Evaluation of acute bronchodilator reversibility in patients with symptoms of GOLD stage I COPD
Open accessAbstract
BACKGROUND: Patients with symptoms of GOLD stage I chronic obstructive pulmonary disease (COPD) can have significant abnormalities of ventilatory mechanics with greater exertional symptoms and exercise limitation than age-matched healthy subjects. In such patients the impact of bronchodilator therapy remains unknown and is difficult to evaluate. METHODS: The acute effects of nebulised ipratropium bromide 500 microg (IB) on resting pulmonary function and on dyspnoea and ventilatory parameters during symptom-limited constant work rate cycle exercise were measured. In a randomised double-blind crossover study, 16 patients with COPD (mean (SD) post-bronchodilator forced expiratory volume in 1 s (FEV(1)) 90 (7)% predicted, FEV(1)/forced vital capacity (FVC) 59 (7)%) with a significant smoking history (mean (SD) 44 (16) pack-years) inhaled either IB or placebo on each of two separate visits. Pulmonary function tests and cycle exercise at 80-85% of each subject's maximal work capacity were performed 2 h after dosing. RESULTS: Compared with placebo, FEV(1) increased 5 (9)% predicted, residual volume decreased 12 (20)% predicted and specific airway resistance decreased 81 (93)% predicted (all p<0.05) after IB. At a standardised time during exercise, dynamic inspiratory capacity and tidal volume significantly increased in tandem by 0.12 and 0.16 litres, respectively (each p<0.05), dyspnoea fell by 0.9 (1.8) Borg units (p = 0.07) and dyspnoea/ventilation ratios fell significantly (p<0.05). The fall in dyspnoea intensity at higher submaximal ventilations correlated with the concurrent decrease in end-expiratory lung volume (p<0.05). CONCLUSION: In patients with symptoms of GOLD stage I COPD, IB treatment is associated with modest but consistent improvements in airway function, operating lung volumes and dyspnoea intensity during exercise. These results provide a physiological rationale for a trial of bronchodilator therapy in selected patients with milder but symptomatic COPD.
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During exercise, dynamic hyperinflation is already present in patients with mild disease (GOLD stage 1), even when resting hyperinflation is slightly present or absent.
“During exercise, some studies report that dynamic hyperinflation is already present in patients with mild disease (GOLD stage 1), even when resting hyperinflation is slightly present22,23 or absent.24,41–43”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [23]
Dynamic hyperinflation also occurs in many patients with mild COPD, independently of the presence of resting hyperinflation.
“Dynamic hyperinflation is highly prevalent in the advanced stages of COPD, and new evidence suggests that it also occurs in many patients with mild disease, independently of the presence of resting hyperinflation.”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [23]
At peak exercise, notwithstanding the severity of the disease, patients with COPD show a consistent fall of approximately 20% of their resting IC at peak exercise.
“At peak exercise, notwithstanding the severity of the disease, patients seem to show a consistent fall of approximately 20% of their resting IC at peak exercise.22–24,45–48”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [23]
Cites
Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., Crapo, R., Enright, P., van der Grinten, C. P. M., Gustafsson, P., et al. (2005) · European Respiratory Journal · doi:10.1183/09031936.05.00034805 · Cited by 15,627 · see citing works
O'Donnell, D. E., Voduc, N., Fitzpatrick, M., & Webb, K. A. (2004) · European Respiratory Journal · doi:10.1183/09031936.04.00072703 · Cited by 365 · see citing works
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Vestbo, J., Hurd, S. S., Agustí, A. G., Jones, P. W., Vogelmeier, C., Anzueto, A., Barnes, P. J., Fabbri, L. M., Martinez, F. J., Nishimura, M., et al. (2013) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201204-0596pp · Cited by 15,983 · see citing works
Pathogenesis of hyperinflation in chronic obstructive pulmonary disease
Saey, Gagnon, P., Guenette, J., Langer, D., Laviolette, L., Mainguy, V., Maltais, F., & Ribeiro, F. (2014) · International Journal of Chronic Obstructive Pulmonary Disease · doi:10.2147/copd.s38934 · Cited by 180 · see citing works
Improving physical activity in COPD: towards a new paradigm
Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R. A., Vogiatzis, I., Weisman, I., & Kulich, K. (2013) · Respiratory Research · doi:10.1186/1465-9921-14-115 · Cited by 158 · see citing works
Laveneziana, P., Palange, P., Ora, J., Martolini, D., & O’Donnell, D. E. (2009) · European Journal of Applied Physiology · doi:10.1007/s00421-009-1169-4 · Cited by 60 · see citing works
Self-citation
- Authors
- O'Donnell, D. E., Laveneziana, P., Ora, J., Webb, K. A., Lam, Y.-M., & Ofir, D.
- Affiliations
- Queen's University (CA)
- Venue
- Thorax
- Publisher
- BMJ
- Published
- 2009-03-01
- Volume
- 64
- Issue
- 3
- Pages
- 216-223
- ISSN
- 0040-6376 (ISSN-L)
- OpenAlex
- W2131452204
- Cited by
- 104
- References
- 2
- Citations by year
- 2025: 1 · 2024: 2 · 2023: 4 · 2021: 3 · 2020: 2 · 2019: 1 · 2018: 2 · 2017: 7 · 2016: 7 · 2015: 7 · 2014: 14 · 2013: 11 · 2012: 13
- FWCI
- 9.22
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Thorax (publishedVersion)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Funders
- Queen's University
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Cystic Fibrosis Research Advances
- Keywords
- chronic obstructive pulmonary disease, ipratropium bromide, bronchodilator response, respiratory mechanics, airway resistance, end-expiratory lung volume, residual volume, inspiratory capacity
- MeSH terms
- Administration, Inhalation, Aged, Analysis of Variance, Bronchodilator Agents, Double-Blind Method, Dyspnea, Female, Humans, Male, Middle Aged, Ipratropium, Respiratory Function Tests, Exercise, Cross-Over Studies, Pulmonary Disease, Chronic Obstructive
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