Indacaterol improves daily physical activity in patients with chronic obstructive pulmonary disease.

Int J Chron Obstruct Pulmon Dis. 2013;8:1-5

Authors: Hataji O, Naito M, Ito K, Watanabe F, Gabazza EC, Taguchi O

Abstract
BACKGROUND: The current mainstay of therapy for chronic obstructive pulmonary disease (COPD) is long-acting bronchodilators. To date, the effect of indacaterol, a β2-agonist, on activities of daily living in COPD patients is not well understood. The aim of this study was to evaluate the efficacy of indacaterol with regard to activities of daily living in patients with COPD.
METHODS: In this nonrandomized open-label study, 23 patients with COPD were instructed to carry an accelerometer for 4 weeks without indacaterol therapy and then for another period of 4 weeks while receiving indacaterol therapy.
RESULTS: The number of steps, duration of moderate or greater physical activity, and energy expenditure were significantly increased after treatment with indacaterol compared with baseline data in all patients with COPD; the metabolic equivalent of task was also significantly enhanced after treatment with indacaterol.
CONCLUSION: This study provides early evidence that indacaterol improves daily physical activity in patients with COPD.

PMID: 23293514 [PubMed - in process]

Indacaterol 75 μg once daily for the treatment of patients with chronic obstructive pulmonary disease: a North American perspective.

Ther Adv Respir Dis. 2013 Jan 7;

Authors: Kerwin EM, Williams J

Abstract
Chronic obstructive pulmonary disease (COPD) is a progressive disease in which patients become increasingly disabled by their symptoms and limited in their activities. Health-related quality of life may be profoundly impaired even in the early stages of the disease. Treatment with long-acting inhaled bronchodilators can improve lung function, symptoms and health status and reduce exacerbations of COPD. This review profiles the efficacy, safety and tolerability of indacaterol, an inhaled β(2)-agonist bronchodilator for once-daily maintenance treatment of patients with COPD. After 12 weeks of treatment with a once-daily dose of 75 µg (the dose approved in the USA and Canada) in patients with moderate to severe COPD, compared with placebo, indacaterol provided significant and clinically relevant levels of bronchodilation [difference in trough forced expiratory volume in 1 s: 131 ml; 95% confidence interval (CI) 104-159; p < 0.001], together with significant reductions in symptom scores (difference in transition dyspnea index total score: 0.84 points; 95% CI 0.37-1.31; p < 0.001) and improvements in health status (difference in St George's Respiratory Questionnaire total score: -3.8 units; 95% CI -5.6 to -2.0; p < 0.001). The overall safety and tolerability of once-daily treatment with indacaterol 75 µg for 12 weeks did not differ in any substantial aspect from placebo treatment. Indirect comparisons analyzing pooled clinical data and meta-analyses suggest that treatment with indacaterol 75 µg once daily may be effective in reducing exacerbations of COPD, and that its effects on lung function and health status will be comparable with other currently available inhaled long-acting bronchodilators used for COPD. Treatment with indacaterol 75 µg once daily provides effective bronchodilation, improves dyspnea and health status, and has a well characterized profile of safety and tolerability.

PMID: 23296242 [PubMed - as supplied by publisher]

Oxidative Stress and COPD: The Impact of Oral Antioxidants on Skeletal Muscle Fatigue.

Med Sci Sports Exerc. 2013 Jan 4;

Authors: Rossman MJ, Groot HJ, Reese V, Zhao J, Amann M, Richardson RS

Abstract
PURPOSE: Oxidative stress may contribute to exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). This study sought to determine the effect of an acute oral antioxidant cocktail (AOC: vitamins C, E, and alpha-lipoic acid) on skeletal muscle function during dynamic quadriceps exercise in COPD. METHODS: Ten patients with COPD performed knee extensor exercise to exhaustion and isotime trials following either the AOC or placebo (PL). Pre- to post-exercise changes in quadriceps maximal voluntary contractions (MVCs) and potentiated twitch forces (Qtw,pot) quantified quadriceps fatigue. RESULTS: Under PL conditions, the plasma electron paramagnetic resonance (EPR) spectroscopy signal was inversely correlated with the forced expiratory volume in one second to forced vital capacity ratio (FEV1/FVC), an index of lung dysfunction (r=-0.61, p=0.02), and MVC force (r=-0.56, p=0.04). AOC consumption increased plasma ascorbate levels (10.1±2.2 to 24.1±3.8 ug/ml, p<0.05) and attenuated the area under the curve of the EPR spectroscopy free radical signal (11.6±3.7 to 4.8±2.2 AU, p<0.05), but did not alter endurance time or quadriceps fatigue. The ability of the AOC to decrease the EPR spectroscopy signal, however, was prominent in those with high basal free radicals (n=5, PL: 19.7±5.8 to AOC: 5.8±4.5 AU, p<0.05) with minimal effects in those with low levels (n=5, PL: 1.6±0.5 to AOC: 3.4±1.1 AU). CONCLUSIONS: These data document a relationship between directly measured free radicals and lung dysfunction, and the ability of the AOC to decrease oxidative stress in COPD. Acute amelioration of free radicals, however, does not appear to impact dynamic quadriceps exercise performance.

PMID: 23299763 [PubMed - as supplied by publisher]

Use of nebulised magnesium sulphate as an adjuvant in the treatment of acute exacerbations of COPD in adults: a randomised double-blind placebo-controlled trial.

Thorax. 2013 Jan 7;

Authors: Edwards L, Shirtcliffe P, Wadsworth K, Healy B, Jefferies S, Weatherall M, Beasley R, on behalf of the Magnesium COPD Study Team

Abstract
BACKGROUND: Intravenous magnesium has been shown to cause bronchodilation in acute severe asthma and in small trials in acute exacerbations of chronic obstructive pulmonary disease (AECOPD). There is also some evidence of benefit from nebulised magnesium in acute severe asthma. Our hypothesis was that adjuvant magnesium treatment administered via repeated nebulisation was effective in the management of AECOPD. METHODS: In this randomised double-blind placebo-controlled trial, we approached 161 patients with AECOPD presenting to the emergency departments at two New Zealand hospitals with a forced expiratory volume in 1 s (FEV(1)) <50% predicted 20 min after initial administration of salbutamol 2.5 mg and ipratropium 500 µg via nebulisation. Patients received 2.5 mg salbutamol mixed with either 2.5 ml isotonic magnesium sulphate (151 mg per dose) or 2.5 ml isotonic saline (placebo) on three occasions at 30 min intervals via nebuliser. The primary outcome measure was FEV(1) at 90 min. RESULTS: 116 patients were randomised, 52 of whom were randomly allocated to the magnesium adjuvant group. At 90 min the mean (SD) FEV(1) in the magnesium group (N=47) was 0.78 (0.33) l compared with 0.81 (0.30) l in the saline group (N=61) (difference -0.026 l (95% CI -0.15 to 0.095, p=0.67). No patients required non-invasive ventilation. There were 43/48 admissions to hospital in the magnesium group and 56/61 in the saline group (RR 0.98, 95% CI 0.86 to 1.10, p=0.69). CONCLUSIONS: Nebulised magnesium as an adjuvant to salbutamol treatment in the setting of AECOPD has no effect on FEV(1).Australian New Zealand Clinical Trials Registry ACTRN12608000167369.

PMID: 23299960 [PubMed - as supplied by publisher]