BACKGROUND AND OBJECTIVE:Combining a long-acting muscarinic antagonist with a long-acting β₂-agonist has been shown to be pharmacologically useful in patients with chronic obstructive pulmonary disease (COPD). The aim of the present study was to evaluate the effectiveness of the dual bronchodilator therapy on airway dimensions in COPD. METHODS:Patients (n = 54) were randomly assigned to receive tiotropium (18 μg once daily), indacaterol (150 μg once daily) or tiotropium plus indacaterol for 16 weeks. Quantitative computed tomography (CT), pulmonary function and health status (St. George's Respiratory Questionnaire) were measured. RESULTS:Compared with tiotropium or indacaterol alone, combination therapy resulted in a significant decrease in percentage wall area (WA%) and wall thickness, corrected for body surface area, and an increase in luminal area (Ai/BSA). Concurrent treatment was superior to monotherapy in physiological indices, including forced vital capacity, forced expiratory volume in 1 s (FEV₁) and inspiratory capacity. The changes in WA% and Ai/BSA were significantly correlated with changes in FEV₁ (r = -0.44, P < 0.01 and r = 0.37, P < 0.01). There were more significant improvements in SGRQ scores after treatment with combined therapy than with either treatment alone. CONCLUSIONS:Concurrent therapy with tiotropium and indacaterol is effective for COPD patients to promote reduction in airway wall thickness, bronchodilation, and improvements in lung function compared with a single inhaler.

译文

背景与目的:已证明将长效毒蕈碱拮抗剂与长效β2-激动剂组合在慢性阻塞性肺疾病(COPD)患者中具有药理作用。本研究的目的是评估COPD双重支气管扩张剂治疗对气道尺寸的有效性。
方法:患者(n = 54)被随机分配接受噻托溴铵(每日一次18μg),茚达特罗(每日一次150μg)或噻托溴铵加茚达特罗治疗16周。测量定量CT(CT),肺功能和健康状况(圣乔治呼吸问卷)。
结果:与单独使用噻托溴铵或茚达特罗相比,组合疗法可显着降低壁面积百分比(WA%)和壁厚(校正体表面积),并增加管腔面积(Ai / BSA)。并发治疗在生理指标上优于单药治疗,包括强制肺活量,强制呼气量(1µs)和吸气能力。 WA%和Ai / BSA的变化与FEV₁的变化显着相关(r = -0.44,P <0.01,r = 0.37,P <0.01)。联合疗法治疗后,SGRQ评分的改善比单独的任何一种治疗都更为显着。
结论:与单一吸入器相比,噻托溴铵和茚达特罗的同时治疗对COPD患者有效地促进了气道壁厚度的减少,支气管扩张和肺功能的改善。

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