Real-World Impact of Initial Dual Bronchodilation on Exercise Physiological Response and Health-Related Quality of Life in Newly Diagnosed, Treatment-Naïve Chronic Obstructive Pulmonary Disease

<i>Background and Objectives:</i> Dual bronchodilation in chronic obstructive pulmonary disease (COPD) has demonstrated beneficial effects on health-related quality of life (HRQoL) and exercise-related outcomes. Real-world evidence in treatment-naïve COPD remains limited. <i>Materials and Methods</i>: Forty-six COPD patients and 23 age-, gender-, BMI-, and cardiovascular comorbidity-matched controls underwent spirometry, plethysmography, symptom-limited incremental cardiopulmonary exercise testing (CPET), and the 36-item Short-Form Health Survey (SF-36). Following baseline assessment, COPD patients received tiotropium/olodaterol as part of routine practice. Thirty-two patients underwent repeated examinations at 12 weeks. Baseline differences between the COPD and control groups were assessed, and longitudinal changes in pulmonary function, CPET, and SF-36 were evaluated in COPD patients. <i>Results</i>: Compared with controls, COPD patients had lower peak oxygen uptake (VO₂; 17.4 ± 4.4 vs. 22.8 ± 4.5 mL/kg/min, <i>p</i> < 0.001) and oxygen pulse (11.5 ± 3.5 vs. 14.0 ± 2.4 mL/beat, <i>p</i> = 0.003), failed to reach 80% of predicted values, and exhibited worse ventilatory efficiency (<i>p</i> < 0.001). SF-36 scores in the COPD group were lower across all domains. After 12 weeks of tiotropium/olodaterol, pulmonary function improved significantly. CPET was performed at comparable efforts at both visits. Peak VO₂ increased from 70 ± 15 to 75 ± 16% predicted (<i>p</i> = 0.044), and peak oxygen pulse from 74 ± 16 to 79 ± 16% predicted (<i>p</i> = 0.015). VE/MVV decreased from 0.77 ± 0.23 to 0.69 ± 0.15 (<i>p</i> = 0.03). Higher baseline VE/MVV predicted a larger improvement after treatment (B = 0.71, <i>p</i> < 0.001), while beta-blocker use had no effect on the change of VE/MVV. SF-36 physical functioning and health change scores improved (both <i>p</i> < 0.01). <i>Conclusions</i>: At diagnosis, COPD was associated with impaired exercise physiology and reduced HRQoL. Dual bronchodilation improved exercise responses and perceived physical functioning. Beta-blocker use was not associated with changes in breathing reserve, supporting the use of cardioselective agents when indicated.