Efficacy of ambroxol combined with antibiotic de-escalation therapy in treatment of chronic obstructive pulmonary disease patients complicated with severe pneumonia

Zhang Zhihui; Wang Xuelin; Chen Xiaocan

doi:10.3969/j.issn.1672-8157.2025.05.040

Abstract：Objective To explore the effect of ambroxol combined with antibiotic de-escalation therapy on treatment of chronic obstructive pulmonary disease(COPD)patients complicated with severe pneumonia and observe the impact on oxidative stress response and immune imbalance state.Methods The clinical data were retrospectively collected from 90 COPD patients with severe pneumo-nia who were treated in the First People's Hospital of Pingdingshan from January 2022 to July 2024.The enrolled patients were divided into the control group(n=46,antibiotic de-escalation therapy:15 mg·kg-1 imipenem for once every 6 hours,adjustment to 15 mg·kg-1 for once every 12 hours after symptom remission;72 h later,intravenous drip of targeted antibiotics according to etiological test results+bronchoscopic lavage)and the combination group(n=44,ambroxol(15 mg each time,once a day,intravenous drip)on the basis of the control group)according to the medications.All patients were treated for 7 days.The improvement time of symptoms and signs,blood gas indexes,respiratory mechanics indexes,inflammatory factors,oxidative stress indexes,T lymphocyte subsets and inci-dence rates of adverse reactions were observed and compared between the two groups.Results The marked effective rate was higher in the combination group(68.18%(30/44))than in the control group(45.65%(21/46))after the treatment,and the differ-ence was statistically significant(χ2=4.649,P<0.05).The antipyretic time,remission time of cough and disappearance time of lung shadow of the combination group were respectively(3.04±0.84)d,(6.19±1.14)d and(9.41±1.29)d,shorter than(3.63±0.79)d,(7.08±1.02)d and(10.35±1.11)d of the control group,and the differences were statistically significant(t=3.434,3.907,3.711,all P<0.05).The arterial partial pressure of oxygen(PaO2),oxygenation index(OI)and end-expiratory transpulmonary pressure(Ptp-ee)of the combina-tion group were respectively(77.39±3.53)mm Hg(1 mm Hg≈0.133 kPa),(349.12±28.36)mm Hg and(4.68±0.72)cm H2O(1 cm H2O≈ 0.098 kPa)after the treatment,higher than(75.01±3.66)mm Hg,(328.70±31.44)mm Hg and(3.92±0.83)cm H2O of the control group;partial pressure of carbon dioxide(PaCO2),respiratory rate(RR)and end-inspiratory transpulmonary pressure(Ptp-ei)of the combination group were respectively(42.41±3.06)mm Hg,(25.04±3.14)times·min-1 and(10.27±1.15)cm H2O,lower than(45.06±3.93)mm Hg,(28.43±3.06)times·min-1 and(11.05±1.07)cm H2O of the control group,and the differences were statistically significant(t=3.138,3.231,4.631,3.558,5.187,3.333,all P<0.05).The levels of interleukin-8(IL-8),tumor necrosis factor α(TNF-α)and C-reac-tive protein(CRP)of the combination group were respectively(126.46±28.85)ng·L-1,(10.04±2.01)pg·mL-1 and(15.08±2.46)mg·L-1 after the treatment,lower than(142.58±24.72)ng·L-1,(12.92±2.64)pg·mL-1 and(17.75±3.20)mg·L-1 of the control group,and the differences were statistically significant(t=2.851,5.804,4.423,all P<0.05).The serum malondialdehyde(MDA)level of the combination group was(4.48±1.11)mmol·L-1 after the treatment,lower than(5.90±1.03)mmol·L-1 of the control group,while the superoxide dismutase(SOD)level of the combination group was(225.95±22.35)U·mL-1,higher than(186.60±20.81)U·mL-1 of the control group(t=6.294,8.649,both P<0.05).The levels of peripheral blood CD4+and CD4+/CD8+of the combination group were respectively(44.71±5.24)%and(1.65±0.27)after the treatment,higher than(41.46±4.27)%and(1.49±0.21)of the control group,and the differences were statistically significant(t=3.232,3.146,both P<0.05).The incidence rates of adverse reactions of the combination group and the control group were 6.82%(3/44)and 4.35%(2/46),and there was no significant difference between the two groups(Fisher's Exact Test,P>0.05).Conclusion Ambroxol combined with antibiotic de-escalation therapy can increase the blood oxygen level of the COPD patients complicated with severe pneumonia,im-prove respiratory function,relieve inflammatory response and oxidative stress,and regulate immune function.