The continuum of physiological impairment during treadmill walking in patients with mild-to-moderate copd: Patient characterization phase of a randomized clinical trial

Abstract

The 205.440 investigators included the following investigators: Jean Bourbeau, Richard Casaburi (and Janos Porszasz, sub-investigator), Mark Dransfield, Gary Ferguson, Charles Fogarty, Joseph Henkle, Donald Mahler, François Maltais, Denis O'Donnell, Claude Poirier, Frank Sciurba, Selwyn Spangenthal, Jan Westerman, Dennis Zawadski, Richard ZuWallack. The authors meet criteria for authorship as recommended by the International Committee of Medical Journal Editors (ICMJE) and were fully responsible for all content and editorial decisions, and were involved at all stages of manuscript development. The authors received no compensation related to the development of the manuscript. The authors would like to thank Zhenchao Guo of BIPI for additional statistical support. Presented in part as a poster at the American Thoracic Society 2012 International Conference, May 18-23, 2012, San Francisco, California, USA. O'Donnell DE, Maltais F, Porszasz P, Albers F, Deng Q, Hernandez G, Iqbal A, Paden H, Casaburi R. Lung function and exercise impairment in patients with GOLD stage I and II COPD. D80 EMPHYSEMA AND COPD: PATHOPHYSIOLOGY. American Thoracic Society; pp. A6400-A6400. Background: To have a better understanding of the mechanisms of exercise limitation in mild-to-moderate chronic obstructive pulmonary disease (COPD), we compared detailed respiratory physiology in patients with COPD and healthy age- and sex-matched controls. Methods: Data were collected during the pre-treatment, patient characterization phase of a multicenter, randomized, double-blind, crossover study. Patients with COPD met Global Initiative for Chronic Obstructive Lung Disease (GOLD) 1 or 2 spirometric criteria, were symptomatic, and had evidence of gas trapping during exercise. All participants completed pulmonary function and symptom-limited incremental treadmill exercise tests. Results: Chronic activity-related dyspnea measured by Baseline Dyspnea Index was similarly increased in patients with GOLD 1 (n = 41) and 2 (n = 63) COPD compared with controls (n = 104). Plethysmographic lung volumes were increased and lung diffusing capacity was decreased in both GOLD groups. Peak oxygen uptake and work rate were reduced in both GOLD groups compared with controls (p<0.001). Submaximal ventilation, dyspnea, and leg discomfort ratings were higher for a given work rate in both GOLD groups compared with controls. Resting inspiratory capacity, peak ventilation, and tidal volume were reduced in patients with GOLD 2 COPD compared with patients with GOLD 1 COPD and controls (p<0.001). Conclusions: Lower exercise tolerance in patients with GOLD 1 and 2 COPD compared with controls was explained by greater mechanical abnormalities, greater ventilatory requirements, and increased subjective discomfort. Lower resting inspiratory capacity in patients with GOLD 2 COPD was associated with greater mechanical constraints and lower peak ventilation compared with patients with GOLD 1 COPD and controls. Trial Registration: ClinicalTrials.gov: NCT01072396 © 2014 O'Donnell et al.