Improvements in symptom-limited exercise performance over 8h with once-daily tiotropium in patients with COPD

Maltais, François; Hamilton, Alan; Marciniuk, Darcy; Hernández, Paul; Sciurba, Frank C.; Richter, Kai; Kesten, Steven; O’Donnell, Denis E.

doi:10.1016/j.rmedu.2006.03.038

Cited by 16 publications

(37 citation statements)

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“…This simple method has been shown to be reliable and recent multicentre clinical trials have confirmed its reproducibility and responsiveness [33,34]. In several studies conducted in .500 patients with moderate-to-severe COPD, the change in EELV during cycle ergometry averaged 0.4 L or ,20% of the resting value with wide variation in the range [17,35,36]. Of this population sample, .80% showed increases in EELV from rest to peak exercise, confirming the presence of significant DH (figs 3 and 4) [17,35,36].…”

Section: Measuring Dhmentioning

confidence: 95%

“…In this respect, the IC is a crude surrogate for the extent of elastic loading. However, the IC remains remarkably preserved in many patients with severe lung hyperinflation, since TLC and EELV can rise in parallel [33][34][35][36]. Clearly, in such circumstances, and in the setting of concomitant mechanical restriction or significant inspiratory muscle weakness, the IC alone is not a reliable marker of lung hyperinflation per se.…”

Section: Detection Measurement and Definitions Of Lung Hyperinflationmentioning

confidence: 99%

“…The rate and magnitude of DH during exercise is generally measured in the laboratory setting using serial IC measurements [33][34][35][36]. Changes in EELV during exercise can also be tracked with newer methods, such as optoelectronic plethysmography or respiratory inductance plethysmography [37,38].…”

Section: Measuring Dhmentioning

confidence: 99%

“…In several studies conducted in .500 patients with moderate-to-severe COPD, the change in EELV during cycle ergometry averaged 0.4 L or ,20% of the resting value with wide variation in the range [17,35,36]. Of this population sample, .80% showed increases in EELV from rest to peak exercise, confirming the presence of significant DH (figs 3 and 4) [17,35,36]. The minority of patients who showed little reduction in IC with exercise demonstrated the most severe resting lung hyperinflation [17].…”

Section: Measuring Dhmentioning

confidence: 99%

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Physiology and consequences of lung hyperinflation in COPD

O’Donnell¹,

Laveneziana²

2006

European Respiratory Review

168

149

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Lung hyperinflation commonly accompanies expiratory flow limitation in patients with chronic obstructive pulmonary disease (COPD) and contributes importantly to morbidity and an impoverished quality of life. It is not surprising, therefore, that lung hyperinflation has become an important therapeutic target in symptomatic COPD patients. Acute dynamic increases in lung hyperinflation under conditions of worsening expiratory flow limitation and increased ventilatory demand (or both) can seriously stress cardiopulmonary reserves in patients with more advanced disease. The present understanding of the physiological mechanisms of dynamic hyperinflation during exacerbations of COPD and during physical activity continues to grow, together with an appreciation of its negative mechanical and sensory consequences. In this brief overview, definitions and measurement of lung hyperinflation during rest and exercise will be discussed and its potential clinical importance will be considered. The focus will mainly be on current concepts of the mechanisms of air trapping and its role in inducing respiratory discomfort and activity limitation in COPD.

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Section: Measuring Dhmentioning

confidence: 95%

Section: Detection Measurement and Definitions Of Lung Hyperinflationmentioning

confidence: 99%

Section: Measuring Dhmentioning

confidence: 99%

Section: Measuring Dhmentioning

confidence: 99%

See 2 more Smart Citations

Physiology and consequences of lung hyperinflation in COPD

O’Donnell¹,

Laveneziana²

2006

European Respiratory Review

168

149

View full text Add to dashboard Cite

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“…There is evidence that lung hyperinflation at rest is partially reversible to bronchodilator therapy and that lung deflation may in turn form the basis for improved respiratory symptoms (12)(13)(14)(15). Indeed, it can be argued that improvement in FEV 1 following bronchodilator treatment mainly reflects recruitment of VC as a result of reduced air trapping (i.e., reduced RV).…”

Section: Introductionmentioning

confidence: 99%

Lung Hyperinflation and Its Reversibility in Patients with Airway Obstruction of Varying Severity

Deesomchok

Webb

Forkert

et al. 2010

COPD: Journal of Chronic Obstructive Pulmonary Disease

103

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The natural history of lung hyperinflation in patients with airway obstruction is unknown. In particular, little information exists about the extent of air trapping and its reversibility to bronchodilator therapy in those with mild airway obstruction. We completed a retrospective analysis of data from individuals with airway obstruction who attended our pulmonary function laboratory and had plethysmographic lung volume measurements pre-and post-bronchodilator (salbutamol). COPD was likely the predominant diagnosis but patients with asthma may have been included. We studied 2,265 subjects (61% male), age 65 ± 9 years (mean ± SD) with a postbronchodilator FEV 1 /FVC <0.70. We examined relationships between indices of airway obstruction and lung hyperinflation, and measured responses to bronchodilation across subgroups stratified by GOLD criteria. In GOLD stage I, vital capacity (VC) and inspiratory capacity (IC) were in the normal range; pre-bronchodilator residual volume (RV), functional residual capacity (FRC) and specific airway resistance were increased to 135%, 119% and 250% of predicted, respectively. For the group as a whole, RV and FRC increased exponentially as FEV 1 decreased, while VC and IC decreased linearly. Regardless of baseline FEV 1 , the most consistent improvement following bronchodilation was RV reduction, in terms of magnitude and responder rate. In conclusion, increases (above normal) in airway resistance and plethysmographic lung volumes were found in those with only minor airway obstruction. Indices of lung hyperinflation increased exponentially as airway obstruction worsened. Those with the greatest resting lung hyperinflation showed the largest bronchodilator-induced volume deflation effects. Reduced air trapping was the predominant response to acute bronchodilation across severity subgroups.

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Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

Jensen

Amjadi

Harris-McAllister

et al. 2008

Thorax

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Background: This study examined the effects of inhaled furosemide on the ventilatory and perceptual response to high-intensity constant-load cycle exercise in chronic obstructive pulmonary disease (COPD). Methods: In a randomised, double-blind, placebocontrolled, crossover study, 20 patients with COPD (mean (SD) forced expiratory volume in 1 s 45 (15)% predicted) received either nebulised furosemide 40 mg or placebo on two separate days. Thirty minutes after each treatment, patients performed pulmonary function tests and a symptom-limited cycle exercise test at 75% of their maximum incremental work rate. Changes in spirometry, plethysmographic lung volumes, dynamic operating lung volumes, ventilation, breathing pattern, cardiovascular function, dyspnoea intensity and exercise endurance time were compared between treatments. Results: Compared with placebo, treatment with furosemide resulted in a mean (SD) decrease in dyspnoea intensity at the highest equivalent exercise time (ie, isotime for each patient) of 0.9 (1.0) Borg units (p,0.01) and an increase in exercise endurance time of 1.65 (0.63) min (p,0.05). These improvements were associated with increases in dynamic inspiratory capacity, tidal volume and mean tidal expiratory flow rates at isotime (p,0.01). The eight patients whose exercise endurance time improved by .1 min had greater changes in operating lung volumes (p,0.05), submaximal oxygen pulse (p,0.05) and oxygen uptake (p = 0.05) than those in whom exercise endurance time did not improve. Conclusion: Alleviation of exertional dyspnoea after single-dose furosemide inhalation in COPD is multifactorial but improvements in dynamic ventilatory mechanics are contributory in some individuals.Perceived respiratory difficulty (dyspnoea) and activity limitation are the dominant symptoms of chronic obstructive pulmonary disease (COPD) and contribute importantly to perceived poor health-related quality of life in this population.

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Improvements in symptom-limited exercise performance over 8h with once-daily tiotropium in patients with COPD

Cited by 16 publications

References 0 publications

Physiology and consequences of lung hyperinflation in COPD

Physiology and consequences of lung hyperinflation in COPD

Lung Hyperinflation and Its Reversibility in Patients with Airway Obstruction of Varying Severity

Mechanisms of dyspnoea relief and improved exercise endurance after furosemide inhalation in COPD

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