Clinical analysis of the efficacy of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with HFNC and NIPPV in the treatment of patients with COPD complicated with type Ⅱ respiratory failure

doi:10.3877/cma.j.issn.1674-6902.2025.05.018

Abstract

Abstract:

Objective

To compare the effects of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with high-flow nasal cannula oxygen therapy (HFNC) and non-invasive positive pressure ventilation (NIPPV) respectively in the treatment of patients with chronic obstructive pulmonary diseases (COPD) complicated with type Ⅱ respiratory failure.

Methods

A total of 96 patients with COPD complicated with type Ⅱ respiratory failure admitted to our hospital were collected as the research objects. They were divided into a control group with 45 cases and an observation group with 51 cases. The control group was treated with budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with NIPPV, and the observation group was treated with budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with HFNC. Both groups were continuously treated for 7 to 10 days. The clinical efficacy, arterial blood gas analysis [respiratory rate (RR), heart rate (HR), oxygenation index (PaO₂/FiO₂), arterial partial pressure of carbon dioxide (PaCO₂), partial pressure of arterial oxygen (PaO₂), potential of hydrogen (pH)], computed tomography (CT) of the lungs and pulmonary function indexes [peak expiratory flow (PEF), forced expiratory volume in one second/forced vital capacity (FEV₁/FVC), maximal inspiratory volume (MIV), maximal expiratory volume (MEV)], oxidative stress and inflammatory indexes [β₂-microglobulin (β₂-MG), cholinesterase (CHE), soluble intercellular adhesion molecule-1 (sICAM-1), lipid peroxidation (LPO)], respiratory status, treatment comfort level and adverse reactions [COPD assessment test (CAT), Kolcaba general comfort questionnaire (GCQ) score, modified medical research council (mMRC) score] were compared between the two groups.

Results

In the observation group, 32 cases were effective and 15 cases were improved, and the improvement rate of pulmonary function was 45 cases(88.24%), which was higher than that in the control group (24 cases were effective and 11 cases were improved, and the improvement rate of pulmonary function was 34 cases(75.56%). The levels of RR, HR, PaCO₂, LPO, sICAM-1, β₂-MG, MIV, MEV, CAT and mMRC scores in the observation group were (18.43±1.85) times/min, (82.89±3.24) times/min, (49.83±3.14) mmHg, (4.56±1.31) nmol/L, (185.45±19.77) ng/ml, (2.19±0.48) mg/L, (4287.51±314.27), (2123.06±274.33), (13.74±2.18) points and (1.57±0.33) points respectively, which were lower than those in the control group [(19.54±2.02) times/min, (84.57±3.36) times/min, (51.35±3.43) mmHg, (5.35±1.47) nmol/L, (196.52±22.37) ng/ml, (2.19±0.48) mg/L, (4 431.24±329.45), (2 269.62±285.47), (15.13±2.32) points and (1.76±0.38) points] (P<0.05). The levels of PaO₂/FiO₂, PaO₂, PEF, pH, FEV₁/FVC value, CHE level and GCQ score in the observation group were (304.54±22.71) mmHg, (66.11±3.56) mmHg, (356.42±25.68) L/min, (7.37±0.08), (70.07±5.22)%, (3 876.29±455.38) U/L and (85.07±4.12) points respectively, which were higher than those in the control group (292.36±24.42) mmHg, (64.25±3.43) mmHg, (343.26±24.73) L/min, (7.33±0.09), (67.76±4.84)%, (3 658.17±423.35) U/L and (82.75±4.34) points (P<0.05).

Conclusion

Budesonide, glycopyrronium bromide and formoterol fumarate combined with HFNC has an obvious curative effect on COPD patients with type Ⅱ respiratory failure, which can reduce the oxidative stress and inflammatory reaction in patients, and improve their physiological function, respiratory function, ventilation status and comfort level.

Key words: Chronic obstructive pulmonary disease, Type Ⅱ respiratory failure, Budesonide, glycopyrronium bromide and formoterol, High-flow nasal cannula oxygen therapy

Min Ge, Xiang Zhu, Dongpeng Chao, Jun Wang, Yidan Guo, Beijuan Wang, Ze Ji, Zengcheng Wang. Clinical analysis of the efficacy of budesonide, glycopyrronium bromide and formoterol fumarate inhalation aerosol combined with HFNC and NIPPV in the treatment of patients with COPD complicated with type Ⅱ respiratory failure[J]. Chinese Journal of Lung Diseases(Electronic Edition), 2025, 18(05): 762-767.

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References 23

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组　别	例数	RR(次/min)		HR(次/min)		PaO₂/FiO₂(mmHg)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	27.35±2.65	18.43±1.85^a	98.21±4.62	82.89±3.24^a	221.19±31.34	304.54±22.71^a
对照组	45	26.78±2.53	19.54±2.02^a	97.48±4.34	84.57±3.36^a	214.52±33.65	292.36±24.42^a
t值		1.074	2.810	0.795	2.492	1.005	2.531
P值		0.285	0.006	0.429	0.014	0.317	0.013
组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		pH
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	65.47±4.29	49.83±3.14^a	52.24±4.28	66.11±3.56^a	7.29±0.09	7.37±0.08^a
对照组	45	64.76±4.12	51.35±3.43^a	51.42±4.19	64.25±3.43^a	7.27±0.10	7.33±0.09^a
t值		0.824	2.267	0.946	2.599	1.031	2.306
P值		0.412	0.026	0.347	0.011	0.305	0.023

组　别	例数	RR(次/min)		HR(次/min)		PaO₂/FiO₂(mmHg)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	27.35±2.65	18.43±1.85^a	98.21±4.62	82.89±3.24^a	221.19±31.34	304.54±22.71^a
对照组	45	26.78±2.53	19.54±2.02^a	97.48±4.34	84.57±3.36^a	214.52±33.65	292.36±24.42^a
t值		1.074	2.810	0.795	2.492	1.005	2.531
P值		0.285	0.006	0.429	0.014	0.317	0.013
组　别	例数	PaCO₂(mmHg)		PaO₂(mmHg)		pH
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	65.47±4.29	49.83±3.14^a	52.24±4.28	66.11±3.56^a	7.29±0.09	7.37±0.08^a
对照组	45	64.76±4.12	51.35±3.43^a	51.42±4.19	64.25±3.43^a	7.27±0.10	7.33±0.09^a
t值		0.824	2.267	0.946	2.599	1.031	2.306
P值		0.412	0.026	0.347	0.011	0.305	0.023

组　别	例数	CHE(U/L)		LPO(nmol/L)		sICAM-1(ng/ml)		β2-MG(mg/L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	2 693.65±374.86	3 876.29±455.38^a	7.69±2.24	4.56±1.31^a	352.35±33.38	185.45±19.77^a	3.08±0.62	2.19±0.48^a
对照组	45	2 764.34±358.71	3 658.17±423.35^a	7.82±2.16	5.35±1.47^a	346.21±31.43	196.52±22.37^a	3.11±0.67	2.43±0.55^a
t值		0.941	2.420	0.289	2.784	0.924	2.547	0.228	2.283
P值		0.349	0.017	0.774	0.006	0.358	0.012	0.820	0.025

组　别	例数	CHE(U/L)		LPO(nmol/L)		sICAM-1(ng/ml)		β2-MG(mg/L)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	2 693.65±374.86	3 876.29±455.38^a	7.69±2.24	4.56±1.31^a	352.35±33.38	185.45±19.77^a	3.08±0.62	2.19±0.48^a
对照组	45	2 764.34±358.71	3 658.17±423.35^a	7.82±2.16	5.35±1.47^a	346.21±31.43	196.52±22.37^a	3.11±0.67	2.43±0.55^a
t值		0.941	2.420	0.289	2.784	0.924	2.547	0.228	2.283
P值		0.349	0.017	0.774	0.006	0.358	0.012	0.820	0.025

组　别	例数	PEF(L/min)		FEV₁/FVC(%)		MIV(ml)		MEV(ml)
组　别	例数	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后	治疗前	治疗后
观察组	51	224.34±21.55	356.42±25.68^a	47.29±5.13	70.07±5.22^a	4 714.±389.34	4 287.51±314.27^a	2 414.93±238.24	2 123.06±274.33^a
对照组	45	227.81±23.63	343.26±24.73^a	48.68±4.52	67.76±4.84^a	4 842.57±376.29	4 431.24±329.45^a	2 431.49±241.53	2 269.62±285.47^a
t值		0.752	2.549	1.400	2.238	1.637	2.599	0.338	2.563
P值		0.454	0.012	0.165	0.028	0.105	0.011	0.736	0.012

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