Chest
Volume 123, Issue 6, June 2003, Pages 1810-1816
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Clinical Investigations
COPD
A Comparison of the Effects of Salbutamol and Ipratropium Bromide on Exercise Endurance in Patients With COPDa

https://doi.org/10.1378/chest.123.6.1810Get rights and content

Study objective

Inhaled bronchodilators are the first-line pharmacotherapy against COPD. The purpose of the present study was to investigate the effects of β2-agonists and anticholinergic agents on the exercise capacity of patients with COPD.

Methods

A total of 67 stable patients with COPD were recruited at the Kyoto University Hospital. After inhaling 400 μg salbutamol, 80 μg ipratropium bromide, or an identical placebo in a randomized, double-blind, crossover fashion, the patients performed cycle endurance tests at a constant workload of 80% of the maximum work rate reached on progressive cycle ergometry, and the endurance time was recorded.

Results

Both salbutamol and ipratropium bromide significantly improved the endurance time by 29 s (15%; p < 0.001) and 27 s (14%; p < 0.001), respectively, in comparison with the placebo. However, there was no statistically significant difference between them (p = 0.71). The dyspnea ratios were also similarly reduced by both bronchodilators. The difference in the endurance time between therapy with salbutamol and placebo was significantly, but moderately, related to the difference between therapy with ipratropium bromide and placebo. In addition, there were no relationships, or only weakly significant relationships, between the change in FEV1 and the change in the endurance time, the highest oxygen uptake, and the highest minute ventilation for both salbutamol and ipratropium bromide.

Conclusions

Therapy with both salbutamol and ipratropium bromide improved exercise capacity, as evaluated by the endurance time, and reduced dyspnea similarly in patients with COPD. In addition, the effects of the different bronchodilators on exercise capacity varied within individuals, and a complex mechanism may be responsible for the different effects of these two bronchodilators on exercise capacity vs airflow limitation. These results support the conclusion that both types of inhaled bronchodilators can be used as first-line drugs for the treatment of stable patients with COPD.

Section snippets

Patients

We recruited a total of 67 consecutive patients with clinically stable COPD, as defined by the American Thoracic Society,10between January 1999 and December 2001. The entry criteria for the study included the following: (1) age > 50 years; (2) a history of cigarette smoking of > 20 pack-years; (3) FEV1 of < 80% of the predicted value; and (4) best postbronchodilator FEV1/FVC ratio of < 0.7. The present study included those who had mild-to-severe airflow limitation. The exclusion criteria

Results

The baseline characteristics of the 67 COPD patients are presented in Table 1. Their mean age was 70.4 ± 5.6 years, and the mean FEV1 was 1.15 ± 0.41 L (44.2 ± 15.5% predicted). The effects of salbutamol and ipratropium bromide on pulmonary function and the results of the exercise performance tests are presented in Table 2. At 30 min, both bronchodilators produced significant improvements in FEV1 and FVC compared to placebo (p < 0.001). When comparing the changes between the two

Discussion

We found that salbutamol and ipratropium bromide had significant and similar effects on exercise capacity in stable patients with COPD, using the endurance time as an index of exercise capacity. In addition, the response to the different bronchodilators was shown to vary within individuals, for both FEV1 and exercise capacity.

We demonstrated that the endurance time after therapy with salbutamol and ipratropium bromide were similar in 67 patients with COPD. Previous studies have addressed the

References (23)

  • T Oga et al.

    The effects of oxitropium bromide on exercise performance in patients with stable chronic obstructive pulmonary disease: a comparison of three different exercise tests

    Am J Respir Crit Care Med

    (2000)
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