oxitropium and Dyspnea

Tiotropium partially relieves exertional dyspnea and reduces the risk of congestive heart failure in chronic obstructive pulmonary disease (COPD) patients. However, its effect on the sympathetic activation response to exercise is unknown.. This study aimed to determine whether tiotropium use results in a sustained reduction in sympathetic activation during exercise.. We conducted a 12-week, open-label (treatments: tiotropium 18 μg or oxitropium 0.2 mg × 3 mg), crossover study in 17 COPD patients. Treatment order was randomized across subjects. The subjects underwent a pulmonary function test and two modes of cardiopulmonary exercise (constant work rate and incremental exercise) testing using a cycle ergometer, with measurement of arterial catecholamines after each treatment period.. Forced expiratory volume in 1 second and forced vital capacity were significantly larger in the tiotropium treatment group. In constant exercise testing, exercise endurance time was longer, with improvement in dyspnea during exercise and reduction in dynamic hyperinflation in the tiotropium treatment group. Similarly, in incremental exercise testing, exercise time, carbon dioxide production, and minute ventilation at peak exercise were significantly higher in the tiotropium treatment group. Plasma norepinephrine concentrations and dyspnea intensity were also lower during submaximal isotime exercise and throughout the incremental workload exercise in the tiotropium treatment group.. Tiotropium suppressed the increase of sympathetic activation during exercise at the end of the 6-week treatment, as compared with the effect of oxipropium. This effect might be attributed to improvement in lung function and exercise capacity and reduction in exertional dyspnea, which were associated with decreases in respiratory frequency and heart rate and reduced progression of arterial acidosis.

Topics: Aged; Cholinergic Agents; Cholinergic Antagonists; Cross-Over Studies; Dyspnea; Exercise Tolerance; Female; Heart Failure; Heart Function Tests; Humans; Male; Physical Exertion; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Scopolamine Derivatives; Tiotropium Bromide; Treatment Outcome

No consistent data are available regarding the effect of inhaled corticosteroids (ICS) in alpha(1)-antitrypsin-deficiency (AATD)-related COPD. Recent data report inflammatory effects of the polymers of alpha(1)-antitrypsin on the peripheral lung.. The aim of this study was to assess the effectiveness of an extra-fine ICS, hydrofluoroalkane-134a beclometasone dipropionate (HFA-BDP) with a mass median aerodynamic diameter of 1.1 microm, on lung function and exercise tolerance in COPD patients with AATD when added to long-acting bronchodilators (LABAs).. After a 1-week washout, 8 steroid-naïve COPD patients with AATD (ZZ genotype), within a double-blind randomized cross-over study, were assigned to one of the following 16-week treatments: (1) HFA-BDP 400 microg b.i.d., salmeterol 50 microg b.i.d. and oxitropium bromide 200 microg t.i.d. or (2) placebo, salmeterol 50 microg b.i.d. and oxitropium bromide 200 microg t.i.d; after a 2-week washout period they received the other treatment. In weeks 1, 17, 19 and 35, patients took a spirometry assessment (breathing air and heliox) and a shuttle walking test (SWT) with dyspnea assessed by the modified Borg scale.. Significant differences in improvement were found in FEV(1), FVC, IC, distance covered and dyspnea perceived during SWT between the 2 treatments and baseline values (p < 0.05; Friedman's test). However, further analysis showed that only the LABAs + ICS condition showed significant increases in the FEV(1), FVC, IC, DeltaMEF(50%) and distance covered during SWT along with a reduction in maximum isostep exertional dyspnea (p < 0.05; Wilcoxon test). A greater distance was walked at the end of the SWT with LABA + ICS than LABAs alone (301 +/- 105 vs. 270 +/- 112 m; p < 0.05).. In AATD-related COPD patients (ZZ genotype) the addition of extra-fine ICS to LABAs decreases airway narrowing, mostly in the small airways, further reducing dynamic hyperinflation with a marked improvement in exercise tolerance and dyspnea, suggesting that a peripheral inflammatory process contributes to airflow obstruction in these patients.

Topics: Administration, Inhalation; Aged; Albuterol; alpha 1-Antitrypsin Deficiency; Beclomethasone; Bronchodilator Agents; Cross-Over Studies; Double-Blind Method; Drug Therapy, Combination; Dyspnea; Exercise Tolerance; Female; Glucocorticoids; Humans; Male; Middle Aged; Pulmonary Disease, Chronic Obstructive; Respiratory Function Tests; Salmeterol Xinafoate; Scopolamine Derivatives

It has been shown that patients with chronic obstructive pulmonary disease (COPD) develop dynamic hyperinflation (DH), which contributes to dyspnoea and exercise intolerance. Formoterol, salmeterol and oxitropium have been recommended for maintenance therapy in COPD patients, but their effect on DH has only been assessed for salmeterol. The aim of the present study was to compare the acute effect of four inhaled bronchodilators (salbutamol, formoterol, salmeterol and oxitropium) and placebo on forced expiratory volume in one second, inspiratory capacity, forced vital capacity and dyspnoea in COPD patients. A cross-over, randomised, double-blind, placebo-controlled study was carried out on 20 COPD patients. Patients underwent pulmonary function testing and dyspnoea evaluation, in basal condition and 5, 15, 30, 60 and 120 min after bronchodilator or placebo administration. The results indicate that in chronic obstructive pulmonary disease patients with decreased baseline inspiratory capacity, there was a much greater increase of inspiratory capacity after bronchodilator administration, which correlated closely with the improvement of dyspnoea sensation at rest. For all bronchodilators used, inspiratory capacity reversibility should be tested at 30 min following the bronchodilator. On average, formoterol elicited the greatest increase in inspiratory capacity than the other bronchodilators used, though the difference was significant only with salmeterol and oxitropium. The potential advantage of formoterol needs to be tested in a larger patient population.

Topics: Administration, Inhalation; Adrenergic beta-Agonists; Aged; Albuterol; Bronchodilator Agents; Cross-Over Studies; Double-Blind Method; Dyspnea; Ethanolamines; Female; Forced Expiratory Volume; Formoterol Fumarate; Humans; Male; Pulmonary Disease, Chronic Obstructive; Salmeterol Xinafoate; Scopolamine Derivatives; Time Factors; Vital Capacity

To investigate the long-term effects of the inhaled anticholinergic bronchodilator, oxitropium bromide (OTB), on lung function, exercise capacity, and dyspnea in patients with chronic obstructive pulmonary disease (COPD), spirometry and symptom-limited exercise testing before and 1, 6, and 12 months after the regular use of OTB (600 micrograms/day) were performed in 12 patients with the use of OTB (mean age 69.9 +/- 3.1 years; FEV1/FVC 53.3 +/- 1.6%) as well as in 12 control patients who were not treated with OTB (Mean age 68.8 +/- 2.8 years; FEV1/FVC 52.6 +/- 1.9%). The dyspnea was evaluated by the slope of the regression line between Borg scale and oxygen uptake (Vo2) during exercise (Borg scale slope: BSS). At 1, 6, and 12 months after the start of OTB, the forced expiratory volume in one second (FEV1) and the exercise capacity (maximal Vo2) were greater than the pretreatment values and the dyspnea index (BSS) was significantly improved compared with the pretreatment value, while these parameters slightly worsened in the control patients over one year. In conclusion, the chronic use of an inhaled anticholinergic bronchodilator may provide beneficial improvements in expiratory flow rate, exercise performance, and dyspnea in mild to moderate COPD patients over one year.

Topics: Administration, Inhalation; Aged; Cholinergic Antagonists; Dyspnea; Exercise Test; Exercise Tolerance; Follow-Up Studies; Humans; Lung Diseases, Obstructive; Male; Respiratory Function Tests; Scopolamine Derivatives; Treatment Outcome

Although exercise induced desaturation can occur in patients with chronic obstructive pulmonary disease (COPD), little is known about its frequency during everyday exercise, or how it relates to dyspnoea or prior drug treatment.. The effects of 200 micrograms inhaled oxitropium bromide, an anticholinergic bronchodilator drug, on spirometric values, dyspnoea score, and oxygen saturation during corridor walking and cycle ergometry were studied in a double blind, randomised, placebo controlled study.. Oxitropium produced a small increase in forced expired volume in one second (FEV1) from 0.76 (0.28) 1 to 0.93 (0.69) 1 and in six minute walking distance from 311 (93) m to 332 (86) m, but did not change progressive cycle exercise duration. Resting and end exercise breathlessness levels were reduced in both forms of exercise after oxitropium. Resting oxygen saturation fell significantly after active bronchodilator from 92.9% (3.7%) to 92.0% (4.1%) but the nadir saturation during exercise was unchanged. The patients desaturated more during corridor walking than cycle ergometry [walking 7.8% (4.4%), cycle ergometry 2.1% (2.1%)]. Baseline walking distance was related to FVC, resting breathlessness and resting oxygen saturation (multiple r2 = 0.46) but only resting saturation correlated with end exercise breathlessness (r2 = -0.25). Improvements in symptoms or exercise performance after oxitropium could not be predicted by changes in spirometric indices or oxygen saturation.. In patients with COPD arterial oxygen desaturation during self-paced walking is common, of greater severity than that during cycle ergometry, but is unaffected by inhaled oxitropium bromide. The factors that predict initial performance are not appropriate markers of functional improvement after an active bronchodilator drug.

Topics: Double-Blind Method; Dyspnea; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Parasympatholytics; Physical Exertion; Scopolamine Derivatives; Vital Capacity; Walking

To elucidate the effect of oxitropium bromide (OTB), an anticholinergic drug, on dyspnea and gas exchange during exercise in patients with chronic obstructive pulmonary disease (COPD), we performed the cycle exercise test on 19 patients with COPD (mean age, 72.0 +/- 1.9 years; mean FEV1, 1.28 +/- 0.07 L) before and after inhalation of OTB, 300 micrograms, or placebo, 300 micrograms, in randomized fashion. Spirometry was performed immediately before and 30 min after inhalation of either OTB or placebo. Dyspnea during exercise was evaluated using the Borg scale (BS) and the slope of the regression between BS and oxygen uptake (VO2) during exercise (Borg scale slope: BSS). Arterial oxygen saturation (SaO2) was continuously monitored by pulse oximeter during and after exercise. We also measured the recovery time, which was defined as the time to recover decreases in SaO2 after exercise. After OTB, spirometric indices were improved (delta FEV1 16.8 +/- 0.9 percent) and maximal VO2 during exercise increased significantly (from 986 +/- 46 ml/min to 1,156 +/- 55 ml/min, p < 0.01), but not after placebo. The maximal scores of BS and the BSS were significantly decreased after OTB, but not after placebo. Although the SaO2 at rest and during exercise did not differ with or without either OTB or placebo, the recovery time after OTB (77.3 +/- 6.8 s) was significantly shorter than that before administration (98.4 +/- 14.6 s) (p < 0.01). We conclude that the inhaled OTB produces small but significant improvement both in dyspnea during exercise and in exercise performance in stable COPD and may contribute to improve the quality of life in some patients with COPD. However, gas exchange during exercise of COPD patients is little affected by OTB.

Topics: Administration, Inhalation; Aged; Aged, 80 and over; Double-Blind Method; Dyspnea; Exercise Test; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Middle Aged; Oxygen; Parasympatholytics; Pulmonary Gas Exchange; Scopolamine Derivatives; Vital Capacity

Partial bronchodilator reversibility can be demonstrated in many patients with stable chronic obstructive pulmonary disease (COPD), but its relevance to exercise capacity and symptoms is uncertain. Previous data suggest that anticholinergic bronchodilators do not improve exercise tolerance in such patients. We studied 32 patients with stable COPD, mean age 65 yrs, in a double-blind, placebo-controlled, cross-over trial of the inhaled anticholinergic drug, oxitropium bromide. From the within and between day placebo spirometry, we derived the spontaneous variation in forced expiratory volume in one second (FEV1) and forced vital capacity (FVC) of this population (FEV1 140 ml; FVC 390 ml) and considered responses beyond this to be significant. Oxitropium bromide increased baseline FEV1 from 0.70 (0.28) l (mean (SD)) to 0.88 (0.36) l. The 6 min walking distance increased by 7% compared with placebo, whilst resting breathlessness scores fell from 2.0 to 1.23 at rest and 4.09 to 3.28 at the end of exercise after the active drug. Improvements in walking distances and symptoms were unrelated to changes in either FEV1 or FVC, indicating that routine reversibility testing is not a good predictor of symptomatic benefit in these patients.

Topics: Aged; Bronchi; Bronchodilator Agents; Double-Blind Method; Dyspnea; Exercise; Female; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Parasympatholytics; Scopolamine Derivatives; Time Factors; Vital Capacity

Topics: Adolescent; Bronchodilator Agents; Child; Cromolyn Sodium; Double-Blind Method; Dyspnea; Female; Fenoterol; Forced Expiratory Volume; Humans; Lung Diseases, Obstructive; Male; Physical Exertion; Random Allocation; Scopolamine Derivatives

Topics: Dyspnea; Exercise; Humans; Lung Diseases, Obstructive; Parasympatholytics; Respiratory Function Tests; Scopolamine Derivatives

Topics: Dyspnea; Exercise Tolerance; Humans; Lung Diseases, Obstructive; Parasympatholytics; Perception; Scopolamine Derivatives