| Background: A chronic obstructive pulmonary disease (COPD) has been ranked thefourth cause of death in the world. In2020, COPD may become one of the top fiveeconomic burdens of disease. Studies have shown that the majority of COPD incidence inour country is those over the age of40with a prevalence rate of8.2%. Many patients withCOPD manifested significantly reduced pulmonary function, impaired ambulatory ability.Those may lead to great threat to their healthy life and become a heavy burden to theirfamilies as well as to the society. Therefore, timely and effective clinical treatment isutmost important and closely related with short-term and long-term prognosis and qualityof patients with COPD.Objective: To observe the effect of dry power inhalation with Symbicor turbuhalert or Seretide accuhaler and theophylline tablets in the maintenance treatment of patientswith stable COPD in order to find more effective drugs and optimize the clinical treatmentof COPD.Patients and Method:1. Object of study:186admitted cases with stable COPD were enrolled fromFebruary2012to September2013in Zhangjiagang Hospital of Traditional ChineseMedicine. The diagnosis was based on history taking, clinical assessment, physicalexamination, chest X-ray examination and pulmonary function analysis. All the patientsmet the diagnostic criteria of COPD in the guideline released by the Respiratory DiseaseSociety of Chinese Association in2011.2. Research Methods:186cases of COPD were randomly divided into three groups:Symbicor turbuhaler group, Seretide accuhaler group and aminophylline group, Thedosage in Symbicor turbuhaler group was160micrograms/4.5micrograms Symbicor turbuhaler per inhalation,2whiff every time，twice a day.In Seretide accuhaler group, thedosage used was50micrograms/250micrograms Salmeterol Xinafoate and FluticasonePropionate1whiff every time twice a day. In Aminophylline group, the patients tookaminophylline tablets100—200mg every time,3times a day.3.Outcome evaluation: Before and after6months of treatment,forced expiratoryvolume in1s(FEV1) forced vital capacity(FVC) inspiratory capacity(IC) forcedexpiratory volume in one second to forced vital capacity ratio(FEV1%) and other lungfunction parameters were measured.Transient dyspnea index were used to evaluate theseverity of dyspnea.St.George’Hospital Respiratory Questionnaire was used to assess theQuality of Life of the patients;Exercise endurance was measured using6-minute walk test.4. Statistical Methods: Measurement data as mean±standard deviation (±S) saidthat the count information to patients and percentage (%) said.The data were analyzedusing SPSS software version15.count data taken using χ2test, measurement data taken ttest comparison among groups take F test,P <0.05was statistically significant as standard..Results:1. No statistical difference was found in gender, age, body mass index, smoking status,IC, FEV1,FVC，FEV1%and6MWD among the three COPD groups(P>0.05).2. After6months of treatment, the IC of the COPD patients in Symbicor turbuhalergroup increased from (1.74±0.55) L to (2.23±0.61) L; FEV1increased form (0.96±0.44)L to (1.12±0.46) L and FVC from (2.21±0.78) L at baseline to (2.49±0.82) L，andFEV1%increased from（40.02±0.41）%to（50.13±0.49）%Differences with statisticallysignificance were found before and after treatment (P <0.05).3. In Seretide accuhaler treated COPD group, IC increased from (1.71±0.51) L to(2.19±0.59) L, FEV1from（1.08±0.33）L to（1.19±0.49）L, and FVC from (2.22±0.81)L to (2.51±0.91) L，and FEV1%increased from（39.53±0.38）%to（48.32±0.43）%Significant difference was found between pre-treated group and post-treated group withSeretide accuhaler (P <0.05).4. In aminophylline treated group, IC increased from (1.73±0.52) L before treatmentto (2.02±0.59) L after six-month treatment with significant statistical difference (P <0.05).FEV1rose from (1.03±0.31) L at baseline to (1.05±0.37) L after6months of treatment;FVC increased from (2.19±0.82) L before treatment to (2.23±0.85) L，and FEV1% increased from（41.26±0.36）%to（43.03±0.42）%However, no statistical differencewas found in FEV1FVC and FEV1%before and after treatment with aminophylline(P>0.05).5. Compared with the baseline level before treatment, the variation of IC in Symbicorturbuhaler group, Seretide accuhaler group and aminophylline group was (0.49±0.17) L,(0.48±0.15) L and (0.29±0.11) L. Significant improvement was found in IC level inCOPD patients treated with Symbicor turbuhaler as well as Seretide accuhaler. Thechanges in FEV1was (0.02±0.01) L in aminophylline group,(0.16±0.09) L in Symbicorturbuhaler group and (0.11±0.06) L in Seretide accuhaler group; The variation of FVCafter treatment was (0.02±0.01) L,(0.28±0.11) L and (0.29±0.14) L in aminophylline,Symbicor turbuhaler and Seretide accuhaler group respectively, The variation of FEV1%after treatment was (1.77±0.09)%,(10.11±0.12)%and (8.79±0.15)%inaminophylline, Symbicor turbuhaler and Seretide accuhaler group respectively, DPI withSymbicor turbuhaler and Seretide accuhaler had significant improvement in IC,FEV1,FVC and FEV1%compared to the theophylline tablet group (P <0.05). But nostatistical significance in variation of IC, FEV1，FVE and FEV1%was was foundbetween the two groups treated with DPI (P>0.05).6. Compared with pre-treatment baseline value, the variation of Transient DyspneaIndex (TDI) was0.34±0.37,0.69±0.39and0.74±0.42after6months of treatment inaminophylline group, Symbicor turbuhaler group and Seretide accuhaler group respectively.The changes in6minute walk distance(6MWD) was (26.04±11.53) meters,(41.95±18.47) meters,(45.86±22.69) meters respectively, Both Symbicor turbuhaler group andSeretide accuhaler group had improvement in TDI and6MWD compared withaminophylline tablet group with significant statistical difference(P<0.05). Same as above,no statistical difference in TDI and6MWD was found between the two groups adoptedDPI with Symbicor turbuhaler and Seretide accuhaler.(P>0.05).7. In evaluation health related quality of life (HRQoL), all three COPD groups treatedwith DPI and aminophylline had improvement in symptom score, impact score, activityscore and total score of the St. George’s respiratory questionnaire after six months oftreatment compared with pre-treatment baseline level; Both Symbicor turbuhalergroup andSeretide accuhaler group had improvement in SGRQ with significant difference comparedwith theophylline tablet group (P <0.05). But no significant HRQoL evaluated by SGRQ was found between two groups using DPI (P>0.05).Conclusion:1In stable COPD cases, treatment with aminophylline may help relieve symptoms ofdyspean, improve exercise endurance and HRQoL, but had limited effect on improvementof lung function.2DPI treatment with Symbicor turbuhaler and Seretide accuhaler in stable COPDpatients could help relieve symptoms, improve lung function and exercise tolerance as wellHRQoL, both had advantage over theophylline sustained release tablets. The effect wasequivalent between Symbicor turbuhaler and Seretide accuhaler dry powder inhalation.3Combined treatments with inhaled corticosteroids and β2agonists can better dilatebronchi and bronchiole; reduce air trapping in different mechanisms. In contrast to oraldrug treatment, dry powder inhalation has direct effect on target organ and may improveefficacy and prognosis and decrease the incidence of adverse systemic effect. |
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