Chest
Volume 103, Issue 6, June 1993, Pages 1774-1782
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Clinical Investigations
Effects of Inhaled Anticholinergic Drug on Dyspnea and Gas Exchange During Exercise in Patients With Chronic Obstructive Pulmonary Disease

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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 µg, or placebo, 300 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 (V o2) 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 (AFEV1 16.8 ± 0.9 percent) and maximal V˙o2 during exercise increased significantly (from 986 ± 46 ml/min to 1,156 ± 55 mil/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.

(Chest 1993; 103:1774-82)

Section snippets

METHODS

We studied 19 male patients with stable COPD. The diagnosis was determined by patient history, the usual radiologic and pulmonary criteria, and persistent exertional dyspnea with signs of overdistended lung volume. The clinical and physiologic data are presented in Table 1. The mean age was 72.0 ± 1.9 years (range, 55 to 85 years). No patient had a forced expiratory volume in 1 s (FEV1) to more than 60 percent predicted, and no patient had more than 15 percent reversibility on β-adrenergic

RESULTS

Lung function measurements before study are summarized in Table 1. Mean pretreatment FEV1 was 1.28 ± 0.07 L, which was 40.5 ± 2.5 percent predicted. The mean changes in spirometric indices after each administration of agents are shown in Table 2. The FVC and FEV1 after OTB administration were significantly greater than those before administration, but not after placebo. After 15 min, the mean increase in FEV1 after OTB was 16.8 ± 0.9 percent of baseline value, and after placebo it was 0.3 ± 0.6

DISCUSSION

The usefulness of various inhaled bronchodilators, including anticholinergic agents, in COPD has been well established recently.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 The bronchodilating effect of anticholinergic drugs seems to be superior to that of adrenergic agents in COPD and anticholinergic drugs seem not to induce tachyphylaxis.2, 6, 7, 8 Although the effects of anticholinergic drugs on spirometric indices and gas exchange in resting ventilation have been widely examined in COPD,1, 2, 3, 4, 5,

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  • Cited by (0)

    This study was supported by Nippon Boerhinger-Ingelheim Co Ltd.

    Manuscript received May 27; revision accepted October 12

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