Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease.

Belman, Michael J.; Botnick, Warren C.; Shin, John W.

doi:10.1164/ajrccm.153.3.8630581

Cited by 362 publications

(259 citation statements)

References 25 publications

(57 reference statements)

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“…In keeping with numerous previous bronchodilator studies, the FEV1/FVC ratio was unchanged, indicating that increases in FEV1 were mainly the result of volume recruitment [2,3,[23][24][25].…”

Section: Effect Of Salmeterol On Resting Lung Volumessupporting

confidence: 88%

“…Bronchodilator-induced lung deflation reduced mechanical restriction, increased ventilatory capacity and decreased respiratory discomfort, thereby increasing exercise endurance. Several recent studies have shown that improvements in exertional dyspnoea following bronchodilator therapy in chronic obstructive pulmonary disease (COPD) correlate well with reductions in lung hyperinflation, as indicated by increases in inspiratory capacity (IC) [1][2][3][4][5]. However, the relationship between bronchodilator-induced increases in IC and improvements in symptoms and exercise performance is complex and poorly understood.…”

mentioning

confidence: 99%

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Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease

O’Donnell¹,

Voduc²,

Fitzpatrick³

et al. 2004

Eur Respir J

330

273

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This study examined the effects of bronchodilator-induced reductions in lung hyperinflation on breathing pattern, ventilation and dyspnoea during exercise in chronic obstructive pulmonary disease (COPD). Quantitative tidal flow/volume loop analysis was used to evaluate abnormalities in dynamic ventilatory mechanics and their manipulation by a bronchodilator.In a randomised double-blind crossover study, 23 patients with COPD (mean¡SEM forced expiratory volume in one second 42¡3% of the predicted value) inhaled salmeterol 50 mg or placebo twice daily for 2 weeks each. After each treatment period, 2 h after dose, patients performed pulmonary function tests and symptom-limited cycle exercise at 75% of their maximal work-rate.After salmeterol versus placebo at rest, volume-corrected maximal expiratory flow rates increased by 175¡52%, inspiratory capacity (IC) increased by 11¡2% pred and functional residual capacity decreased by 11¡3% pred. At a standardised time during exercise, salmeterol increased IC, tidal volume (VT), mean inspiratory and expiratory flows, ventilation, oxygen uptake (V9O 2 ) and carbon dioxide output. Salmeterol increased peak exercise endurance, V9O 2 and ventilation by 58¡19, 8¡3 and 12¡3%, respectively. Improvements in peak V9O 2 correlated best with increases in peak VT; increases in peak VT and resting IC were interrelated. The reduction in dyspnoea ratings at a standardised time correlated with the increased VT.Mechanical factors play an important role in shaping the ventilatory response to exercise in chronic obstructive pulmonary disease. Bronchodilator-induced lung deflation reduced mechanical restriction, increased ventilatory capacity and decreased respiratory discomfort, thereby increasing exercise endurance. Several recent studies have shown that improvements in exertional dyspnoea following bronchodilator therapy in chronic obstructive pulmonary disease (COPD) correlate well with reductions in lung hyperinflation, as indicated by increases in inspiratory capacity (IC) [1][2][3][4][5]. However, the relationship between bronchodilator-induced increases in IC and improvements in symptoms and exercise performance is complex and poorly understood. Given the multifactorial nature of dyspnoea and exercise limitation in COPD, it remains unclear why small increases in resting IC (in the order of 0.3 L) appear to be clinically important. The current study extends previous studies conducted in the present authors9 laboratory using ipratropium bromide by, in addition, examining the effect of a bronchodilator (salmeterol) on plethysmographic lung volume components at rest and on breathing pattern and ventilatory capacity during exercise. Moreover, the study was designed to advance understanding of the mechanisms of bronchodilatorinduced dyspnoea relief, especially the role of reduced mechanical restriction.It has previously been shown that acute-on-chronic hyperinflation during exercise severely constrains tidal volume (VT) expansion, and that this dynamic mechanical restriction makes ...

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Section: Effect Of Salmeterol On Resting Lung Volumessupporting

confidence: 88%

mentioning

confidence: 99%

Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease

O’Donnell¹,

Voduc²,

Fitzpatrick³

et al. 2004

Eur Respir J

330

273

View full text Add to dashboard Cite

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“…These symptomatic improvements are associated with decreases in functional residual capacity (FRC) and residual volume (RV) and with increases in FVC, SVC, inspiratory capacity (IC) and specific conductance. RV was the most frequently reduced lung volume [18,22,25,[29][30][31]. The decrease in FRC means that end-expiratory lung volume decreased and that tidal breathing had moved to a lower operational lung volume.…”

Section: Discussionmentioning

confidence: 99%

Airway inflammation in COPD: physiological outcome measures and induced sputum

Crapo

Jensen²,

Hargreave³

2003

Eur Respir J

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Chronic obstructive pulmonary disease (COPD) is a result of airway inflammation, and the best predictor of COPD is the early detection of airflow limitation by spirometry. The Global Initiative for Obstructive Lung Disease Workshop Report defines airflow limitation using simple spirometric indices. Available guidelines categorise the severity of COPD using forced expiratory volume in one second (FEV1) and forced vital capacity (FVC), with symptoms playing a minor role in the assessment.Current standards define COPD by progressive loss of FEV1, and thus longitudinal decline in FEV1 will be the primary outcome variable for intervention studies aimed at preventing or reducing the loss of pulmonary function. There is evidence, however, that the variable FEV1/FVC and FEV1 are often not measured properly in all settings.This article will discuss the roles of physiological measurements in diagnosing COPD and physiological outcome measures for COPD. It does not formally compare physiological measures with other outcome measures, such as symptoms or quality of life. Additionally, improved treatment of established disease requires a better understanding of the inflammatory process and its clinical effects and treatment.The inflammatory process, and how drugs affect it, can be studied noninvasively or relatively noninvasively by using refined methods of examining spontaneous or induced sputum. Enhanced understanding of the use of induced sputum will assist in predicting patients9 responses to short-and long-term inhaled corticosteroid treatment, and the methods of sputum examination need to be simplified so that they can be applied more easily to clinical practice. Eur Respir J 2003; 21: Suppl. 41, 19s- Chronic obstructive pulmonary disease (COPD) is defined by the Global Initiative for Obstructive Lung Disease (GOLD) as a "disease state characterised by airflow limitation that is not fully reversible. …The airflow limitation is usually both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases" [1]. The absence of reversibility tends to exclude asthma by definition, although asthma can coexist with COPD. Methods of assessing airflow limitation: current recommendations and their limitationsAvailable guidelines categorise the severity of COPD primarily by using forced expiratory volume in one second (FEV1), whereas symptoms play a minor role in the assessment [1][2][3][4][5]. This tight link between FEV1 and COPD reflects the fact that spirometry is the standard for defining the presence of airway obstruction and the progressive loss of FEV1, the physiological variable that characterises COPD severity and predicts its mortality. Spirometry has become the standard, in part, because good quality and inexpensive tests are widely available.The GOLD Workshop Report explicitly defines airflow limitation using simple spirometric indices. Specifically, airflow limitation is defined as an FEV1/forced vital capacity (FVC)v70% and a postbronchodilator FEV1v80% of predict...

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“…A BDinduced increase in the resting IC (indicating reduced lung hyperinflation) in the order of 0.3 L or ,10% predicted, appears to be clinically meaningful and corresponds to important improvements in exertional dyspnoea and exercise endurance [3][4][5][16][17][18][19]. Several studies have shown that BD therapy does not alter the rate of dynamic hyperinflation (or air trapping) during exercise [3][4][5][16][17][18][19][20].…”

mentioning

confidence: 95%

“…EFFECT OF BDs ON DYNAMIC VENTILATORY MECHANICS DURING EXERCISE Improvements in resting inspiratory capacity (IC) have been shown to occur as a result of treatment with all classes of BDs and this indirectly signifies reduced EELV [3,[16][17][18]. A BDinduced increase in the resting IC (indicating reduced lung hyperinflation) in the order of 0.3 L or ,10% predicted, appears to be clinically meaningful and corresponds to important improvements in exertional dyspnoea and exercise endurance [3][4][5][16][17][18][19].…”

mentioning

confidence: 99%

Lung hyperinflation in COPD: the impact of pharmacotherapy

O’Donnell¹,

Laveneziana²

2006

Eur Respir Rev

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Improvement in airway function in response to bronchodilator therapy is generally confirmed by simple spirometry. However, improvements in maximal expiratory flow rates have been shown to correlate poorly with important patient-centred outcomes, such as reduced exertional dyspnoea and improved exercise performance. Recent studies have suggested that attendant reductions in end-expiratory lung volume as a result of bronchodilator-induced improvements in lung emptying may be more closely associated with symptom relief and increased exercise capacity than traditional spirometric indices. To the extent that chronic lung hyperinflation and the superimposition of acute dynamic hyperinflation (in response to increased ventilation or expiratory flow limitation) result in excessive loading and weakening of the inspiratory muscles, then pharmacological lung volume reduction should have important mechanical and sensory benefits for the patient.The present article will examine the mechanisms of lung deflation following short-term bronchodilator therapy. The physiological links between reduced hyperinflation, improved dyspnoea and exercise endurance will be examined, and the emerging evidence for the additive effects of combining various modern pharmacological therapies will be reviewed.

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Inhaled bronchodilators reduce dynamic hyperinflation during exercise in patients with chronic obstructive pulmonary disease.

Cited by 362 publications

References 25 publications

Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease

Effect of salmeterol on the ventilatory response to exercise in chronic obstructive pulmonary disease

Airway inflammation in COPD: physiological outcome measures and induced sputum

Lung hyperinflation in COPD: the impact of pharmacotherapy

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