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Cited by 402Chronic Obstructive Pulmonary Disease (COPD) ResearchCardiovascular and exercise physiologyAsthma and respiratory diseases

Inhaled Bronchodilators Reduce Dynamic Hyperinflation During Exercise in Patients With Chronic Obstructive Pulmonary Disease

Belman, M J, Botnick, W C, Shin, J W·1996·American journal of respiratory and critical care medicine
DOI 10.1164/ajrccm.153.3.8630581
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Abstract

Dynamic hyperinflation (DH) is a major pathophysiologic consequence of airflow limitation during exercise in patients with chronic obstructive pulmonary disease (COPD) and an important contributing factor to breathlessness. In this study we aimed to examine the effect of inhaled beta agonist therapy on DH during exercise in these patients and the relationship between changes in DH and breathlessness. In 13 COPD patients (mean age 65.1 +/- 2.0, FEV1 1.20 +/- 0.17, FEV1/FVC 40 +/- 3) we measured pulmonary function tests, exercise breathlessness by Borg score, and exercise flow volume and pressure volume loops on two separate days. Prior to testing, patients randomly received inhaled placebo or albuterol on the first test day and the alternative medication on the second test day. From measurements of exercise inspiratory capacity (IC), we calculated the end-expiratory and end-inspiratory lung volumes (EELV, EILV). We used esophageal pressure recordings to measure peak inspiratory esophageal pressure (Pesins) during exercise and this was related to the maximal capacity for pressure generation taking into account lung volume and airflow changes (Pcapi). Bronchodilator caused significant increase in both FEV1 and FVC (+0.23 and +0.51, p<0.01). Comparisons of breathlessness, exercise volumes, and pressures were made at the highest equivalent work load. There was a significant reduction in the peak exercise EELV/TLC (80 +/- 0.02% to 76 +/- 0.02%, p<0.05) while the peak EILV/TLC decreased by 2% (97 +/- 1% to 95 +/- 1%, p<0.05). The peak Pesins/Pcapi decreased (0.79 +/- 0.10 to 0.57 +/- 0.05, p<0.05), and the Pcapi - Pesins increased (7.4 +/- 3 to 13.0 +/- 3 cm H2O, p<0.05). There was significant improvement in neuroventilatory coupling for volume change (Pesins/Pcapi/VT/TLC 5.45 +/- 0.5 to 3.25 +/- 1.0, p<0.05). There was a significant reduction in breathlessness as measured by Borg score (4.5 +/- 0.7 to 3.1 +/- 0.5, p<0.05) and there was a significant correlation between delta Borg and delta EILV/TLC (r=0.771, p<0.01) with a trend for Pesins/Pcapi/VT/TLC (r=0.544, p=0.067). There was also a significant correlation between delta EELV/TLC and delta Pesins/Pcapi/VT/TLC (r=0.772, p<0.01). The relationships between delta Borg, delta resting volumes, and flow rates were not significant. We conclude that in patients with COPD, inhaled bronchodilator reduces exercise DH and improves inspiratory pressure reserve and neuroventilatory coupling. Changes in DH and neuroventilatory coupling were the main determinants of reduced breathlessness.

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Crossref · 10.1164/ajrccm.153.3.8630581

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  • Interventions that deflate the lungs and delay the onset of critical VT constraints consistently reduce dyspnea intensity in patients with COPD during exercise.

    “Moreover, interventions that deflate the lungs (ie, reduce EILV and EELV) and delay the onset of critical VT constraints consistently reduce dyspnea intensity in patients with COPD during exercise.45,46,55,56”

    From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [55]

  • Pharmacological interventions that reduce operating lung volumes and delay the onset of ventilatory limitation consistently reduce the intensity of dyspnea during exercise in patients with COPD.

    “Pharmacological interventions that reduce operating lung volumes and delay the onset of ventilatory limitation consistently reduce the intensity of dyspnea during exercise in patients with COPD.46,55,56”

    From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [55]

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Authors
Belman, M. J., Botnick, W. C., & Shin, J. W.
Affiliations
Cedars-Sinai Medical Center (US)
ORCID
Shin, J W
Venue
American journal of respiratory and critical care medicine
Publisher
Oxford University Press (OUP)
Published
1996-03-01
Volume
153
Issue
3
Pages
967-975
ISSN
  • 1073-449X (ISSN-L)
  • 1535-4970
DOI
10.1164/ajrccm.153.3.8630581
OpenAlex
W2007810665
Cited by
402
References
21
Citations by year
2026: 1 · 2025: 3 · 2024: 1 · 2023: 4 · 2022: 1 · 2021: 1 · 2020: 8 · 2019: 5 · 2018: 1 · 2017: 4 · 2016: 9 · 2015: 6 · 2014: 8 · 2013: 10 · 2012: 10
FWCI
11.72
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • American Journal of Respiratory and Critical Care Medicine (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Complementary and alternative medicine › Cardiovascular and exercise physiology
  • Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
Keywords
dynamic hyperinflation, chronic obstructive pulmonary disease, inhaled beta-agonists, salbutamol, esophageal pressure, end-expiratory lung volume, inspiratory capacity, pressure-volume loops, inspiratory muscle strength, inspiratory muscle endurance, inspiratory muscle training
MeSH terms
Administration, Inhalation, Adrenergic beta-Agonists, Aged, Albuterol, Bronchodilator Agents, Dyspnea, Esophagus, Physical Exertion, Female, Forced Expiratory Volume, Humans, Inspiratory Capacity, Lung, Lung Diseases, Obstructive, Male, Middle Aged, Peak Expiratory Flow Rate, Pressure, Pulmonary Ventilation, Total Lung Capacity, Vital Capacity, Respiratory Mechanics

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