The Clinical Study Of The Treatment By Seretide Combined With Tiotropium In Patients With Asthma-COPD Overlap

Objective: To investigate the clinical efficacy and safety of seretide combined with tiotropium in the treatment of asthma-COPD overlap.Methods: 80 patients with asthma-COPD overlap were randomly divided into two groups.There were 40 patients with an average age of 65.5±5.2 years old(range: 55 to 85 years old)in the observation group,which involved 26 males and 14 females.There were 40 patients with an average age of 67.3±4.5 years old(range: 57 to 83 years old)in the control group,which involved 25 males and 15 females.Before the treatment,the patients of two groups have no statistically significant differences in age and sex composition(P>0.05).Meanwhile,the recorded observation indicators of the patients have no statistically significant differences in ACT score?CAT score?mMRC grade?lung function test?blood eosinophil counts?percentage of eosinophils in induced sputum and FeNO(P>0.05).The observation group was treated with seretide 50ug/250?g inhaled 2 times a day and tiotropium 18?g inhaled 1 time a day.The control group was treated with seretide 50ug/250?g inhaled 2 times a day only.After three monthes,patients were recorded the changes about ACT score?CAT score?mMRC grade?lung function test?blood eosinophil counts?percentage of eosinophils in induced sputum?FeNO and complications in the two groups beforce and after treatment.Results:(1)Before treatment,the ACT score(12.9±7.2)? CAT score(31.6±6.2)?mMRC grade(2.7±0.7)of the patients in observation group had no statistically different from those containing the ACT score(13.4±4.3)?CAT score(32.1±5.7)?mMRC grade(2.5±0.9)in control group(P>0.05).After treatment,the ACT score(21.8±3.4)of the observation group was increased by 69.0%,and the differece was statistically significant(P<0.05).At the same time,the ACT score(18.6±2.1)of the control group was increased by 38.8%,and the differece was statistically significant(P<0.05).Obviously,the ACT score was significantly higher after treatment than that in control group,and the differece was statistically significant(P<0.05).After treatment,the CAT score(17.8±1.5)?mMRC grade(1.4±0.5)of the observation group were reduced by 43.7%?48.1%,and the differece was statistically significant(P<0.05).At the same time,the CAT score(22.7±6.3)?mMRC grade(1.9±0.6)of the control group were reduced by 29.3%?24.0%,and the differece was statistically significant(P<0.05).Obviously,the CAT score and mMRC grade were significantly lower after treatment than those in control group,and the differece was statistically significant(P<0.05).(2)Before treatment,the FEV1(1.04±0.26)L?FEV1%pred(46.6±5.4)%?FEV1/FVC(52.8±4.6)% of the patients in observation group had no statistically different from those containing FEV1(1.07±0.21)L?FEV1%pred(47.5±7.6)%?FEV1/FVC(53.4±7.3)% in control group(P > 0.05).After treatment,the FEV1(1.42 ± 0.38)L ?FEV1%pred(63.4±6.7)%?FEV1/FVC(62.5±3.8)% of the observation group were increased by 36.5%?16.8%?9.7% and the FEV1(1.30±0.41)L?FEV1%pred(58.1±6.5)%?FEV1/FVC(58.6±7.2)% of the control group were increased by 21.5%?10.6%?5.2%.There was statistically significant difference between before treatment and after treatment(P<0.05).Obviously,FEV1?FEV1%pred and FEV1/FVC were significantly higher after treatment than those in control group,and the differece was statistically significant(P<0.05).(3)Before treatment,the blood eosinophil counts(0.36±0.06)*10^9/L?percentage of eosinophils in induced sputum(7.30±0.94)%?FeNO(46.5±9.2)ppb of the patients in observation group had no statistically different from those containing the blood eosinophil counts(0.31±0.03)*10^9/L?percentage of eosinophils in induced sputum(6.98±1.52)%?FeNO(45.7±9.4)ppb in control group(P>0.05).After treatment,the blood eosinophil counts(0.22±0.05)*10^9/L?percentage of eosinophils in induced sputum(3.52±1.16)%?FeNO(23.8±6.3)ppb of the observation group were reduced by 38.8%?3.78%?48.8%,and there was statistically significant difference between before treatment and after treatment(P<0.05).The blood eosinophil counts(0.18±0.09)*10^9/L?percentage of eosinophils in induced sputum(3.03±0.87)%?FeNO(24.2±7.1)ppb of the control group were reduced by 41.9%?3.95%?47.0%,and there was statistically significant difference between before treatment and after treatment(P<0.05).But there was no statistically significant difference between the two groups(P<0.05).(4)As for the complications,there were 5.0% patients with thirst and 2.5% patients with hoarseness in observation group,while 2.5% patients with hoarseness and 2.5% patients with palpitation in control group.There was no statistically significant difference between the two groups(P<0.05).Conclusion:(1)The using of seretide combined with tiotropium and the using of seretide only can both improve the symptoms and pulmonary function,and can reduce the blood eosinophil counts?percentage of eosinophils in induced sputum?FeNO of ACO.(2)But compared with the seretide only,the seretide combined with tiotropium can much more effectively improve the symptoms and lung function.(3)The combination of two drugs may have a synergistic and complementary effect,and the rate of adverse reactions between two groups is similar.It could be a effective and safe treatment.