RATIONALE: Patients with mild chronic obstructive pulmonary disease (COPD) present abnormal ventilatory mechanics during exercise and may require bronchodilator therapy. However, bronchodilation does not enhance cycling exercise tolerance in these patients whereas walking may be more sensitive to the effects of bronchodilation. OBJECTIVES: To characterize the impact of bronchodilation on i) exercise tolerance ii) cardiopulmonary response and iii) dynamic hyperinflation following an endurance shuttle walking test in patients with mild COPD. METHODS: In a randomized double-blind cross-over trial, 37 patients with GOLD stage I COPD (FEV(1), 96 ± 2% predicted, mean ± SEM) completed anendurance shuttle walking test up to exhaustion 90 ± 15 min following nebulization of a placebo [NaCl] or of ipratropium bromide/salbutamol sulfate (500 μg/2.5 mg) combination. RESULTS: FEV(1) significantly increased following bronchodilation compared with placebo (0.17 ± 0.02 vs. -0.02 ± 0.01 L, p < 0.0001, mean ± SEM). The difference in walking endurance time between bronchodilation and placebo was not statistically significant (Δ15 ± 12 s, p = 0.21), with the upper and lower boundaries of the 95% confidence interval [-9-40 s, 95% CI] within the proposed minimally important difference for this variable (65 s). The ratio of breathing frequency to tidal volume tended to be decreased with bronchodilation during exercise (p = 0.07), indicating a deeper and slower breathing pattern with bronchodilation. Bronchodilation had a significant effect on dynamic hyperinflation at isotime and at peak exercise. CONCLUSION: Bronchodilation did not improve walking endurance in patients with mild COPD despite small physiological benefits of uncertain clinical relevance.
RCT Entities:
RATIONALE: Patients with mild chronic obstructive pulmonary disease (COPD) present abnormal ventilatory mechanics during exercise and may require bronchodilator therapy. However, bronchodilation does not enhance cycling exercise tolerance in these patients whereas walking may be more sensitive to the effects of bronchodilation. OBJECTIVES: To characterize the impact of bronchodilation on i) exercise tolerance ii) cardiopulmonary response and iii) dynamic hyperinflation following an endurance shuttle walking test in patients with mild COPD. METHODS: In a randomized double-blind cross-over trial, 37 patients with GOLD stage I COPD (FEV(1), 96 ± 2% predicted, mean ± SEM) completed an endurance shuttle walking test up to exhaustion 90 ± 15 min following nebulization of a placebo [NaCl] or of ipratropium bromide/salbutamol sulfate (500 μg/2.5 mg) combination. RESULTS: FEV(1) significantly increased following bronchodilation compared with placebo (0.17 ± 0.02 vs. -0.02 ± 0.01 L, p < 0.0001, mean ± SEM). The difference in walking endurance time between bronchodilation and placebo was not statistically significant (Δ15 ± 12 s, p = 0.21), with the upper and lower boundaries of the 95% confidence interval [-9-40 s, 95% CI] within the proposed minimally important difference for this variable (65 s). The ratio of breathing frequency to tidal volume tended to be decreased with bronchodilation during exercise (p = 0.07), indicating a deeper and slower breathing pattern with bronchodilation. Bronchodilation had a significant effect on dynamic hyperinflation at isotime and at peak exercise. CONCLUSION: Bronchodilation did not improve walking endurance in patients with mild COPD despite small physiological benefits of uncertain clinical relevance.
Authors: Fernando J Martinez; Alvar Agusti; Bartolome R Celli; MeiLan K Han; James P Allinson; Surya P Bhatt; Peter Calverley; Sanjay H Chotirmall; Badrul Chowdhury; Patrick Darken; Carla A Da Silva; Gavin Donaldson; Paul Dorinsky; Mark Dransfield; Rosa Faner; David M Halpin; Paul Jones; Jerry A Krishnan; Nicholas Locantore; Fernando D Martinez; Hana Mullerova; David Price; Klaus F Rabe; Colin Reisner; Dave Singh; Jørgen Vestbo; Claus F Vogelmeier; Robert A Wise; Ruth Tal-Singer; Jadwiga A Wedzicha Journal: Am J Respir Crit Care Med Date: 2022-02-01 Impact factor: 21.405
Authors: Philippe Gagnon; Richard Casaburi; Didier Saey; Janos Porszasz; Steeve Provencher; Julie Milot; Jean Bourbeau; Denis E O'Donnell; François Maltais Journal: PLoS One Date: 2015-04-23 Impact factor: 3.240
Authors: Philippe Gagnon; Jordan A Guenette; Daniel Langer; Louis Laviolette; Vincent Mainguy; François Maltais; Fernanda Ribeiro; Didier Saey Journal: Int J Chron Obstruct Pulmon Dis Date: 2014-02-15