Effects of dual bronchodilation on cardiopulmonary exercise testing in patients with newly diagnosed moderate-to-severe chronic obstructive pulmonary disease: a prospective study

Introduction Dual bronchodilation in patients with chronic obstructive pulmonary disease (COPD) has been shown to reduce hyperinflation and improve exercise tolerance by optimizing lung mechanics [1,2]. However, while its impact on pulmonary function is well-documented, data regarding the effects of dual bronchodilation on cardiovascular parameters during cardiopulmonary exercise testing (CPET) is limited. Aim To evaluate the effects of 12 weeks of dual bronchodilation on CPET parameters in patients with moderate-to-severe COPD. Methods We conducted a single-group prospective study. Body plethysmography and CPET were performed in patients with newly diagnosed moderate-to-severe COPD before initiating dual bronchodilation treatment and after 12 weeks. Results A total of twenty-seven patients were enrolled in the study. After 12 weeks of dual bronchodilation a decrease in functional residual capacity (FRC), FRC to total lung capacity (TLC) ratio and residual volume to TLC was observed (p=0.034, p=0.014 and p=0.004, respectively). In CPET we found improvements in oxygen consumption (VO2 ) which increased from 18 mL/kg/min (IQR 7.1) to 19.7 mL/kg/min (IQR 4.1) (p=0.022), O2 pulse which increased from 11.2 mL/beat (IQR 3.9) to 12 mL/beat (IQR 4.7) (p=0.002), minute ventilation (VE) which increased from 51.96 L/min (IQR 14.92) to 56.62 L/min (IQR 13.1) (p=0.029) and workload which increased from 72% (IQR 21) to 76% (IQR 20) (p=0.047) at peak exercise. Ventilatory equivalent for carbon dioxide (VE/VCO2) slope and heart rate remained unchanged. Conclusions Dual bronchodilation in patients with COPD reduces hyperinflation and improves exercise tolerance. Furthermore, it significantly enhances cardiovascular performance. Due to the cardiovascular involvement in COPD, these findings emphasize the importance of early treatment.