title: A systematic review of the effects of bronchodilators on exercise capacity in patients with COPD.
abstract: One of the major goals of bronchodilator therapy in patients with COPD is to decrease airflow limitation in the airways and, as a consequence, improve dyspnea and exercise tolerance. The focus of this systematic review is to assess the effects of treatment with beta-agonists, anticholinergics, and theophyllines on dyspnea, and steady-state and incremental exercise capacity. Thirty-three, double-blind, randomized, placebo-controlled studies written in English were selected. This review shows that approximately half of the studies showed a significant effect of bronchodilator therapy on exercise capacity. Anticholinergic agents have significant beneficial effects in the majority of studies, especially when measured by steady-state exercise protocols. There is a trend toward a better effect of high-dose compared to low-dose anticholinergics. Short-acting beta(2)-mimetics have favorable effects on exercise capacity in more than two thirds of the studies; surprisingly, the situation is less clear for long-acting beta(2)-agents. The majority of the results of the published reports on theophyllines and their effects on exercise are negative. Direct comparisons of different classes of bronchodilators have not been made in a sufficient number of studies for a rational preference. The addition of a second bronchodilator has no proven advantage for improving exercise test results, but this has not been studied extensively and not in sufficiently large studies. The majority of studies reporting a measure of dyspnea found improvements, even in the absence of improvement in exercise capacity.
authors.affiliation: Department of Pulmonary Diseases, University Hospital Groningen, Groningen, The Netherlands. J.J.W.Liesker@int.azg.nl
authors.forename: Jeroen J W
authors.initials: JJ
authors.lastname: Liesker
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Wijkstra
authors.forename: Nick H T
authors.initials: NH
authors.lastname: Ten Hacken
authors.forename: Gerard H
authors.initials: GH
authors.lastname: Koëter
authors.forename: Dirkje S
authors.initials: DS
authors.lastname: Postma
authors.forename: Huib A M
authors.initials: HA
authors.lastname: Kerstjens
mesh_terms: D000318:Adrenergic beta-Agonists / Q000494:pharmacology; D001993:Bronchodilator Agents / Q000494:pharmacology*; D018680:Cholinergic Antagonists / Q000494:pharmacology; D017079:Exercise Tolerance / Q000187:drug effects*; D006801:Humans; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy / Q000503:physiopathology*; D013806:Theophylline / Q000494:pharmacology
chemical_list: D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D018680:Cholinergic Antagonists; D013806:Theophylline