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Deterioration of Nighttime Respiratory Mechanics in COPD: Impact of Bronchodilator Therapy.
- Source :
-
Chest [Chest] 2021 Jan; Vol. 159 (1), pp. 116-127. Date of Electronic Publication: 2020 Jun 27. - Publication Year :
- 2021
-
Abstract
- Background: COPD is associated with nighttime respiratory symptoms, poor sleep quality, and increased risk of nocturnal death. Overnight deterioration of inspiratory capacity (IC) and FEV <subscript>1</subscript> have been documented previously. However, the precise nature of this deterioration and mechanisms by which evening bronchodilation may mitigate this occurrence have not been studied.<br />Research Question: What is the effect of evening dosing of dual, long-acting bronchodilation on detailed nocturnal respiratory mechanics and inspiratory neural drive (IND)?<br />Study Design and Methods: A double-blind, randomized, placebo-controlled crossover study assessed the effects of evening long-acting bronchodilation (aclidinium bromide/formoterol fumarate dihydrate: 400/12 μg) or placebo on morning trough IC (12 h after the dose; primary outcome) and serial overnight measurements of spirometry, dynamic respiratory mechanics, and IND (secondary outcomes). Twenty participants with COPD (moderate/severe airway obstruction and lung hyperinflation) underwent serial measurements of IC, spirometry, breathing pattern, esophageal and transdiaphragmatic pressures, and diaphragm electromyography (diaphragmatic electromyography as a percentage of maximum; IND) at 6 time points from 0 to 12 h after the dose and compared with sleeping IND.<br />Results: Compared with placebo, evening bronchodilation was not associated with increased morning trough IC 12 h after the dose (P = .48); however, nadir IC (lowest IC, independent of time), peak IC, area under the curve for 12 h after the dose, and IC for 10 h after the dose were improved (P < .05). During placebo, total airways resistance, lung hyperinflation, IND, and tidal esophageal and transdiaphragmatic pressure swings all increased significantly overnight compared with baseline evening values; however, each of these parameters improved with bronchodilator treatment (P < .05) with no change in ventilation or breathing pattern.<br />Interpretation: Respiratory mechanics significantly deteriorated at night during placebo. Although the morning trough IC was unchanged, evening bronchodilator treatment was associated consistently with sustained overnight improvements in dynamic respiratory mechanics and inspiratory neural drive compared with placebo CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02429765.<br /> (Copyright © 2020 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Subjects :
- Aged
Cross-Over Studies
Double-Blind Method
Drug Administration Schedule
Female
Forced Expiratory Volume drug effects
Humans
Inspiratory Capacity drug effects
Male
Middle Aged
Pulmonary Disease, Chronic Obstructive complications
Sleep
Spirometry
Bronchodilator Agents administration & dosage
Formoterol Fumarate administration & dosage
Pulmonary Disease, Chronic Obstructive drug therapy
Pulmonary Disease, Chronic Obstructive physiopathology
Respiratory Mechanics drug effects
Tropanes administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 1931-3543
- Volume :
- 159
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- Chest
- Publication Type :
- Academic Journal
- Accession number :
- 32603714
- Full Text :
- https://doi.org/10.1016/j.chest.2020.06.033