Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in Chronic Obstructive Pulmonary Disease

Troosters, Thierry; Maltais, François; Leidy, Nancy Kline; Lavoie, Kim; Sedeno, Maria; Janssens, Wim; Garcia‐Aymerich, Judith; Eržen, Damijan; Sousa, Dorothy De; Korducki, Lawrence; Hamilton, Alan; Bourbeau, Jean

doi:10.1164/rccm.201706-1288oc

Cited by 91 publications

(118 citation statements)

References 40 publications

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“…A recent study evaluated the benefits of a self‐management behavior modification (SMBM) program in addition to dual bronchodilators and exercise training. The study demonstrated increased physical activity by 10–11 min per day, but exercise and inhaler therapy did not significantly increase physical activity(Troosters et al, 2018). This was surprising given that the study showed evidence of increase exercise endurance testing and resting inspiratory capacity, with an associated reduction in the intensity of dyspnea during exercise.…”

Section: Discussionmentioning

confidence: 99%

The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

et al. 2020

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Rationale:The effort required to cycle and breathe intensify as power increases during incremental exercise. It is currently unclear how changes in FEV 1 in the presence or absence of airflow limitation) impacts the intensity of dyspnea and leg effort. This is clinically important as the improvement in FEV 1 is often the target for improving dyspnea. Objectives: To investigate the relationship between dyspnea (D), leg effort, power (P), and FEV 1 with and without airflow limitation using direct psychophysical scaling performed during incremental exercise testing to symptom limited capacity. Methods: Retrospective analysis of consecutive patients over the age of 35 referred for cardio-pulmonary exercise testing at McMaster University Medical Centre from 1988-2012.The modified Borg scale was used to measure dyspnea throughout incremental exercise testing. Measurements and results: 38,788 patients were included in the analysis [Mean Age 58.6 years (SD ±11.8), Males 61%, BMI 28.1 kg/m 2 (SD ±5.1), FEV 1 was 2.7 L (SD ±0.85), 95% predicted (SD ±20.4), FVC 3.4 L (SD ± 1.0), 94% predicted (SD ±17.0)], and 10.9% had airflow limitation (AL, FEV 1 /FVC < 70%). In a nonlinear regression analysis, the intensity of dyspnea increased in a positively accelerating manner with power and as the FEV 1 % predicted decreased: Dyspnea = 0.06 * Pow er 1.03 * FEV 1 %Pred −0.66 (r = .63). The intensity of leg effort increased with power and declining quadricep strength and FEV1% predicted: Leg Effort = 0.06 * Power 1 .22 * Quad −0.56 *FEV 1 %Pred −0.39 (r = .73). There was no independent effect of AL on dyspnea of leg effort. Conclusion: Power, quadriceps strength and FEV1 are the dominant factors contributing to dyspnea and leg effort, irrespective of the degree of airflow limitation. K E Y W O R D S cardio-pulmonary exercise testing, dyspnea, leg effort, physiology How to cite this article: Satia I, Farooqi MAM, Cusack R, et al. The contribution of FEV 1 and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real-world cohort.

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Section: Discussionmentioning

confidence: 99%

The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

et al. 2020

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“…Tiotropium has been shown to decreases hyperinflation over 24 h and improve continuous work rate endurance on cycle ergometry [122]. Recently, it was shown that dual bronchodilatation improves exercise capacity in patients with COPD participating in a self-management behavior-modification program, irrespective of add-on exercise training [123], emphasizing the importance of lung deflation.…”

Section: Lung Volume Reduction and Pulmonary Rehabilitationmentioning

confidence: 99%

An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease

Wouters

Posthuma

Koopman

et al. 2020

Expert Review of Respiratory Medicine

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Introduction: Pulmonary rehabilitation (PR) is one of the core components in the management of patients with chronic obstructive pulmonary disease (COPD). In order to achieve the maximal level of independence, autonomy, and functioning of the patient, targeted therapies and interventions based on the identification of physical, emotional and social traits need to be provided by a dedicated, interdisciplinary PR team. Areas covered: The review discusses cardiopulmonary exercise testing in the selection of different modes of training modalities. Neuromuscular electrical stimulation as well as gait assessment and training are discussed as well as add-on therapies as oxygen, noninvasive ventilator support or endoscopic lung volume reduction in selected patients. The potentials of pulsed inhaled nitric oxide in patients with underlying pulmonary hypertension is explored as well as nutritional support. The impact of sleep quality on outcomes of PR is reviewed. Expert opinion: Individualized, comprehensive intervention based on thorough assessment of physical, emotional, and social traits in COPD patients forms a continuous challenge for health-care professionals and PR organizations in order to dynamically implement and adapt these strategies based on dynamic, more optimal understanding of underlying pathophysiological mechanisms.

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“…Eighty six full text articles were identified and sixty three were excluded by assessing the title and abstract; sixteen out of the twenty three eligible studies were excluded by considering each whole paper and in agreement with reasons reported in Figure 1. Finally, data obtained from 12,690 COPD patients (44.47% treated with T/O 5/5 mg FDC, 43.60% treated with T 5 mg, 11.93% treated with O 5 mg) were extracted from 7 studies including 10 RCTs published between 2015 and 2018 [31][32][33][34][35][36][37].…”

Section: Studies Characteristicsmentioning

confidence: 99%

Adding a Second Bronchodilator in COPD: A Meta-Analysis on the Risk of Specific Cardiovascular Serious Adverse Events of Tiotropium/Olodaterol Fixed-Dose Combination

Rogliani

Ritondo

Zerillo

et al. 2020

COPD: Journal of Chronic Obstructive Pulmonary Disease

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Dual bronchodilation therapy represents the cornerstone for the treatment of COPD. A large retrospective study reports that adding a second long-acting bronchodilator in patients with COPD significantly increases the risk of heart failure. Nevertheless, retrospective studies are characterized by limitations including misdiagnosis and inaccuracy of recordkeeping. This study aimed to ascertain whether tiotropium/olodaterol (T/O) 5/5 lg fixed-dose combination (FDC) may modulate the risk of main cardiovascular outcomes in COPD patients enrolled in randomized controlled trials (RCTs). A meta-analysis (CRD42017070100) was performed by selecting RCTs reporting raw data from the ClinicalTrials.gov database concerning the impact of T/O 5/5 mg FDC vs. monocomponents on the occurrence of specific cardiovascular serious adverse events: arrhythmia, heart failure, myocardial infarction, and stroke. Data were reported as relative risk and 95% Confidence Interval, and the risk of publication bias assessed via Egger's test. Eighty six full text articles were identified, and 10 RCTs published in 7 studies between 2015 and 2018 were included into the analysis. Data obtained from 12,690 COPD patients (44.47% T/O FDC, 55.53% monocomponents) were extracted. T/O 5/5 lg FDCs did not significantly modulate (p-value > 0.05) the risk of arrhythmia (1.02, 0.55-1.92), heart failure (0.88, 0.41-1.92), myocardial infarction (1.15, 0.70-1.87), and stroke (0.98, 0.44-2.16) vs. monocomponents. No significant publication bias affected the effect estimates of this meta-analysis. The results of this quantitative synthesis indicate that dual bronchodilation with T/O 5/5 lg FDC is characterized by an acceptable cardiovascular safety profile in COPD patients.

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Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in Chronic Obstructive Pulmonary Disease

Cited by 91 publications

References 40 publications

The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease

Adding a Second Bronchodilator in COPD: A Meta-Analysis on the Risk of Specific Cardiovascular Serious Adverse Events of Tiotropium/Olodaterol Fixed-Dose Combination

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Effect of Bronchodilation, Exercise Training, and Behavior Modification on Symptoms and Physical Activity in Chronic Obstructive Pulmonary Disease

Cited by 91 publications

References 40 publications

The contribution of FEV 1 and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

The contribution of FEV 1 and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

An update on pulmonary rehabilitation techniques for patients with chronic obstructive pulmonary disease

Adding a Second Bronchodilator in COPD: A Meta-Analysis on the Risk of Specific Cardiovascular Serious Adverse Events of Tiotropium/Olodaterol Fixed-Dose Combination

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Product

Resources

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The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort

The contribution of FEV ₁ and airflow limitation on the intensity of dyspnea and leg effort during exercise. Insights from a real‐world cohort