Impact of bronchodilator therapy on exercise tolerance in COPD

Aguilaniu, B.

doi:10.2147/copd.s7404

Cited by 25 publications

(20 citation statements)

References 82 publications

(133 reference statements)

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“…[36,37] Pulmonary rehabilitation improves quality of life in COPD and exercise tolerance[38] and may increase the level of physical activity at home as assessed by activity monitors. [39] Additionally bronchodilator therapy[40] and supplemental oxygen[41] may increase exercise tolerance in COPD. Therefore optimization of medical therapy and increased access to pulmonary rehabilitation may be ways to improve physical activity and decrease disability that should be examined in future studies of interventions to promote physical activity in obstructive lung disease.…”

Section: Discussionmentioning

confidence: 99%

Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

et al. 2014

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Background: Chronic obstructive lung disease frequently leads to disability. Older patients may experience transitions between states of disability and independence over time. Objective: To identify factors associated with transition between states of disability and independent function in obstructive lung disease. Methods: We analyzed data on 4,394 participants in the Cardiovascular Health Study who completed prebronchodilator spirometry. We calculated the 1-year probability of developing and resolving impairment in ≥1 instrumental activity of daily living (IADL) or ≥1 activity of daily living (ADL) using transition probability analysis. We identified factors associated with resolving disability using relative risk (RR) regression. Results: The prevalence of IADL impairment was higher with moderate (23.9%) and severe (36.9%) airflow obstruction compared to normal spirometry (22.5%; p < 0.001). Among participants with severe airflow obstruction, 23.5% recovered independence in IADLs and 40.5% recovered independence in ADLs. In the adjusted analyses, airflow obstruction predicted the development of IADL, but not ADL impairment. Participants with severe airflow obstruction were less likely to resolve IADL impairment [RR 0.67 and 95% confidence interval (CI) 0.49-0.94]. Compared to the most active individuals (i.e. who walked ≥28 blocks per week), walking less was associated with a decreased likelihood of resolving IADL impairment (7-27 blocks: RR 0.81 and 95% CI 0.69-0.86 and <7 blocks: RR 0.73 and 95% CI 0.61-0.86). Increased strength (RR 1.16 and 95% CI 1.05-1.29) was associated with resolving IADL impairment. Conclusions: Disability is common in older people, especially in those with severe airflow obstruction. Increased physical activity and muscle strength are associated with recovery. Research is needed on interventions to improve these factors among patients with obstructive lung disease and disability.

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Section: Discussionmentioning

confidence: 99%

Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

et al. 2014

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“…Most, but not all of these studies reported significant, yet small (i.e. 3-10 W) improvements in WRpeak [60,64] (table 4).…”

Section: Evaluative Aspectsmentioning

confidence: 96%

“…With regard to pharmacological interventions, V′O 2 peak can improve after short- [60] and long-acting inhaled bronchodilator therapy [60][61][62][63] in COPD patients, although the magnitude of this response tends to be modest (0.04-0.18 L·min ) [60] and it is not always evident [60,64]. V′O 2 peak has been able to detect the long-term (i.e.…”

Section: Evaluative Aspectsmentioning

confidence: 99%

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

et al. 2016

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This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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“…Exercise testing can be used to document the severity of pulmonary disease, the functional impact of altered respiratory function and to better understand the physiopathological mechanisms involved in exercise intolerance; this refers to the discriminative characteristic of the test. Exercise testing can also be used to quantify the impact of an intervention to improve exercise tolerance [9, 10] or dyspnea [11, 12] and in the preoperative and pre rehabilitation assessments of patients, corresponding to the evaluative characteristic of the test. A third characteristic corresponds to the reproducibility of the test.…”

Section: Introductionmentioning

confidence: 99%

Responsiveness of Various Exercise-Testing Protocols to Therapeutic Interventions in COPD

et al. 2013

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Exercise intolerance is a key element in the pathophysiology and course of Chronic Obstructive Pulmonary Disease (COPD). As such, evaluating exercise tolerance has become an important part of the management of COPD. A wide variety of exercise-testing protocols is currently available, each protocol having its own strengths and weaknesses relative to their discriminative, methodological, and evaluative characteristics. This paper aims to review the responsiveness of several exercise-testing protocols used to evaluate the efficacy of pharmacological and nonpharmacological interventions to improve exercise tolerance in COPD. This will be done taking into account the minimally important difference, an important concept in the interpretation of the findings about responsiveness of exercise testing protocols. Among the currently available exercise-testing protocols (incremental, constant work rate, or self-paced), constant work rate exercise tests (cycle endurance test and endurance shuttle walking test) emerge as the most responsive ones for detecting and quantifying changes in exercise capacity after an intervention in COPD.

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Impact of bronchodilator therapy on exercise tolerance in COPD

Cited by 25 publications

References 82 publications

Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

Disability and Recovery of Independent Function in Obstructive Lung Disease: The Cardiovascular Health Study

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Responsiveness of Various Exercise-Testing Protocols to Therapeutic Interventions in COPD

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