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Am. J. Respir. Crit. Care Med., Volume 160, Number 2, August 1999, 542-549

Spirometric Correlates of Improvement in Exercise Performance after Anticholinergic Therapy in Chronic Obstructive Pulmonary Disease

DENIS E. O'DONNELL, MIU LAM, and KATHERINE A. WEBB

Respiratory Investigation Unit, Departments of Medicine and Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada

We wished to determine which resting spirometric parameters best reflect improvements in exercise tolerance and exertional dyspnea in response to acute high-dose anticholinergic therapy in advanced COPD. We studied 29 patients with stable COPD (FEV1 = 40 ± 2% predicted [%pred]; mean ± SEM) and moderate to severe chronic dyspnea. In a double-blind placebo-controlled cross-over study, patients performed spirometry and symptom-limited constant-load cycle exercise before and 1 h after receiving 500 µg of nebulized ipratropium bromide (IB) or saline placebo. There were no significant changes in spirometry, exercise endurance, or exertional dyspnea after receiving placebo. In response to IB (n = 58): FEV1, FVC, and inspiratory capacity (IC) increased by 7 ± 1%pred, 10 ± 1%pred, and 14 ± 2%pred, respectively (p < 0.001), with no change in the FEV1/FVC ratio. After receiving IB, exercise endurance time (Tlim) increased by 32 ± 9% (p < 0.001) and slopes of Borg dyspnea ratings over time decreased by 11 ± 6% (p < 0.05). Percent change (%Delta ) in Tlim correlated best with Delta IC%pred (p = 0.020) and change in inspiratory reserve volume (Delta TLC%pred) (p = 0.014), but not with Delta FVC%pred, Delta PEFR%pred, or Delta FEV1%pred. Change in Borg dyspnea ratings at isotime near end exercise also correlated with Delta IC%pred (p = 0.04), but not with any other resting parameter. Changes in spirometric measurements are generally poor predictors of clinical improvement in response to bronchodilators in COPD. Of the available parameters, increased IC, which is an index of reduced resting lung hyperinflation, best reflected the improvements in exercise endurance and dyspnea after IB. IC should be used in conjunction with FEV1 when evaluating therapeutic responses in COPD. O'Donnell DE, Lam M, Webb KA. Spirometric correlates of improvement in exercise performance after anticholinergic therapy in chronic obstructive pulmonary disease.




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[Abstract] [Full Text] [PDF]

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P W Jones
Health status measurement in chronic obstructive pulmonary disease
Thorax, November 1, 2001; 56(11): 880 - 887.
[Abstract] [Full Text] [PDF]

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 Am. J. Respir. Crit. Care Med.Home page
D. E. O'DONNELL, S. M. REVILL, and K. A. WEBB
Dynamic Hyperinflation and Exercise Intolerance in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., September 1, 2001; 164(5): 770 - 777.
[Abstract] [Full Text] [PDF]

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J Hadcroft and P M A Calverley
Alternative methods for assessing bronchodilator reversibility in chronic obstructive pulmonary disease
Thorax, September 1, 2001; 56(9): 713 - 720.
[Abstract] [Full Text] [PDF]

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P.M.A. Calverley
Modern treatment of chronic obstructive pulmonary disease
Eur. Respir. J., July 2, 2001; 18(34_suppl): 60S - 66s.
[Abstract] [Full Text] [PDF]

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J. M. MARIN, S. J. CARRIZO, M. GASCON, A. SANCHEZ, B. GALLEGO, and B. R. CELLI
Inspiratory Capacity, Dynamic Hyperinflation, Breathlessness, and Exercise Performance during the 6-Minute-Walk Test in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., May 1, 2001; 163(6): 1395 - 1399.
[Abstract] [Full Text]

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C O'Brien, P J Guest, S L Hill, and R A Stockley
Physiological and radiological characterisation of patients diagnosed with chronic obstructive pulmonary disease in primary care
Thorax, August 1, 2000; 55(8): 635 - 642.
[Abstract] [Full Text]

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C. TAUBE, B. LEHNIGK, K. PAASCH, D. K. KIRSTEN, R. A. JÖRRES, and H. MAGNUSSEN
Factor Analysis of Changes in Dyspnea and Lung Function Parameters after Bronchodilation in Chronic Obstructive Pulmonary Disease
Am. J. Respir. Crit. Care Med., July 1, 2000; 162(1): 216 - 220.
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D. E. O'Donnell
Assessment of Bronchodilator Efficacy in Symptomatic COPD : Is Spirometry Useful?
Chest, February 1, 2000; 117 (2009): 42S - 47S.
[Abstract] [Full Text] [PDF]


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