Combination of Medicine, Exercise Training, Behavior Modification Improves COPD Symptoms

The first trial to examine the impact of a self-management behavior-modification (SMBM) program combined with bronchodilator therapy and exercise training (ExT) on exercise capacity and physical activity in patients with chronic obstructive pulmonary disease (COPD) showed positive results, according to a recently published study in the American Journal of Respiratory and Critical Care Medicine.

COPD affects about 10% of adults older than 40 years of age. By 2020, COPD, which is largely preventable and often stems from smoking, is expected to be the third-leading cause of death.

The expiratory flow limitation that characterizes COPD is commonly accompanied by lung hyperinflation and breathlessness on exertion, which is the primary symptom limiting exercise tolerance in many patients. Patients typically begin to start reducing their activity levels early on in the disease to avoid discomfort, but that inactivity sends them into a downward spiral.

In this study, researchers enrolled patients with COPD between the ages of 40 and 75 years with a smoking history of more than 10 pack-years, postbronchodilator FEV₁ 30% to 80% predicted, and in the first forced expiratory volume/forced vital capacity (FEV₁/FVC) less than 70% were included in the 12-week, randomized, partially double-blind, placebo-controlled, parallel-group trial.

Patients were excluded if they had a significant disease other than COPD or any condition precluding them from participating in exercise.

All patients were enrolled into SMBM and randomized 1:1:1:1 to once-daily placebo (n = 65), tiotropium 5 mg (n= 67), tiotropium/olodaterol 5/5 mg (n = 72), or tiotropium/olodaterol 5/5 mg plus 8 weeks ExT (n = 70).

Exercise endurance time, as measured by the endurance shuttle walk test after 8 weeks, was the primary endpoint.

SMBM plus tiotropium/ olodaterol, with or without ExT, significantly improved exercise endurance time at week 8 versus SMBM plus placebo (treatment ratio vs. placebo: with ExT, 1.46; 95% confidence interval, 1.20-1.78; P = 0.0002; without ExT, 1.29; 95% confidence interval, 1.06-1.57; P = 0.0109).

No significant increases in steps per day from baseline were observed over SMBM plus placebo at week 12 (increase of 1098) when other therapies were added.

The researchers said adding tiotropium/olodaterol, with or without ExT, to SMBM reduced activity-related dyspnea versus placebo, whereas adding tiotropium/olodaterol plus ExT reduced activity-related difficulty.

Although SMBM alone was sufficient to increase physical activity, combination bronchodilation, alone or combined with ExT, was useful to reduce physical activity-related dyspnea and patient-reported difficulty. The combination of behavioral, exercise, and drug interventions resulted in the largest effect.

Reference

Troosters T, Maltais F, Leidy N, et al. Effect of bronchodilation, exercise training, and behavior modification on symptoms and physical activity in chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 2018;198(8)1021-1032. doi: 10.1164/rccm.201706-1288OC.