Effects of tiotropium on lung hyperinflation, dyspnoea and exercise tolerance in COPD
Abstract
The aim of this study was to test the hypothesis that use of tiotropium, a new long-acting anticholinergic bronchodilator, would be associated with sustained reduction in lung hyperinflation and, thereby, would improve exertional dyspnoea and exercise performance in patients with chronic obstructive pulmonary disease. A randomised, double-blind, placebo-controlled, parallel-group study was conducted in 187 patients (forced expiratory volume in one second 44 +/- 13% pred): 96 patients received 18 microg tiotropium and 91 patients received placebo once daily for 42 days. Spirometry, plethysmographic lung volumes, cycle exercise endurance and exertional dyspnoea intensity at 75% of each patient's maximal work capacity were compared. On day 42, the use of tiotropium was associated with the following effects at pre-dose and post-dose measurements as compared to placebo: vital capacity and inspiratory capacity (IC) increased, with inverse decreases in residual volume and functional residual capacity. Tiotropium increased post-dose exercise endurance time by 105 +/- 40 s (21%) as compared to placebo on day 42. At a standardised time near end-exercise (isotime), IC, tidal volume and minute ventilation all increased, whilst dyspnoea decreased by 0.9 +/- 0.3 Borg scale units. In conclusion, the use of tiotropium was associated with sustained reductions of lung hyperinflation at rest and during exercise. Resultant increases in inspiratory capacity permitted greater expansion of tidal volume and contributed to improvements in both exertional dyspnoea and exercise endurance.
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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 [46]
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 [46]
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 [46]
More than 80% of patients with moderate-to-severe COPD showed significant increases in EELV during exercise.
“More than 80% of patients with moderate-to-severe COPD showed significant increases in EELV during exercise.11,13,46,150”
From Pathogenesis of hyperinflation in chronic obstructive pulmonary disease (2014) · cites this paper as [46]
The improvement in airflow associated with effective bronchodilators will improve dyspnea and exercise tolerance.
“The improvement in airflow associated with effective bronchodilators will improve dyspnea and exercise tolerance.94”
From Anxiety and Depression in COPD (2008) · cites this paper as [94]
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- Authors
- O'Donnell, D. E., Flüge, T., Gerken, F., Hamilton, A., Webb, K., Aguilaniu, B., Make, B., & Magnussen, H.
- Affiliations
- Boehringer Ingelheim (Germany) (DE)
- Queen's University (CA)
- National Jewish Health (US)
- Venue
- European Respiratory Journal
- Publisher
- European Respiratory Society (ERS)
- Published
- 2004-06
- Volume
- 23
- Issue
- 6
- Pages
- 832-840
- ISSN
- 0903-1936 (ISSN-L)
- 1399-3003
- OpenAlex
- W2121914298
- Cited by
- 859
- References
- 38
- Citations by year
- 2026: 8 · 2025: 5 · 2024: 14 · 2023: 15 · 2022: 10 · 2021: 17 · 2020: 29 · 2019: 17 · 2018: 30 · 2017: 35 · 2016: 36 · 2015: 34 · 2014: 43 · 2013: 50 · 2012: 55
- FWCI
- 63.27
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Respiratory Journal (publishedVersion)
- PubMed (publishedVersion)
- 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 › Inhalation and Respiratory Drug Delivery
- Keywords
- tiotropium, chronic obstructive pulmonary disease, lung hyperinflation, exertional dyspnea, exercise endurance, inspiratory capacity, residual volume, tidal volume, vital capacity
- MeSH terms
- Tiotropium Bromide, Aged, Analysis of Variance, Double-Blind Method, Dyspnea, Exercise Test, Female, Humans, Lung Volume Measurements, Male, Middle Aged, Physical Endurance, Plethysmography, Scopolamine Derivatives, Spirometry, Exercise Tolerance, Cholinergic Antagonists, Pulmonary Disease, Chronic Obstructive
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