| ObjectObserve the clinical efficacy of tiotropium bromide inhalation (sunny-speed music) in the treatment of moderate to severe chronic obstructive pulmonary disease (COPD) in stable stage and their efficacy in those patients based on bronchodilation test results.MethodsThe64patients, with moderate to severe chronic obstructive pulmonary disease in stable stage in Zhengzhou University First Affiliated Hospital of respiratory outpatients period from September in2010to September in2011were enrolled, with38cases of male patients,26cases of female patients and aged45-76years. All patients must met the following criteria:①oderate to severe chronic obstructive pulmonary disease in stable stage was diagnosed according to the Global Initiative of Chronic Obstructive Pulmonary Disease.②Without a history of acute onset and antibiotics within two weeks,③No oral or inhaled glucocorticoid adiminstration within one month,④o using of long-acting bronchodilators at least for two weeks and no short-acting bronchodilators for48h. Exclusion criteria:①A history of bronchial asthma,②No other severe disease in addition to chronic obstructive pulmonary disease.③istory of pneumonectomy,④ith narrow angle glaucoma,⑤ith symptoms and signs of with acute exacerbation of chronic obstructive pulmonary disease cough, sputum. Lung function, bronchodilation test and exercise tolerance was evaluated in64case by spirometer.Patients were divided into two groups, defined as bronchodilation test positive and bronchodilation test negative group. The two groups of patients were treated with thiophene tiotropium powder for inhalation18ug, per day. After12weeks of treatment, the changes of lung function, exercise tolerance and dyspnea degree in the two groups of patients were studied.Lung function was observed as:force expiratory volume in one second (FEV1), the percentage of FEV1percentage of Predicted value (FEV1%), forced vital capacity (FVC), the percentage of FEV1percentage of forced vital capacity (FEV1/FVC).Exercise tolerance was assessed by6minutes walk distance (6MWT).The degree of dyspnea was evaluated by British Medical Research Council (MRC) dyspnea grading:0. not troubled with breathlessness except with strenuous exercise.1. troubled by shortness of breath when hurrying or walking up a slight hill,2. walks slower than people of the same age due to breathlessness or has to stop for breath when walking at own pace on the level.3. stops for breath after walking about100m or after a few minutes on the level.4. too breathless to leave the house or breathless when dressing or undressing.The data were analyzed using SPSS17.0statistical software, the measurement data were expressed as x±s, and analyzed using t test, the technical information analyzed using x2test. P<0.05indicated a statistically significant difference.Result1. The positive bronchodilation test group:lung function before and after application tiotropium bromide inhalation treatment were FEV1pre-treatment was1.10±0.96liter, post-treatment was1.42±1.03liter, with significant difference between them (t=3.362, P=0.028, P<0.05). FVC pre-treatment was2.37±0.27liter, post-treatment was3.24±0.26liter, with significant difference between them (t=4.190, P=0.008, P<0.05). FEV1%pre-treatment was42.08±3.64%, post-treatment was57.68±3.20%, with significant difference between them (x2=3.503, P=0.023, P<0.05), FEVi/FVC pre-treatment was51.62±6.06%, post-treatment was55.84±6.50%, with significant difference between them (x2=4.041, P=0.035, P<0.05). The lung functions were significantly improved after treatment in bronchodilation positive group is different.2.6MWT pre-treatment was165.00±17.63meter, post-treatment was222.00±11.89meter, with significant difference between them (t=3.017, P=0.039, P<0.05). Dyspnea index pre-treatment was3.20±0.37, post-treatment was0.8±0.43, with significant difference between them (t=9.78, P=0.001, P<0.05).2.The negative bronchodilator test group:lung function before and after application tiotropium bromide inhalation treatment were FEV1pre-treatment was1.40±0.31liter, post-treatment was1.628±0.27liter, with significant difference between them (t=3.094, P=0.021, P<0.05). FVC pre-treatment was2.56±0.33liter, post-treatment was2.91±0.32liter, with significant difference between them (t=2.88, P=0.028, P<0.05).FEV1%pre-treatment was45.81±5.24%, post-treatment was56.57±7.20%, with significant difference between them (x2=2.617, P=0.04, P<0.05). FEV1/FVC pre-treatment was51.62±6.06%, post-treatment the was55.84±6.50%, with significant difference between them (x2=2.72, P=0.035, P<0.05). The lung functions were significantly improved after treatment in bronchodilation negative group is different.6MWT pre-treatment was147.28±30.17meter, post-treatment was184.42±36.11meter, with siginificant difference between them (t=3.12, P=0.021, P<.05). Dyspnea index pre-treatment was3.14±0.28, post-treatment was1.57±0.36, with significant difference between them (t=7.78, P=0.001, P<.05).3. After treatment, the efficacy of the difference between the two groups was analyzed by the difference before and after treatment, with two independent samples t-test analysis, P<0.05different was significant. The efficacy of FEV1after treatment, t=1.328, P=0.214, no significant difference. In FVC, t=2.475P=0.037,P<.05, have a statistically significant difference. The efficacy of FEV1%after treatment, x2=2.694 P=0.027, have a statistically significant difference. In FEV1/FVC, χ2=2.3369, P=0.049, P<0.05, have a statistically significant difference.6MWT and dyspnea index, the efficacy after treatment, t=3.591, P=0.014and t=2.61, P=0.029, both have a statistically significant difference.Conclusion1. In patients with stable moderate to severe chronic obstructive pulmonary disease after treatment with tiotropium bromide powder for inhalation, lung function, exercise tolerance, dyspnea index were significantly improved.2. The therapeutic effect and lung functions in the bronchodilation test positive group were significantly better those in the bronchodilation test negative group.3. Tiotropium is recommended in the treatment of moderate to severe stable chronic obstructive pulmonary disease in dilation test-positive patients. |
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