Although home nebulizers are widely used to deliver bronchodilator medication to patients with asthma and chronic obstructive pulmonary disease (COPD), the long-term benefits and hazards are unknown. The present authors have previously reported a prospective 12-month study of home nebulizer use involving 49 patients (15 asthma, mean forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) 1.3/2.1 1; 34 COPD, mean FEV1/FVC 0.7/1.8 1). Thirty-two of these patients were treated with long-term domiciliary nebulized bronchodilator treatment, the other 17 patients chose metered dose inhaler (MDI) therapy. The present paper reports the progress of these patients over 5 yr. Five-year survival was similar in both groups (nebulizer users 56%, MDI users 53%). Most deaths were due to respiratory failure (14 deaths) or lung cancer (four deaths). Survival was determined mainly by FEV1 (R = 0.54, P = 0.0001) and age (R = -0.47, P = 0.0007). Laboratory lung function tests (16 nebulizer users) showed that FEV1 and FVC were still higher than pre-nebulizer baseline measurements after 36 months of nebulizer use, but PEFR had fallen by 7%. Twenty-one of 23 surviving nebulizer users completed a questionnaire after 36 months of treatment. All used their nebulizer at least once per day and 20 of 21 patients reported that they still obtained full benefit from each nebulized treatment. The morning peak flow response to nebulized treatment was the same at baseline and at 36 months (48 1 min-1). All patients remained breathless (mean subjective score 4.8 on seven-point scale) but the subjective response to nebulized treatment was unchanged at 36 months. Tachyphylaxis did not develop among 13 patients who underwent repeated reversibility studies using 200 micrograms of salbutamol at 6, 12 and 36 months. It is concluded that home nebulizer therapy is safe and effective for a small number of carefully selected patients with severe asthma or COPD, who have been evaluated by a rigorous home nebulizer assessment protocol prior to commencing home nebulizer therapy.

译文

尽管家用雾化器广泛用于向哮喘和慢性阻塞性肺疾病 (COPD) 患者提供支气管扩张剂药物,但其长期益处和危害尚不清楚。本作者先前报道了一项涉及49例患者的家庭雾化器使用的前瞻性12个月研究 (15例哮喘,1 s/强制肺活量 (FEV1/FVC) 1.3/2.1 1; 34例COPD,平均FEV1/FVC 0.7/1.8 1)。其中32例患者接受了长期家庭雾化支气管扩张剂治疗,其他17例患者选择了定量吸入器 (MDI) 治疗。本文报告了这些患者超过5年的进展。两组的五年生存率相似 (雾化器用户56%,MDI用户53%)。大多数死亡是由于呼吸衰竭 (14例死亡) 或肺癌 (4例死亡)。生存率主要由FEV1 (R = 0.54,P = 0.0001) 和年龄 (R = -0.47,P = 0.0007) 决定。实验室肺功能测试 (16位雾化器使用者) 显示,在使用雾化器36个月后,FEV1和FVC仍高于雾化器前的基线测量值,但PEFR下降了7%。在治疗36个月后,23名幸存的雾化器使用者中有21名完成了问卷调查。所有人每天至少使用一次雾化器,21名患者中有20名报告说,他们仍然从每次雾化治疗中获得了全部收益。在基线和36个月 (48 1 min-1) 时,对雾化治疗的晨峰流量反应相同。所有患者均保持呼吸困难 (平均主观评分以7分制4.8),但对雾化治疗的主观反应在36个月时没有变化。在6、12和36个月时,使用200微克沙丁胺醇进行了反复可逆性研究的13例患者中没有出现速激肽。结论家庭雾化器治疗对于少数精心挑选的重度哮喘或COPD患者是安全有效的,这些患者在开始家庭雾化器治疗之前已经通过严格的家庭雾化器评估方案进行了评估。

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