Clinical observation of tiotropium combined with high dose salmeterol/fluticasone combination treatment of severe bronchial asthma merger stable chronic obstructive pulmonary disease

Abstract

Objective To explore a better treatment of severe bronchial asthma (asthma) merger chronic obstructive pulmonary disease (COPD), and methods to improve severe asthma merger COPD patients' quality of life. To accumulate more clinical experience for severe asthma merger COPD prevention and treatment. Methods Clinical diagnosis of severe asthma merger COPD were randomly divided into two groups, one given Compound Ipratropium Bromide Aerosol (Combivent) united moderate dose of salmeterol/fluticasone (Seretide 50/250 μg) treatment for the control group, one given Tiotropium dry powder inhaler (Spiriva) combined with high dose salmeterol/fluticasone (Seretide 50/500 μg) powder inhalation therapy for the treatment group. A random, open, self-control and group control method,monthly visit once. Detailed records of each patient lung function changes, quality of life, acute exacerbation,acute onset of the next interval, frequency of hospitalization, the economic costs and adverse reactions. Year, which to analyze the comparative treatment of severe asthma merger COPD on a comprehensive treatment. Results FEV1 two groups of patients before treatment were the control group (1.14±0. 13) L, the treatment group ( 1.11 ± 0. 15) L, there were no significant difference between the two groups. Treatment after one year FEV1 control group (1.30±0. 14) L,the treatment group (1.39±0.15) L,there were no significant difference between the two groups. Among the same group before and after treatment were significantly different (P ＜ 0.05). Two groups before treatment, the clinical symptom scores were the control group (43.3±1.11) scores,the treatment group (44.7±0. 97) scores,there were no significant difference between the two groups. Treatment of after one year were the control group (38. 9± 1.07) scores, the treatment group (38. 2±0.96) scores, there were no significant difference between the two groups. Control group,clinical symptoms before and after treatment the average dropped 4. 4 points, before and after treatment, clinical symptom scores decreased 6.5 points, before and after treatment were significantly different ( P ＜0. 001) ,compared the two groups were significantly different ( P ＜0.05). Year of treatment in the two groups,the average number of acute attacks were the control group ( 1.24 ± 0.21) times/year, the treatment group (0. 79± 0.13) times/year, the treatment group was reduced (0. 45± 0. 15) times/year, the two groups were significantly different ( P ＜ 0.01). Treatment next year, two groups of patients with acute exacerbation, respectively, the average time between the control group ( 162 ± 27) days, the treated group ( 187 ± 32) days, there were no significant difference. The two groups were the control group frequency of hospitalization (0.22±0.04) times,the treatment group (0.12±0.06) times,the treatment group compared with the control group were significantly different ( P ＜0.05). Year of treatment the economic costs of the two groups were the control group (4 212 ± 383)yuan, treatment group ( 12 382± 475) yuan, treatment group was significantly increased compared with the control group were significantly different ( P ＜0.001). Adverse reactions similar to the two groups, but were mild. Conclusions Tiotropium combined with high dose salmeterol/fluticasone inhalation therapy and Compound Ipratropium Bromide Aerosol united moderate dose of salmeterol/fluticasone treatment were able to improve severe asthma merger COPD patients' lung function and clinical symptoms,improve quality of life and reduce the number of acute attack,acute onset of the next longer interval to reduce the number of hospitalizations,adverse reactions are mild, suitable for severe asthma merger COPD treatment.Tiotropium combined with high dose salmeterol/fluticasone inhalation therapy in improving quality of life and reduce the number of acute attack,reduce the number of hospitalization is superior to moderate dose of salmeterol/fluticasone combined with Compound Ipratropium Bromide Aerosol treatment, but they are costly,limiting its clinical promotion. Key words: Asthma; Chronic obstructive pulmonary disease; Tiotropium; Salmeterol/fluticasone