Clinical Curative Effect Of Tiotropium Bromide Powder For Inhalation On The Stable Bronchiectasis Patients

1. Backgroud and ObjectivesBronchiectasis is a chronic airway disease characterized bySexual and non-reversible destruction and expansion of airway. Because of persistent bronchial inflammation, In some patients, there may be reversible airflow obstruction and airway hyper-responsiveness, Manifested as wheezing, breathing difficulties and cyanosis, thus affecting the quality of life. Because of the application of antibiotics, tuberculosis control and other reasons, The incidence of bronchiectasis once reduced.But in recent years, many different study of global scholars shows, The incidence in recent years has increased, It has become an important health issueControl infection, expectoration, stop bleeding,and other measures are the maijor treatment for Bronchiectas, Short course of antibiotic therapy can effectively control the branch expansion phase of acute exacerbation of airway inflammation,but have little effect to chronic airway inflammation.Study showed that the airway infection, inflammation, and a variety of inflammatory in Bronchiectasis activity increased significantly, and those three pathological factors Long-term existed, interaced, would created a vicious cycle and induced airway injury, With the extension of disease course, the damage of Bronchiectasis on the human body became more and more heavier. Now varies treatment have been studied to treat bronchiectasis,especially to stable bronchodilation. Among them, Using bronchodilators,Inhaling steroid,Long-term low-dose oral roxithromycin and other treatments have made some progress to control the chronic airway inflammation and the clinical symptoms.Tiotropium bromide is a novel selective M3 receptor antagonist, Its role is not only limited to expansion of the bronchi, but also plays a role in the regulation of airway inflammation and remodeling. Large clinical trials confirmed that Long-term regular using tiotropium bromide could significantly sustained improve the stable COPD patients' lung function, reduce dyspnea on exertion,markedly improve exercise tolerance, improve the quality of life. Chronic airway inflammation and airflow limitation also exist in Bronchiectasis patients, but now there are little clinical observation can proved that Long-term regular using tiotropium bromide in these patients can get the same effect. This research will Select patients with stable bronchiectasis, through observing the patients with dyspnea score, BODE index, symptom score and other indicators, Preliminary study the efficacy of patients with stable bronchiectasis treated by tiotropium bromide inhalation powder。Try to offer research basis for the new treatment of bronchiectasis.2. Objects and Methods:2.1 ObjectsThe study enrolled patients with stable bronchiectasis in Pingxiang People's Hospital Respiratory during 2008-10～2009-11.2.2 Diagnostic criteria, inclusion and exclusion criteriaInclusion criteria:1,Patients corresponding to the diagnostic criteria in stable bronchiectasis; 2,Between the ages of 18-80 years oldDiagnostic criteria:1. Chronic cough, a large number of Nong Tan, or a history of repeated hemoptysis, pulmonary lesions are moist rale, or clubbing;2. Chest X-ray showed lung markings in the rough chaos there are multiple irregular ring translucent shadow or curl-shaped shadow along the bronchial;3. Chest CT showed Bronchial wall thickening of the columnar expansion or clusters clusters of cystic change;4. Bronchography or high-resolution CT (HRCT) showed cystic expansion, columnar, columnar bronchial cyst shadow the patient should be diagnosed by at least one of 1 and 2-4 itemsStable:Cough, sputum, shortness of breath and other symptoms stable or almost disappeared.Exclusion criteria:1. During pregnancy or breast-feeding women.2. patients who are hypersensitive to Tiotropium bromide inhalation powder agents and auxiliary materials.3.patients With severe liver and kidney function abnormal.4. patients who can not follow-up.Termination Test:Those who can not continue medication because of side effects;patients who are unwilling to continue medication because of poor efficacy; patients unwilling to participate in the experiment because of his own factors, and end of the experiment; And other factors have led to end of the experiment.2.3 Experimental MethodsChoose the case which are met the inclusion criteria and without exclusion criteria. Each patient was treated with tiotropium bromide inhalation powder(maded in jiangsu chia tai-tianqing pharmaceutical co., ltd, State medicine accurate H20060454). everyday inhale one time with 18ug, A total of 4 weeks.If there are Acute exacerbation give the conventional anti-inflammatory, expectorant treatment,while continue the same treatment.2.4 Outcome measuresIncluding the lung function and the BODE index(including FEV1%,6MWD, BMI,MMRC) and symptom score.2.5 Statistical treatmentThe results were analyzed by SPSS13.0.measurement data would be presented as means±SD, and t test was conducted for comparison between the two groups. P values< 0.05 were considered significant.3.Results3.1 general conditions of patients22 patients were included, Including 12 males and 10 females, The age between 39 to 79 years, Age 60.45±12.86, Body weight 51.80±9.44kg, Height 1.61±0.10m, Body mass index (BMI) 19.81±1.98. Three cases of normal lung function, four cases of obstructive ventilation dysfunction, two cases of restrictive ventilation dysfunction, thirteen patients with mixed ventilation dysfunction. FEV1 (L) 1.63±0.78. 3.2.1 Analysis, FVC,FEV1%,FEV1/FVC which Responsed the indicators of lung function have increased after treatment,but no statistically significant difference (P>0.05),but FEV1,MVV% have increased after treatment,and difference have Statistically significant (P<0.05), This may be different from the changes in different lung function, need continue to increase sample size and extend observation time for further analysis.3.2.2 Analysis,6MWD,BOED,symptom scores which responsed the indicators of patients symptom reduced, have Statistically significant (P<0.05)4.ConclusionsTiotropium bromide Powder for Inhalation which could significantly improved the symptom score and BODE index of the stable bronchiectasis patients. but lung function have no significant change,the clinical curative effect which needs to be further expolred with Large sample, long time experiment.