Objective To investigate the effects of inhaled Tiotropium on pulmonary function results and airway inflammation in patients with stable chronic obstructive pulmonary disease ( COPD) . Methods 76 COPD patients were randomly divided into two with one group given tiotropium additionally. St. George's Respiratory Questionnaire (SGRQ) , pulmonary function tests (PFT) ,6-min walk distance (6MWD) ,and induced sputum tests were measured both before and (4 weeks and 8 weeks) after inhalation. Results Improvements in SGRQ were observed at 4 w(7. 8 ±0. 5) and 8 w( 12. 6 ±0. 7) after inhalation of tiotropium. However,PFT(FEV1 ,FVC,and FEV1/FVC) were seldom changed except for inspiratory capacity (IC). Enhanced 6MWD were also observed, with (332. 1 ±21. 6) meters for 4 w and (365. 3 ± 23. 5) meters for 8 w. Neutrophilic granulocyte (NEU) was decreased significantly (47. 7 ± 3. 2) % at 4 w, (42. 3 ± 2. 8) % at 8 w. Macrophage was increased significantly (48.3 ±3.7) % at 4 w, (54.2 ±5.2) % at 8 w. Correlations between sputum NEU and SGRQ.IC and SGRQ,6MWD and SGRQ were better than that between SGRQ and other pulmonary function indexes. Conclusions Inhaled tiotropium relieves breathlessness in COPD without a significant improvement in PFT. Inspiratory capacity and sputum NEU and SGRQ together may be better indices for evaluating the effect of tiotropium on breathlessness in COPD.%目的 评价噻托溴铵对稳定期慢性阻塞性肺病(COPD)患者肺功能和气道炎症的影响.方法 76例COPD患者随机分成吸入噻托溴铵药物组和不吸入对照组,在治疗前、治疗后第4周和第8周分别进行圣乔治生活质量问卷(SGRQ)、肺功能检查、6分钟步行距离(6 MWD)和诱导痰检测.结果 SGRQ评分中,药物组在治疗后4、8 w分别下降(7.8±0.5)分和(12.6±0.7)分,与治疗前和对照组比较均有统计学差异.FEV1、FVC、FEV1/FVC治疗前后差异无统计学意义；但药物组的IC在治疗4、8 w后上升明显,与治疗前和对照组比较均有统计学差异.6MWD中,药物组在治疗后4、8 w分别为(332.1±21.6)m和(365.3±23.5)m,与治疗前和对照组比较均有统计学差异.药物组的中性粒细胞比例在治疗4、8 w均下降,分别为(47.7±3.2)％和(42.3±2.8)％；而巨噬细胞比例相应地上升,分别为(48.3±3.7)％和(54.2±5.2)％,与治疗前和对照组比较均有统计学差异.IC、6 MWD、诱导痰中性粒细胞百分比与SGRQ评分相关性好,优于FEV1％、FVC、FEV1/FVC.结论 老年COPD患者吸入噻托溴铵后呼吸困难症状减轻而常规肺功能指标无明显变化,深吸气量IC改善和诱导痰中性粒细胞比例下降明显,且与圣乔治问卷评分相关性高,不失为反映呼吸困难症状的客观指标.
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