Chest
ReviewsA Systematic Review of the Effects of Bronchodilators on Exercise Capacity in Patients With COPD
Section snippets
Exercise Tests
To assess exercise capacity, different protocols are used depending on the aim of the study. The tests can be classified as steady-state tests and incremental tests, both measuring a different aspect of exercise capacity (Table 1). The term steady state is employed to indicate a more or less constant work rate during the test. Incremental exercise tests assess maximal exercise capacity in terms of peak exercise level, whereas steady-state tests explore the maximal capacity that can be endured
Materials and Methods
A systematic review of the literature searched with MEDLINE was performed including articles up to September 1999. Only randomized, controlled, double-blind trials written in English, were selected. Firstly, a database including all articles about obstructive lung diseases (key words: COPD, lung diseases, obstructive, plus all subheadings) was constructed. From this database, all articles that investigated patients with asthma were excluded (key-word strategy: database minus [asthma minus
Anticholinergics
Seventeen studies examining the effects of anticholinergics on exercise in patients with COPD were identified (Table 2). Ten studies applied ipratropium, 6 studies applied oxitropium, and 1 study applied atropine. At present, no tiotropium study is available. Twelve of 17 studies used a single-dose protocol; 16 of these studies primarily focusing on exercise testing showed a significant effect on FEV1(Table 2).
Discussion
We identified 33 double-blind, randomized, controlled studies investigating the effects of bronchodilators on exercise capacity in patients with COPD. Only a few studies have been published with a head-to-head comparison between different types of bronchodilators. Bronchodilators are frequently prescribed to patients with COPD in order to improve exercise intolerance. Nevertheless, our systematic review shows that approximately half of the studies with bronchodilators do not show a significant
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2008, Respiratory MedicineCitation Excerpt :Our study has documented that a 5-day treatment with formoterol 12 μg twice daily increased the walked distance by 53.6 m at the end of the 6-MWT and 59.9 m at the end of the 12-MWT. This is, in our opinion, an important finding because, at least for the 6-MWT, none of the studies that have explored the effects of bronchodilators in COPD reached the minimal clinical significance limits and, consequently, the relevance of the observed effect to the patient remains debatable.8 It must be pointed out that Redelmeier et al.16 suggested that subjects have to improve their walking distance by 54 m after a 6-MWT in order to appreciate this increase as a beneficial effect, whereas Troosters et al.17 reported a mean increase of 52 m in a study of the short- and longer-term benefits of pulmonary rehabilitation delivered over a 6-month period.
Dr. Liesker received research stipendium from AstraZeneca BV, Zoetermeer, the Netherlands.