Acute administration of bronchodilators on exercise tolerance in treated COPD patients.

Abstract

Exercise intolerance is a major feature in patients with Chronic Obstructive Pulmonary Disease (COPD). Bronchodilators increase endurance time (ET) and reduce dynamic hyperinflation (DH). We evaluated whether a single-dose of salbutamol/ipratropium + flunisolide (BD+ICS), added on top of the regular treatment, may improve ET in COPD patients. In a single-blind randomized crossover pilot trial, nebulised BD+ICS or placebo (PL) was administered 30 min before a constant load cardiopulmonary test, in 22 moderate-to-severe COPD patients (FEV₁: 53.9% pred). ET was the primary outcome measured. BD+ICS did not improve ET or VO₂ peak with respect to PL. BD+ICS increased pre-test FEV₁ and pre-test Inspiratory Capacity but did not modify DH. In a retrospective analysis, patients were divided in Improvers (N=11) and Non-Improvers (N=11) according to the difference in ET between BD+ICS and PL (> 25 s). Improvers had a worst BODE index, a higher static hyperinflation and poorer Vd/Vt ratio at peak of exercise with respect to Non-Improvers. Improvers only had a significant increase from BD+ICS on pre-test FEV₁ and IC. In conclusion, although a single-dose BD+ICS did not improve ET in COPD patients under regular treatment, a subgroup of more severe patients may have some benefit from that.

• Authors: Barbara Vagaggini, Dario Nieri, Laura Malagrinò, Sandra Antonelli, Giovanna De Cusatis, Claudia De Simone, Francesco Costa, Pier Luigi Paggiaro
• Journal: Pulmonary pharmacology & therapeutics (Pulm Pharmacol Ther) Vol. 24 Issue 1 Pg. 49-54 (Feb 2011) ISSN: 1522-9629 [Electronic] England
• PMID: 20970517 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2010. Published by Elsevier Ltd.

Chemical References

• Bronchodilator Agents

Topics

• Aged
• Bronchodilator Agents (pharmacology)
• Cross-Over Studies
• Exercise Tolerance (drug effects)
• Female
• Forced Expiratory Volume
• Humans
• Male
• Middle Aged
• Oxygen Consumption (drug effects)
• Pulmonary Disease, Chronic Obstructive (drug therapy, physiopathology)
• Single-Blind Method