ブデソニド/ホルモテロール配合剤の投与によりピークフロー日内変動が改善したCOPD合併喘息の1例

A Case Report of Bronchial Asthma with COPD, Improved Diurnal Changes in PEF with Budesonide/Formoterol

要旨　気管支喘息と慢性閉塞性肺疾患(COPD)の発症機序，治療法は異なるが，呼吸器の慢性疾患のなかでいずれもその罹患率は高く，近年，両疾患の合併例も増加している．本症例は，53年間喫煙歴のある75歳女性で，2年前より体動時の息切れを自覚し，当院を精査のため受診．閉塞性換気障害と肺気腫病変を認めたため，喫煙歴よりCOPDと診断し，チオトロピウム投与を開始した．その後，症状は改善するも残存しており，朝方の喘鳴や狭窄音を聴取することから，COPD合併喘息と診断した．ブデソニド/ホルモテロール配合剤(BUD/FM)を追加投与後，ピークフロー日内変動，喀痰や咳嗽などの自覚症状の改善を認め，多少，労作時の息切れは自覚するも経過は良好となった．COPDと喘息は主体となる炎症細胞，病態の違いから治療薬の選択順序は異なるが，喘息症状がみられる場合には抗炎症効果を期待できるBUD/FM投与も考慮すべきと考えられた．

　Although the pathogenesis and the treatment differ between bronchial asthma and COPD, account for a high percentage among chronic respiratory diseases and an increasing in recent years. This case is a 75-year-old woman with a smoking history of 53 years, began to become aware of shortness of breath by movement 2 years ago. She visited our facility to receive detailed examination and was found to have obstructive ventilatory disorder and pulmonary emphysema. With her smoking history, we diagnosed COPD and began to start tiotropium. Her symptom alleviated but did not disappear completely. Wheeze and stridor were heard in the morning, she was diagnosed as having bronchial asthma with COPD. After the additional BUD/FM therapy, the circadian variation in peak flow improved and subjective symptoms(sputum, cough, etc.)alleviated. She thus followed a favorable course despite the complaint of shortness of breath during effort. Selected drugs differs between COPD and asthma, because of differences of the inflammatory cells and pathophysiological features, however, BUD/FM treatment is expected to exert anti-inflammatory effects, deserves to be considered when dealing with bronchial asthma with COPD.