Effects of Tiotropium on Hyperinflation and Treadmill Exercise Tolerance in Mild to Moderate Chronic Obstructive Pulmonary Disease

Casaburi, Richard; Maltais, François; Pórszász, János; Albers, Frank C.; Deng, Qi; Iqbal, Ahmar; Paden, Heather; O’Donnell, Denis E.

doi:10.1513/annalsats.201404-174oc

Cited by 58 publications

(57 citation statements)

References 20 publications

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“…Bronchodilators of all classes and duration of action have consistently been shown to decrease lung hyperinflation, with reciprocal increases in resting IC in patients with COPD [103,[106][107][108][109][110][111][112][113][114][115][116][117][118][119][120]. By increasing resting IC, bronchodilators also increase the available IRV and thereby delay the onset of critical respiratory-mechanical constraints on VT expansion during exercise [55,103,106,120].…”

Section: Improving Mechanicsmentioning

confidence: 99%

“…medication [63,[130][131][132][133][134][135], which directly or indirectly reduces central respiratory drive, can ameliorate dyspnoea during physical activity and improve exercise endurance. Reduced neural drive following these interventions usually manifests as reduced breathing frequency (and increased expiratory time) often with an attendant decrease in the rate of dynamic hyperinflation [108,113,126,128,131]. Supplemental O 2 can also improve O 2 delivery and utilisation at the peripheral muscle level thereby delaying onset of metabolic acidosis and the attendant rise in ventilatory stimulation [126,[136][137][138][139][140].…”

Section: Reducing Central Respiratory Drivementioning

confidence: 99%

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Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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Activity-related dyspnoea is often the most distressing symptom experienced by patients with chronic obstructive pulmonary disease (COPD) and can persist despite comprehensive medical management. It is now clear that dyspnoea during physical activity occurs across the spectrum of disease severity, even in those with mild airway obstruction. Our understanding of the nature and source of dyspnoea is incomplete, but current aetiological concepts emphasise the importance of increased central neural drive to breathe in the setting of a reduced ability of the respiratory system to appropriately respond. Since dyspnoea is provoked or aggravated by physical activity, its concurrent measurement during standardised laboratory exercise testing is clearly important. Combining measurement of perceptual and physiological responses during exercise can provide valuable insights into symptom severity and its pathophysiological underpinnings. This review summarises the abnormal physiological responses to exercise in COPD, as these form the basis for modern constructs of the neurobiology of exertional dyspnoea. The main objectives are: 1) to examine the role of cardiopulmonary exercise testing (CPET) in uncovering the physiological mechanisms of exertional dyspnoea in patients with mild-to-moderate COPD; 2) to examine the escalating negative sensory consequences of progressive respiratory impairment with disease advancement; and 3) to build a physiological rationale for individualised treatment optimisation based on CPET. @ERSpublications Measurement of symptom intensity, ventilatory control and mechanics during exercise exposes mechanisms of dyspnoea

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Section: Improving Mechanicsmentioning

confidence: 99%

Section: Reducing Central Respiratory Drivementioning

confidence: 99%

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

et al. 2016

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“…We postulate that the lack of benefit with respect to dyspnoea following bronchodilator treatment in mild COPD reflects the persistence of higher ventilatory demand due to high physiological V D , which is not mitigated by improving airway function. A recent randomized, double‐blind, crossover study confirmed that treatment with tiotropium in GOLD stage 1 COPD (with preserved resting IC) was associated with reduced lung hyperinflation at rest and during treadmill exercise but with no increase in exercise tolerance . By contrast, similar therapy delivered to patients with GOLD stage 2 (with reduced IC) resulted in quantitatively similar mechanical improvements, but in this case there was an attendant increase in exercise tolerance …”

Section: Reversing Physiological Impairment In Mild Copdmentioning

confidence: 96%

Physiological impairment in mild COPD

2015

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Chronic obstructive pulmonary disease (COPD) is a common and often progressive inflammatory disease of the airways, alveoli and microvasculature that is both preventable and treatable. It is well established that smokers with mild airway obstruction, as spirometrically defined, represent the vast majority of patients with COPD, yet this population has not been extensively studied. An insidious preclinical course means that mild COPD is both underdiagnosed and undertreated. In this context, recent studies have confirmed that even patients with mild COPD can have extensive physiological impairment, which contributes to poor perceived health status compared with non-smoking healthy controls. This review describes the heterogeneous pathophysiology that can exist in COPD patients with only mild airway obstruction on spirometry. It exposes the compensatory adaptations that develop in such patients to ensure that the respiratory system fulfils its primary task of maintaining adequate pulmonary gas exchange for the prevailing metabolic demand. It demonstrates that adaptations such as increased inspiratory neural drive to the diaphragm due to combined effects of increased mechanical loading and chemostimulation underscore the increased dyspnoea and exercise intolerance in this population. Finally, based on available evidence, we present what we believe is a sound physiological rationale for earlier diagnosis in this population.

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“…For the patient with abnormal spirometry but relatively infrequent symptoms, short‐acting inhaled bronchodilators would normally suffice (although good data about the frequency of this clinical presentation are lacking). Certainly, bronchodilators can improve lung mechanics but not necessarily exercise endurance even in mild COPD . For patients with more persistent symptoms and especially breathlessness and exercise impairment monotherapy with a LAMA is a good starting point.…”

Section: Discussionmentioning

confidence: 99%

A rational approach to single, dual and triple therapy in COPD

Calverley

Vlies

2015

Respirology

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The complexity of COPD treatment has increased over the last 5 years mainly because of the proliferation of drugs and delivery devices. In this paper, we will focus on currently available therapy used for maintaining patient well-being rather than acute relief of symptoms. We propose a series of principles for rational therapy, and following a review of how currently available treatments perform in isolation and when compared with each other, we suggest an approach to aid the rational selection of the most appropriate treatment based on current evidence.

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Effects of Tiotropium on Hyperinflation and Treadmill Exercise Tolerance in Mild to Moderate Chronic Obstructive Pulmonary Disease

Abstract: Resting and exercise hyperinflation were ameliorated by bronchodilator therapy with tiotropium in the overall GOLD 1 plus 2 COPD group. Exercise tolerance was enhanced in GOLD 2, but not GOLD 1, COPD. Clinical trial registered with www.clinicaltrials.gov (NCT01072396).

Cited by 58 publications

References 20 publications

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Exertional dyspnoea in COPD: the clinical utility of cardiopulmonary exercise testing

Physiological impairment in mild COPD

A rational approach to single, dual and triple therapy in COPD

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