Effect of salmeterol on respiratory muscle activity during exercise in poorly reversible COPD

Man, W. D. C.; Mustfa, N.; Nikoletou, D.; Kaul, S.; Hart, N.; Rafferty, G. F.; Donaldson, N.; Polkey, M. I.; Moxham, J.
June 2004
Thorax;Jun2004, Vol. 59 Issue 6, p471
Academic Journal
Background: Some patients with irreversible chronic obstructive pulmonary disease (COPD) experience subjective benefit from long acting bronchodilators without change in forced expiratory volume in 1 second (FEV1). Dynamic hyperinflation is an important determinant of exercise induced dyspnoeo in COPD. We hypothesised that long acting bronchodilators improve symptoms by reducing dynamic hyperinflation and work of breathing, as measured by respiratory muscle pressure-time products. Methods: Sixteen patients with "irreversible" COPD (<10% improvement in FEV1 following a bronchodilator challenge; mean FEV1 31 .1% predicted) were recruited into a randomised, double blind, placebo controlled, crossover study of salmeterol (50 μg twice a day). Treatment periods were of 2 weeks duration with a 2 week washout period. Primary outcome measures were end exercise isotime transdiaphragmatic pressure-time product and dynamic hyperinflation as measured by inspiratory capacity. Results: Salmeterol significantly reduced the transdiaphragmatic pressure-time product (294.5 v 348.6 cm H2O/s/min; p=0.03), dynamic hyperinflation (0.22 v0.33 litres; p=0.002), and Borg scores during endurance treadmill walk (3.78 v 4.62; p=0.02). There was no significant change in exercise endurance time. Improvements in isotime Borg score were significantly correlated to changes in tidal volume/oesophogeal pressure swings, end expiratory lung volume, and inspiratory capacity, but not pressure-time products. Conclusions: Despite apparent "non-reversibility" in spirometric parameters, long acting bronchodilators can cause both symptomatic and physiological improvement during exercise in severe COPD.


Related Articles

  • A method to study the effect of bronchodilators on smoke retention in COPD patients: study protocol for a randomized controlled trial. van Dijk, W. D.; Scheepers, P. T. J.; Cremers, R.; Lenders, J. W. M.; Klerx, W.; van Weel, C.; Schermer, T. R. J.; Heijdra, Y. // Trials;2011, Vol. 12 Issue 1, p37 

    Background: Chronic obstructive pulmonary disease (COPD) is a common disease, associated with cardiovascular disease. Many patients use (long-acting) bronchodilators, whilst they continue smoking alongside. We hypothesised an interaction between bronchodilators and smoking that...

  • Alterações espirométricas em doenças obstrutivas: afinal, o quanto é relevante? Soares, André Luis Pinto; de Castro Pereira, Carlos Alberto; Rodrigues, Silvia Carla // Jornal Brasileiro de Pneumologia;ene/feb2013, Vol. 39 Issue 1, p56 

    Objective: To establish the upper limits for changes in FEV1, slow vital capacity (SVC), FVC, and inspiratory capacity (IC) after placebo administration in patients with airflow obstruction. Methods: One hundred and two adults with airflow obstruction (FEV1 = 62 ± 19% of predicted) were...

  • Efficacy of once-daily indacaterol 75 μg relative to alternative bronchodilators in COPD: A study level and a patient level network meta-analysis. Cope, Shannon; Jie Zhang; Williams, James; Jansen, Jeroen P. // BMC Pulmonary Medicine;2012, Vol. 12 Issue 1, p29 

    Background: The objective of this study was to evaluate the comparative efficacy of indacaterol 75 µg once daily (OD), tiotropium 18 µg OD, salmeterol 50 µg twice daily (BID), formoterol 12 µg BID, and placebo for the treatment of chronic obstructive pulmonary disease (COPD) based on...

  • Is nebulized saline a placebo in COPD? Khan, Shahina Y.; O'Driscoll, B. Ronan // BMC Pulmonary Medicine;2004, Vol. 4, p1 

    Background: Many trials of nebulized therapy have used nebulized saline as a "placebo". However, nebulized isotonic saline is sometimes used to assist sputum expectoration and relieve breathlessness in COPD patients. We designed this study to establish if nebulized saline had a placebo effect or...

  • Efficacy of indacaterol in the treatment of patients with COPD. Jones, Paul W.; Barnes, Neil; Vogelmeier, Claus; Lawrence, David; Kramer, Benjamin // Primary Care Respiratory Journal;Dec2011, Vol. 20 Issue 4, p380 

    Effective bronchodilation is an important part of the management of patients with chronic obstructive pulmonary disease (COPD) and can improve breathlessness and ability to undertake physical activities. Indacaterol is a new once-daily, long-acting inhaled bronchodilator for COPD. We review here...

  • Phase II UMEC/VI Studies A Win for Theravance/GSK. Powers, Marie // BioWorld Today;7/3/2012, Vol. 23 Issue 128, p1 

    The article reports on the expectation that GloxoSmithKline PLC and longtime partner Theravance Inc. are moving to regulatory filings for the LAMA/LABA bronchodilator combination of umecidinium bromide and vilanterol. The companies got very good results from their first four of seven Phase III...

  • Review: ipratropium is not more effective than β2 agonists for acute exacerbations of chronic obstructive pulmonary disease. McCrory, D. C.; Brown, C. D. // Evidence Based Medicine;May2003, p74 

    The article reviews the study "Anti-Cholinergic Bronchodilators Versus Beta2-Sympathomimetic Agents for Acute Exacerbations of Chronic Obstructive Pulmonary Disease" by D. C. McCrory and colleague. It compares the efficacy of anticholinergic agents against placebo or beta blocker agonists in...

  • Population Pharmacokinetics of Inhaled Umeclidinium and Vilanterol in Patients with Chronic Obstructive Pulmonary Disease. Goyal, Navin; Beerahee, Misba; Kalberg, Chris; Church, Alison; Kilbride, Sally; Mehta, Rashmi // Clinical Pharmacokinetics;Jul2014, Vol. 53 Issue 7, p637 

    Background and objectives: A fixed-dose combination of the bronchodilators umeclidinium and vilanterol is in development for the long-term, once-daily treatment of chronic obstructive pulmonary disease (COPD). We characterized the pharmacokinetics of umeclidinium and vilanterol in ≈1,635...

  • Cost-Effectiveness of Long-Acting Bronchodilators for Chronic Obstructive Pulmonary Disease. Oba, Yuji // Mayo Clinic Proceedings;May2007, Vol. 82 Issue 5, p575 

    OBJECTIVE: To evaluate and compare the cost-effectiveness of long-acting bronchodilators by estimating incremental costs per quality-adjusted life-year (QALY) gained in patients with moderate to severe chronic obstructive pulmonary disease. METHODS: This cost-effective analysis was conducted...


Read the Article


Sign out of this library

Other Topics