Long-acting bronchodilators improve exercise capacity in COPD patients: A systematic review and meta-analysis

Fabiano Di Marco, Giovanni Sotgiu, Pierachille Santus, Denis E. O'Donnell, Kai Michael Beeh, Simone Dore, Maria Adelaide Roggi, Lisa Giuliani, Francesco Blasi, Stefano Centanni

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background: We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of long-acting bronchodilators on exercise capacity in COPD patients. Methods: The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients' inclusion criteria and exercise methodology. Results: Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95% CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162-229), and - 0.41 units (- 0.56 to - 0.27), respectively. The increase in trough IC was 157 ml (138-175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120% as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (- 4 to 121). Conclusions: Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a decrease of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling.

Original languageEnglish
Article number18
JournalRespiratory Research
Volume19
Issue number1
DOIs
Publication statusPublished - Jan 24 2018

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Bronchodilator Agents
Inspiratory Capacity
Chronic Obstructive Pulmonary Disease
Meta-Analysis
Exercise
Dyspnea
Walking
Functional Residual Capacity
Placebos

Keywords

  • Bronchodilator
  • COPD
  • Exercise

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine

Cite this

Di Marco, F., Sotgiu, G., Santus, P., O'Donnell, D. E., Beeh, K. M., Dore, S., ... Centanni, S. (2018). Long-acting bronchodilators improve exercise capacity in COPD patients: A systematic review and meta-analysis. Respiratory Research, 19(1), [18]. https://doi.org/10.1186/s12931-018-0721-3

Long-acting bronchodilators improve exercise capacity in COPD patients : A systematic review and meta-analysis. / Di Marco, Fabiano; Sotgiu, Giovanni; Santus, Pierachille; O'Donnell, Denis E.; Beeh, Kai Michael; Dore, Simone; Roggi, Maria Adelaide; Giuliani, Lisa; Blasi, Francesco; Centanni, Stefano.

In: Respiratory Research, Vol. 19, No. 1, 18, 24.01.2018.

Research output: Contribution to journalArticle

Di Marco, F, Sotgiu, G, Santus, P, O'Donnell, DE, Beeh, KM, Dore, S, Roggi, MA, Giuliani, L, Blasi, F & Centanni, S 2018, 'Long-acting bronchodilators improve exercise capacity in COPD patients: A systematic review and meta-analysis', Respiratory Research, vol. 19, no. 1, 18. https://doi.org/10.1186/s12931-018-0721-3
Di Marco, Fabiano ; Sotgiu, Giovanni ; Santus, Pierachille ; O'Donnell, Denis E. ; Beeh, Kai Michael ; Dore, Simone ; Roggi, Maria Adelaide ; Giuliani, Lisa ; Blasi, Francesco ; Centanni, Stefano. / Long-acting bronchodilators improve exercise capacity in COPD patients : A systematic review and meta-analysis. In: Respiratory Research. 2018 ; Vol. 19, No. 1.
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abstract = "Background: We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of long-acting bronchodilators on exercise capacity in COPD patients. Methods: The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients' inclusion criteria and exercise methodology. Results: Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95{\%} CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162-229), and - 0.41 units (- 0.56 to - 0.27), respectively. The increase in trough IC was 157 ml (138-175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120{\%} as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (- 4 to 121). Conclusions: Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a decrease of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling.",
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AU - Beeh, Kai Michael

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AU - Roggi, Maria Adelaide

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AB - Background: We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of long-acting bronchodilators on exercise capacity in COPD patients. Methods: The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients' inclusion criteria and exercise methodology. Results: Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95% CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162-229), and - 0.41 units (- 0.56 to - 0.27), respectively. The increase in trough IC was 157 ml (138-175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120% as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (- 4 to 121). Conclusions: Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a decrease of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling.

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