临床实践中慢性阻塞性肺疾病加重患者考虑峰值吸气流量的吸入治疗优化

N. V. Sharova, D. V. Cherkashin, A. Sobolev, R. Makiev, S.A. Parcernjak, B.A. Jerdneev
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引用次数: 0

摘要

目的:确定慢性阻塞性肺疾病(COPD)加重期患者选择吸入器时的峰值吸气流量(PIP)值,并评价在实际临床实践中考虑PIP优化吸入治疗的可能性。设计:开放式队列对照前瞻性研究。材料和方法。76人接受了检查。组1纳入32例COPD加重患者,其中18例出院前复查,出院后3个月完成调查。2组15例稳定期COPD患者。第三组包括29名健康个体。使用In-Check DIALTM G16克莱门特克拉克国际有限公司(英国)研究不同吸入器的PIF,固定无阻力水平(R0)和5个阻力水平(R1-R5)。当R0 < 90, R1-R4 < 60, R5 < 30 l/min时,认为PIF (sPIF)值为次优值。在Flowscreen II型肺活量计(Jaeger)上进行肺活量测定,记录流量-体积曲线,计算一般接受的指标,并在PTS-14P-01压力-流速仪上进行肺活量测定,以确定峰值吸气率。统计数据处理使用Statistica v. 10进行。根据Bonferroni原则,当p < 0.005时,差异被认为是显著的。结果。在COPD加重期间,PIF从120 l/min降至40 l/min(与对照组相比p < 0.001),并且根据吸入装置的类型,5-75%的病例存在sPIF(对照组未注意到sPIF)。大多数患者在入院时可自由使用雾化器、计量气溶胶吸入器(MAI)、液体吸入器(Respimat)和呼吸器。47%的患者在使用椭圆时不能产生必要的吸气力,63%的患者使用turbbuhaler, 75%的患者使用nexthaler, 31%的患者使用handdihaler。在治疗过程中,临床和功能动态证明是积极的(FEV1从37% (28;53)至55% (37;62), p < 0.004),识别的变化持续到出院时,未达到稳定期COPD测定的PIF和sPIF值。根据所接受的药物,对实际临床实践中患者的PIF和sPIF进行分析表明,到他们出院时,一半的患者患有sPIF,继续使用涡流吸入器和手吸器,并且无法产生足够的PIF来有效吸入药物。一项对出院后3个月患者的调查显示,PIF值最佳的患者,在使用PPI、Respimat和Breezhaler的帮助下,在指定的时间内没有发作。继续联合使用turbbuhaler和handdihaler的CPIP患者有中度恶化。结论。COPD加重患者基于PIP的吸入治疗优化应包括:1)考虑PIF的直接测定,选择最佳吸入器的可能性;2)用PDI/Respimat或低阻力粉末吸入器(呼吸器,椭圆)替换高阻力粉末吸入器;3)对COPD患者进行正确吸入技术的教育。COPD加重期的PIF测试可以帮助临床医生识别再入院风险较高的患者,并个性化粉末吸入器的选择。关键词:慢性阻塞性肺疾病;吸气流量峰值;吸入疗法;
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Optimization of Inhalation Therapy Considering Peak Inspiratory Flow in Patients with Exacerbation of Chronic Obstructive Pulmonary Disease in Real Clinical Practice
Aim: To determine the values of peak inspiratory flow (PIP) for choosing an inhaler in patients with exacerbation of chronic obstructive pulmonary disease (COPD) and to evaluate the possibility of optimizing inhalation therapy considering PIP in real clinical practice. Design: Open cohort controlled prospective study. Materials and methods. 76 people were examined. Group 1 included 32 patients with COPD exacerbation, 18 of them were re-examined before discharge and completed a survey 3 months after discharge from the hospital. Group 2 consisted of 15 patients with stable COPD. Group 3 included 29 healthy individuals. PIF using various inhalers was studied using the In-Check DIALTM G16 Clement Clarke International Limited (Great Britain), fixing the level without resistance (R0) and 5 levels of resistance (R1–R5). Suboptimal PIF (sPIF) values were considered at R0 < 90, R1–R4 < 60, R5 < 30 l/min. Spirometry was performed on a Flowscreen II spirometer (Jaeger) with a flow-volume curve recording, calculation of generally accepted indicators, and on a PTS-14P-01 pressure-tachospirograph to determine the peak inspiratory rate. Statistical data processing was carried out using the Statistica v. 10. According to the Bonferroni principle, differences were considered significant at p < 0.005. Results. During exacerbation of COPD, a decrease in PIF from 120 to 40 l/min (p < 0.001 compared with the control) and the presence of sPIF in 5–75% of cases, depending on the type of inhalation device, were revealed (no sPIF was noted in the control). Most patients were free to use a nebulizer, a metered-dose aerosol inhaler (MAI), a liquid inhaler (Respimat) and a breathhaler upon admission to the hospital. Patients could not create the necessary inspiratory effort when using the ellipt in 47% of cases, turbuhaler — in 63%, nexthaler — in 75%, handihaler — in 31%. With proven positive clinical and functional dynamics during treatment (increase in FEV1 from 37% (28; 53) to 55% (37; 62), p < 0.004), the identified changes persisted by the time of discharge from the hospital and did not reach the values of PIF and sPIF, determined in stable COPD. Analysis of PIF and sPIF in patients in real clinical practice, depending on the drugs received, showed that by the time they were discharged from the hospital, half of the patients had sPIF, continued to use turbuhaler and handihaler inhalers, and were not able to create an adequate PIF for effective inhalation of drugs. A survey of patients 3 months after discharge from the hospital showed that patients with optimal PIF values, who used drugs with the help of PPI, Respimat and Breezhaler, did not have exacerbations within the indicated periods. Patients with CPIP who continued to use the combination of turbuhaler and handihaler had moderate exacerbations. Conclusion. Optimization of inhalation therapy based on PIP in patients with COPD exacerbation should include: 1) the possibility of choosing the optimal inhaler, considering the direct determination of PIF; 2) replacement of a high-resistance powder inhaler with a PDI/Respimat or a low-resistance powder inhaler (breather, ellipta); 3) education of COPD patients in the correct technique of inhalation. PIF testing in COPD exacerbations may help clinicians identify patients at higher risk of readmission and personalize powder inhaler selection. Keywords: chronic obstructive pulmonary disease, peak inspiratory flow, inhalation therapy, inhaler resistance.
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