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The Effect of Salmeterol/Fluticasone on Pulmonary Function and Quality of Life in Severe Stable Chronic Obstructive Pulmonary Disease

Author: LiShuZuo
Tutor: LiHuaiChen
School: Shandong University
Course: Internal Medicine
Keywords: COPD (chronic obstructive pulmonary disease) quality of life (QOL) SM/FP (salmeterol/fluticasone) inhaled corticosteroids (ICS) long-actingβ2-adrenergic agonist （LABA） long-acting anticholinergic 6MWT (six-minute walking test) 6-minute walking distance transition dyspnea index (TDI)
CLC: R563.9
Type: Master's thesis
Year: 2011
Downloads: 102
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Abstract


BackgroundCOPD is characterized by reduced airflow on expiration due to airway obstruction that is partially reversible and usually worsens over time. The separate or combined effects of dyspnea, reduced exercise capacity, and repeated exacerbations cause impairment of the health-related quality of life of many patients with COPD, as well as causing a greater burden on health-care resources. The increasing burden of COPD has stimulated research into novel treatment approaches and optimized management strategies. In the 2006 update of the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines, it provided a staging system for the classification of disease severity based on a combination of spirometric lung function and symptoms. The severity of COPD is defined in four stages—mild, moderate, severe, and very severe—according to the severity of impairment in the FEV]. The GOLD guidelines recommend a stepwise approach to disease management, with bronchodilators being the mainstay of treatment. The guidelines note that long-acting bronchodilators are more convenient. The bronchodilators currently available for use in COPD can be broadly categorized into three classes: anticholinergics,β2-sympathomimetic agonists, and methylxanthines. GOLD is recognized that long-acting inhaled bronchodilators are more effective and convenient than short-acting bronchodilators. It has also been demonstrated that combining bronchodilators improve efficacy without additional side effects, compared to increasing the dose of a single bronchodilaror. The guidelines note that long-acting bronchodilators are more convenient. In more severe disease, polypharmacy becomes common and a trial of inhaled corticosteroids is recommended. Two types of inhaled drugs are available for clinical use:the long-acting (LABAs) formoterol and corticosteroid salmeterol inhaled twice daily. Inhaled combination therapy with long-actingβ2-agonists and corticosteroids in stable COPD was effective in significantly reducing the number of excacerbations. The combination therapy with the long-actingβ2-agonists and corticosteroids can achieve even greater benefit in lung function and symptoms.ObjectiveTo study the effects of inhaled corticosteroids (ICS) in combination with long-actingβ2 agonist (LABA) (salmeterol/fluticasone) on pulmonary function and quality of life (QOL) in patients with severe stable chronic obstructive pulmonary disease (COPD).MethodsTherapy effect of pulmonary function and QOL in 60 stable outpatients with severe chronic obstructive pulmonary disease (GOLD stageⅢ) after taking salmeterol/fluticasone was examined using randomized and controlled design methods. Sixty patients were divided into two groups, examined group and controlled group. All the patients, before this treatment, had no application history of any type of hormones, receptor agonists and they never had oxygen theipy. Theophylline sustained-release tablets were given to all the patients in both groups, 100mg once and two times per day. The examined group added to use inhalation of Seretide Dry Powder (salmeterol/fluticasone, SM/FP,50ug of salmeterol/500ug of fluticasone) one puffs and twice per day. After 3-month followed-up visiting, the changes of the clinical symptoms, lung pulmonary fuction (FEV1%, IC),6-min walking distance, Modified Borg’s scale score, TDI (Transition Dyspnea Index), CAT score and the acute exacerbations times were compared. ResultsCompared to controlled group, after inhaled salmeterol/fluticasone three months, IC in lung function of examined group was improved significantly (P<0.05), and the ratio of FEV1 in lung function of examined group was not improved significantly (P>0.05).6-min walking distance and Modified Borg Dyspnea scale score were improved significantly (P<0.05) in examined group. CAT score were improved significantly (P<.05) in examined group. Transition Dyspnea Index were improved significantly (P<0.05) in examined group. The acute exacerbations times was not improved significantly (P>0.05).ConclusionThe combination inhaled therapy with salmeterol and fluticasone can not improve the ratio of FEV1 significantly, but it can improve IC,6-min walking distance, Borg’s scale score, TDI (Transition Dyspnea Index) and CAT score. And then the combined application of drugs achieved even greater benefit in symptoms and quality of life (QOL).

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