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Walking exercise response to bronchodilation in mild COPD: A randomized trial.
MedLine Citation:
PMID:  22999808     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
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:
Philippe Gagnon; Didier Saey; Steeve Provencher; Julie Milot; Jean Bourbeau; Wan C Tan; Simon Martel; François Maltais
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-19
Journal Detail:
Title:  Respiratory medicine     Volume:  -     ISSN:  1532-3064     ISO Abbreviation:  Respir Med     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908438     Medline TA:  Respir Med     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Elsevier Ltd. All rights reserved.
Affiliation:
Centre de recherche, Institut Universitaire de cardiologie et de pneumologie de Québec, 2725 Chemin Ste-Foy Québec, Université Laval, Québec G1V 4G5, Canada. Electronic address: philippe.gagnon@criucpq.ulaval.ca.
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