Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?

Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?

Author Scuarcialupi, Maria Enedina Aquino Google Scholar
Berton, Danilo Cortozi Google Scholar
Cordoni, Priscila Kessar Google Scholar
Squassoni, Selma Denis Google Scholar
Fiss, Elie Google Scholar
Neder, Jose Alberto Autor UNIFESP Google Scholar
Institution Fac Ciencias Med Paraiba
Univ Fed Rio Grande do Sul
Fac Med ABC
Queens Univ
Kingston Gen Hosp
Universidade Federal de São Paulo (UNIFESP)
Abstract Objective: To investigate the modulatory effects that dynamic hyperinflation (UFO, defined as a reduction in inspiratory capacity (lC), has on exercise tolerance after bronchodilator in patients with COPD. Methods: An experimental, randomized study involving 30 COPD patients without severe hypoxemia. At baseline, the patients underwent clinical assessment, spirometry, and incremental cardiopulmonary exercise testing (CPET). On two subsequent visits, the patients were randomized to receive a combination of inhaled fenoterol/ipratropium or placebo. All patients then underwent spirometiy and submaximal CPET at constant speed up to the limit of tolerance (Tlim). The patients who showed Delta lC(peak-rest) < 0 were considered to present with DH (DH+). Results: In this sample, 21 patients (70%) had DH. The DH+ patients had higher airflow obstruction and lower Tlim than did the patients without Did (DH-). Despite equivalent improvement in FEV1 after bronchodilator, the DH- group showed higher Delta lC(bronchodilator-placebo) at rest in relation to the DH+ group (p < 0.05). However, this was not found in relation to Delta lC at peak exercise between DH+ and DH- groups (0.19 +/- 0.17 L vs. 0.17 +/- 0.15 L, p > 0.05). in addition, both groups showed similar improvements in Tlim after bronchodilator (median [interquartile range]: 22% [3-60% vs. 10% [3-53%]; p > 0.05). Conclusions: Improvement in TLim was associated with an increase in lC at rest after bronchodilator in HD- patients with COPD. However, even without that improvement, COPD patients can present with greater exercise tolerance after bronchodilator provided that they develop DH during exercise.
Keywords Pulmonary disease
chronic obstructive
Bronchodilator agents
Exercise test
Exercise tolerance
Inspiratory capacity
Language Portuguese
Date 2014-03-01
Published in Jornal Brasileiro De Pneumologia. Brasilia Df: Soc Brasileira Pneumologia Tisiologia, v. 40, n. 2, p. 111-118, 2014.
ISSN 1806-3713 (Sherpa/Romeo, impact factor)
Publisher Soc Brasileira Pneumologia Tisiologia
Extent 111-118
Access rights Open access Open Access
Type Article
Web of Science ID WOS:000334569100003
SciELO ID S1806-37132014000200111 (statistics in SciELO)

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