COPD患者使用噻托溴铵吸乐装置转换为能倍乐装置的效果研究

Effect of Switching Tiotropium Handi Haler to Respimat Soft Mist Inhaler in Patients with Chronic Obstructive Pulmonary Disease

目的:评估慢性阻塞性肺疾病(COPD)患者吸入噻托溴铵由吸乐装置转换为能倍乐装置的影响。方法:以2016年3月至2016年8月使用噻托溴铵吸乐装置的42例COPD患者为研究对象。观察由噻托溴铵吸乐转换到能倍乐前及转换后4周、8周症状评分,药物相关不良事件,肺功能和对吸入装置评价。结果:转换装置后36例患者完成8周的随访。平均FEV1转换前、转换后4、8周分别为(1.09±0.43)L,(1.12±0.39)L和(1.13±0.40)L,无统计学差异。除了咳嗽,由吸乐转换为能倍乐后在咽部不适、排尿困难、声嘶、口干等方面无明显差异。转换后4周6例患者吸入能倍乐出现咳嗽;继续吸入能倍乐后5例咳嗽得到缓解;关于吸乐使用步骤中最难操作的是缓慢深吸入,其次是屏气;而能倍乐最难操作的是按下药物释放按钮并同时缓慢深吸气,其后是屏气10秒、打开防护套装入药瓶和装好防护套。大多数患者认为两种装置都容易使用,但28例倾向选择能倍乐装置。结论:从吸乐转换到能倍乐是容易、安全的,两者疗效相似,但转换为能倍乐早期容易引起咳嗽。

Objective：The aim of this study is to assess the effect of switching from tiotropium Handi Haler to Respimat in patients with chronic obstructive pulmonary disease（COPD）. Methods：42 patients with COPD who received 18μg of tiotropium delivered by the Handi Haler once daily were enrolled in the study from Mar 2016 to Aug2016. Symptoms,adverse events,pulmonary functions and usability of inhaler devices were assessed before and 4weeks,8 weeks after switching from Handi Haler to 5 μg of tiotropium delivered by the Respimat. The usability of inhaler devices was scored using a 12-step checklist. Results：36 cases were followed until 8 weeks after switching. The median FEV1（forced expiratory volume in 1 sec）values before and 4 weeks,8 weeks after switching to Respimat were（1.09±0.43）L,（1.12±0.39）L and（1.13±0.40）L,respectively,and there was no significant difference. There was not different about adverse events except cough. Cough just after inhalation was observed in 6 cases until 4 weeks after switching,one case until 8 weeks. Regarding the handling of inhaler devices,patients were not good at taking a slow and deep breath and holding breath for at least 5 sec with Handi Haler,Pushing the dose-release button while taking a slow deep breath,holding breath for at least 10 sec and installing the medicine bottle with Respimat. In general,both inhalers were considered to be easy to use. However,most patients preferred to use Respimat. Conclusion：There is no major problem in switching from tiotropium Handi Haler to Respimat. Respimat and Handi Haler show similar effects and usability. However,we should be aware of cough just after inhalation with Respimat.