Research On The Change Of Micro-Ecological Flora On Oropharynx And SIgA And Lysozyme Levels In Sputum Of Chronic Obstructive Pulmonary Disease Patients In Remission Period After Combined Inhalation Of Salmeterol/Fluticasone

Objective To explore the effects of long-term combined inhalation of Salmeterol /Fluticasone at 50/500μg on the normal flora on oropharynx and the concentration of SIgA and Lysozyme in sputum of chronic obstructive pulmonary disease patients.Method 33 COPD patients in remission period who would voluntarily receive long-term combined inhalation of Salmeterol/Fluticasone were chosen by random.Subjects stayed for clearance 2 weeks before sampling and regularly inhaled Salmeterol/ Fluticasone at 50/500μg, twice daily. The experiment lasted for 32 weeks. Follow-up were taken in week 2,8 and 32. Natural salivary vomiting method was adopted to take the patients’sputum and swab was used to cultivate bacterium. BioMerieux API System was used to qualitatively analyze the variety and quantity of oropharynx flora. Microplate Reader SpectraMax 340PC was used to detect the concentration of SIgA and Lysozyme in sputum. Comparison of the change of micro-ecological indexes (flora variety, flora diversity and dominant flora) on the COPD patients’oropharynx and SIgA and Lysozyme concentration in sputum before and after usage of medicine and different period after usage. To explore and analyze the effects of combining inhalation of ICS-LABA on the patients’upper respiratory micro-ecology and mucosa immunity.Result Streptococcus viridans and Neissiria were the main dominant flora of chronic obstructive pulmonary disease patient oropharynx flora with a detection rate of 100%. Comparison by Fisher Exact Probability Method of follow-ups taken 2,8and 32 weeks after treatment showed that the detection rate difference of dominant flora streptococcus viridans had no statistical meaning. Fisher Exact Probability valued 0.4485 respectively, X2 valued 2.713 respectively, P>0.05. Detection rate of Neisseria sicca was different, with Fisher Exact Probability value of 0.0023 respectively, X2 value of 9.5095 respectively, P<0.05. Detection rate of fungus from each group after combined inhalation of Salmeterol/Fluticasone had no statistical meaning. Constituent ratio of streptococcus viridans and Neisseria was tested repeatedly. X2 examination variation showed that Neisseria constituent ratio on the 3 time points in the COPD experimental group had no difference, with X2 value of 2.70 respectively, P>0.05. Streptococcus viridans constituent ratio on the 3 time points in the COPD experimental group was different, with X2 value of 9.06 respectively, P<0.05, out of which, follow-ups in week 2 and week 32 were different (P<0.05). Comparison of oropharynx dominant flora 8 weeks and 32 weeks after treatment:streptococcus viridans constituent ratio further raised, P<0.05. Flora diversity of the COPED experimental group didn’t change significantly on the 3 time points (P>0.05). SIgA content in sputum reduced differently 2 weeks and 32 weeks after inhalation of Salmeterol/Fluticasone,P<0.05. Further reduction occurred 8 weeks and 32 weeks after inhalation, P<0.05. Lysozyme content remained the same as that after 8 weeks of inhalation. Lysozyme raised till 32 weeks after treatment, P<0.05.Conclusion Compared the 3 times follow-up results,when COPD subjects received treatment of combined inhaled corticosteroids and long-acting beta2 agonist, the research found that Streptococcus viridans and Neissiria were still the main flora of subjects oropharynx flora, and the pathogenic bacterial is little in bacterial-culture. Meanwhile we found Candida abicans were also in subjects oropharyxn, but there is no syndrome of Candida infection, so we thought these were bacterial parasite. In the oropharynx of COPD, the bacterial quantities、species、diversity and main flora were no much difference between the 3 times dectection. It’s suggested that regularly combined inhalation of Salmeterol/Fluticasone 50/500μg is no much effect on the oropharynx micro-ecology. From this research, we found that combined inhalation of corticosteroids and long-acting beta2 agonist, especially inhaled coticosteroids had some effects on the sputum SIgA and lysozyme, however, the oral infection of Candida albicans is also low. So far as the status, GOLD suggest that combined inhalation of corticosteroids and long-acting beta2 agonist for the oropharynx micro-ecology of COPD is relative safety.