Effects of Ghrelin Treatment on Exercise Capacity in Underweight COPD Patients: a substudy of a multicenter, randomized, double-blind, placebo-controlled trial of ghrelin treatment

Miki, Keisuke; Maekura, Ryoji; Nagaya, Noritoshi; Kitada, Shuichi; Miki, Mari; Yoshimura, K.; Tateishi, Yoshitaka; Motone, Masaharu; Hiraga, Toru; Mori, Masahide; Kangawa, Kenji

doi:10.1186/1471-2466-13-37

Cited by 22 publications

(33 citation statements)

References 32 publications

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“…The substudy showed that ghrelin administration improved exercise capacity and ventilatory cardiac data, but that endurance time was not increased after administration of ghrelin; in other words, COPD patients treated with ghrelin could exercise more rapidly. Absolute dyspnea level during exercise was not significantly improved compared with placebo [21], however, which suggests a discrepancy between improved physiological findings and measures of direct patient benefit, i.e., exertional dyspnea level. Therefore, after completion of the main multicenter trial, including the substudy, to clarify more precisely the exertional dyspnea pattern after treatment with ghrelin, we examined, for a subpopulation of the substudy (n = 20), whether ghrelin administration affects the break-point in dyspnea during exercise.…”

Section: Introductioncontrasting

confidence: 61%

“…These encouraging results prompted us to undertake a multicenter, randomized, double-blind, placebo-controlled trial of ghrelin with 33 COPD patients; this showed that ghrelin administration improved symptoms and respiratory muscle strength [20]. In parallel with the main multicenter trial, to understand the precise mechanism that underlies the improvement of exercise performance or symptoms, a substudy with 20 COPD patients was conducted in a single center (Toneyama National Hospital) as part of the main multicenter trial [21]. The substudy showed that ghrelin administration improved exercise capacity and ventilatory cardiac data, but that endurance time was not increased after administration of ghrelin; in other words, COPD patients treated with ghrelin could exercise more rapidly.…”

Section: Introductionmentioning

confidence: 98%

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Effects of ghrelin treatment on exertional dyspnea in COPD: an exploratory analysis

et al. 2015

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A substudy of ghrelin treatment in a multicenter trial previously revealed that administration of ghrelin improves the exercise capacity of underweight COPD patients. To clarify exertional dyspnea more precisely, exploratory analysis was conducted on data from the substudy. Of 20 underweight COPD patients who were randomized to pulmonary rehabilitation with intravenous ghrelin (2 μg/kg, n = 10) or placebo (n = 10) twice daily for 3 weeks in the substudy, 16 (ghrelin = 9, placebo = 7) could be investigated for dyspnea break-point on the dyspnea-ratio (%) of Δoxygen uptake ([Formula: see text]) (= peak minus resting [Formula: see text]) curve. A significant treatment effect of ghrelin on percentage [Formula: see text] at the dyspnea break-point to Δ[Formula: see text] (p = 0.049) was achieved. In conclusion, underweight COPD patients benefitted from ghrelin treatment in terms of shifts to the early exercise phase of the dyspnea break-point during a standardized exercise program.

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Section: Introductioncontrasting

confidence: 61%

Section: Introductionmentioning

confidence: 98%

Effects of ghrelin treatment on exertional dyspnea in COPD: an exploratory analysis

et al. 2015

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“…However, there was no effect of nitric oxide inhalation [95]. A study of ghrelin in underweight COPD patients showed an average reduction in V′E-V′CO 2 slope of ∼4 units [96]. In cystic fibrosis, oxygen therapy reduced the minimum V′E-V′CO 2 [58].…”

Section: Clinically Meaningful Differencementioning

confidence: 99%

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

et al. 2016

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This document reviews 1) the measurement properties of commonly used exercise tests in patients with chronic respiratory diseases and 2) published studies on their utilty and/or evaluation obtained from MEDLINE and Cochrane Library searches between 1990 and March 2015.Exercise tests are reliable and consistently responsive to rehabilitative and pharmacological interventions. Thresholds for clinically important changes in performance are available for several tests. In pulmonary arterial hypertension, the 6-min walk test (6MWT), peak oxygen uptake and ventilation/carbon dioxide output indices appear to be the variables most responsive to vasodilators. While bronchodilators do not always show clinically relevant effects in chronic obstructive pulmonary disease, high-intensity constant work-rate (endurance) tests (CWRET) are considerably more responsive than incremental exercise tests and 6MWTs. High-intensity CWRETs need to be standardised to reduce interindividual variability. Additional physiological information and responsiveness can be obtained from isotime measurements, particularly of inspiratory capacity and dyspnoea. Less evidence is available for the endurance shuttle walk test. Although the incremental shuttle walk test and 6MWT are reliable and less expensive than cardiopulmonary exercise testing, two repetitions are needed at baseline. All exercise tests are safe when recommended precautions are followed, with evidence suggesting that no test is safer than others. @ERSpublications A review of exercise testing to evaluate interventions aimed to improve exercise tolerance in respiratory patients

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“…One clinical trial with ghrelin analogues have been conducted in COPD patients. They reported improvements of ventilatory efficiency at peak exercise, reflected by increased peak oxygen uptake 236. However, it did not translate in improved 6‐min walk distance, and no data are available about body composition or food intake.…”

Section: Compromised Dietary Intakementioning

confidence: 98%

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

Sanders¹,

Kneppers²,

Bool³

et al. 2015

Journal of Cachexia, Sarcopenia and Muscle

121

101

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Cachexia and muscle wasting are well recognized as common and partly reversible features of chronic obstructive pulmonary disease (COPD), adversely affecting disease progression and prognosis. This argues for integration of weight and muscle maintenance in patient care. In this review, recent insights are presented in the diagnosis of muscle wasting in COPD, the pathophysiology of muscle wasting, and putative mechanisms involved in a disturbed energy balance as cachexia driver. We discuss the therapeutic implications of these new insights for optimizing and personalizing management of COPD‐induced cachexia.

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Effects of Ghrelin Treatment on Exercise Capacity in Underweight COPD Patients: a substudy of a multicenter, randomized, double-blind, placebo-controlled trial of ghrelin treatment

Cited by 22 publications

References 32 publications

Effects of ghrelin treatment on exertional dyspnea in COPD: an exploratory analysis

Effects of ghrelin treatment on exertional dyspnea in COPD: an exploratory analysis

Use of exercise testing in the evaluation of interventional efficacy: an official ERS statement

Cachexia in chronic obstructive pulmonary disease: new insights and therapeutic perspective

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