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Title: Can bronchodilators improve exercise tolerance in COPD patients without dynamic hyperinflation?
Authors: Scuarcialupi, Maria Enedina Aquino
Berton, Danilo Cortozi
Cordoni, Priscila Kessar
Squassoni, Selma Denis
Fiss, Elie
Neder, Jose Alberto [UNIFESP]
Fac Ciencias Med Paraiba
Univ Fed Rio Grande do Sul
Fac Med ABC
Queens Univ
Kingston Gen Hosp
Universidade Federal de São Paulo (UNIFESP)
Keywords: Pulmonary disease
chronic obstructive
Bronchodilator agents
Exercise test
Exercise tolerance
Inspiratory capacity
Issue Date: 1-Mar-2014
Publisher: Soc Brasileira Pneumologia Tisiologia
Citation: Jornal Brasileiro De Pneumologia. Brasilia Df: Soc Brasileira Pneumologia Tisiologia, v. 40, n. 2, p. 111-118, 2014.
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.
ISSN: 1806-3713
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