Three-minute constant rate step test for detecting exertional dyspnea relief after bronchodilation in COPD

Benoit Borel, Courtney A Wilkinson-Maitland, Alan Hamilton, Jean Bourbeau, Hélène Perrault, Dennis Jensen, François Maltais, Benoit Borel, Courtney A Wilkinson-Maitland, Alan Hamilton, Jean Bourbeau, Hélène Perrault, Dennis Jensen, François Maltais

Abstract

Background: The aim of this study was to evaluate the responsiveness of the 3-minute constant rate step test (3-MST) to detect the relief of exertional dyspnea (respiratory discomfort) after acute bronchodilation in COPD patients.

Patients and methods: A total of 40 patients with moderate-to-severe COPD (mean forced expiratory volume in 1 second: 45.7 (±14.7), % predicted) performed four 3-MSTs at randomly assigned stepping rates of 14, 16, 20 and 24 steps/min after inhalation of nebulized ipratropium bromide (500 µg)/salbutamol (2.5 mg) and saline placebo, which were randomized to order. Patients rated their intensity of perceived dyspnea at the end of each 3-MST using Borg 0-10 category ratio scale.

Results: A total of 37 (92.5%), 36 (90%), 34 (85%) and 27 (67.5%) patients completed all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions, respectively. Compared with placebo, ipratropium bromide/salbutamol significantly decreased dyspnea at the end of the third minute of exercise at 14 steps/min (by 0.6±1.0 Borg 0-10 scale units, P<0.01) and 16 steps/min (by 0.7±1.3 Borg 0-10 scale units, P<0.01); however, no statically significant differences were observed between treatments at 20 and 24 steps/min (both P>0.05).

Conclusion: The 3-MST, when performed at 14 and 16 steps/min, was responsive to detect the relief of exertional dyspnea after acute bronchodilation in patients with moderate-to-severe COPD.

Keywords: chronic obstructive pulmonary disease; dyspnea; exercise testing; intervention.

Conflict of interest statement

JB reports unrestricted educational grants from GSK, Pfizer, Boehringer Ingelheim (Canada) Limited and AstraZeneca, and funding for the operations of CanCOLD Longitudinal Epidemiological Study from the CIHR/Rx&D Collaborative Research Program with industry partners such as AstraZeneca Canada, Boehringer Ingelheim (Canada) Limited, GSK Canada, Merck and Novartis. DJ has received an unrestricted research grant from Boehringer Ingelheim (Canada) Limited and an education grant from AstraZeneca Canada. FM received fees for speaking at conferences sponsored by Boehringer Ingelheim (Canada) Limited, GSK, Novartis and Grifols; research grants for participating in multicenter trials sponsored by GSK, Boehringer Ingelheim (Canada) Limited, Astra Zeneca, Nycomed and Novartis and unrestricted research grants from Boehringer Ingelheim (Canada) Limited and GSK.BB, CAW-M, AH and HP report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Study design for V2 and V3 during which one of the study medications (ipratropium bromide [500 µg]/salbutamol [2.5 mg] [Combivent®] or placebo) was administered. Abbreviations: V2, visit 2; V3, visit 3.
Figure 2
Figure 2
Flowchart of the two-site clinical study. Abbreviation: V2, visit 2.
Figure 3
Figure 3
Effect of nebulized fixed-dose combination of ipratropium bromide (500 µg)/salbutamol (2.5 mg) (Combivent®) and 0.9% saline placebo on Borg 0–10 scale intensity ratings of dyspnea at the end of the third minute of exercise. Note: The number of patients completing all 3 minutes of exercise at 14, 16, 20 and 24 steps/min under both treatment conditions are indicated in the white boxes.

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Source: PubMed

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