Chest

Chest

Volume 119, Issue 2, February 2001, Pages 387-393
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Clinical Investigations
Pulmonary Function
Effects of Levodopa on Pulmonary Function in Parkinson's Disease

https://doi.org/10.1378/chest.119.2.387Get rights and content

Study objectives

Upper-airway obstruction (UAO) may bepresent in patients with Parkinson's disease (PD), and itsreversibility after levodopa therapy has been suggested. To investigatethe effects of oral intake of levodopa on pulmonary function and UAOcriteria in patients with PD, we studied 22 patients with PD.

Design

Pulmonary function tests were performed after a12-h withdrawal of levodopa therapy, and 1 h after oral intake ofplacebo or levodopa, according to a double-blind, placebo-controlled, crossover study. Six UAO criteria were recorded to detect UAO inpatients. UAO was found in 5 of 21 patients on baseline conditions (1patient could not perform all tests).

Results

Among the patients with UAO, after levodopa therapy three of fivepatients did not meet the four of six required criteria for defining, UAO. Levodopa produced its effects on UAO criteria by means of asaw-tooth pattern improvement and/or a decrease below the definedthresholds of the peak inspiratory flow and the FEV1/peakexpiratory flow (PEF) and FEV1/forced expiratory flow after50% of the FVC (FEV0.5) ratios. Levodopa PEF increased by0.85 L/s in patients with UAO and by 0.24 L/s in patients without UAO, while after placebo it increased by 0.03 L/s in patients with UAO anddecreased by 0.16 L/s in patients without UAO (p = 0.02). Whereas inpatients without UAO an increase of the FEV1/PEF and, FEV1/FEV0.5 ratios was observed after placeboand levodopa intake, these ratios decreased after levodopa andincreased after placebo in patients with UAO.

Conclusions

These results show that levodopaadministration in patients with PD induces significant variations in, PEF and UAO ratios (FEV1/PEF and, FEV1/FEV0.5).

Section snippets

Patients

The study, which was approved by the local ethics committee, included 22 consecutive patients (age range, 52 to 89 years) drawn fromgeneral clinics, who met the criteria for idiopathic PD13and gave informed consent. Potential study subjects were identified inthe patient population of one of the investigators. One patient waswithdrawn after enrollment because she could not perform the wholestudy. Severity of PD was classified on a scale from I to V, as stage, II (n = 9), stage III (n = 10), and

Clinical Characteristics

The study population consisted of 7 women and 14 men. Fivepatients (two women, three men) had UAO according to our criteria. Thedemographic and clinical characteristics of the patients are expressedin Table 1, showing no significant difference between patients with and without, UAO.

Pulmonary Function and UAO Criteria at Baseline

Tables 2, 3summarize spirometry data and UAO criteria at baseline evaluation andfollowing oral intake of placebo and levodopa in patients with andwithout UAO. At baseline, patients with UAO exhibited the

Discussion

Our data show that in PD patients, levodopa administrationinduces significant variations in PEF and UAO ratios(FEV1/PEF and, FEV1/FEV0.5).

The involvement of the upper airways in the respiratory dysfunctionfound in patients with PD has been shown in previousreports.41617 Our patients were classified as having UAOif they fulfilled at least four of six UAO criteria on both baselinestudies, and the thresholds for the UAO ratios were chosen accordingto several studies.4151617 Patients with UAO had

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    Copyright © 2001 The American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.