Exercise Capacity and Ventilatory Response During Exercise in COPD Patients With and Without β Blockade

Thirapatarapong, Wilawan; Armstrong, Hilary F.; Bartels, Matthew N.

doi:10.1007/s00408-013-9492-2

Cited by 8 publications

(12 citation statements)

References 38 publications

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“…26 However, we kept individuals who used this medication in our study sample because exercise capacity remained unchanged during ␤-blocker use in a study by Thirapatarapong et al 26 In their study, individuals with COPD with and without ␤-blocker medications were compared in a maximum exercise test, and no difference was found in exercise capacity and ventilatory demand among the groups. 26 Other studies also included individuals using this medication in their heart rate analysis and demonstrated that there is no influence of ␤ blockers on analyzed outcomes. 1,23 Thus, the clinical applicability of our results can be considered more generalizable.…”

Section: Discussionmentioning

confidence: 99%

Heart Rate Recovery, Physical Activity Level, and Functional Status in Subjects With COPD

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Heart Rate Recovery, Physical Activity Level, and Functional Status in Subjects With COPD

et al. 2018

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“…Arterial hypoxemia leading to high hypoxic drive does not seem to contribute to poor ventilatory efficiency in overlap [44]; however, few hypoxaemic patients were enrolled in previous studies [41,43,44]. Although β-blockers failed to decrease the V′E/V′CO 2 nadir in COPD [39], the impact of prospective pharmacological interventions on ventilatory efficiency remains unknown in COPD-heart failure overlap and in COPD patients with out-of-proportion pulmonary hypertension. Potential improvements in ventilatory efficiency might prove valuable to decrease exertional dyspnoea and improve exercise tolerance in selected patients, particularly when cardiocirculatory abnormalities predominate over mechanical constraints (table 2) [38].…”

Section: Impact Of Co-morbidities On Ventilatory Efficiencymentioning

confidence: 99%

“…Thus, single- [51] and double-lung [61] transplantation and lung volume reduction surgery [63,66] lessened VD and increased VT thereby reducing VD/VT with consequent benefits to ventilatory efficiency. This suggests that the marked effects of these interventions on VD/VT (which would lessen V′E) relatively outweighed the consequences of lower mechanical constraints, which would otherwise increase V′E [39,[46][47][48][49][98][99][100]. Lower neural drive (e.g.…”

Section: Effects Of Interventionsmentioning

confidence: 99%

“…Since high-intensity, constant work rate exercise testing is more sensitive than incremental CPET for the purpose of bronchodilator evaluation [104,105], there are only sparse data on effects of bronchodilators on V′E−V′CO 2 slope and V′E intercept during incremental tests. For instance, less mechanical constraints tending to increase V′E [39,[46][47][48][49]98-100] may be off-set by a lower VD/VT, which tends to decrease V′E [50,55,59,60]. Such complex interactions would probably vary among subjects in large clinical trials.…”

Section: Effects Of Interventionsmentioning

confidence: 99%

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Physiological and clinical relevance of exercise ventilatory efficiency in COPD

et al. 2017

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Exercise ventilation (') relative to carbon dioxide output (' ) is particularly relevant to patients limited by the respiratory system, those with chronic obstructive pulmonary disease (COPD). High'-' (poor ventilatory efficiency) has been found to be a key physiological abnormality in symptomatic patients with largely preserved forced expiratory volume in 1 s (FEV). Establishing an association between high '-' and exertional dyspnoea in mild COPD provides evidence that exercise intolerance is not a mere consequence of detraining. As the disease evolves, poor ventilatory efficiency might help explaining "out-of-proportion" breathlessness (to FEV impairment). Regardless, disease severity, cardiocirculatory co-morbidities such as heart failure and pulmonary hypertension have been found to increase '-' In fact, a high '-' has been found to be a powerful predictor of poor outcome in lung resection surgery. Moreover, a high '-' has added value to resting lung hyperinflation in predicting all-cause and respiratory mortality across the spectrum of COPD severity. Documenting improved ventilatory efficiency after lung transplantation and lung volume reduction surgery provides objective evidence of treatment efficacy. Considering the usefulness of exercise ventilatory efficiency in different clinical scenarios, the '-' relationship should be valued in the interpretation of cardiopulmonary exercise tests in patients with mild-to-end-stage COPD.

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“…In a comparison of bisoprolol and placebo in patients with moderate-to-severe COPD, there was a significantly worsening of dynamic hyperinflation during cycle endurance while exercise duration was unaltered [57]. In a study comparing 24 COPD patients on beta-blockers matched to patients not taking beta-blockers there was no difference in exercise capacity or gas exchange despite lower heart rate and blood pressure, in turn suggesting great oxygen delivery per heart beat [58].…”

Section: Choice Of Beta-blocker and Effects On Pulmonary Functionmentioning

confidence: 99%

Beta-blockers in COPD: time for reappraisal

et al. 2016

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The combined effects on the heart of smoking and hypoxaemia may contribute to an increased cardiovascular burden in chronic obstructive pulmonary disease (COPD). The use of beta-blockers in COPD has been proposed because of their known cardioprotective effects as well as reducing heart rate and improving systolic function. Despite the proven cardiac benefits of beta-blockers post-myocardial infarction and in heart failure they remain underused due to concerns regarding potential bronchoconstriction, even with cardioselective drugs. Initiating treatment with beta-blockers requires dose titration and monitoring over a period of weeks, and beta-blockers may be less well tolerated in older patients with COPD who have other comorbidities. Medium-term prospective placebo-controlled safety studies in COPD are warranted to reassure prescribers regarding the pulmonary and cardiac tolerability of beta-blockers as well as evaluating their potential interaction with concomitant inhaled long-acting bronchodilator therapy. Several retrospective observational studies have shown impressive reductions in mortality and exacerbations conferred by beta-blockers in COPD. However, this requires confirmation from long-term prospective placebo-controlled randomised controlled trials. The real challenge is to establish whether beta-blockers confer benefits on mortality and exacerbations in all patients with COPD, including those with silent cardiovascular disease where the situation is less clear.

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Exercise Capacity and Ventilatory Response During Exercise in COPD Patients With and Without β Blockade

Abstract: Exercise capacity and gas exchange remain unaffected in patients with COPD in the presence of BB, although heart rate and blood pressure are lower. These findings imply that BB does not adversely affect functional capacity in patients with COPD.

Cited by 8 publications

References 38 publications

Heart Rate Recovery, Physical Activity Level, and Functional Status in Subjects With COPD

Heart Rate Recovery, Physical Activity Level, and Functional Status in Subjects With COPD

Physiological and clinical relevance of exercise ventilatory efficiency in COPD

Beta-blockers in COPD: time for reappraisal

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