Residual reversibility in COPD patients already on long-acting bronchodilator: The OscilloRevers Study.

Background: Dyspnea is a complex symptom of chronic obstructive pulmonary disease (COPD) which is not strongly correlated with lung function measures. Long-acting bronchodilators (LAB) may reduce this dyspnea, but some patients report persistent chronic dyspnea despite this treatment. This study aims to assess residual reversibility and clinical response after short-acting bronchodilator (SAB) in COPD patients already treated by LAB and reporting persistent dyspnea.
Methods: COPD patients with a persistent dyspnea (modified Medical Research Council scale (mMRC) ≥1) despite current stable treatment with at least one LAB were included. Spirometry, plethysmography and impulse oscillometry (IOS) were performed at peak effect of their LAB and repeat 45 min after the intake of two SAB (400 µg of salbutamol and 80 µg of ipratropium). Dyspnea improvement was assessed at 45 min after SAB through a comparative two-sided VAS (-100 mm for maximal improvement; +100 mm for maximal degradation).
Results: Twenty-two COPD patients were analyzed, mainly men (59.1 %) with a mean age of 60.6 years and a median FEV1 of 54 % of predicted values. Fifty percent of patients reported a severe basal dyspnea (mMRC ≥2). After SAB, spirometric and plethysmographic measurements were statistically improved. For IOS measurement, reactance at 5 Hz (X5) and area of reactance (AX) were also improved. Fifty percent of patients reported a clinically relevant improvement of their resting dyspnea. However, no correlation was found between dyspnea improvement and functional measures.
Conclusions: Fifty percent of COPD patients regularly treated with one or two LAB still report a relevant improvement of resting dyspnea after the adjunctive intake of double short-acting bronchodilators. Physiological mechanisms associated with this improvement remain to be determined.
Clinical Trial Registration: NCT02928744.
Competing Interests: Declaration of Competing Interest OLR reports personal fees from AstraZeneca, Boehringer Ingelheim and GlaxoSmithKline, and non-financial supports from AstraZeneca, Boehringer Ingelheim, Chiesi, Correvio, GlaxoSmithKline, Mayoli, MSD, Mylan, Novartis, Pfizer, PulmonX, Santelys Association, Vertex and Zambon, unrelated to the submitted work. MP reports non-financial supports from Boehringer Ingelheim, GlaxoSmithKline, Sanofi Aventis France and Sysmed, unrelated to the submitted work. HS reports non-financial support from GlaxoSmithKline, LVL médical, Oxyvie, unrelated to the submitted work. NB reports personal fees from AstraZeneca, and non-financial support from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKlein, Novartis, Santelys association, SOS oxygène and Teva, unrelated to the submitted work. PD reports personnal fees and non-financial support from ALK, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Menarini, Novartis, Sanofi and Stallergènes, unrelated to the submitted work. TP reports grants from AstraZeneca, personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Novartis, and congress support from AstraZeneca, GlaxoSmithKlein, Novartis and Chiesi, unrelated to the submitted work.
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