We carried out a systematic review and meta-analysis with the aim to evaluate the efficacy of long-acting bronchodilators on exercise capacity in COPD patients.
The endpoints were the efficacy of long-acting bronchodilators (altogether, and by single classes) vs. placebo in modifying endurance time (ET), inspiratory capacity (IC) and dyspnea during exercise, taking into consideration the outcomes according to different patients’ inclusion criteria and exercise methodology.
Twenty-two studies were deemed eligible for analysis. Weighted mean increase in ET resulted of 67 s (95% CI ranges from 55 to 79). For isotime IC and dyspnea during exercise, weighted improvements were 195 ml (162–229), and − 0.41 units (− 0.56 to − 0.27), respectively. The increase in trough IC was 157 ml (138–175). We found a trend in favour of LAMA compared to LABA in terms of ET. In the 11 studies which reported a value of functional residual capacity > 120% as inclusion criterion, weighted mean increase in endurance time was 94 s (65 to 123); however we did not find any significant correlation between ET and mean trough IC (P: 0.593). The improvement of ET in the 5 studies using walking as exercise methodology resulted of 58 s (− 4 to 121).
Long-acting bronchodilators improve exercise capacity in COPD. The main effect of long-acting bronchodilators seems to be a decrease of basal IC rather than a modification of dynamic hyperinflation during exercise. The efficacy in terms of endurance time seems higher in studies which enrolled patients with hyperinflation, with a similar efficacy on walking or cycling.
Additional file 1: Figure S1. Funnel plots for ET, isotime IC and isotime dyspnea. Figure S2A Forest and Funnel plots of ET, isotime IC and isotime dyspnea in the 11 studies which included only COPD patients with functional residual capacity (FRC) > 120%. Figure S2B Forest and Funnel plots of ET, isotime IC and isotime dyspnea in the 11 studies which did not require an increase of functional residual capacity (FRC) as inclusion criterion (i.e. unselected COPD patients). Figure S3 Forest and Funnel plots of ET of the 5 studies (A) which used walking, and 17 studies (B) which used cycling as exercise methodology to assess the efficacy of long-acting bronchodilators. Table S1 Cochrane collaboration tool for assessing risk of bias. (DOCX 545 kb)12931_2018_721_MOESM1_ESM.docx
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- Long-acting bronchodilators improve exercise capacity in COPD patients: a systematic review and meta-analysis
Fabiano Di Marco
Denis E. O’Donnell
Maria Adelaide Roggi
- BioMed Central
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