Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

Berton, Danilo Cortozi; Reis, Michel Silva; Siqueira, Ana Cristina B.; Barroco, Adriano; Takara, Luciana S.; Bravo, Daniela M.; Andreoni, Solange; Neder, J. Alberto

doi:10.1016/j.rmed.2010.05.017

Cited by 54 publications

(53 citation statements)

References 39 publications

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“…(26) In addition, most of the patients mechanics during walking in patients with COPD and that allow us to reflect on the mechanisms underlying the heterogeneity of the responses to pharmacological and nonpharmacological interventions that characterizes this population, (1,(6)(7)(8)(9)(10) although the methods employed in the present study do not allow us to draw definitive conclusions regarding this issue. transforms into progressively higher lung volumes that are typically located in the least compliant portion of the pressure-volume curve.…”

Section: Discussionmentioning

confidence: 94%

“…One of the consequences of such changes is that there is a significant increase in the work of breathing and a reduction in the ability of the diaphragm to generate effective pressures, leading to a progressive neuromechanical dissociation and dyspnea. (2,(6)(7)(8)(9)(10) Dyspnea can also be induced by EFL per se, probably through reflexes originating from the dynamic compression of the intrathoracic airways. (27) The findings of the present study corroborate the concept that DH plays an important role as an etiological factor for exercise limitation in patients with moderate to severe COPD.…”

Section: Discussionmentioning

confidence: 99%

“…(6)(7)(8) However, nearly all of the studies evaluating DH during exercise in patients with COPD paradoxically employed a cycle ergometer, having generally evaluated DH in response to constant workload protocols. (6)(7)(8)(9)(10) Nevertheless, ventilatory demand and exerciseinduced hypoxemia are known to be greater during walking, and there are distinct patterns of recruitment of accessory respiratory muscles. (11)(12)(13) In contrast, cycle ergometer exercise tends to trigger greater leg fatigue, ventilatory rates that are sufficiently high for the DH process to be truly limiting being therefore more difficult to achieve.…”

Section: Introductionmentioning

confidence: 99%

“…In order to mimic constant workload cycle ergometer tests and allow the extrapolation of 15 extensively demonstrated in patients with COPD. (6)(7)(8)(9)(10) Two maneuvers were performed at rest, at the end of the initial period and every 2 min after the beginning of the constant speed test, in order to obtain reproducible values (< 10% difference in relation to the highest value, at each stage). We defined DH as any reduction in IC in relation to the initial values at rest.…”

Section: Introductionmentioning

confidence: 99%

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Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

et al. 2012

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Objective: To characterize the presence, extent, and patterns of dynamic hyperinflation (DH) during treadmill exercise testing in patients with moderate to severe COPD. Methods: This was a cross-sectional study involving 30 non-hypoxemic patients (FEV 1 = 43 ± 14% of predicted) who were submitted to a cardiopulmonary exercise test on a treadmill at a constant speed (70-80% of maximum speed) to the tolerance limit (Tlim). Serial inspiratory capacity (IC) maneuvers were used in order to assess DH. Results: Of the 30 patients studied, 19 (63.3%) presented with DH (DH+ group), having greater pulmonary function impairment at rest than did those without DH (DH− group). None of the variables studied correlated with exercise tolerance in the DH− group, whereas Tlim, IC, and perception of dyspnea during exercise did so correlate in the DH+ group (p < 0.05). In the DH+ group, 7 and 12 patients, respectively, presented with a progressive and a stable pattern of DH (ΔIC Tlim,2min = −0.28 ± 0.11 L vs. 0.04 ± 0.10 L; p < 0.01). Patients with a progressive pattern of DH presented with higher perception of dyspnea/Tlim rate and lower exercise tolerance than did those with a stable pattern (354 ± 118 s and 465 ± 178 s, respectively; p < 0.05). Conclusions: The presence of DH is not a universal phenomenon during walking in COPD patients, even in those with moderate to severe airflow limitation. In the patients who presented DH, a progressive pattern of DH had a greater impact on exercise tolerance than did a stable pattern of DH.Keywords: Pulmonary disease, chronic obstructive; Exercise; Exercise test; Inspiratory capacity. ResumoObjetivo: Caracterizar a presença, extensão e padrões de hiperinsuflação dinâmica (HD) durante teste em esteira rolante em pacientes com DPOC moderada a grave. Métodos: Estudo transversal com 30 pacientes não hipoxêmicos (VEF 1 = 43 ± 14% do previsto) submetidos a teste cardiopulmonar de exercício em esteira rolante em velocidade constante (70-80% da velocidade máxima) até o limite da tolerância (Tlim). Manobras seriadas de capacidade inspiratória (CI) foram utilizadas para avaliação da HD. Resultados: Dos 30 pacientes estudados, 19 (63,3%) apresentaram HD (grupo HD+), que apresentaram maior comprometimento funcional em repouso do que os pacientes sem HD (grupo HD−). Nenhuma das variáveis obtidas relacionou-se com a tolerância ao exercício no grupo HD−, enquanto Tlim, CI e percepção de dispneia ao esforço foram significativamente correlacionados no grupo HD+ (p< 0,05). No grupo HD+, 7 e 12 pacientes, respectivamente, apresentaram padrão progressivo e estável de HD (ΔCI Tlim,2min = −0,28 ± 0,11 L e 0,04 ± 0,10 L; p < 0,01). Pacientes com padrão progressivo de HD apresentaram maior relação percepção de dispneia/Tlim e menor tolerância ao exercício do que aqueles com padrão estável (354 ± 118 s e 465 ± 178 s, respectivamente; p < 0,05). Conclusões: A HD não é um fenômeno universal durante a caminhada em pacientes com DPOC, mesmo que apresentem obstrução ao fluxo aéreo de graus moderado a acentuado. ...

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Section: Discussionmentioning

confidence: 94%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

et al. 2012

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“…7) Tiotropium has been reported to improve dynamic hyperinflation in COPD patients. 8) Since LV diastolic dysfunction has been associated with hyperinflation in COPD patients, 9) it is plausible to expect that tiotropium will affect LV diastolic function. However, the effects of tiotropium on LV diastolic function have not been clear.…”

Section: Introductionmentioning

confidence: 99%

Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection

Nojiri

Yamamoto

Maeda

et al. 2012

ATCS

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Purpose: The objective of the present study was to evaluate the effects of inhaled tiotropium on pulmonary function and left ventricular diastolic function in chronic obstructive pulmonary disease patients ≥1 year after pulmonary resection for lung cancer. Methods: This prospective single-arm analysis involved 21 chronic obstructive pulmonary disease patients who underwent pulmonary resection for lung cancer at least one year earlier. Blood pressures, heart rate, spirometry, transthoracic echocardiography including tissue Doppler imaging, and quality of life were evaluated prior to and after 3 months of inhaled tiotropium treatment. B-type natriuretic peptide, white blood cell counts, and C-reactive protein levels before and after inhaled tiotropium treatment were also examined. Results: There were no significant differences between before and after treatment in forced vital capacity and left ventricular ejection fraction. Forced expiratory volume in 1 second and early transmitral velocity/tissue Doppler mitral annular early diastolic velocity values improved from 1.60 ± 0.5 L and 8.97 ± 1.6, respectively, before treatment, to 1.84 ± 0.5 L and 7.59 ± 1.4, respectively, 3 months after treatment (P <0.001). Conclusion: Treatment with inhaled tiotropium may be effective in improving not only pulmonary function but also left ventricular diastolic function of patients with chronic obstructive pulmonary disease in the chronic phase after pulmonary resection.

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Once daily long-acting beta2-agonists and long-acting muscarinic antagonists in a combined inhaler versus placebo for chronic obstructive pulmonary disease

Maqsood

Palmer

et al. 2019

Cochrane Database of Systematic Reviews

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Effects of tiotropium and formoterol on dynamic hyperinflation and exercise endurance in COPD

Abstract: Clinicaltrials.gov Identifier: NCT00680056 [ClinicalTrials.gov].

Cited by 54 publications

References 39 publications

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

Comportamento da hiperinsuflação dinâmica em teste em esteira rolante em pacientes com DPOC moderada a grave

Effects of Inhaled Tiotropium on Left Ventricular Diastolic Function in Chronic Obstructive Pulmonary Disease Patients after Pulmonary Resection

Once daily long-acting beta2-agonists and long-acting muscarinic antagonists in a combined inhaler versus placebo for chronic obstructive pulmonary disease

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