Objective To investigate the treatment on severe bronchial asthma with chronic obstructive pulmonary disease (COPD), and to improve the quality of life of patients severe asthma and COPD. Methods 83 cases with severe asthma and COPD in our hospital from March 2007 to June 2011 were selected and divided into control group (n = 38) and treatment group (n = 45). Patients in control group were treated with the compound ipratropium bromide aerosol and moderate dose of salmeterol/fluticasone propionate (50/250 μg), patients in treatment group were treated with thio-phene tiotropium dry powder inhalation with high-dose salmeterol/fluticasone propionate (50/500 μg), the course of treatment was 1 year with subsequent visit once a month. Lung function changes, quality of life, the number of episodes of acute, acute time of intervals between attacks were observed. Results Predicted value of FEV1%, increment of FEV1 and △PEF in treatment group 1 year after the treatment were all better than those before the treatment, the differences were all statistically significant (all P < 0.05); the items in treatment group 1 year after the treatment were all better than those in control group, the differences were all statistically significant (all P < 0.05). The life quality scores in treatment group 1 year after the treatment were better than those before the treatment, the numbers of episodes of acute in treatment group 1 year after the treatment were lower than those before the treatment, the acute time of intervals between attacks in treatment group 1 year after the treatment were lower than those before the treatment, the differences were all statistically significant (all P < 0.05); the differences of the items 1 year after the treatment between the two groups were all statistically significant (all P < 0.05). The differences of adverse effects rate between the two groups was not statistically significant (P > 0.05). Conclusion The treatment of Tiotropine with high-dose Seretide in severe asthma and COPD is effective, the adverse reactions is mild, it is worthy of promotion.%目的 探讨重度支气管哮喘合并慢性阻塞性肺疾病(COPD)的治疗方法,提高重度哮喘合并COPD患者的生活质量.方法 选择我院2007年3月～2011年6月重度哮喘合并COPD患者83例,分为治疗组45例和对照组38例.对照组使用复方异丙托溴铵气雾剂联合中等剂量沙美特罗/氟替卡松(50/250 μg)治疗,治疗组给予噻托溴铵干粉吸入剂联合大剂量沙美特罗/氟替卡松(50/500 μg),疗程均为1年,每月复诊1次,观察患者肺功能变化、生活质量、急性加重发作次数、急性加重发作间隔时间.结果 治疗组治疗后1年肺功能1秒钟用力呼气量(FEV1)增加量、FEV1%预计值、呼气峰值流速增加量(△PEF)较治疗前明显改善,差异均有统计学意义(均P < 0.05);治疗组治疗后1年各项目均优于较对照组,差异均有统计学意义(均P < 0.05).治疗组治疗后1年生活质量评分较治疗前明显提高,急性发作次数明显减少,急性加重发作间隔时间明显延长,差异均有统计学意义(均P < 0.05);治疗组治疗后1年时各项目与对照组比较差异均有统计学意义(均P < 0.05).两组不良反应发生率比较差异无统计学意义(P > 0.05).结论 噻托溴铵粉吸入剂联合大剂量舒利迭治疗重度哮喘合并COPD疗效显著,不良反应轻,值得临床推广.
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