The Cumulative Effect of Long-Acting Bronchodilators, Exercise, and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Advanced COPD

doi:10.1378/chest.118.3.672

Chest

Volume 118, Issue 3, September 2000, Pages 672-678

https://doi.org/10.1378/chest.118.3.672 Get rights and content

Background

Dyspnea is a common complaint during dailyactivities in patients with advanced COPD. The mechanisms underlyingdyspnea and the appropriate treatment strategies to relieve it are still not totally understood. We hypothesized that the perception ofdyspnea (POD) may be modified by the accumulative effect ofbronchodilator therapy, exercise, and inspiratory muscletraining (IMT).

Methods

Spirometry, submaximalexercise performance, inspiratory muscle strength and endurance, and the POD were assessed before and following three consecutive 6-weekperiods of therapy with a long-acting bronchodilator (LABD), the LABDplus exercise, and the LABD plus exercise plus IMT in 30 patients withmoderate-to-severe COPD.

Results

There was a small, statistically insignificant, increase in FEV₁ in the studygroup (mean [± SEM] increase, 1.42 ± 0.3 to 1.49 ± 0.4L) following the LABD therapy period, and no additional increasefollowing the two other periods of therapy. There was a significantincrease (p < 0.05) in the 6-min walk distance following the therapyperiod with the LABD plus exercise (mean increase, 252 ± 41 to294 ± 47 m) and an additional small increase following the therapyperiod with the LABD plus exercise plus IMT period (mean increase,252 ± 41 to 302 ± 49 m). The decrease in the POD was small and statistically not significant following the therapy periods with the, LABD and the LABD plus exercise. The major and statisticallysignificant decrease in the POD was noted following the therapy periodwith the LABD plus exercise plus IMT.

Conclusions

Inpatients with moderate-to-severe COPD, following sequential periods oftherapy with the LABD, the LABD plus exercise, and the LABD plusexercise plus IMT, there is a cumulative benefit in the POD. The mostsignificant improvement was associated with IMT and not with the LABDand exercise training. The FEV₁ was moderately increasedfollowing the therapy period with the LABD, and the addition ofexercise has most affected the 6-min walk distance.

Section snippets

Subjects

Thirty patients, 27 men and 3 women, with spirometric evidenceof chronic air flow limitation, and a diagnosis of moderate-to-severeCOPD according to the criteria of the American Thoracic Society,¹⁶ were recruited for the study. They all wereobserved during a 4-week run-in period, while their regular treatmentwas maintained, to verify stability in their clinical and functionalstatus. Their characteristics are summarized in Table 1.

Study Design

The study design is shown graphically in Figure 1. During the

Spirometry

The mean baseline FEV₁ was almost identicalfor the study and the control group (Table 1). Following 6 weeks ofsalmeterol xinafoate treatment, there was a small, but statisticallyinsignificant, increase in FEV₁ in the studygroup (mean [± SEM] increase, 1.42 ± 0.3 to 1.49 ± 0.4 L) butnot in the control group. Following the therapy periods with the LABDplus general exercise and the LABD plus general exercise plus IMT,there was no additional change in the FEV₁ level, either in the study group or in

Discussion

Our study shows that following sequential periods of therapy withthe LABD alone, the LABD plus exercise, and the LABD plus exercise plus, IMT, there is a cumulative benefit in the POD in patients with COPD.However, the most significant improvement was associated with IMT, and not with the LABD and exercise training. The FEV₁level was moderately increased (5%) following the LABD therapy period. No further increase was noted during the therapy periods with the LABDplus exercise and the LABD plus

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Another study on severe COPD, 54 m (95% confidence interval, 37–71 m) was identified as the minimum difference in a COPD patient to perceive improvements between one test and another as clinically significant [56]. Another study observed a mean increase of 50 m (20%) in 6MWD for COPD patients after exercise and diaphragmatic strength training [57]. Mahler et al. [58] showed a comparable small decrease in dyspnea intensity, regardless of improved exercise capacity after six weeks exercise training in COPD patients.
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Chest

Clinical InvestigationsDyspneaThe Cumulative Effect of Long-Acting Bronchodilators, Exercise, and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Advanced COPD

Background

Methods

Results

Conclusions

Section snippets

Subjects

Study Design

Spirometry

Discussion

Chest

Clin Chest Med

Adv Physiol Sci

Chest

Chest

Right ventricular performance during upright exercise in patients with chronic obstructive pulmonary disease

Am Rev Respir Dis

Exercise capacity and ventilatory, circulatory and symptom limitation in patients with chronic airflow limitation

Am Rev Respir Dis

Dyspnea mechanism, assessment, and management: a consensus statement

Am J Respir Crit Care Med

Breathlessness induced by dissociation between ventilation and chemical drive

Am Rev Respir Dis

Dyspnea: a sensory experience

Lung

Dyspnea and leg effort, during incremental cycle ergometry

Am Rev Respir Dis

Dyspnea and exercise

Ann Rev Physiol

Sensation from J receptors

NIPS

Factors contributing to relief of exertional breathlessness during hyperoxia in chronic airflow limitation

Am J Respir Crit Care Med

Sensation of dyspnea during hypercapnia, exercise and voluntary hyperventilation

J Appl Physiol

The sense of effort, oxygen cost, and pattern of breathing associated with progressive elastic loading to fatigue [abstract]

Fed Proc

Clinical Investigations
Dyspnea
The Cumulative Effect of Long-Acting Bronchodilators, Exercise, and Inspiratory Muscle Training on the Perception of Dyspnea in Patients With Advanced COPD