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Introduction: Quadriceps dysfunction is a common systemic manifestation of chronic obstructive pulmonary disease (COPD), for which treatment using resistance training is highly recommended. Even though training volume is suggested to be a key explanatory factor for intramuscular adaptation to resistance training in healthy older adults, knowledge is scarce on the role of progression of training volume for intramuscular adaptations in COPD.Methods: This study was a sub-analysis of a parallel-group randomized controlled trial. Thirteen patients with severe to very severe COPD (median 66 yrs, forced expiratory volume in 1 s 44% predicted) performed 8 weeks of low-load resistance training. In a post hoc analysis, they were divided into two groups according to their training volume progression. Those in whom training volume continued to increase after the first 4 weeks of training outlined the continued progression group (n = 9), while those with limited increase (n = 4). Fiber-type distribution and oxidative muscle protein levels, i.e., citrate synthase (CS), hydroxyacyl-coenzyme A dehydrogenase (HADH), mitochondrial transcription factor A (TfAM) as well as quadriceps endurance measures (total work from elastic band and isokinetic knee extension tests), were assessed before and after the intervention period.Results: The continued progression group sustained their training volume progression during weeks 5–8 compared to weeks 1–4 (median +25%), while the discontinued progression group did not (median -2%) (p = 0.007 between groups). Compared with baseline values, significant between-group differences in fiber type distribution and TfAM muscle protein levels (range ± 17–62%, p < 0.05) and in individual responses to change in Type I and Type IIa fiber type proportion, CS, HADH, and TfAM muscle protein levels outcomes (median 89 vs. 50%, p = 0.001) were seen in favor of the continued progression group. Moreover, only the continued progression group had a significant increase in HADH muscle protein levels (+24%, p = 0.004), elastic band (+56%, p = 0.004) and isokinetic (+7%, p = 0.004) quadriceps endurance, but the between-group differences did not reach statistical significance (range 14–29%, p = 0.330–1.000).Discussion: The novel findings of the current study were that patients with COPD who had a continued progression of training volume across the 8-weeks intervention had an increased proportion of Type I fibers, and TfAM muscle protein levels and decreased proportion of Type II fibers compared to those that did not continue to progress their training volume after the initial weeks. Additionally, HADH muscle protein levels and quadriceps endurance measurements only improved in the continued progression group, although no significant between-group differences were seen. These findings highlight the importance of continued progression of training volume during resistive training to counteract quadriceps dysfunction within the COPD population. Still, considering the small sample size and the post hoc nature of our analyses, these results should be interpreted cautiously, and further research is necessary.

BackgroundDyspnoea is a multidimensional experience of breathing discomfort, but its affective dimension is unfrequently assessed in people with chronic obstructive pulmonary disease (COPD). We evaluated the effectiveness of a home-based pulmonary rehabilitation (PR) programme on the physical and affective components of dyspnoea assessed by the Dyspnoea-12 (D-12) questionnaire. We also determined the baseline characteristics that contributed to the change in D-12 scores.MethodsIn this retrospective study, 225 people with COPD (age, 65±11 years; forced expiratory volume in 1 s (FEV1), 35±15% of predicted value) were enrolled into a person-centric home-based PR, consisting of a weekly supervised 90 min home session during 8 weeks. D-12 questionnaire, health status, anxiety and depressive symptoms, exercise tolerance and general fatigue were assessed at baseline (M0), at the end of PR programme (M2), and 8 (M8) and 14 months (M14) after M0. Multivariable analysis of covariance (ANCOVA) models were performed to identify the baseline characteristics that contributed to the change in D-12 scores.ResultsBoth physical and affective components of dyspnoea and all the other outcome measures were improved at M2, M8 and M14 compared with baseline (p1, anxiety symptoms and exercise tolerance (6 min stepper test). However, since these variables had only a small impact on the changes in D-12 questionnaire scores, results from the ANCOVA analysis should be taken cautiously.ConclusionBoth physical and affective components of dyspnoea were improved, at short term and long term, by 8 weeks of individualised home-based PR. The present results support the importance of assessing dyspnoea as a multidimensional experience during PR, warranting replication by robustly designed randomised and controlled studies.

One of the most debilitating symptoms of chronic obstructive pulmonary disease (COPD) is breathlessness, which leads to avoidance of physical activities in daily living and hastens clinical deterioration. Treatment of patients with COPD with inhaled long-acting muscarinic antagonist (LAMA)/long-acting β2-agonist (LABA) combination therapy improves airflow limitation, reduces breathlessness compared with LAMA or LABA monotherapies, and improves health status and quality of life. A large clinical trial programme focusing on the effects of tiotropium/olodaterol combination therapy demonstrated that this LAMA/LABA combination improves lung function and reduces hyperinflation (assessed by serial inspiratory capacity measurements) compared with either tiotropium alone or placebo in patients with COPD. Tiotropium/olodaterol also increases exercise endurance capacity and improves patient perception of the intensity of breathlessness compared with placebo. In this narrative review, we focus on the relationship between improving symptoms during activity, the ability to remain active in daily life and how this may impact quality of life. We consider the benefits of therapy optimisation by means of dual bronchodilation with tiotropium/olodaterol, and present new data from meta-analyses/pooled analyses showing that tiotropium/olodaterol improves inspiratory capacity compared with placebo and tiotropium and improves exercise endurance time compared with placebo after 6weeks of treatment. We also discuss the importance of taking a holistic approach to improving physical activity, including pulmonary rehabilitation and exercise programmes in parallel with bronchodilator therapy and psychological programmes to support behaviour change.

BACKGROUND: The 3-minute constant-rate stair stepping (3-min CRSST) and constant-speed shuttle tests (3-min CSST) were developed to assess breathlessness in response to a standardized exercise stimulus. Estimating the rate of oxygen consumption (V’O(2)) during these tests would assist clinicians to relate the stepping/shuttle speeds that elicit breathlessness to daily physical activities with a similar metabolic demand. This study: (I) developed equations to estimate the V’O(2) of these tests in people with chronic obstructive pulmonary disease (COPD); and (II) compared the newly developed and American College of Sports Medicine (ACSM) metabolic equations for estimating the V’O(2) of these tests. METHODS: This study was a retrospective analysis of people with COPD who completed a 3-min CRSST (n=98) or 3-min CSST (n=69). Multivariate linear regression estimated predictors (alpha

Damien Viglino,1,2,* Mickaël Martin,1,* Natalie Almeras,1 Jean-Pierre Després,1 Harvey O Coxson,3 Jean-Louis Pépin,2 Isabelle Vivodtzev,2 François Maltais1 On behalf of the Evaluation of COPD Longitudinally to Identify Predictive Surrogate Endpoints (ECLIPSE) investigators1Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Québec, Canada; 2Hypoxia Pathophysiology Laboratory INSERM U1042, Grenoble Alpes University Hospital, Grenoble, France; 3Radiology, University of British Columbia, Vancouver, British Columbia, Canada*These authors contributed equally to this workCorrespondence: Damien ViglinoCentre de Recherche Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, QC G1V 4G5, CanadaTel +1 418 656 8711Email damien.viglino.1@ulaval.caPurpose: Fatty liver disease is associated with cardiometabolic disorders and represents a potential key comorbidity in Chronic Obstructive Pulmonary Disease (COPD). Some intermediary mechanisms of fatty liver disease (including its histological component steatosis) include tissue hypoxia, low-grade inflammation and oxidative stress that are key features of COPD. Despite these shared physiological pathways, the effect of COPD on the prevalence of hepatic steatosis, and the association between hepatic steatosis and comorbidities in this population remain unclear. Liver density measured by computed tomography (CT)-scan is a non-invasive surrogate of fat infiltration, with lower liver densities reflecting more fat infiltration and a liver density of 40 Hounsfield Units (HU) corresponding to a severe 30% fat infiltration.Patients and Methods: We took advantage of the international cohort ECLIPSE in which non-enhanced chest CT-scans were obtained in 1554 patients with COPD and 387 healthy controls to analyse the liver density at T12-L1.Results: The distribution of liver density was similar and the prevalence of severe steatosis (densitya=1.59, 95% CI 1.12 to 2.24) and stroke (ORa=2.20, 95% CI 1.07 to 4.50), in comparison with the highest liver density quartile.Conclusion: The present data indicate that a low liver density emerged as a predictor of cardiovascular comorbidities in the COPD population. However, the distribution of liver density and the prevalence of severe steatosis were similar in patients with COPD and control subjects.Keywords: chronic obstructive pulmonary disease, liver density, steatosis, fatty liver disease, chest CT-scan, cardiovascular comorbidity, ECLIPSE &nbsp

Supplemental material, Reviewer_3_v.1 for Comparative measurement properties of constant work rate cycling and the endurance shuttle walking test in COPD: the TORRACTO® clinical trial by François Maltais, Denis E. O’Donnell, Alan Hamilton, Yihua Zhao and Richard Casaburi in Therapeutic Advances in Respiratory Disease

Supplemental material, Supplementary_Figures_and_Table for Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial by Claus F. Vogelmeier, Edward M. Kerwin, Leif H. Bjermer, Lee Tombs, Paul W. Jones, Isabelle H. Boucot, Ian P. Naya, David A. Lipson, Chris Compton, Neil Barnes and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_1_v.1 for Comparative measurement properties of constant work rate cycling and the endurance shuttle walking test in COPD: the TORRACTO® clinical trial by François Maltais, Denis E. O’Donnell, Alan Hamilton, Yihua Zhao and Richard Casaburi in Therapeutic Advances in Respiratory Disease

Supplemental material, Author_Response_1 for Comparative measurement properties of constant work rate cycling and the endurance shuttle walking test in COPD: the TORRACTO® clinical trial by François Maltais, Denis E. O’Donnell, Alan Hamilton, Yihua Zhao and Richard Casaburi in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_2_v.1 for Comparative measurement properties of constant work rate cycling and the endurance shuttle walking test in COPD: the TORRACTO® clinical trial by François Maltais, Denis E. O’Donnell, Alan Hamilton, Yihua Zhao and Richard Casaburi in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_1_v.1 for Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial by Claus F. Vogelmeier, Edward M. Kerwin, Leif H. Bjermer, Lee Tombs, Paul W. Jones, Isabelle H. Boucot, Ian P. Naya, David A. Lipson, Chris Compton, Neil Barnes and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Supplement for Comparative measurement properties of constant work rate cycling and the endurance shuttle walking test in COPD: the TORRACTO® clinical trial by François Maltais, Denis E. O’Donnell, Alan Hamilton, Yihua Zhao and Richard Casaburi in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_1_v.1 for Relieving exertional dyspnea during the 3-min constant speed shuttle test in patients with COPD with indacaterol/glycopyrronium versus tiotropium: the RED trial by Jessie Beaulieu, Dennis Jensen, Denis E. O’Donnell, Cynthia Brouillard, Lauren Tracey, Sandra Vincent, Éric Nadreau, Emmanuelle Bernard, Sarah Bernard and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_2_v.1 for Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial by Claus F. Vogelmeier, Edward M. Kerwin, Leif H. Bjermer, Lee Tombs, Paul W. Jones, Isabelle H. Boucot, Ian P. Naya, David A. Lipson, Chris Compton, Neil Barnes and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Author_Response_1 for Impact of baseline COPD symptom severity on the benefit from dual versus mono-bronchodilators: an analysis of the EMAX randomised controlled trial by Claus F. Vogelmeier, Edward M. Kerwin, Leif H. Bjermer, Lee Tombs, Paul W. Jones, Isabelle H. Boucot, Ian P. Naya, David A. Lipson, Chris Compton, Neil Barnes and François Maltais in Therapeutic Advances in Respiratory Disease

Supplemental material, Reviewer_2_v.1 for Relieving exertional dyspnea during the 3-min constant speed shuttle test in patients with COPD with indacaterol/glycopyrronium versus tiotropium: the RED trial by Jessie Beaulieu, Dennis Jensen, Denis E. O’Donnell, Cynthia Brouillard, Lauren Tracey, Sandra Vincent, Éric Nadreau, Emmanuelle Bernard, Sarah Bernard and François Maltais in Therapeutic Advances in Respiratory Disease

BackgroundCOPD increases susceptibility to sleep disturbances, which may in turn predispose to increased respiratory symptoms. The objective of this study was to evaluate, in a population-based sample, the relationship between subjective sleep quality and risk of COPD exacerbations.MethodsData were obtained from the Canadian Cohort Obstructive Lung Disease (CanCOLD) study. Participants with COPD who had completed 18months of follow-up were included. Sleep quality was measured with the Pittsburgh Sleep Quality Index (PSQI) and a three-factor analysis. Symptom-based (dyspnea or sputum change ≥ 48 h) and event-based (symptoms plus medication or unscheduled health services use) exacerbations were assessed. Association of PSQI with exacerbation rate was assessed by using negative binomial regression. Exacerbation-free survival was also assessed.ResultsA total of 480 participants with COPD were studied, including 185 with one or more exacerbations during follow-up and 203 with poor baseline sleep quality (PSQI score > 5). Participants with subsequent symptom-based exacerbations had higher median baseline PSQI scores than those without (6.0 [interquartile range, 3.0-8.0] vs5.0 [interquartile range, 2.0-7.0]; P= .01), and they were more likely to have baseline PSQI scores > 5 (50.3%vs37.3%; P= .01). Higher PSQI scores were associated with increased symptom-based exacerbation risk (adjusted rate ratio, 1.09; 95%CI, 1.01-1.18; P= .02) and event-based exacerbation risk (adjusted rate ratio, 1.10; 95%CI, 1.00-1.21; P= .048). The association occurred mainly in those with undiagnosed COPD. Strongest associations were with Factor 3 (sleep disturbances and daytime dysfunction). Time to symptom-based exacerbation was shorter in participants with poor sleep quality (adjusted hazard ratio, 1.49; 95%CI, 1.09-2.03).ConclusionsHigher baseline PSQI scores were associated with increased risk of COPD exacerbation over 18months' prospective follow-up.

Additional file 2: Table S2. UMEC versus salmeterol comparisons for all outcomes. aSymptom severity outcomes presented for Week 24 for SAC-TDI and global assessment of disease severity, for Weeks 21–24 for E-RS, and for Weeks 1–24 for rescue salbutamol use; bdata are LS mean (95% CI); cSAC-TDI responders were defined as a ≥ 1-unit improvement from baseline; dE-RS responders were defined as a reduction of ≥2 from baseline; eoverall assessment of change in COPD severity was rated using a seven-point Likert scale (‘Much Better’, ‘Slightly Better’, ‘Better’, ‘No Change’, ‘Slightly Worse’, ‘Worse’, ‘Much Worse’). Ordered response ratios were reported as odds of better response category; fSGRQ responders were defined as a ≥ 4-point reduction from baseline; gCAT responders were defined as a ≥ 2-unit improvement from baseline. CAT, COPD Assessment Test; CI, confidence interval; CID, clinically important deterioration; COPD, chronic obstructive pulmonary disease; E-RS, Evaluating Respiratory Symptoms-COPD; FEV1, trough forced expiratory volume in 1 sec; LS, least squares; n, number of responders/patients with an event; N, number of patients with analysable data; SAC-TDI, self-administered computerised Transition Dyspnoea Index; SAL, salmeterol; SGRQ, St George’s Respiratory Questionnaire; UMEC, umeclidinium; VI, vilanterol.

Additional file 3: Table S3. Proportion of responders for symptom severity and health status outcomes – additional timepoints. aSAC-TDI responders were defined as a ≥ 1-unit improvement from baseline; bE-RS responders were defined as a reduction of ≥2 from baseline; coverall assessment of change in COPD severity was rated using a seven-point Likert scale (‘Much Better’, ‘Slightly Better’, ‘Better’, ‘No Change’, ‘Slightly Worse’, ‘Worse’, ‘Much Worse’). Ordered response ratios were reported as odds of better response category; dSGRQ responders were defined as a ≥ 4-point reduction from baseline; eCAT responders were defined as a ≥ 2-unit improvement from baseline. CAT, COPD Assessment Test; CI, confidence interval; COPD, chronic obstructive pulmonary disease; e-diary, electronic diary; E-RS, Evaluating Respiratory Symptoms-COPD; n/N, number of responders/number of patients with analysable data; SAC-TDI, self-administered computerised Transition Dyspnoea Index; SAL, salmeterol; SGRQ, St George’s Respiratory Questionnaire; UMEC, umeclidinium; VI, vilanterol.

Additional file 1: Table S1. Patient-reported outcomes. aSAC-TDI responders were defined as a ≥ 1-unit improvement from baseline; btotal score and subscales (breathlessness, cough and sputum, chest); cE-RS responders were defined as a reduction of ≥2 from baseline; dSGRQ responders were defined as a ≥ 4-point reduction from baseline; eCAT responders were defined as a ≥ 2-unit improvement from baseline. CAT, COPD Assessment Test; COPD, chronic obstructive pulmonary disease; E-RS, Evaluating Respiratory Symptoms-COPD; LS, least squares; SAC-TDI, self-administered computerised-Transition Dyspnoea Index; SGRQ, St George’s Respiratory Questionnaire.

Objective The objective of this review was to summarize the current best evidence for the effectiveness, feasibility, user compliance and safety of exercise-based games (EBGs), including virtual reality and interactive video game interventions, for the rehabilitation of individuals with neurological disorders at home. Material and methods We identified randomized controlled trials (RCT) evaluating the effects of EBGs in neurological patients in home settings by searching 3 electronic databases (MEDLINE, SCOPUS, CENTRAL Library) from inception to March 2018. All data pertaining to participants, interventions, outcomes, supervision and cost-effectiveness were independently extracted by 2 reviewers. Risk of bias was independently assessed by 2 reviewers. Results Reports of 11 RCT studies with heterogeneous populations (i.e., stroke, Parkinson disease and multiple sclerosis) were included in the review. The treatment of experimental groups included EBGs (i.e., commercially available games such as Nintendo Wii or Dance Dance Revolution or custom-designed devices), and control groups received a controlled (i.e., conventional therapy) or uncontrolled (i.e., usual care) intervention. Across studies, EBGs at home tended to have limited effects on upper and lower limbs. We demonstrated an increased risk of participants dropping out of the program or discontinuing training in experimental groups (n = 51 participants) as compared with controls (n = 23 participants). Few adverse events (2 of 6 studies), such as minor musculoskeletal pain, were reported in balance training. Conclusions This systematic review reveals that EBGs seem a relevant alternative for rehabilitation at home because the effectiveness of these interventions was at least equivalent to conventional therapy or usual care. We give recommendations for the development of new EBG therapies.

BACKGROUND: Cardiovascular disease is a frequent co-morbidity in patients with chronic obstructive pulmonary disease (COPD). Many clinicians, particularly pulmonologists, are reluctant to use β-adrenoceptor blocking agents (β-blockers) in patients with COPD, despite their proven effectiveness in preventing cardiovascular events.METHODS: The large (5,163 patients) phase III TONADO® 1 and 2 studies assessed lung function and patient-reported outcomes (PROs) in patients with moderate to very severe COPD receiving long-acting bronchodilator treatment over 1 year. This post hoc analysis characterised lung-function changes, PROs and safety in the subgroup of patients receiving β-blockers in the studies.RESULTS: In total, 557/5,163 patients (11%) received β-blockers at baseline. Post-bronchodilator trough FEV1 at baseline was higher in the β-blocker group (1.476 L) compared to the no β-blocker group (1.362 L). As expected, patients on β-blockers had a more frequent history of cardiovascular co-morbidities and medications. Lung function improved from baseline in patients with or without β-blocker treatment, and no relevant between-group differences were observed in trough FEV1 or trough FVC at 24 or 52 weeks. No relevant differences were observed for SGRQ and Transition Dyspnoea Index between patients with β-blockers compared to those without. Safety findings were comparable between groups.CONCLUSIONS: Lung function, overall respiratory status and safety of tiotropium/olodaterol were not influenced by baseline β-blocker treatment in patients with moderate to very severe COPD. Results from this large patient cohort support the cautious and appropriate use of β-blockers in patients with COPD and cardiovascular co-morbidity.

Background: Limb muscle dysfunction is prevalent in chronic obstructive pulmonary disease (COPD) and it has important clinical implications, such as reduced exercise tolerance, quality of life, and even survival. Since the previous American Thoracic Society/European Respiratory Society (ATS/ERS) statement on limb muscle dysfunction, important progress has been made on the characterization of this problem and on our understanding of its pathophysiology and clinical implications. Purpose: The purpose of this document is to update the 1999 ATS/ERS statement on limb muscle dysfunction in COPD. Methods: An interdisciplinary committee of experts from the ATS and ERS Pulmonary Rehabilitation and Clinical Problems assemblies determined that the scope of this document should be limited to limb muscles. Committee members conducted focused reviews of the literature on several topics. A librarian also performed a literature search. An ATS methodologist provided advice to the committee, ensuring that the methodological approach was consistent with ATS standards. Results: We identified important advances in our understanding of the extent and nature of the structural alterations in limb muscles in patients with COPD. Since the last update, landmark studies were published on the mechanisms of development of limb muscle dysfunction in COPD and on the treatment of this condition. We now have a better understanding of the clinical implications of limb muscle dysfunction. Although exercise training is the most potent intervention to address this condition, other therapies, such as neuromuscular electrical stimulation, are emerging. Assessment of limb muscle function can identify patients who are at increased risk of poor clinical outcomes, such as exercise intolerance and premature mortality. Conclusions: Limb muscle dysfunction is a key systemic consequence of COPD. However, there are still important gaps in our knowledge about the mechanisms of development of this problem. Strategies for early detection and specific treatments for this condition are also needed. ispartof: American Journal of Respiratory and Critical Care Medicine vol:189 issue:9 pages:1121-1137 ispartof: location:United States status: published

Table S1. Pulmonary medication use prior to enrolment (treated set). Table S2. Arithmetic mean, geometric mean and median endurance times after 6 weeks (full analysis set). Table S3. Geometric mean (SE) endurance time after 6 weeks by GOLD (full analysis set). Table S4. Peak expiratory flow outcomes at 6 weeks (full analysis set). Figure S1. Hierarchical testing order: each test was considered confirmatory only if all of the previous tests were positive. Figure S2. Participant flow in (a) Study 1222.37 and (b) Study 1222.38. Figure S3. Exercise endurance time after 6 weeks for (a) Study 1222.37 and (c) Study 1222.38. Log10-transformation of exercise endurance time after 6 weeks for (b) Study 1222.37 and (d) Study 1222.38 (full analysis set). (DOCX 631 kb)

Computed tomography (CT) of the chest can be used to assess pectoralis muscle area (PMA) and subcutaneous adipose tissue (SAT) area. Adipose tissue content is associated with inflammatory mediators in chronic obstructive pulmonary disease (COPD) subjects. Based on gender differences in body composition, we aimed to assess the hypothesis that in subjects with COPD, the relationships between PMA, SAT, and blood biomarkers of inflammation differ by gender.We compared chest CT measures of PMA and SAT on a single slice at aortic arch and supraesternal notch levels from 73 subjects (28 women) with COPD between genders. The relationships of PMA and SAT area to biomarkers were assessed using within-gender regression models.Women had a lesser PMA and a greater SAT area than men (difference range for PMA, 13.3-22.8 cm²; for SAT, 11.8-12.4 cm²; P.05 for all comparisons) at both anatomic levels. These differences in PMA and SAT remained significant after adjustment for age and body mass index. Within-gender regression models adjusted for age showed that SAT was directly associated with C-reactive protein (for aortic arch level, P = .04) and fibrinogen (for both anatomic locations, P = .003) only in women, whereas PMA was not associated with any biomarkers in either gender.It appears that in subjects with COPD, there are gender-based differences in the relationships between subcutaneous adipose tissue and inflammatory biomarkers.

Author(s): O'Donnell, Denis E; Maltais, Francois; Porszasz, Janos; Webb, Katherine A; Albers, Frank C; Deng, Qiqi; Iqbal, Ahmar; Paden, Heather A; Casaburi, Richard; 205.440 investigators | Abstract: BackgroundTo 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.MethodsData 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.ResultsChronic 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 (pl0.001). 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 (pl0.001).ConclusionsLower 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 registrationClinicalTrials.gov: NCT01072396.

Adult respirologists are often involved in the evaluation and treatment of young adult patients with Duchenne muscular dystrophy. In this context, the most frequent respiratory complication is nocturnal and daytime hypoventilation related to respiratory muscle weakness. The present article describes cases of Duchenne muscular dystrophy involving two brothers, 17 and 19 years of age, respectively, who presented with less frequently reported respiratory complications of their disease: obstructive sleep apnea and Cheyne-Stokes respiration with central apnea, which were believed to be partially or completely related to congestive cardiomyopathy.

ObjectivesThis study sought to determine the effects of chronic obstructive pulmonary disease (COPD) on clinical outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and to determine the factors associated with worse outcomes in COPD patients.BackgroundNo data exist on the factors determining poorer outcomes in COPD patients undergoing TAVI.MethodsA total of 319 consecutive patients (29.5% with COPD) who underwent TAVI were studied. Functional status was evaluated by New York Heart Association (NYHA) functional class, Duke Activity Status Index, and the 6-min walk test (6MWT) at baseline and at 6 to 12 months. The TAVI treatment was considered futile if the patient either died or did not improve in NYHA functional class at 6-month follow-up.ResultsSurvival rates at 1 year were 70.6% in COPD patients and 84.5% in patients without COPD (p = 0.008). COPD was an independent predictor of cumulative mortality after TAVI (hazard ratio: 1.84; 95% confidence interval: 1.08 to 3.13; p = 0.026). Improvement in functional status was observed after TAVI (p < 0.001 for NYHA functional class, Duke Activity Status Index, and 6MWT), but COPD patients exhibited less (p = 0.036) improvement in NYHA functional class. Among COPD patients, a shorter 6MWT distance predicted cumulative mortality (p = 0.013), whereas poorer baseline spirometry results (FEV1 [forced expiratory volume in the first second of expiration]) determined a higher rate of periprocedural pulmonary complications (p = 0.040). The TAVI treatment was futile in 40 COPD patients (42.5%) and a baseline 6MWT distance

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 120 kb)

Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) 2013 Checklist: recommended items to address in a clinical trial protocol and related documents. (DOC 120 kb)