Comparison of the effects of salmeterol and ipratropium bromide on exercise performance and breathlessness in patients with stable chronic obstructive pulmonary disease

Respir Med. 1998 Sep;92(9):1116-21. doi: 10.1016/s0954-6111(98)90404-8.


To compare the effects of salmeterol, an adrenergic drug, and ipratropium bromide, an anticholinergic drug, on breathlessness and gas exchange during exercise in patients with chronic obstructive lung disease (COPD), we performed a progressive treadmill exercise test on 15 patients on 3 days (24 h apart), after inhalation placebo, ipratropium bromide (120 micrograms) or salmeterol (50 micrograms) in a randomized fashion. Dyspnoea during exercise was evaluated from the regression slope between Borg scale (BS) scores and distance walked each minute on the treadmill. The regression was expressed as the distance walked at BS score 5, the threshold load of dyspnoea (TLD) and breakpoint load of dyspnoea. During and after the exercise, oxygen saturation was monitored by pulse oxymeter and we measured the lower SaO2 during exercise and the recovery time of SaO2 after exercise. In comparison to placebo inhalation we found the same small but significant improvement in airflow limitation after salmeterol or ipratropium inhalation, also the distance walked on treadmill increased after bronchodilators. After bronchodilators the magnitude of oxyhaemoglobin desaturation with exercise was similar to that observed after placebo but the duration of the recovery from sustained SaO2 desaturation after exercise was shorter to the same extent as after ipratropium or salmeterol. Dyspnoeic sensation, when assessed by the TLD and by the distance walked at BS score 5, was decreased after salmeterol and after ipratropium bromide to a similar extent. We conclude that the salmeterol, when given in conventional doses, produces significant improvement in the airway obstruction in the recovery of postexercise HbO2 desaturation and in dyspnoeic sensation in patients with COPD, effects which were similar to those observed after inhalation of the anticholinergic agent ipratropium bromide.

Publication types

  • Clinical Trial
  • Comparative Study
  • Randomized Controlled Trial

MeSH terms

  • Adrenergic beta-Agonists / therapeutic use*
  • Aged
  • Albuterol / analogs & derivatives*
  • Albuterol / therapeutic use
  • Bronchodilator Agents / therapeutic use*
  • Exercise Tolerance / drug effects
  • Humans
  • Ipratropium / therapeutic use*
  • Lung / physiopathology
  • Lung Diseases, Obstructive / blood
  • Lung Diseases, Obstructive / drug therapy*
  • Lung Diseases, Obstructive / physiopathology
  • Middle Aged
  • Muscarinic Antagonists / therapeutic use*
  • Oxygen / blood
  • Pulmonary Gas Exchange / drug effects
  • Respiratory Function Tests
  • Salmeterol Xinafoate


  • Adrenergic beta-Agonists
  • Bronchodilator Agents
  • Muscarinic Antagonists
  • Salmeterol Xinafoate
  • Ipratropium
  • Albuterol
  • Oxygen