Relationship between exercise endurance and static hyperinflation in a post hoc analysis of two clinical trials in patients with COPD

Int J Chron Obstruct Pulmon Dis. 2018 Jan 8:13:203-215. doi: 10.2147/COPD.S145285. eCollection 2018.

Abstract

Background: Lung hyperinflation and exercise intolerance are hallmarks of chronic obstructive pulmonary disease (COPD). However, their relationship remains uncertain. A combined analysis of two placebo-controlled, randomized studies examined the effects of the long-acting muscarinic antagonist umeclidinium (UMEC) and long-acting β2-agonist vilanterol (VI) separately and in combination on static hyperinflation, exercise endurance time (EET), and their relationship in patients with COPD.

Methods: Patients with moderate-to-severe stable COPD and resting functional residual capacity >120% predicted were randomized to UMEC/VI 62.5/25 μg, UMEC 62.5 μg, VI 25 μg, or placebo for 12 weeks. Inspiratory capacity (IC), residual volume (RV), total lung capacity (TLC), and EET in an endurance shuttle-walk test were measured. In this post hoc analysis, IC/TLC, RV/TLC, and IC were used as hyperinflation markers.

Results: After 12 weeks, UMEC/VI and UMEC and VI showed significant improvements in hyperinflation versus placebo when measured by absolute change from baseline in IC/TLC (trough and 3 hours postdose [P≤0.011]). UMEC/VI showed significant improvements versus UMEC and VI in absolute changes in IC/TLC (trough and 3 hours postdose [P≤0.001]). Statistical significance for comparisons with placebo and between treatments for absolute changes in IC and percentage changes in RV/TLC followed similar patterns to those for absolute changes in IC/TLC. UMEC/VI showed significant improvements in EET versus placebo at day 2 and week 12, measured as change from baseline in seconds (P≤0.002) and as a percentage from baseline (P≤0.005). There was a lack of evidence to suggest a correlation between improvements in static hyperinflation and EET at any time point.

Conclusion: Although the dual bronchodilator UMEC/VI demonstrated greater improvements in static hyperinflation markers than UMEC or VI and significant improvements in exercise endurance, no direct relationship was observed between static hyperinflation and exercise endurance.

Keywords: COPD; bronchodilators; exercise; hyperinflation.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-2 Receptor Agonists / administration & dosage*
  • Adrenergic beta-2 Receptor Agonists / adverse effects
  • Aged
  • Benzyl Alcohols / administration & dosage*
  • Benzyl Alcohols / adverse effects
  • Chlorobenzenes / administration & dosage*
  • Chlorobenzenes / adverse effects
  • Double-Blind Method
  • Drug Combinations
  • Exercise Tolerance / drug effects*
  • Female
  • Functional Residual Capacity
  • Humans
  • Inspiratory Capacity
  • Lung / drug effects*
  • Lung / physiopathology
  • Lung Volume Measurements
  • Male
  • Middle Aged
  • Muscarinic Antagonists / administration & dosage*
  • Muscarinic Antagonists / adverse effects
  • Pulmonary Disease, Chronic Obstructive / diagnosis
  • Pulmonary Disease, Chronic Obstructive / drug therapy*
  • Pulmonary Disease, Chronic Obstructive / physiopathology
  • Quinuclidines / administration & dosage*
  • Quinuclidines / adverse effects
  • Recovery of Function
  • Residual Volume
  • Severity of Illness Index
  • Time Factors
  • Total Lung Capacity
  • Treatment Outcome
  • Walk Test

Substances

  • Adrenergic beta-2 Receptor Agonists
  • Benzyl Alcohols
  • Chlorobenzenes
  • Drug Combinations
  • GSK573719
  • Muscarinic Antagonists
  • Quinuclidines
  • vilanterol