Impacting patient-centred outcomes in COPD: breathlessness and exercise tolerance

Abstract

The physiological hallmark of chronic obstructive pulmonary disease (COPD) is expiratory flow limitation. However, it is the resultant air trapping and associated increases in lung volume (hyperinflation) that provide a mechanistic link between the physiological impairment and the characteristic symptoms of COPD, such as dyspnoea (breathlessness), exercise intolerance and reduced health-related quality of life (HRQoL).During exercise, the negative consequences of hyperinflation are particularly apparent. Delayed lung emptying and increased end-expiratory lung volume are aggravated, and tidal volume cannot rise to meet the increased ventilatory demands. Dyspnoea intensity rises abruptly to intolerable levels, and further increases in ventilation can only be achieved by rapid breathing. This rebounds to cause greater hyperinflation in a vicious cycle. As a result, patients with COPD often prematurely stop or avoid activity, leading to deconditioning, increased dyspnoea, worsening of disease and, ultimately, reduced HRQoL.The Global Initiative for Chronic Obstructive Lung Disease guidelines recommend long-acting bronchodilators as first-line maintenance treatment in COPD.Once-daily tiotropium 18 mg, a long-acting anticholinergic agent with 24-h efficacy, has been consistently shown to relieve dyspnoea and improve exercise tolerance and health status. These improvements may allow patients with chronic obstructive pulmonary disease to increase their daily activities, thereby reversing the cycle of chronic inactivity and muscle deconditioning.

A randomized study using functional respiratory imaging to characterize bronchodilator effects of glycopyrrolate/formoterol fumarate delivered by a metered dose inhaler using co-suspension delivery technology in patients with COPD

“…The FRI-observed changes occurred distally, between the third and eighth bronchi generations, and were associated with clinically meaningful improvements in post-dose FEV 1 and IC 19. This indicates an important reduction in hyperinflation after treatment with GFF MDI 20–23. Furthermore, the improvements in lung function with GFF MDI vs placebo MDI seen in this study were consistently reflected across other FRI, spirometry, and body plethysmography evaluations.…”

COPD symptom burden: impact on health care resource utilization, and work and activity impairment

“…The progression of symptoms and the subsequent reduction in daily activities contribute collectively to a gradual deterioration in the patient’s health-related quality of life. 4 It is not surprising that from the perspective of the patient, the improvement of symptoms and enhancement of ability to engage in the normal activities of daily living (eg, family routine and, if applicable, work) are desirable goals of COPD management. 4 , 5…”

New developments in optimizing bronchodilator treatment of COPD: a focus on glycopyrrolate/formoterol combination formulated by co-suspension delivery technology

“…Reduced expiratory airflow in patients with COPD, insufficient expiration during cycles of breathing, and decreased lung elasticity due to emphysema can lead to air becoming trapped, which contributes to lung hyperinflation. 107 , 108 Lung hyperinflation can worsen at times when expiratory flow is suddenly reduced, such as during an exacerbation or bronchospasm, or when the rate of breathing is accelerated, such as during exercise. 107 , 109 …”

“… 107 , 108 Lung hyperinflation can worsen at times when expiratory flow is suddenly reduced, such as during an exacerbation or bronchospasm, or when the rate of breathing is accelerated, such as during exercise. 107 , 109 …”

“… 113 IC is an indirect measure of lung hyperinflation, since it decreases as more air becomes trapped in the lungs. 107 Therefore, therapies that increase IC may help improve exercise tolerance, lower exacerbation risk, and ultimately result in a better prognosis for patients with COPD.…”