory cytokines such as TNF-a, IL-8, IL-6during the36weeks. But SAL/FP50/500ug is more effective to decreased the inflammatory Cytokines of TNF-a and improving lung function than SAL/FP50/250ug. At the some times, those two differet doses of SAL/FP dose not increase the risk of osteoporosis by compared with BMD of L1-4between before treatment and after. But the adverse reaction could be increasing in SAL/FP50/500ug compared with SAL/FP50/250ug. In conclusion, inhalating SAL/FP50/500ug is more effective than SAL/FP50/250ug in treatment among elderly Patients with moderate to severe stable COPD.