| Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease. | |
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MedLine Citation:
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PMID: 10430726 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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We wished to determine which resting spirometric parameters best reflect improvements in exercise tolerance and exertional dyspnea in response to acute high-dose anticholinergic therapy in advanced COPD. We studied 29 patients with stable COPD (FEV(1) = 40 +/- 2% predicted [%pred]; mean +/- SEM) and moderate to severe chronic dyspnea. In a double-blind placebo-controlled cross-over study, patients performed spirometry and symptom-limited constant-load cycle exercise before and 1 h after receiving 500 micrograms of nebulized ipratropium bromide (IB) or saline placebo. There were no significant changes in spirometry, exercise endurance, or exertional dyspnea after receiving placebo. In response to IB (n = 58): FEV(1), FVC, and inspiratory capacity (IC) increased by 7 +/- 1%pred, 10 +/- 1%pred, and 14 +/- 2%pred, respectively (p < 0.001), with no change in the FEV(1)/FVC ratio. After receiving IB, exercise endurance time (Tlim) increased by 32 +/- 9% (p < 0.001) and slopes of Borg dyspnea ratings over time decreased by 11 +/- 6% (p < 0.05). Percent change (%Delta) in Tlim correlated best with DeltaIC%pred (p = 0.020) and change in inspiratory reserve volume (DeltaTLC%pred) (p = 0.014), but not with DeltaFVC%pred, DeltaPEFR%pred, or DeltaFEV(1)%pred. Change in Borg dyspnea ratings at isotime near end exercise also correlated with DeltaIC%pred (p = 0.04), but not with any other resting parameter. Changes in spirometric measurements are generally poor predictors of clinical improvement in response to bronchodilators in COPD. Of the available parameters, increased IC, which is an index of reduced resting lung hyperinflation, best reflected the improvements in exercise endurance and dyspnea after IB. IC should be used in conjunction with FEV(1) when evaluating therapeutic responses in COPD. |
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Authors:
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D E O'Donnell; M Lam; K A Webb |
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Publication Detail:
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Type: Clinical Trial; Journal Article; Randomized Controlled Trial; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: American journal of respiratory and critical care medicine Volume: 160 ISSN: 1073-449X ISO Abbreviation: Am. J. Respir. Crit. Care Med. Publication Date: 1999 Aug |
Date Detail:
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Created Date: 1999-08-30 Completed Date: 1999-08-30 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 9421642 Medline TA: Am J Respir Crit Care Med Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 542-9 Citation Subset: AIM; IM |
Affiliation:
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Respiratory Investigation Unit, Departments of Medicine and Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada. odonnell@post.queensu.ca |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Administration, Inhalation Aged Cholinergic Antagonists / administration & dosage*, adverse effects Cross-Over Studies Double-Blind Method Exercise Test / drug effects* Female Forced Expiratory Volume / drug effects Humans Inspiratory Capacity / drug effects Ipratropium / administration & dosage*, adverse effects Lung Diseases, Obstructive / drug therapy* Male Middle Aged Spirometry* Vital Capacity / drug effects |
| Chemical | |
Reg. No./Substance:
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0/Cholinergic Antagonists; 60205-81-4/Ipratropium |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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